2. Styles of communication

3. University of Florida, Psychiatry Dept. http://www.youtube.com/watch?v=2fdfzUS1qDc

4. Styles of communication Rollnick, et al., 2008

5. Styles of communication

6. Brief interventions

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

8. Steps of the brief intervention http://www.youtube.com/watch?v=b-ilxvHZJDc

9. Steps of the brief intervention

13. Clinic tools

17. Practice

18. Brief intervention ServicePayerCodeDescription Medicaid & Commercial 99408 15-30 minutes spent administrating and interpreting a full screen, plus performing a brief intervention. MedicareG0396 Medicaid & Commercial 99409 Same as above, only 30 minutes. MedicareG0397

19. ServicePayerCodeDescription Medicaid & Commercial 99420 Plus V79.1 or V82.9 Administration and interpretation of a full screen. Medicaid & Commercial 99408 15-30 minutes spent administrating and interpreting a full screen, plus performing a brief intervention. MedicareG0396 Medicaid & Commercial 99409 Same as above, only 30 minutes. MedicareG0397

20. Referring your patient

22. Billing

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

24. Pre- contemplation Contemplation Preparation Action Maintenance Relapse Stages of change

25. Pre- contemplation Stages of change

26. Contemplation Stages of change

27. Preparation Stages of change

28. Action Stages of change

29. Maintenance Stages of change

30. Medications

31. 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

33. III II IV Making recommendations

34. III II IV Making recommendations Low risk or abstention

35. Making recommendations

36. Practice

37. http://www.youtube.com/watch?v=1kalMZCelNw&feature=related

38. Pipeline