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What are the public health priorities?

Tobacco Free Living

Preventing Drug and Excessive Alcohol Use

Healthy Eating

Active Living

Mental and Emotional Well-being

Reproductive and Sexual Health

Injury and Violence Free Living

How has the trend of alcohol in the past month changed from 2021-2025?

The overall trend has DECREASED

What is binge drinking?

the consumption of an excessive amount of alcohol on one occasion

What is the binge drinking limit for females?

> or equal to 4

What is the binge drinking limit for males?

> or equal to 5

What is heavy alcohol use?

Binge drinking on 5 or more days in the past month

What is the trend of underage alcohol use in the past month from 2021-2025?

Overall trend has DECREASED

How much is the rate declining when comparing underage to adult alcohol use?

In underage alcohol use the rates are declining more slowly than adult binge/heavy measures

What is the overall trend of cigarette use and nicotine vaping from 2021-2025 for adults?

Cigarette use is DECREASING while nicotine vaping is INCREASING

What is the overall trend of cigarette use and nicotine vaping from 2021-2025 for underage?

Cigarette use there is NO CHANGE and vaping has DECREASED

What does illicit drugs include?

Includes marijuana, cocaine, heroin, hallucinogens, inhalants, meth, and misuse of prescription drugs

What is the overall trend of illicit drug use in the past year from 2021-2025?

Any illicit drug use is INCREASING

What is the overall trend of marijuana use in adolescents in the past year from 2021-2025?

DECREASED

What are central nervous system stimulants?

Cocaine, meth, and misuse of prescription stimulants

What is the most used CNS stimulant?

Cocaine

What is substance use disorder?

Impairment from recurrent alcohol or drug use to the extent that it is impairing function

What is the overall trend of substance use disorders from 2021-2025?

DECREASED

What is the most common drug use disorder?

Marijuana

What is the overall trend of opioid misuse from 2021-2025?

DECREASED

What is the overall trend of illegally made fentanyl from 2021-2025?

NO CHANGE

96.4% of past year opioid misuses misused what type of drug?

Misused a prescription pain reliever

What drives the most current overdose deaths?

Illegally made fentanyl

What are the health effects of smoking and vaping?

Nicotine's vasoconstriction and toxin exposure directly impairs tissue healing and rehab outcomes

What does fracture union look like in someone who smokes or vapes?

Fracture union: >48 weeks in smokers vs. ~24 weeks in nonsmokers

What are the rates of nonunion after 1 year if you are a smoker/vaper or not?

Nonunion after 1 year: 23.6% of smokers vs. 0% of nonsmokers in one cohort

What are smokers/vapers more likely to develop after fracture surgery?

Smokers ~3.7× more likely to develop osteomyelitis after fracture surgery

How much percentage of smoker/vapers compared to non-smokers form adequate callus after 1 month?

Adequate 1-month callus formation:

47.3% (smokers) vs. 94.5%

(nonsmokers)

How does smoking/vaping interfere with cardiopulmonary function?

Reduced VO₂max and exercise tolerance limit therapeutic exercise capacity

How does smoking/vaping impair tendon/ligament healing?

Impaired soft-tissue microcirculation slows post-surgical wound and tendon/ligament healing

What limits functional activity tolerance in smokers/vapers?

Chronic cough and reduced lung function limit functional activity tolerance

What is the emerging evidence for vaping?

Vaping: emerging evidence of airway inflammation and lung injury (e.g., EVALI); long-term musculoskeletal effects still under study

Why does vasoconstriction impact healing?

Vasoconstriction cuts oxygen and nutrient

delivery to healing bone and soft tissue

What reduces the blood's oxygen carrying capacity?

Carbon Monoxide

How do the effects of smoking cessation affect surgery?

Effects are dose related and improve with cessation, even shortly before surgery

What is the term that is used to describe muscle loss due to alcohol consumption?

Alcoholic myopathy

How much percentage of people with at risk alcohol use show skeletal muscle maladaptation?

40-60%

How much percentage of loss in skeletal muscle mass can there be with chronic alcohol use?

20%

What fibers are selectively atrophied with heavy alcohol consumption?

Type 2

Proximal muscle weakness and reduced peak torque is most prevalent when?

Ages 40-60

What impairs balance, proprioception and gait?

Peripheral Neuropathy

In heavy alcohol consumption what happens with bone remodeling?

Impaired bone remodeling lowers bone density, raising fracture risk

When combined what substantially increases fall risk?

Weakness + Neuropathy + Intoxication

What does abstinence from alcohol do for muscle strength?

Abstinence improves strength but often does NOT formally normalize it - set realistic goals

What should be screened if patients drink heavily?

Fall Risk

How much percentage of non-cancer patients develop opioid- induced constipation?

40-60%

How much morphine a day raises overdoes risk, especially with benzos?

> or equal to 50

How much is spent annually on laxatives tied largely to opioid related constipation?

$800M+

What is opioid induced hyperalgesia?

Paradoxical increase in pain sensitivity with prolonged opioid exposure — patients can become more pain-sensitive, not less

What are systemic effects of opioid misuse?

Decreased tolerance and physical dependence with escalating dose

Sedation, cognitive impairment, and fall risk

Endocrine dysfunction (suppressed testosterone/cortisol

Reduced physical function and QOL despite continued use

How many of adults had co-occurring mental illness (AMI) and a substance use disorder in 2025?

7.0%

How many adolescents (12-17) had co-occurring depressive episode and SUD in 2025

2.5%

What can reduce adherence to HEP and pain self-management strategies?

Unmanaged anxiety and depression

What do adolescents with depression and substance abuse need?

Coordinated, NOT siloed care

What are screening tools that can flag the need for a referral when someone is suffering from substance use and a mental illness?

AUDIT-C or NIDA Quick Screen

What was the most common treatment setting for substance use?

Outpatient care

What does recovery from a substance use problem mean?

A person who has ever perceived a substance use problem, and whether they consider themselves recovered

What is the trend of drug overdoses?

DECREASING - in almost every state

What demographic is affected the most by fatal overdoses?

Male, White, Ages 35-44

What are the 3 waves of opioid overdose deaths?

1.) Rise in Prescription Opioid Deaths Started in 1990s

2.) Rise in Heroin Overdose Deaths Started in 2010

3.) Rise in Synthetic Opioid Overdose Deaths Started in 2013 (Fetanyl)

Which opioid is involved in the most overdose deaths?

Illegally made Fentayl

Which stimulant is involved in the most overdose deaths?

Cocaine

What are the efficacy limitations of opioids for pain management?

No long-term advantage of opioids over non-opioid medications for chronic pain

Benefits typically fade while risks accumulate with continued use

What are the risks associated with opioids for pain management?

Tolerance - patients need higher doses for the same effect

Dependence and Addiction

Overdose Risk

What is the impact on function when taking opioids for pain management?

Opioids often do not improve physical function or quality of life

Functional restoration — the core of PT care — targets what opioids alone cannot fix

What are the CDC guidelines for opioid prescribing?

1.) Start Cautiously

2.) Choose Immediate Release

3.) Use Lowest Dose

4.) Limit Duration

5.) Reassess Early and Often

6.) Mitigate Risk

7.) Monitor Ongoing Therapy

8.) Individualize Care

What does start cautiously mean for CDC guidelines for opioid prescribing?

Use opioids only if expected benefits outweigh risks; prioritize non-opioid options first

What does choose immediate release mean for CDC guidelines for opioid prescribing?

Avoid starting with long-acting/extended-release

formulations

What does use lowest dose mean for CDC guidelines for opioid prescribing?

Prescribe the minimum effective dose and avoid

unnecessary escalation

What does limit duration mean for CDC guidelines for opioid prescribing?

For acute pain, prescribe only the shortest effective course.

What does reassess early and often mean for CDC guidelines for opioid prescribing?

Reevaluate within 1-4 weeks of starting/changing, then at least every 3 months

What does mitigate risk mean for CDC guidelines for opioid prescribing?

Check the Prescription Drug Monitoring Program, consider urine drug testing, avoid benzodiazepine co-prescribing, offer naloxone if indicated

What does monitor ongoing therapy mean for CDC guidelines for opioid prescribing?

Continue only if benefits persist; taper gradually if risks outweigh benefits.

What does individualize care mean for CDC guidelines for opioid prescribing?

Shared decision-making, patient-specific goals, avoid rigid cutoffs or abrupt discontinuation

What are non-opioid approaches for pain management?

Physical therapy and Related approaches

Psychological Therapies

Mind-Body Practices

Neuromodulation

XR (Extended Reality) - Virtual Reality

Placebo and Expectation Management

What are the APTA policy recommendations for shifting care away from opioids?

Public Awareness

Benefit Design

Remove Cost Barriers

Provider Education

Finance Effective Models

Workforce Incentives

What does public awareness entail in the APTA policy recommendations for shifting care away from opioids?

Federal campaign for providers, payers, regulators, employers, and the public on pain assessment and management options.

What does benefit design entail in the APTA policy recommendations for shifting care away from opioids?

Health plans should support early access to

nonpharmacological interventions, including physical therapy, for primary pain care

What does remove cost barriers entail in the APTA policy recommendations for shifting care away from opioids?

Reduce or eliminate patient out-of-pocket costs for person-centered, nonpharmacological pain treatment

What does provider education entail in the APTA policy recommendations for shifting care away from opioids?

Educate primary care providers on the value of

nonpharmacological interventions and how to assess, treat, and refer patients with pain

What does finance effective models entail in the APTA policy recommendations for shifting care away from opioids?

Federal and state policymakers should fund replication of effective pain-management care, including bundled payment for multidisciplinary programs

What does workforce incentives entail in the APTA policy recommendations for shifting care away from opioids?

Student loan repayment programs should incentivize PTs and other providers to work in communities hit hardest by the opioid crisis

What is early PT associated with when talking about opioids?

Reduced opioid use - stops addiction before it even starts

What is early PT associated with when talking about costs?

Decreased healthcare costs

What is the PT's role in the opioid crisis?

1.) Overcome the stigma

2.) Screen Routinely

3.) Track function, NOT just pain

4.) Lead with functional restoration

5.) Educate on Risk

6.) Coordinate Care

7.) Encourage Evidence-Based OUD Treatment

What is the PT's role in alcohol use for screening and assessment?

1.) Ask about alcohol use as part of every standard health history, not only when injury seems alcohol- related

2.) Use the AUDIT-C brief screening tool to flag risky or heavy use

3.) Assess fall risk more closely given alcohol's effects on muscle strength, neuropathy, and balance

What is the PT's role in alcohol use for adapting the plan of care?

1.) Set realistic strength and function goals — myopathy from heavy use may not fully resolve with abstinence alone

2.) Modify exercise prescription and fall- prevention strategies for reduced proprioception and Type II fiber weakness

3.) Flag interactions between alcohol and prescribed NSAIDs, muscle relaxants, or opioids

What is the PT's role in alcohol use for educating and refering?

1.) Explain how alcohol slows healing and rehab progress in terms tied to the patient's own goals

2.) Refer patients who screen positive to primary care or counseling — mirror the referral step used for opioids

3.) Track alcohol use and function together at follow-up visits

What are the 3 questions of the AUDIT-C?

1.) How often do you have a drink containing alcohol?

2.) How many standard drinks do you have on a typical day when you are drinking?

3.) How often do you have 6 or more drinks on one occasion?

What is the PT's role in tobacco and nicotine vaping for asking and screening?

Ask every patient about cigarette use and nicotine vaping at intake, not just pre-surgical patients

A single-question status check (current / former / never) takes seconds and identifies who needs counseling

What is the PT's role in tobacco and nicotine vaping for setting realistic expectations?

For smokers, plan around slower bone and soft-tissue healing

Coordinate with the surgeon or physician on a pre-operative cessation window — even brief

cessation before surgery improves healing

Explain that vaping's long-term musculoskeletal effects are still being studied, so caution is still warranted

What is the PT's role in tobacco and nicotine vaping for advising and refer?

Give brief, direct cessation advice — even a short conversation increases quit attempts

Refer to a tobacco quitline (1-800- QUIT-NOW) or cessation program

Reinforce progress at follow-up visits alongside functional gains

What is the 5A's used for?

For every patient who uses tobacco or nicotine

What are the 5A's?

Ask, Advise, Assess, Assist, Arrange

What are the 5R's used for?

For patients not ready to quit

What are the 5R's?

Relevance, Risks, Rewards, Roadblocks, Repetition

What is the ADA (legal) definition of disability?

A physical or mental impairment that substantially limits one or more major life activities, a record of one, or being regarded as having one

What definition of disability is used to decide civil rights protection?

ADA

What is the WHO ICF (biopsychosocial) definition of disability?

Umbrella term for impairments, activity limitations, and participation restrictions, arising

from the interaction of a health condition with environmental and personal factors

What is the definition of disability that PTs use to plan care?

WHO ICF

What is the surveys (CDC BRFSS, Census ACS) definition of disability?

Functional: serious difficulty with cognition, mobility, hearing, vision, self-care, or independent living