Alcohol treatment may be shifting to primary care

This issue covers topics such as the uptick of alcohol misuse treatment in primary care, the mind-body connection between mental health and heart disease, and ways in which patients can educate each other more effectively about lifestyle maintenance.

The U.S. Preventive Services Task Force has long recommended screening adults in primary care to reduce alcohol misuse, but in 2013 it revised its recommendation to clarify that such screening should include “the full spectrum of unhealthy drinking behaviors, from risky drinking to alcohol dependence.” In addition, new coverage rules under the Affordable Care Act and new classifications of at-risk drinking in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) may move treatment for alcoholism more firmly into the area of primary care. In our story, staff writer Mollie Durkin looks into what has changed and talks to experts about how to address unhealthy alcohol use, deal with more severe disorders, and ensure optimal use of medications.

The mind-body connection is much discussed in medicine, and a fair amount of recent research has focused on the ways in which mental health, specifically depression, may affect heart disease. While there has not been (and will likely never be) a randomized, controlled trial in this area, some experts feel that the evidence warrants proactive efforts from internists to consider both physical and mental health in their treatment approach. Read our story to learn more.

Peer education is an appealing idea but has yielded mixed results as a way of controlling chronic conditions such as hypertension and diabetes. Our story examines peer education methods that have worked and those that haven't, offering advice to internists who might be considering this model in their practices or who have patients who are interested in trying it.

New drugs for type 2 diabetes have been approved recently and have given physicians more options for treatment. It's not all good news, though: For some drugs, additional risks have come to light post-marketing, and other drugs have been found to be not as effective as initially thought. Our story looks at the risks and benefits of prescribing new drugs in patients with diabetes and how to determine which combination of treatments is most appropriate.

Finally, we're heading into influenza season, and this issue has 2 articles on the topic. The first, a Perspective from leading immunization experts, outlines physicians' responsibilities to increase vaccination rates in their practices, as well as ways that ACP's I Raise the Rates campaign can help. The second looks at mandatory vaccination of health care workers, including the growth of the practice at health care facilities, the reasons behind it, and how it is generally received by employees.

How do you keep on top of vaccinations at your practice? Does your facility mandate the flu shot? Let us know.


Jennifer Kearney-Strouse