Section: Module 5: Managing Comorbidities and Special Populations | Substance Use Disorders in Primary Care | NextGenU.org

  • 852Competency covered in this module: 
    • Be able to provide general care, monitoring, and follow-up, taking into consideration general health status, common comorbidities, and issues faced by those with substance use disorders.
    • Understand comorbidities 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 comorbidities.
    • Understand the importance of promoting healthy lifestyles and the general well-being of those with substance use disorders and/or mental health conditions.

    Approximate time required for the readings for this module (at 144 words/minute): 46 hours and 28 minutes.

    • Module 5: Lesson 1: Mental Health Comorbidities

      Learning Outcomes:

      Upon completion of this lesson, you will 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.

      • Explain 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.

      • Discuss how to offer psychosocial support to patients with self-harm and suicidal thoughts.

      Required Learning Resources and Activities
    • url icon
      Common Comorbidities with Substance Use Disorders Research Report URL
      Students must
      View

      Read the entire article (30 minutes)

      National Library of Medicine - 2020

    • url icon
      Co-Occurring Disorders and Health Conditions URL
      Students must
      View

      Read the sections on: "What are co-occurring disorders or health conditions?", "How many people have both a substance use disorder and another mental disorder?" "Why do substance use problems often occur along with other mental disorders?" "Can a person have more than one substance use disorder?" "Other health conditions often co-occur with substance use disorders" and "Treatment for co-occurring disorders". (24 minutes)

      National Institute on Drug Abuse - 2024

    • url icon
      mhGAP Intervention Guide: For Mental, Neurological and Substance Use Disorders in Non-specialized Health Settings v2.0 URL
      Students must
      View

      Read the sections on self-harm and suicide (PDF pgs. 139-147). (13 minutes)

      WHO - 2019

    • url icon
      Patient Communication In Substance Abuse Disorders URL
      Students must
      View

      Read the entire article. (10 minutes)

      National Center for Biotechnology Information, US National Library of Medicine - 2021

    • url icon
      mhGAP Intervention Guide: For Mental, Neurological and Substance Use Disorders in Non-specialized Health Settings version 2.0 URL
      Students must
      View

      Read the section on depression (PDF pages 27-31). (18 minutes)

      WHO - 2019

    • url icon
      Depression — Understanding, Identifying, and Diagnosing URL
      Students must
      View

      Watch the first three videos, consider the fourth video as complementary. (48 minutes)

      The New England Journal of Medicine - 2024

    • url icon
      How to assess and intervene with patients at risk of suicide URL
      Students must
      View

      Read the entire article. (60 minutes)

      American Psychological Association - 2022

    • url icon
      Self-harm and suicide in adults URL
      Students must
      View

      Read Section 6 (pgs. 46-50). (14 minutes)

      Royal College of Psychiatrists - 2020

    • url icon
      Suicidal Ideation URL
      Students must
      View

      Read the section on "Treatment / Management". (22 minutes)

      StatPearls Publishing LLC - 2024

    •  
      Recommended Additional Readings
    • url icon
      Self-harm: assessment, management and preventing recurrence URL

      Read the entire article.

      NICE Guideline - 2022

    • url icon
      Rapid access to brief psychological treatments for self-harm and suicidal crisis URL

      Read the entire article. (9 minutes)

      British Journal of General Practice - 2020

    • Module 5: Lesson 2: Substance Use and HIV 

      Learning Outcomes:

      Upon completion of this lesson, you will be able to:

      • Explain how substance use (including alcohol and tobacco) interacts with HIV.

      • Summarize the relationship between alcohol use and HIV, including the increased risk of HIV infection in those who consume alcohol.

      • Explore the relationship between Substance Use Disorders and HIV infection.

      Required Learning Resources and Activities
    • url icon
      Substance Use Disorders and HIV URL
      Students must
      View

      Read the entire webpage. (42 minutes)

      HIVinfo.NIH.gov - 2024

    • url icon
      Tobacco and HIV URL
      Students must
      View

      Read the entire article. (29 minutes)

      WHO - 2024

    • url icon
      Alcohol and HIV Risk URL
      Students must
      View

      Read the entire webpage. (4 minutes)

      HIVinfo.NIH.gov - 2024

    • url icon
      Substance Use Disorders URL
      Students must
      View

      Read the following sections: “Background”, “Substance Use Disorders in People with HIV”, and “Alcohol Use Disorder”. (55 minutes)

      National HIV Curriculum - 2025

    • url icon
      Substance Use Disorders and HIV URL
      Students must
      View

      Read the entire article. (50 minutes)

      NIH - Clinical Info HIV .org - 2024

    • url icon
      Substance Abuse Treatment for Persons With HIV/AIDS URL
      Students must
      View

      Read the table on PDF page 69: Figure 2-6 "Medical Complications of Substance Abuse That May Affect Differential Diagnosis of Injection Drug Users With HIV". (5 minutes)

      Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment - 2014

    •  
      Recommended Additional Readings
    • url icon
      HIV and Substance Use URL

      Read the entire webpage. (6 minutes)

      HIVinfo.NIH.gov - 2024

    • url icon
      Interactions between HIV treatment and recreational drugs URL

      Read the entire webpage. (9 minutes)

      NAM - 2020

    • url icon
      A client-centered relational framework on barriers to the integration of HIV and substance use services: a systematic review URL

      Read the Abstract, Background, Discussion, and Conclusion of the article. (18 minutes)

      Harm Reduction Journal - 2019

    • url icon
      The prevalence of alcohol use disorders among people living with HIV/AIDS: a systematic review and meta-analysis URL

      Read the Abstract, Background, Discussion, and Conclusion of the article. (11 minutes)

      Substance Abuse Treatment, Prevention, and Policy - 2019

    • url icon
      Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study URL

      Read the entire article. (37 minutes)

      PLOS One - 2022

    • Module 5: Lesson 3: Substance Use and Pregnancy 

      Learning Outcomes:

      Upon completion of this lesson, you will be able to:

      • Describe 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.

      • Explain how babies being breastfed by women on medications are monitored for adverse effects or withdrawal, and undergo comprehensive examinations if required.

      Required Learning Resources and Activities
    • url icon
      Smoke, alcohol and drug addiction and female fertility URL
      Students must
      View

      Read the sections "Introduction" and "Conclusions." (10 minutes)

      Reproductive Biology and Endocrinology - 2020

    • url icon
      Why do women consume alcohol during pregnancy or while URL
      Students must
      View

      Read the sections "Introduction", "Results", and "Discussion". (35 minutes)

      Drug and Alcohol Review by John Wiley & Sons Australia, Ltd - 2022

    • url icon
      Opioid Use Disorder and Pregnancy URL
      Students must
      View

      Interact with the tabs to read the entire web page.  (20 minutes)

      American College of Obstetricians and Gynecologists - 2024

    • url icon
      Substance Use in Pregnancy URL
      Students must
      View

      Read the entire document. (1 hour 39 minutes)

      StatPearls Publishing LLC. - 2023

    • url icon
      About Fetal Alcohol Spectrum Disorders (FASDs) URL
      Students must
      View

      Read the entire webpage. (26 minutes)

      CDC - 2025

    • url icon
      Safety of psychotropic medications in pregnancy: an umbrella review URL
      Students must
      View

      Read the following sections: "Introduction", "Results", and "Discussion". (60 minutes)

      Springer Nature Limited- 2024

    • url icon
      Perinatal Drug Abuse And Neonatal Drug Withdrawal URL
      Students must
      View

      Read the entire article. (12 minutes)

      StatPearls Publishing - 2021

    •  
      Recommended Additional Readings
    • url icon
      Queensland Clinical Guidelines - Perinatal substance use: neonatal URL

      Read the flowchart on page 3, as well as Section 2 "Initial newborn care," Section 3 "assessment," and Section 4 "Supportive care" on pages 8-15. (23 minutes)

      Queensland Health - 2021

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

      Learning Outcomes:

      Upon completion of this lesson, you will be able to:

      • Recognize when to refer patients - Assist the patient in acquiring healthy lifestyles, which can improve mental health and help manage substance use disorder triggers such as stress - Perform a general healthy weight assessment (BMI, weight, and height)."

      • Explain 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.

      • Explain 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.

      • Explore strategies that promote autonomy and independent living among individuals with substance use disorders, while minimizing reliance on institutional or long-term residential care.

      • Explore useful self-help and well-being resources for Substance Use Disorder patients.

      • Describe 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.

      • Describe how to perform a general healthy weight assessment (BMI, weight, and height).

      Required Learning Resources and Activities
    • url icon
      Patient Communication In Substance Use Disorders URL
      Students must
      View

      Read the entire article. (32 minutes)

      StatPearls Publishing LLC. - 2025

    • url icon
      How to Know When to Refer a Client to Rehab: These Six Telebehavioral Tips Can Help URL
      Students must
      View

      Read the entire webpage. (5 minutes)

      The University of Arizona - 2019

    • url icon
      Can addiction be treated successfully? URL
      Students must
      View

      Read the entire webpage. (7 minutes)

      National Institutes of Health - 2020

    • url icon
      Treating Addiction URL
      Students must
      View

      Read the entire webpage.  (3 minutes)

      Camh - 2021

    • url icon
      mhGAP Intervention Guide - Version 2.0 URL
      Students must
      View

      Read No.5 "Follow-up" in the "Essential care and practice" section (PDF pg. 21), as well as Sub 3 "Follow-up" in the Disorders due to substance use" section (PDF pgs. 136-137). (6 minutes)

      WHO- 2019

    • url icon
      Targeting the Barriers in the Substance Use Disorder Continuum of Care With Peer Recovery Support URL
      Students must
      View

      Read the entire article. (43 minutes)

      NCBI - 2021

    • url icon
      Substance use disorder patients’ expectations on transition from treatment to post-discharge period URL
      Students must
      View

      Read the sections "Introduction," "Findings," and "Discussion." (35 minutes)

      SAGE Publications Ltd - 2020

    • url icon
      Drug Misuse and Addiction URL
      Students must
      View

      Read the entire article  (33 minutes)

      NIDA - 2020

    • url icon
      Alcohol-Medication Interactions: Potentially Dangerous Mixes URL
      Students must
      View

      Read the entire article (58 minutes)

      NIAAA - 2025

    • url icon
      Polydrug use URL
      Students must
      View

      Read the entire webpage. (19 minutes)

      Alcohol and Drug Foundation - 2024

    • url icon
      Guidance Part 3: supporting service users to get the most out of opioid substitution treatment (OST) URL
      Students must
      View

      Read Sections 1 "Monitoring, support and review," 2 "What to do when a treatment and recovery care plan is not working?" and 3 "How to respond if OST is not working?". (34 minutes)

      Public Health England - 2021

    • url icon
      Recovery-Oriented Mutual Self-help Groups URL
      Students must
      View

      Read the entire webpage. (15 minutes)

      US Department of Veterans Affairs - 2025

    • url icon
      Substance Use Disorder Treatment and Family Therapy URL
      Students must
      View

      Read the entire chapter: "Chapter 3—Family Counseling Approaches ". (60 minutes)

      SAMHSA - 2020

    • url icon
      The mhGAP community toolkit: field test version URL
      Students must
      View

      Read section 4.2 "Vocational, educational, and housing support" on pgs. 83-84. (4 minutes)

      WHO - 2019

    • url icon
      Integrating Vocational Services Into Substance Use Disorder Treatment URL
      Students must
      View

      Read pages 1 to 7. (19 minutes)

      SAMHSA - 2021

    • url icon
      Signs of Opioid Misuse, Opioid Use Disorder, and Overdose URL
      Students must
      View

      Read the entire webpage. (14 minutes)

      CDC - 2022

    • url icon
      Signs of Drug Use & Addiction: How To Tell if Someone Is On Drugs URL
      Students must
      View

      Read the entire webpage. (49 minutes)

      AAC - 2024

    • url icon
      Family Therapy for Substance Use Disorders and Addiction Recovery URL
      Students must
      View

      Read the entire webpage.  (21 minutes)

      AAC - 2025

    • url icon
      Examining Utilization of Family-Based Treatment in Substance Use Treatment Centers URL
      Students must
      View

      Read the selected sections: "Introduction" and "Discussion". (77 minutes)

      Springer Nature Limited - 2024

    • url icon
      Counseling Approaches To Promote Recovery From Problematic Substance Use and Related Issues URL
      Students must
      View

      Read Chapter 4—Counseling Approaches for Sustaining Recovery and Promoting a Healthy Life (153-205). (60 minutes)

      SAMHSA) - 2023

    • url icon
      Structured programs for the self-management of substance addiction consequences in outpatient services: A scoping review URL
      Students must
      View

      Read the following sections: "Introduction", "Results", and "Discussion". (54 minutes)

      Springer Nature Limited - 2023

    • url icon
      The Psychological Toolkit URL
      Students must
      View

      Read the sheets under the sections "Lifestyle: Exercise, diet & sleep" and  "Meditation and relaxation." Although not required, you may read the other sheets from this resource. (30 minutes)

      Black Dog Institute - 2025

    • url icon
      The Role of Self-Care in Substance Use Prevention URL
      Students must
      View

      Read the entire web page (10 minutes)

      Samarpan - 2024

    • url icon
      PRINCIPLES OF HARM REDUCTION URL
      Students must
      View

      Read the entire guide. (10 minutes)

      Harm Reduction Coalition - 2020

    • url icon
      The Benefits of Physical Exercise on Mental Disorders and Quality of Life in Substance Use Disorders Patients. Systematic Review and Meta-Analysis URL
      Students must
      View

      Read the introduction (pgs. 1-3), discussion, and conclusion (pgs. 27-31). (28 minutes)

      International Journal of Environmental Research and Public Health - 2020

    • url icon
      Exercise and mental health URL
      Students must
      View

      Read the entire webpage. (7 minutes)

      State Government of Victoria - 2021

    • url icon
      Diet, Nutrition, and Substance Use Disorder URL
      Students must
      View

      Read the entire webpage. (11 minutes)

      Utah State University - 2020

    • url icon
      The Power of Mindfulness and Medication in Addiction Recovery URL
      Students must
      View

      Read the entire article. (11 minutes)

      Journal of Addictive Behaviours and Therapy - 2024

    • url icon
      Body Mass Index (BMI) URL
      Students must
      View

      Read the entire webpage. (8 minutes)

      Cleveland Clinic - 2022

    • url icon
      BMI Calculator URL
      Students must
      View

      Interact with the website and read the complete content. (10 minutes)

      2024 calculator.net - 2024

    •  
      Recommended Additional Readings
    • url icon
      Substance Use Disorder Treatment for People With Co-Occurring Disorders URL

      Read Chapter 3: "Screening and Assessment of Co-Occurring Disorders" (pages 31-68). (132 minutes)

      NIH - SAMHSA- 2020

    • url icon
      Counseling Approaches To Promote Recovery From Problematic Substance Use and Related Issues: Chapter 4—Counseling Approaches for Sustaining Recovery and Promoting a Healthy Life URL

      Read the entire article. (60 minutes)

      NCBI - 2023

    • forum icon
      Module 5: Managing Comorbidities and Special Populations Forum

      SLOs:

      • Distinguish links between mental health conditions and substance use disorders

      • Explain how substance use interacts with HIV

      • Describe reproductive health considerations for substance users

      • Identify strategies for follow-up care and community support

      General Instructions:

      In this activity, you will analyze the complex relationships between substance use disorders and comorbid conditions, with special attention to vulnerable populations.

      Step 1: Select and Reflect

      • Review evidence on the bidirectional relationship between mental health disorders and substance use

      • Study the impact of substance use on HIV transmission, progression, and treatment adherence

      • Examine the effects of substance use during pregnancy and reproductive health implications

      Step 2: Respond

      Develop a comprehensive post (400-600 words) addressing one of the following topics:

      1. Dual Diagnosis: Strategies for managing co-occurring mental health and substance use disorders in primary care

      2. Substance Use and HIV: Approaches to prevention, screening, and integrated treatment

      3. Substance Use in Pregnancy: Screening, intervention, and harm reduction approaches

      4. Community-Based Recovery Support: Models for long-term management and wellness

      Your post should include:

      • Analysis of evidence-based approaches to your chosen topic

      • Discussion of implementation challenges in primary care settings

      • Consideration of cultural and contextual factors

      • Recommendations for integrated care delivery

      Step 3: Share

      To share your work, click on the "Add a new discussion topic" button under this post and paste your work into the "Message" box. Make sure to reference others' intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B.: references are excluded from word counts).

    • quiz icon
      Quiz: Module 5

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to view the case studies and respond to the questions.

      TO PASS THIS QUIZ YOU MUST OBTAIN A SCORE OF 80%.


      Not available unless: The activity Quiz: Module 4 is marked complete
    • Required Learning Resources
    • resource icon
      Lesson Summary: Module 5: Managing Comorbidities and Special Populations File
      Students must
      Mark as done

      The lesson summary includes key information needed to meet the objectives of this module. You are encouraged to review it carefully. At the end of the lesson summary, you'll also find a list of references with clickable links, you can explore them if you'd like to learn more or dive deeper into the topic.

      899.3 KB
    •  
      Supplementary Learning Resources (Not Required)
    • resource icon
      Study Guide: Module 5: Managing Comorbidities and Special Populations File

      In this document, we summarized key topics of the module to help you study. Please note that these notes do not cover all of the material in its entirety; you are still encouraged to read and study all of the required learning resources.

      1.0 MB
    • page icon
      Flashcards Module 5: Managing Comorbidities and Special Populations Page

      Here are specialized flashcards designed to reinforce and test your knowledge throughout this course.

    • scorm icon
      Microlearning Module 5: Managing Comorbidities and Special Populations SCORM package