Styles of communication

University of Florida, Psychiatry Dept.

Styles of communication Rollnick, et al., 2008

Styles of communication

Brief interventions

Steps of the brief intervention D`Onofrio, et al., 2005

Steps of the brief intervention

Steps of the brief intervention

Clinic tools

Practice

Brief intervention ServicePayerCodeDescription Medicaid & Commercial minutes spent administrating and interpreting a full screen, plus performing a brief intervention. MedicareG0396 Medicaid & Commercial Same as above, only 30 minutes. MedicareG0397

ServicePayerCodeDescription Medicaid & Commercial Plus V79.1 or V82.9 Administration and interpretation of a full screen. Medicaid & Commercial minutes spent administrating and interpreting a full screen, plus performing a brief intervention. MedicareG0396 Medicaid & Commercial Same as above, only 30 minutes. MedicareG0397

Referring your patient

Billing

Stages of change Cell phone use increases cancer risk International Agency for Research on Caner (IARC)

Pre- contemplation Contemplation Preparation Action Maintenance Relapse Stages of change

Pre- contemplation Stages of change

Contemplation Stages of change

Preparation Stages of change

Action Stages of change

Maintenance Stages of change

Medications

Naltrexone (Revia) Injectable Naltrexone (Vivitrol) Acamprosate (Campral) Disulfiram (Antabuse) Action Blocks opioid receptors. Thought to interfere with reward pathways important in alcohol dependence. Same as oral naltrexone; 30-day duration Affects glutamate and GABA and neurotransmitter systems but its alcohol- related action is unclear. Inhibits intermediate metabolism of alcohol, causing a buildup of acetaldehyde and reactions if a patient drinks alcohol. Dosage 50 mg QD380 mg IM monthly333 mg tabs, 2 tabs TID250 QD or 500 3X/wk Benefits Modest reductions in relapse rates and severity Side effects Nausea (10%) LFT elevations (uncom.) Nausea (~10%) LFT elevations and sterile abscess (uncom.) Diarrhea (16% vs. 10% in placebo) Liver problems including (rare) fulminant hepatitis Cost $4/day$25/day$4/day Medications

III II IV Making recommendations

III II IV Making recommendations Low risk or abstention

Making recommendations

Practice

Pipeline