Jamie Manser

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(This is the last part of a 4-part series. The previous pieces provided an intro to the “Psychiatry for Non-Psychiatrists: The University of Arizona Update in Behavioral Medicine for Primary Care” conference, as well as updates on attention-deficit/hyperactivity disorder and suicide risk assessment and prevention.—Ed.)

The data on substance use disorders (SUDs) and overdose deaths are staggering and deeply concerning. According to the National Center for Drug Abuse Statistics, “165 million, or 60.2% of Americans aged 12 years or older, currently abuse drugs,” which includes illegal drugs, misusing prescribing drugs, and abusing alcohol and tobacco.

is a clinical assistant professor at the University of Arizona College of Medicine Department of Psychiatry, the department’s director of the Addiction Medicine Fellowship, and the medical director of addiction services at the Southern Arizona Veterans Affairs Health Care System. 

She developed the University of Arizona Addiction Medicine Fellowship in 2018, and, in 2020, she secured a $1.4 million Health Resources and Services Administration (HRSA) grant to expand the fellowship and further enhance the infrastructure of the program.

The Centers for Disease Control and Prevention’s National Center for Health Statistics shows that the number of overdose deaths has climbed from more than 70,000 in the 12-month period ending in January 2018 to more than 99,000 in the 12-month period ending September 2021. Preliminary reports indicate the number of drug overdose deaths in America increased 30% in 2020. In January 2021, drug overdose deaths exceeded homicides by 307%.

The positive implications for screening for and treating individuals with SUDs are vast, from preventing HIV and hepatitis in injection-drug users to improving patients’ physical health, mental health, employment, and housing.

Elisa Gumm, DO, who is presenting on “Screening for Addiction in a 20-Minute Appointment” at the “

Psychiatry for Non-Psychiatrists: The University of Arizona Update in Behavioral Medicine for Primary Care

” conference, stated that “offering addiction interventions at every level reduces the overall costs to the person and society.”

According to the National Institute on Drug Abuse publication, 

Principles of Drug Addiction Treatment: A Research-Based Guide

, “every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1.”

 Past-Year SUD and Any Mental Illness (AMI) Among Adults Aged 18 or Older, 2020

In addition, there are studies showing that addiction treatment has ripple effects and can even improve the health of family members when the patient with addiction gets treatment.

“Primary care teams should screen for addiction and assist their patients with care,” Gumm said. “When patients receive addiction treatment, comorbidities improve. It is difficult to treat medical conditions when a patient has an active substance use disorder, including nicotine and alcohol. It makes managing numerous diseases difficult and exhausting because there seems to be a hidden factor at play.”

Substance Use Among Adults Aged 18 or Older by Mental Illness Status, 2020

Primary care providers should also consider cooccurring mental health disorders, per the correlation with substance use/abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that, of adults aged 18 or older in 2020, 29% (or 74 million people) had either any mental illness (AMI) or an SUD in the past year; 14% (or 36 million people) had AMI, but not an SUD; 8% (or 21 million people) had an SUD, but not AMI; and 7% (or 17 million people) had both AMI and an SUD”(

The SAMHSA report also shows the percent of adults with mental illnesses and their substance use, as summarized in 

Gumm recommends primary care providers implement the Screening, Brief Intervention, and Referral to Treatment (SBIRT),

 as SBIRT is “proven successful in screening patients quickly and arming primary care doctors with treatment options when the screen is positive.” She also advises to, “be kind to all those involved. Soften the approach to asking patients about addiction.”

We hope you join us and Dr Gumm to learn more about helping patients with substance use disorders on Saturday, March 12. Find conference details, including the schedule, description of presenters, and registration at 

 is professor and department chair of psychiatry at the University of Arizona College of Medicine. He is an expert in the fields of geriatric psychiatry, depression treatment, and suicide prevention. He is committed to educating health care providers about the principles of psychiatry and behavioral medicine. 

 is the communication and marketing specialist for the University of Arizona College of Medicine Department of Psychiatry.

. National Center for Drug Abuse Statistics. February 19, 2022. Accessed February 25, 2022.

Vital statistics rapid release provisional drug overdose death counts

. Centers for Disease Control and Prevention. February 16, 2022. Accessed February 25, 2022.

 National Institute on Drug Abuse. January 2018. Accessed February 25, 2022.

4. Weisner C, Parthasarathy S, Moore C, et al. 

Individuals receiving addiction treatment: are medical costs of their family members reduced?

Key substance use and mental health indicators in the United States: results from the 2020 National Survey on Drug Use and Health (NSDUH)

. Substance Abuse and Mental Health Services Administration. Accessed February 25, 2022.

Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review

Articles

The data on substance use disorders are staggering. What can primary care providers do to help?

Psychiatry for Primary Care: An Update on Substance Use Disorders (Part 4)

(This is the second part of a 4-part series. The next 2 pieces will discuss addiction and suicide prevention as covered in the “Psychiatry for Non-Psychiatrists: The University of Arizona Update in Behavioral Medicine for Primary Care” conference.—Ed.)

The late Paul H. Wender, MD, once wrote that “ADHD is probably the most common chronic undiagnosed psychiatric disorder in adults.”

 The primary care providers (PCPs) on our planning committee for the “

” conference unanimously favored covering this topic, and we are thrilled that Jeffrey Newcorn, MD, professor of psychiatry and pediatrics and director of the Division of ADHD and Learning Disorders at Icahn School of Medicine at Mount Sinai, will present a 30-minute lecture titled,“Diagnosis & Treatment of ADHD Across the Lifespan: A Primer for Primary Care Physicians.”

Newcorn shares with us that the main obstacle to the diagnosis and treatment of adults with attention-deficit/hyperactivity disorder (ADHD) is that most PCPs are not trained to consider it in the differential diagnosis.

“Very few physician training programs outside of psychiatry, pediatrics, and family medicine include ADHD in their curricula, yet ADHD is often present in ~4.5% of the adult population,” he said. 

is professor of psychiatry and pediatrics, director of the Division of ADHD and Learning Disorders at Icahn School of Medicine at Mount Sinai, and director of pediatric psychopharmacology for the Mount Sinai Health System. 

He is also the immediate past president of the American Professional Society of ADHD and Related Disorders (APSARD). He is a highly regarded clinician—a researcher with special expertise in the field of ADHD across the lifespan, as well as child, adolescent, and adult psychopharmacology, whose academic work spans both clinical and translational topics.

“Adults with ADHD underachieve at work and often have multiple changes in jobs. They earn less money than their non-ADHD peers—across all socioeconomic and social strata.

 Further, ADHD complicates family relationships and is associated with high rates of divorce. Moreover, a missed diagnosis of ADHD is a very common contributor to treatment failure of other disorders. Unfortunately, the vast majority of adults with ADHD who are seen for medical checkups by their primary care providers never come to psychiatric care. So, identifying ADHD in medical settings is extremely important.”

For adults with undiagnosed ADHD, the consequences can have serious implications. The National Comorbidity Survey Replication study reported a significant degree of psychiatric comorbidity among adults with ADHD: 19% had major depressive disorder, compared with 8% of those without ADHD; 47% also had a coexisting anxiety disorder (vs 20%), 38% had a mood disorder (vs 11%), and 15% had a substance use disorder (vs 6%).

Unfortunately, there are not current treatment guidelines for adult ADHD, so extrapolation from guidelines and best practices in treating adolescents is necessary. Treatments can include a combination of medication, environmental modifications, and psychosocial interventions. For medication treatment, whether to use simulants or approved nonstimulant medications, or to use them in combination, of course depends on many factors. Newcorn’s presentation will review ways to choose from among the various medications and nonmedication approaches to care.

We hope you join us and Dr Newcorn on Saturday, March 12, to learn more about how to treat your patients with ADHD. Find conference details, including the schedule, description of presenters, and registration at 

Attention-Deficit Hyperactivity Disorder in Adults

2. Biederman J, Faraone SV, Spencer TJ, et al. 

Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community

3. Kessler RC, Adler L, Barkley R, et al. 

The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication

Being able to identify ADHD in medical settings is very important. One doctor will offer some guidelines for diagnosis and treatment.

Psychiatry for Primary Care: An Update on ADHD (Part 2)

(This is the first part of a 4-part series. The following 3 pieces will discuss ADHD, addiction, and suicide prevention as covered in the “Psychiatry for Non-Psychiatrists: The University of Arizona Update in Behavioral Medicine for Primary Care” conference.—Ed.)

Prior to the COVID-19 pandemic, the prevalence of mental illness was rising at an alarming rate. Since March 2020, it has only gotten worse.

 Between the increase in psychiatric conditions and the dearth of mental health care professionals, primary care providers (PCPs) are increasingly confronted with patients who are struggling with behavioral health conditions such as depression, attention-deficit/hyperactivity disorder (ADHD), insomnia, addiction, and suicidal ideation.

In response to this intersecting crisis of limited access to mental health specialists and rising rates of these disorders, the Department of Psychiatry at the University of Arizona College of Medicine in Tucson convened a committee of PCPs and psychiatrists with the charge to organize a fully virtual conference on Saturday, March 12, targeting the educational needs of physicians and allied health professionals working in primary care settings. “

” was created to provide PCPs with new and updated knowledge to enhance their clinical confidence and skills, improve comorbid medical comorbidities, and reduce the stigma of seeking treatment for mental illness.

Because the topics are wide-ranging and packed into 30- to 45-minute presentations, there are plenty of options for physicians, nurses, physician assistants, practicing psychiatrists, and resident physicians to gain valuable and applicable clinical knowledge.

In this series on the conference (for which participants may receive up to 5.5 CME hours), we will cover the presentations in 3 subsequent articles on ADHD in adults, screening for addiction, and suicide prevention.

1. Czeisler MÉ, Lane RI, Petrosky E, et al. 

Mental health, substance use, and suicidal ideation during the COVID-19 pandemic – United States, June 24-30, 2020

Primary care providers are increasingly seeing patients who are struggling with mental illness—how can they effectively assist these patients?

Jamie Manser

Articles

Psychiatry for Primary Care: An Update on Substance Use Disorders (Part 4)

Psychiatry for Primary Care: An Update on ADHD (Part 2)

Psychiatry for Primary Care: A Behavioral Medicine Update (Part 1)