Section: Module 5: Lesson 4: Substance Use Follow-Up, Self-Help, Well-Being, and the Community | Substance Use Disorders in Primary Care | NextGenU.org

  • 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).
    Approximate time required for the readings for this lesson (at 144 words/minute): 3 hours.

    Click here to start this lesson

    • Required Learning Resources and Activities
    • Read the content of this page.  Review the recommendations on to when to refer patients for more specialized interventions.

    • Review this guide titled "Self-Help Strategies" paying special attention to what you think might be useful for your patients.

    • Read section 4 "Information and Supports for Individuals and Families,"  Then, please review the section on 'Warning Signs for Onset or Relapse`(section 2.34-2.35). This will give you a good indication of what to look for in terms of when to assess mental health or substance use disorder in patients presenting for other reasons, as well as when to assess for relapses in patients with a known mental health issue or substance use disorder.

    • Healthy lifestyles and stress management are important aspects of well-being for those suffering from mental health or substance use disorders. This resource does a good job of teaching relaxation skills to address stress. First, navigate to the 'Relaxation Module' (pages 70-82). Perform all of the exercises, taking note of how you react to them so that you can teach those exercises when needed. Then try to offer them to someone you know (e.g., a friend, a family member, or a peer) and ask them how they feel after the exercise. Please also review the 'Lifestyle Module' (pages 101-106). The rest of the guide, which is optional reading, covers many skills that are useful in addressing depression and improving well-being. If your patient has access to the Internet, this might be a fantastic resource for them. If so, please guide them through the process of finding and reviewing the material. The 'Introduction' and the following section can help guide you in supporting your patient to use this resource.

    • Read the entire web page about exercise and mental health, paying special attention to the benefits and possible tips that you can give to patients who may be suffering from mental health disorders, to increase their level of physical activity.

    • Read the entire web page to learn about diet and mental health.

    • Read this entire resource titled "About BMI for Adults" to learn more about the usefulness and limitations of the BMI.

    • Many countries, cities, or counties have websites that list resources for those with mental health conditions and/or substance use disorders. For example, Kenya’s National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA) lists the rehabilitation centers by region. Please find similar websites for your area and post them in the discussion forum, indicating the country and/or region that they serve. Many countries (including Kenya) also have help lines. Please try to contact one of the resources you find in your country/area, and ask them about the services they offer and the challenges they have. In the same forum, post the highlights of that conversation in the discussion forum. If possible, try to call that resource for a patient you have, trying concretely to help him/her connect with that resource.

      To submit click on the button at the bottom of the screen labeled 'Add a new discussion topic.' You should comment on at least one other posting in the discussion forum, by clicking the reply button and discussing your thoughts as they relate to that posting in a respectful and professional manner. If a peer comments on your posting, please reply back. Click on the particular discussion and then click on reply.

    • To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

    • Additional Learning Options
    • Read the following three sections in "The Role of Recovery Support Services in Recovery-Oriented Systems of Care." On p. 1, read the first two paragraphs of the "Introduction" and the 4 bullet points underneath those two paragraphs. Then, read pp. 5 - 10 covering section "IV. Recovery and Recovery Oriented Systems of Care" and section "V. "Recovery Support Services." This should give you an idea of how and why family and other support services are important when helping those with addiction problems.

    • "The Antidepressant Skills Workbook" allows you to consult online or download the workbook. It is a very practical guide that patients can use for mood self-management.

    • In "The Psychological Toolkit" review any info-sheets you feel are useful, and take a look at items that you want to learn about in more depth.

    • This is the "Guidelines on Overweight and Obesity: Electronic Textbook," produced by the U.S. National Heart, Lung, and Blood Institute. You can use the tabs at the top to review any sections about which you might want additional information.

    • Read these "Hints for Developing Exercise Plans with Depressed Patients" for GPs. There are also other links and info-sheets provided by the Black Dog Institute as supplementary resources.

    • Read this entire document titled "3 Steps to Initiate Discussion about Weight Management with your Patients" for some tips on how to discuss overweight and obesity issues with your patients.

    • Read the entire book especially the section titled "Stress Symptom Test" (pages 6-10).  This e-book is another fantastic resource to help patients through the difficulties of living with a chronic health condition of any kind. It addresses many skills that are highly relevant to general well-being, as well as supporting mental health and substance use disorder recovery. You can review this resource to help you advise your patients, or suggest it to your patients who have access to the Internet.

    • Read the entire guide.  This resource gives you access to a table (in metric units) to assess BMI risk levels, as well as BMI combined with waist circumference risk level. Of note, this resource explicitly states that a BMI below 18.5 is associated with a higher risk of undernutrition, malnutrition, osteoporosis, infertility and an impaired immune system.

    • This is a direct link to an online BMI calculator (in metric units) titled "Calculate Your Body Mass Index." Please calculate your own BMI for practice.

    • The free version of "Epocrates" is available both on-line or for download on mobile devices. To access it, click on the icon that says 'My Account' (towards the top right) and then register or login. It will give you access to interaction databases, drug monographs, and quick clinical guides, including many natural supplements, all for free. There might be other similar programs so if you know of another useful program please share it with us.