Substance Use Disorders in Primary Care Homepage

This course has been updated to better reflect the current themes surrounding substance use disorders in a primary care setting. 

If you are already enrolled in this version of the course, you are allowed to complete it and obtain a certificate or register for the new course version using this link.

For all new students, register for the updated version following the next steps: 

1. Register for the Substance Use Disorders in Primary Care course. 
2. Begin the course with Module 1.

This course has been developed for implementation and use by for use by the majority of primary care workers around the world and in low-resource settings, and provides an introduction to the prevention and treatment of substance use disorders through online didactics, and provides the student a chance to practice techniques, with locally and globally available peers and mentors, that may reduce the prevalence and the health effects of substance use disorders. All components of this training (like all NextGenU.org training) are free, including registration, learning, testing, and a certificate of completion.

The course consists of 6 modules to be completed through online study and peer activities. These modules provide:

• a basic introduction to mental health and substance use services
• an overview of stigma and how it can be addressed
• an introduction to best practices for the management of substance use disorders in primary care
• an introduction to the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) Package
• a few key tips for monitoring and follow-up care for those suffering from substance use disorders, with a special emphasis on common co-morbidities
• strategies to communicate with people seeking care and their families and caregivers

Evaluation consists of a practice quiz in each module, completion of two peer activities, and a final exam. In order to take the final exam, you will need to complete two peer activities. A certificate will be issued if the final exam is passed with a minimum score of 70 percent. You will also have an opportunity to provide feedback on the course to help us make the learning experience even better. We will give you all the results of your assessments, such as your final exam and peer activities. We can report your testing information and share your work with anyone (your school, employer, etc.) that you request. We hope this is a wonderful learning experience for you, and the assessment that you provide at the course’s conclusion will help us improve the training for future students.

This course is cosponsored by: the Africa Mental Health Foundation, the Annenberg Physician Training Program in Addiction Medicine, and the University of Florida and sponsored in part by the Annenberg Physician Training Program. This course uses competencies adapted from the WHO Mental Health Gap Action Programme (mhGAP), and resources from accredited, world-class organizations such as the National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA), the National Institute on Drug Abuse, the  World Health Organization, and the World Medical Association. Course co-developers are: Veronic Clair, MD, MSc, CCFP, FRCPC; Sukhdeep Jassar, MPH; and Abednego Musau, MBChB. Our Advisory Group is: Erica Frank, MD, MPH; Stuart Gitlow, MD, MPH, MBA; Victoria Mutiso, PhD; David Ndetei, MD, PhD; Scott Teitelbaum, MD; and Randall F. White, MD, FRCPC. We also gratefully acknowledge major review and contributions from: Bernice Apondi; Chelsea Hitchen, BA; Sandra W. Kimani, MBChB; Mwiti K. Makathimo, Project Management, MBChB; Aggrey G. Mokaya; Johnston M. Muthoka, BSc, MBChB; and Jackson N. Njoroge, MBChB.

For publications on this course’s efficacy, see “Online Learning Improves Substance Use Care in Kenya: Randomized Control Trial Results and Implications,” (2016), Annals of Global Health,  https://www.sciencedirect.com/science/article/pii/S2214999616306129?via%3Dihub; see also “Peer and Mentored Enhanced Web-Based Training on Substance Use Disorders: A Promising Approach in Low-Resource Settings to Teach Knowledge and Skills and Decrease Stigma,” (2019), Psychiatric Services, https://www.ncbi.nlm.nih.gov/pubmed/31551043. In addition, see “Building Public Health Capacity through Online Global Learning,” (2018), to see more research related to NextGenU.org’s educational model, check out NextGenU.org’s publication page.

Module 1: Introduction to Substance Use Disorder Services in Primary Care

Competency covered in this module: 

• Understand and be receptive to including mental health and substance use disorder services in primary care.

Module 1: Lesson 1: General Information

Learning Objectives:

Upon completion of this module, students should be able to:

• Discuss how primary health care can be involved in lessening the burden of mental illness, including substance use disorders.
• Define the concept of "task-shifting".
• Describe the WHO mhGAP principles of care and priority conditions.
• Summarize the science behind substance abuse and its possible effects on health and social functioning.

Click here to start this lesson

Module 2: Addressing Stigma and Protecting Human Rights

Competencies covered in this module:

• Being aware of and being able to address stigma.
• Promoting and protecting the human rights of those you serve.

Click here to start for breif module introduction

Module 2: Lesson 1: Policies and Legislation

Learning Objectives:

Upon completion of the first lesson of Module 2, students should be able to:

• Describe stigma and its potential impact, as well as the practical strategies to address it.
• Describe how physician/clinician attitudes toward patients with substance use disorders can impact recognition, diagnosis, and treatment of patients.
• Illustrate care that is free from discrimination on the basis of race, color, sex, language, religion, political or other opinion, nationality, ethnicity, indigenous or social origin, property, birth, age, or other status.
  
• Discuss how to provide care in a way that respects the dignity of the person and is culturally sensitive and appropriate.
  
• Discuss how to minimize stigma, marginalization, and discrimination, and promote the social inclusion of people with mental, neurological, and substance use disorders by fostering strong links with the employment, educational, social (including housing), and other relevant sectors.
  

• Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma (15 mins)
• Taking Action on Stigma and Social Inclusion in British Columbia (56 mins)

• The 10 Essential Shared Capabilities for Mental Health Practice: Learning Materials (Scotland) (30 mins)
• Mental Health and Addiction 101 Series: Stigma (20 mins)

• Quiz: Module 2: Lesson 1

• Module 2: Lesson 1: Discussion Forum

Module 2: Lesson 2: International and National Standards

Learning Objectives:

Upon completion of the second lesson of module 2, students should be able to:

• Explain international and national standards, legislation, and policies on mental health and human rights.
• Demonstrate how to pay greater attention to the patient's right to privacy and confidentiality.
• Demonstrate how a patient (or their designated decision-maker) is aware of the proposed therapy and has given their free and informed permission.
  

Click here to start this lesson

Module 3: Substance Use Disorders and Primary Health Care

Competencies covered in this module:

• Understand various best practices for the medical management of tobacco, alcohol, and other substance use disorders in primary care

Module 3: Lesson 1: Tobacco Specific Information and Approaches

Learning Objectives:

Upon completion of the first lesson of Module 3, students should be able to:

• Discuss the effectiveness of tobacco cessation interventions.
• Recognize quick, in-practice resources to support tobacco cessation interventions.
  
• Describe the personal health disease risks (cardiovascular, respiratory, and cancer) associated with tobacco use.
  
• Describe the general benefits of quitting smoking.
  
• Discuss the symptoms of tobacco withdrawal and the methods of dealing with those symptoms.
  
• Summarize the health consequences of involuntary (secondhand) exposure to tobacco smoke.
  
• Describe the link between tobacco and Chronic Obstructive Pulmonary Disorder (COPD) and be familiar with best practices for the management of COPD.
  

Click here to start this lesson

• Quitting Tobacco (5 mins)
• The Role of the Primary Care Physician in Tobacco Use Prevention and Cessation (5 mins)
• Helping Smokers Quit: A Guide for Clinicians (5 mins)
• Behavioural Science Learning Modules: Encouraging People to Stop Smoking (30 mins)
• Health Effects of Cigarette Smoking (5 mins)
• Benefits of quitting smoking (3 mins)
• How To Handle Withdrawal Symptoms and Triggers When You Decide To Quit Smoking (10 mins)
• The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, U.S. Department of Health and Human Services (19 mins)
• Health Effects of Secondhand Smoke (5 mins)
• Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Health Care Professionals, 2017 Edition (20 mins)

• Physician Communication Regarding Smoking and Adolescent Tobacco Use (10 mins)
• Smoking and cancer (30 mins)
• COPD - Tools & Resources (20 mins)
• Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management (36 mins)

• Quiz: Module 3: Lesson 1

Module 3: Lesson 2: General Approaches to Address Alcohol and Other Substance Use Disorders in Primary Care

Learning Objectives:

Upon completion of the second lesson of Module 3, students should be able to:

• Describe the general approaches to address alcohol, tobacco, and other substance use in primary care.
  
• Recognize the symptoms of acute intoxication for a substance and treat or refer accordingly.
  
• Demonstrate how to take a thorough medical history, including the history of the presenting complaint(s), past history, and family history (as relevant), and know the red flags for substance use disorders.
• Summarize the evidence-based model of brief intervention in primary care for other psychoactive substances.
  

Click here to start this lesson

• Alcohol & Other Drugs: A Handbook for Health Professionals (90 mins)
• IBA e-Learning course on the Alcohol Learning Centre: Primary Care e-Learning (100 mins)
• mhGAP intervention guide for mental, neurological and sub-stance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP) Version 1.0 (30 mins)

• Screening for Drug Use in General Medical Settings: Quick Reference Guide (10 mins)
• Guideline Summaries: National Collaborating Centre For Mental Health (120 mins)
• A Guide to Substance Abuse Services for Primary Care Clinicians (30 mins)
• Primary Care Addiction Toolkit: Dealing with Alcohol Problems (14 mins)

• Quiz: Module 3: Lesson 2

Module 3: Lesson 3: Alcohol Use Disorder Specific Information

Learning Objectives:

Upon completion of the third lesson of Module 3, students should be able to:

• Describe the specific effects of alcohol on the overall health.
• Describe the specific effects of alcohol on the liver.
• Demonstrate how to assess the person for alcohol withdrawal symptoms and treat or refer accordingly.
  

Click here to start this lesson

Module 4: Using the ASSIST Package for the Assessment and Brief Intervention for Substance Use

Competencies covered in this module:

• Understand how to effectively screen for substance use disorders using the ASSIST package
• Be able to deliver an effective brief intervention to address substance abuse

Module 4: Lesson 1: Ability to Screen Effectively and Quickly for Substance Use Disorders

Learning Objectives:

Upon completion of the first lesson of Module 4, students should be able to:

• Demonstrate the skills necessary to screen for substance disorders using the ASSIST Screening Tool.
• Recognize the skills required for addiction prevention counseling.
  
• Demonstrate the skills that help set respectful limits on patient requests for prescription medication.
  
• Demonstrate how to clearly and supportively recommend treatment to patients with substance use disorders.
  
• Demonstrate the skills for evaluating a patient’s stage of change, readiness to accept the diagnosis, and readiness to undertake behavior change.
  

Click here to start this lesson

Module 5: Monitoring, Follow-Up, Comorbidities, and General Well-Being

Competencies covered in this module:

• Be able to provide general care, monitoring and follow-up, taking into consideration general health status, common co-morbidities and issues faced by those with substance use disorders
• Understand co-morbidities associated with alcohol abuse including: HIV, depression, psychosis and reproduction implications such as fetal alcohol spectrum disorders
• Address special reproductive health issues for women using substances or receiving pharmacological treatments for co-morbidities
• Understand the importance of promoting healthy lifestyles and the general well-being of those with substance use disorders and/or mental health conditions

Module 5: Lesson 1: Mental Health Comorbidities

Learning Objectives:

Upon completion of the first lesson of Module 5, students should be able to:

• Distinguish the link between various mental health conditions and substance use disorders.
• Recognize evidence of SEVERE self-injury such as signs of poisoning or intoxication or signs/symptoms requiring urgent medical treatment such as bleeding from a self-inflicted wound, loss of consciousness, or extreme lethargy.
• Understand how to maintain regular contact and follow-up with patients as needed.
  
• Explain how to identify and manage depression in all who have a tobacco, alcohol or other substance use disorder.
  
• Explain how and when to ask patients for self-harm or suicidal thoughts and how to offer psychosocial support.
  

Click here to start this lesson

• Comorbidity of Mental Disorders and Substance Use: A Brief Guide for the Primary Care Clinician (90 mins)
• mhGAP Intervention Guide: For Mental, Neurological and Substance Use Disorders in Non-specialized Health Settings (30 mins)
• Pharmacological treatment of mental disorders in primary health care (70 mins)
• Working with the Suicidal Patient: A Guide for Health Care Professionals (15 mins)

• Family physician guide : for depression, anxiety disorders, early psychosis and substance use disorders (20 mins)
• Adult Mental Health Tools and Resources
• Depression (30 mins)
• Substance Abuse Among Older Adults.Treatment Improvement Protocol (TIP) Series, No. 26 (120 mins)
• Tools and Resources (120 mins)

• Quiz: Module 5: Lesson 1

Module 5: Lesson 2: Substance Use and HIV

Learning Objectives:

Upon completion of the second lesson of Module 5, students should be able to:

• Understand how substance use (including alcohol and tobacco) interacts with HIV.
  
• Understand the relationship between alcohol use and HIV, including the increased risk of HIV infection in those who consume alcohol.

Click here to start this lesson

• SmokinCessation—The Role of Healthcare Professionals and Health Systems (8 mins)
• Alcohol Use and Abuse (12 mins)
• Management of HIV Infection in Patients With Substance Use Problems (26 mins)
• Substance Abuse Treatments for Persons with HIV/AIDS. Treatment Improvement Protocol (TIP) Series No. 37 (15 mins)

• Recreational Drugs and HIV Antiretrovirals: A Guide to Interactions for Clinicians
• Primary HIV Care: Primary Care Approach (32 mins)
• The Association Between HIV Infection and Alcohol Use: A Systematic Review and Meta-analysis of African Studies (5 mins)
• Substance Use, Sexual Risk, and Violence: HIV Prevention Intervention with Sex Workers in Pretoria (11 mins)

• Quiz: Module 5: Lesson 2:

• Discussion Forum: Mental health disorders and HIV-infected clients

Module 5: Lesson 3: Substance Use and Pregnancy

Learning Objectives:

Upon completion of the third lesson of Module 5, students should be able to:

• Understand the links between alcohol and other substance use and reproduction, and be able to discuss pregnancy planning and contraception methods with men and with women of childbearing age.
• Identify the potential risks of medications and substance use on the fetus or baby when providing care to a pregnant or breastfeeding woman.
• Understand how babies being breastfed by women on medications are monitored for adverse effects or withdrawal, and undergo comprehensive examinations if required.
  

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• Fetal Alcohol Spectrum Disorders: FASD The Course (45 mins)
• The use of psychotropic medication during pregnancy: how about the newborn? (30 mins)
• Primary Care Addiction Toolkit: Dealing with Alcohol Problems (15 mins)

• Substance Abuse Treatment: Addressing the Specific Needs of Women (120 mins)

• Quiz: Module 5: Lesson 3:

Module 5: Lesson 4: Substance Use Follow-Up, Self-Help, Well-Being, and the Community

Learning Objectives:

Upon completion of the fourth lesson of Module 5, students should be able to:

• Recognize when to refer patients.
• Demonstrate how, at follow-ups, to reassess the person’s expectations of treatment, clinical status, understanding of treatment, and adherence to the treatment and correct any misconceptions.
  
• Understand how to continually monitor for treatment effects and outcomes, drug interactions with substances (alcohol and illicit drugs) and medicines (both naturopathic and traditional), and adjust accordingly.
  
• Explore involvement in self-help and family support groups, where available.
  
• Identify and mobilize possible sources of social and community support in the local area, including educational, housing, and vocational supports.
  
• Discuss the self-monitoring of symptoms and explain when to seek care immediately.
• Identify when it is appropriate to involve the carer or family member in the person’s care.
  
• Understand autonomy and independent living in the community and discourage institutionalization.
  
• Understand when to assist the patient in acquiring a healthy lifestyle, which can improve mental health and help manage substance use disorder triggers such as stress.
  
• Understand how to perform a general healthy weight assessment (BMI, weight, and height).

Click here to start this lesson

Module 6: Communication with People Seeking Care, Their Caregivers and Family

Competency covered in this module:

• Communicate effectively with those to whom you provide care, their family and caregivers

Module 6: Lesson 1: Communication Strategies

Learning Objectives:

Upon completion of this module, students should be able to:

• Demonstrate how to use simple and clear language.
• Demonstrate how to ask the person for his or her own understanding of the condition.
• Understand how to provide information to the person on their health status in terms that they can understand.
  
• Understand that you must be friendly, respectful, and nonjudgmental at all times.
  
• Understand that communication is clear, empathic, and sensitive to age, gender, culture, and language differences.
  
• Demonstrate how to respond to the disclosure of private and distressing information (e.g. regarding sexual assault or self-harm) with sensitivity.
  
• Identify the typical families' reaction to knowledge of substance use issues in a family member.
  
• Demonstrate how to gain the consent of the person to keep carers informed about the person’s health status, including issues related to assessment, treatment, follow-up, and any potential side effects.
  

Click here to start this lesson

• Patient-Physician Communication: Why and How (30 mins)
• Quitting Smoking and Beating Nicotine Addiction (10 mins)
• When a parent drinks too much alcohol... What kids want to know (14 mins)
• Parental Substance Misuse: Module 1: Understanding substance misuse (30 mins)
• Talking to Patients About Sensitive Topics: Techniques for Increasing the Reliability of Patient Self-Report (30 mins)

• Substance Abuse Treatment for Persons with HIV/AIDS (5 mins)

• Quiz: Module 6: Lesson 1

• Effective Communication Simulation

Final Exam

• Final Exam

Course and Self Evaluation & Certificate

In this section, you can provide feedback about this course to help us make NextGenU.org better. Once evaluations are completed, you will be able to download your certificate of completion.

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• Self Evaluation
• Course Evaluation

Course Activities