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:
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:
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.
Click here for the brief module introduction
This module will act as a foundation for the rest of this course, providing you with information on how primary health care can be used to lessen the burden of mental illness, including substance use disorders. Key terms such as ‘task-shifting’ will be
introduced. You will also learn about the WHO mhGAP (Mental Health Gap Action Programme) principles of care and priority conditions. Finally, you will come to understand the science behind substance abuse and its effect on human health and social
Upon completion of this module, students should be able to:
Click here to start this lesson
Read the entire document titled "The Optimal Mix of Services for Mental Health Care."
Read the entire article titled "Human Resources for Mental Health Care: Current Situation and Strategies for Action." Focus on the idea of task-shifting and primary health care involvement in mental health care.
This training, using the "mhGAP Intervention Guide," is largely based on the mhGAP goals and recommendations for the implementation of mental health services in primary care. To familiarize yourself with the rationale for doing so and how the mhGAP Intervention Guide works, please read the Introduction, General Principles of Care, and the Master Chart (pp. 1-8 in the document or pp. 10-21 in the page navigator). In this training, we will mostly focus on alcohol use and substance use disorders, including tobacco use (although it is not covered in the mhGAP). The training will also review when to refer to primary care practitioners with additional training in mental health and substance use disorders. For example, referral would be advised when the patient may be a danger to himself or others or when the patient is severely intoxicated. NextGenU's Alcohol, Tobacco, and Other Substance Use Disorder training (a companion to this training) can assist practitioners in addressing those conditions, as well as common co-occurring conditions like depression and psychosis.
Please save this document so that you can access it later in this course, as well as in your practice as a quick reference guide. You are welcome to review the rest of the mhGAP Intervention Guide to familiarize yourself with the World Health Organization's recommendations on addressing the other priority conditions in primary care.
Read the entire manual titled "Drugs, Brains and Behavior: The Science of Addiction" as this will be your foundation for understanding the science behind addiction and health.
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.
Click here to start for breif module introduction
This module will discuss stigma and illustrate its effect on human health (especially mental health) and the measures that can be taken to eliminate it. You will be introduced to international standards and regulations on mental health and human rights.
In addition, this module will help individuals appreciate the impact that stigmatizing attitudes, words, or other behaviors can have on patient outcomes. This module will assist individuals in paying closer attention to the rights of patients/clients
so as to provide better quality service in their practice.
Upon completion of the first lesson of Module 2, students should be able to:
Read "Chapter 1: Background" (pp. 7 to 14) in the "Anti-Stigma Toolkit."
Read Section 1 (Defining the Issues, pages 12-16), Section 2 (Current
Approaches, pages 17-20), and Section 3 (Key Trends, Themes and Emergent
Practice, pages 25-28) to learn more about stigma, marginalization, and
discrimination and the interventions that can minimize it..
This activity will help you reflect on the ethical and appropriate delivery of mental health care, which includes delivery of services for those who suffer from alcohol or other substance use disorders. This exercise uses the Scottish model of delivery, but can be very appropriately applied to similar difficulties with stigma and discrimination in most other countries. This activity includes answering questions that are meant to trigger reflections about your own practice and how you can contribute to improve the care of those with mental health or substance use disorders through the application of patient-centered, ethical, and human rights principles of care.
Please perform the following activities outlined inthis document from NHS Education for Scotland. Because you will be posting four key learning from these activities, you will have to take your own notes and record your reflections in a way that you will be able to access them later. Some of the suggestions to obtain information are specific to the UK and their National Health System (NHS). Resources on policies, strategies, laws, and service standards in many countries are available through the WHO MiNDbank (http://www.mindbank.info/).
Begin reading at page 1, Introduction to the learning resource, and continue until the end of page 3. After that, read Module 1 and perform activities 1.1 to 1.17 (pp. 9-35) by taking notes, answering the questions within the document, or just thinking about them – but remember that you will need to write a brief reflection about your responses.
Share your learning with your peers by posting four key points you have learned through performing those activities. Describe each key point and the importance of learning that point (in a few sentences for each point).
To submit, click on the button at the bottom of the screen labeled 'Add a new topic’. You should comment on at least one other posting in the discussion forumby 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 by clicking on the particular discussion and then clicking on reply. Please feel free to ask questions or provide alternative resources that you feel are helpful to support any of the capabilities touched on in the NHS document.
In the document from the NHS Education for Scotland, read and complete the various learning activities outlined in "Module 4: Equality and diversity: respecting the difference" (pp. 75-106). You will have to take your own notes and record your reflections in a way that you will be able to share with your mentor later. Some of the listed resources are specific to the UK and their National Health System (NHS). You can discuss with your mentor how to find locally relevant information, and use your own experience as a source of knowledge on the situation. Be careful if you only use your own experience, as it might not be fully representative of the situation in your community.
You will need to be using either Internet Explorer or Mozilla Firefox in
order for this resource to work correctly.Go through the presentation.
When you see an icon (such as "Story" or "Myth Check", please click on
it. Another pop-up window will appear, containing essential information
for the module,which you should read. At the end of the presentation,
you can click on the tab titled "content" where you can access a quiz.
This quiz is optional to complete, as it might not work well in your
browser. However, if it works, we encourage you to take it to test
Upon completion of the second lesson of module 2, students should be able to:
Read the entire web page. This document will give you an overview of international considerations for mental health human rights, legislations, standards, and policies. Feel free to click on any of the links to learn more about mental health, human rights and legislation.
Click on the links titled "Circle of Care" and "Breaches" found under the heading "Privacy and Confidentiality" located on the left side of the web page. Read each section. The section, called 'Breaches', will provide you with valuable information, such as examples of breaches of confidentiality or privacy. These breaches occur too often, usually inadvertently. The link titled 'Test yourself' located under the "Privacy and Confidentiality' tab can help you test your knowledge and understanding of the content of the module. The other sections are optional reading. Note: If your browser asks you to select an item from the list, please select ‘public’ and then press submit.
Read the document to learn about consent.
Read this document titled "The protection of persons with mental illness and the improvement of mental health care" for an overview of international standards for human rights and mental health.
Read the editorial article titled "Global Mental Health: A Failure of Humanity." Think about whether or not you agree with the position taken by the author of this article and your reasons for your position.
Read this article titled "Understanding and Responding to Youth Substance Use" about the current global situation in relation to the use of psychoactive substances, international policies, and a human rights approach to the issue.
Upon opening this resource titled "Medical Certificates, Forms, Notes, Legal Reports," turn the audio off if the sound is distorted or if you do not have speakers or headphones. Do this by selecting the square symbol beside the 'Audio On' button. Hover your cursor above the 'Transcript' button and you can read the text version of the audio. Select the 'Accept' button and continue through the entire e-learning module. Familiarize yourself with best practices for taking case notes, especially in relation to discussions with those who are supportive of your patient (e.g., family, friends, carers or others).
"Chapter 2: Physicians and Patients" will cover some of the concepts seen in the mandatory resources, but in a different way. This puts the information in the context of patient-centered care, and covers, in more detail, issues of consent and confidentiality, as well as appropriate communication. Read the entire chapter.
Understand various best practices for the medical management of tobacco, alcohol, and other substance use disorders in primary care
Click here for brief module introduction
This module will introduce you to best practices for managing tobacco, alcohol, and other substance use at the primary care level. It provides insight into the various risks and physical effects associated with substance use and how they can be prevented.
It introduces skills and techniques for effective diagnosis of tobacco use and related diseases. The links between tobacco use and Chronic Obstructive Pulmonary Disease (COPD), as well as tobacco use and cancer, will be elaborated upon. There will
be an introduction to screening for alcohol intoxication as well as an overview of current treatment and referral strategies.
Upon completion of the first lesson of Module 3, students should be able to:
In this resource titled "Quitting Tobacco" read the information in the table to learn about the effectiveness of smoking cessation interventions.
Read this entire article titled "The Role of the Primary Care Physician in Tobacco Use Prevention and Cessation." It is an excellent overview of the physician's role in tobacco use prevention and cessation.
Use "Helping Smokers Quit: A Guide for Clinicians" as an overview resource to consult conveniently and often as you implement smoking cessation advice in your practice. If you wish, build your own tip sheet for your clinical practice, including elements that are most relevant to your context based on this and other resources.
In the "Behavioural Science Learning Modules" document review Tables 2-3 and Figure 1, (pp. 8-10). Note: Table 4 (p. 13), and Table 5 (pp. 16 - 18) are optional. These tables and figures will give you a general overview of statistics and conditions related to smoking. Then, beginning at the section titled "Address the topic of smoking and tobacco use," read pp. 23-33. Pay special attention to Tables 7-11 and Figure 2 for tips and flowcharts to help you in your clinical practice. Read Appendices 3 and 4 (pp. 46-57) to help you understand how to give cessation advice in practice. The rest of this manual is supplementary. As you might have already noticed, similar intervention protocols and concepts are covered in other learning resources. This particular resource is more than 10 years old, so some new research has since influenced practices and policies, but most of it is still relevant and accurate.
Read the entire webpage titled the "Health Effects of Cigarette Smoking" to learn more about the personal health risks of tobacco use.
Read the entire factsheet to learn more about the general benefits of quitting smoking.
Read the entire webpage titled "How To Handle Withdrawal Symptoms and Triggers When You Decide To Quit Smoking." It provides further information on how to deal with tobacco withdrawal symptoms in language adapted for patient self-help.
Read the entire report to learn about the harm of second-hand smoke.
Read this short resource to learn more about the effects of secondhand smoke on the health of children.
This "Pocket Guide to COPD Diagnosis, Management, and Prevention" provides you with an overview of COPD diagnosis and management, including co-morbidities. Please read pp. 4 - 22. It is very likely that spirometry for diagnosis and many of the medications for COPD will be hard to access in the setting of a low- or middle-income country, but this will nevertheless give an overview of best practices. If appropriate, you can discuss with your peers and your mentor how to best address the difficulties in accessing adequate assessment and management tools, drugs, and other support for this condition, or any other of the comorbidities or complications associated with substance use disorders.
In this article titled "Physician Communication Regarding Smoking and Adolescent Tobacco Use" read the "Abstract" and the "Discussion" section.
The most useful sections in this resource are titled "How does smoking
cause cancer?" and "What's in a cigarette?". However, read any section
of interest to you.
This web page titled "COPD - Tools & Resources" offers links to several clinical resources for COPD.
This resource titled "Chronic Obstructive Pulmonary Disease (COPD)" provides you with another set of best practices in relation to COPD diagnosis and management.
Upon completion of the second lesson of Module 3, students should be able to:
The following page numbers refer to the full document, but note that the resource is also available in smaller sections, which may load more quickly. Please read Chapter 1 (pp. 1 - 11) and Chapter 2 to 6 (pp. 17 - 94). Please note that many other substances can be amphetamine-like. For example, in Kenya, miraa (also known as khat) is an amphetamine-like substance, and the learning in Chapter 6 is applicable to all amphetamine-like substances. Please also review Chapter 11 (pp. 147 - 156), Chapter 15 (pp. 185 - 192), Chapter 18 (pp. 207 - 214), and p. 243, p. 249, and p. 261 of the Appendices.
The substances covered in the other chapters are supplementary readings, as are Chapters 13 and 14, since you will learn most of those non-medical intervention techniques with the ASSIST Brief Intervention Guide. Review the Table of Contents to determine whether any other section is relevant to your clinical practice and, if so, please read it as well. There is a useful glossary at the end of the document, and tips to help implement the interventions in clinical practice are found in Appendix I.
On the website titled "PHE Alcohol Learning Resources" please click on "Primary Care eLearning" and review sessions 1, 2, 4, 5 and 6. Please attempt to answer all questions to the best of your ability before submitting and reviewing the answers. Those questions are for your own learning and are not part of the course evaluation.
The third session, which covers the AUDIT, is optional. This course will cover screening through the ASSIST screening tool but it does not cover the AUDIT tool. The AUDIT is a very useful and simple tool and because you might not be part of a site where there is someone who can administer the ASSIST, you might still wish to review session 3, focusing on those who use alcohol and/or tobacco in your practice rather than screening for all substances.
In the "mhGAP Intervention Guide" review sections ALC1 - ALC3 and DRU1 - DRU 3 (pp. 58 - 72). Those are the sections on "Alcohol Use and Alcohol Disorders" and "Drug Use and Drug Use Disorders." Each section begins with an 'Assessment and Management Guide for Emergency Cases,' which is followed by an ‘Assessment and Management Guide’ (which, for alcohol, covers an algorithm to look at consumption), and the last section is 'Intervention Details.' These sections provide a very basic overview of care for alcohol and substance use disorders. Many resources in the rest of this training will assist you in further developing your skills for brief interventions and the management of alcohol use and other substance use disorders.
This "Screening for Drug Use in General Medical Settings: Quick Reference Guide" is a very simple and easy way to understand how to provide care to individuals who are using substances. After reading this you should understand the basic functions of screening and brief interventions.
Review this list of guidelines from the "National Collaborating Centre for Mental Health" that cover various topics in relation to mental health and substance use disorders. Choose the topics that are of greatest interest to you. It should take approximately 1-2 hours to review each set of guidelines, therefore it would take considerably longer to read them all.
This detailed manual titled "A Guide to Substance Abuse Services for Primary Care Clinicians" is a good reference manual for primary care intervention for substance use disorders. We will be covering many of the topics included in this manual through other resources found in this and other modules. You do not need to review this entire guide now. However, it is recommended that you download it and review the Table of Contents now, so that you become familiar with what it covers and can refer back to it as needed. Many issues covered in this manual, such as specialized treatment and some pharmacotherapy, will not be addressed by the other resources in this training.
Click on the tab titled "Assessment", and read the content of the link titled "Assessing alcohol problems in older adults". Then, under the tab titled "Treatment", click on the link titled "Treating alcohol problems in older adults" and read the content of that link. As optional reading, click on the tab titled "Screening" and read the content of the link titled "Screening for alcohol problems in older adults".
Upon completion of the third lesson of Module 3, students should be able to:
This resource titled "Beyond Hangovers" will give you a good understanding of the impact of alcohol on the body.
On the "CAMH and McMaster Addictions Curriculum Project" website open "Module 1: At Risk Drinking." From the Table of Contents on the left, click on "A Case of a Drinking Problem." Use the 'next' button to go over each of the following slides to the end of the presentation. Attempt to answer all the questions as best as you can before clicking to get the answer. This will test your understanding and skills on many of the aspects covered by this module.
This resource titled "Alcoholic Liver Disease" includes some hyperlinks (the blue, underlined text) with more information about assessment, such as blood tests and imaging studies.
"Diagnosis and Treatment of Alcoholic Liver Disease and Its Complications" is a more detailed resource on alcoholic liver disease. We expect you to review this resource only if you find that you are required to assess and manage liver disease without much support, and/or to understand better what might be done in more specialized settings.
"EASL Clinical Practical Guidelines: Management of Alcoholic Liver Disease" is a very detailed clinical guideline that covers recent scientific advances. We do not expect anyone in primary care to cover this, but this resource may help you to understand specialized treatment if a patient gets to that point.
This resource titled "Alcohol Withdrawal: Development of a Standing Order Set" may be of assistance in some situations.This training is not meant to fully teach how to assess or treat severe alcohol withdrawal in detail. However, individual practitioners might find themselves in a situation where they have no choice but to support safer withdrawal. The article explores the impact of using a standardized order set for alcohol withdrawal management in an acute care setting. It reviews the background to alcohol withdrawal management and provides an example of the standard order set that can be used in acute care (Figure 1). It is based on the CIWA protocol, which is also used in community settings for primary care management of alcohol withdrawal. Read the article from the beginning until the section titled 'Procedure.' It may be easier to review Figure 1 by downloading the PDF version of the article.
The "Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)" is a protocol that is used in outpatient settings. We suggest that you review this protocol and keep it accessible for your practice (either in print or electronic format) to assess and help patients with alcohol withdrawal.
In this module you will apply the foundational knowledge you have developed in the previous three modules and learn how to screen and treat alcohol and substance use disorders in your practice. Specifically, you will use the Alcohol, Smoking and Substance
Involvement Screening Test (ASSIST) developed by the World Health Organization. The ASSIST package was developed by a number of international substance abuse researchers to provide substance abuse screening and brief interventions in primary and general
medical care worldwide.
Upon completion of the first lesson of Module 4, students should be able to:
In "The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for Use in Primary Care" read sections 1 - 7 (pp. 1 - 10). This should give you a sufficient understanding of how and why the ASSIST and the ASSIST-Linked Brief Intervention are used in primary health care. Next, read sections 9 - 15 (pp. 19 - 36). This should provide you with a basic understanding of how to screen using the ASSIST and how to categorize a patient using an ASSIST Scorecard.
You will be reading this entire manual titled "Brief Intervention," therefore you may wish to download it (for your own personal use only). The first 3 sections review concepts that are similar to those covered in the ASSIST screening manual, so you do not need to spend a lot of time reviewing those sections. Read sections 4 - 6 that will provide you with new theories and skills for brief interventions. You need to thoroughly understand these sections before continuing on to read section 7. Read section 8 on high risk and injecting clients that will help you understand and apply what you have read in the mhGAP. Section 9 will provide you with case examples of brief interventions. Section 10 to 12 provide further techniques to deliver longer interventions as well as how to include the ASSIST-linked brief intervention in practice.
After you have read the required resources provided in this module, you should feel comfortable participating in this simulation assessment activity about tobacco, alcohol, and other substance use. Step 1: Select two local peers with whom you can role-play. Using the sample case scenarios from the WHO (Appendix 1, p. 41), perform the following simulation:
Click on the links titled "Influencing motivation to change", "Negotiating a change plan", "Setting goals and finding solutions", and "Preventing and managing relapse". Read the content of those links for additional information about change and motivation and well as how to ask solution-focused questions to help assess and improve a patient's ability to change.
From the menu on the left-hand side of the document titled "The Clinical Assessment of Substance Use Disorders," read the sections titled 'Key Concepts' and 'Learning Goals' and then read the 'Questions' section. Answer the 'Questions' and post them online (within the resource - there is no need to submit anything to NextGenU).
Continue reading the 'Introduction' section, 'Medical Model', and all the materials under 'Clinical Evaluation', from 'Red Flags' to 'Initial Visit'. While watching the 'Initial Visit' video, take note of the blue icons and comments on the right. At appropriate times during the video, these comments will be highlighted in yellow. At this time, you can click on the blue icon and another smaller video will pop up. This smaller video will share thoughts and comments running through the minds of the doctors and patients during the interview.
This module will further outline the complexities of substance use disorders and the tendency of these disorders to co-occur with other health conditions. Substance use may be related to mental illness, HIV status, or malnutrition, and can have serious
implications for women’s reproductive health. Both mental and physical co-morbidities may increase the levels of dysfunction, leading to more complicated treatment and management. You will learn how psychoactive substances are related to HIV status,
general health status, and lifestyle, as well as various mental illnesses. You will receive instruction on how to treat and manage patients with co-occurring depression and substance use disorders as well as manage the reproductive health of female
patients with past or current substance misuse and their infants. You will also learn how to continue treatment and to mobilize community support for individuals with substance use disorders. You will learn what formal and informal supports are
currently in your community as well as how to involve and inform families and caregivers how to best support their loved ones. In your clinical practice, you will learn how to continually monitor the health and well-being of these at-risk individuals.
Upon completion of the first lesson of Module 5, students should be able to:
Read "Comorbidity of Mental Disorders and Substance Use" Chapter 4 (from 4.1.1 to 4.1.3, inclusive) to learn more about mental health comorbidities with tobacco use. Also read all of Chapter 5, which covers depression as a comorbidity with various psychoactive substances, and Chapter 7, which covers psychosis comorbidity with psychoactive substances. All the other chapters are supplementary and you may refer to them as needed (for example, if you wish to learn more about personality disorders or other mental health comorbidities).
Read the "mhGAP Intervention Guide" sections on "Depression" (pp. 10 - 17 in the document; pp. 25 - 32 in the page navigator) and "Psychosis" (pp. 18 - 23 in the document; pp. 35 - 40 in the page navigator). Please also read Module 10 on "Self-Harm/Suicide" (pp. 74 - 79 in the document; pp. 107 - 112 in the page navigator). After this, you should understand the importance of inquiring about self-harm.
This WHO manual titled "Pharmacological Treatment of Mental Disorders in Primary Health Care" covers the essential medicines for mental health conditions. Within each disorder/chapter, the sections 6, 7, 8, and 9 cover adverse reactions, overdoses, special patient populations, and potentially relevant interactions, respectively. You should review: the treatment of psychosis (pp. 11 - 16); the entire chapter 4 on depression (pp. 19 - 28); relevant medications for bipolar disorders (pp. 31 - 35); relevant medications for anxiety disorders (pp. 38 - 42); and adverse reactions, overdoses, special patient populations, and potentially relevant interactions for alcohol and opioids (p. 51 - 59). The rest of the manual is supplementary. Pay particular attention to the medications that are readily available in your setting.
Read this entire document titled "Working with the Suicidal Patient" which provides a practical technique to assess and address sucidal risk in primary care.
In the "Family Physician Guide" under the section titled "Overview of Disorders," read from segment 1.14 to 1.19. In the "Diagnostic Issues" section, read the segments on "Diagnosing Early Psychosis" (2.11 - 2.12) and "Diagnosing Major Depressive Disorders" (2.4 - 2.7 and 2.22). In the "Management Issues" section, under the subsection "Psychotherapies and Other Non-Pharmacological Interventions," read the segments pertaining to "Electroconvulsive Therapy ECT" (3.23 to 3.25) and "Major Depressive Disorder" (3.5 - 3.7). In the "Pharmacological Intervention" subsection, read the segments pertaining to "Major Depressive Disorder" (3.29 to 3.33) and "Early Psychosis" (3.35 to 3.38). There is also valuable information found in "Appendix 2: Women's Mental Health Issues." Review the "Screening Tool" for postpartum depression and "Pharmacotherapy in the Perinatal Period" (7.12 and 7.13). The rest of the manual is excellent, and you can use it as a reference. A few other sections of this guide are used in other parts of this training.
This resource offers videos related to alcohol use and mental illness. Click on the 'Videos' link to 'Kick Start Recovery', 'Getting Real', 'Ask the Questions', 'Ben and the Antidepressant Skills Workbook', 'Bounce Back', 'CBIS Skills', and 'Problem and Resource Lists'.
This link brings you to an overview of the Black Dog Institute's model of depression. You can read this overview and decide if you want to gain further experience in diagnosing and treating patients based on this approach.
If you treat many seniors, this resource titled "Substance Abuse Among Older Adults" will be useful for you. It provides detailed instructions on seniors' health and possible interactions, comorbidities, and co-occurrences.
This webpage titled "Tools and Resources" provides links to other resources from CARMHA, including resources for workplace mental health, adolescent health, and many other practical tools.
Upon completion of the second lesson of Module 5, students should be able to:
Read the entire content and review the links on the web to learn about Health Systems and know the statistics on tobacco consumption.
Read the entire section titled "Introduction". Then, click on the links
titled "Identifying Alcohol Abuse", "Effects of Alcohol Use", and
"Brief Interventions and Referrals". Ensure you review the
recommendations in bold. The rest of the resource is optional reading.
Read the entire article to learn about the co-management of HIV and substance use.
In the "Substance Abuse Treatments for Persons with HIV/AIDS" manual read "Chapter 3--Mental Health Treatment." The rest of the document is supplementary, as the rest of the treatment issues and protocols for HIV are likely different in low- and middle-income countries, and even different in various other high-income countries, compared to what is done in North America.
As you read through Substance Abuse Treatments for Persons with HIV/AIDS: Chapter 3: Mental Health Treatment (pp. 69-89), reflect on the mental health disorders for which HIV-infected clients are at increased risk. For any two mental health disorders, write down what is currently being done and what you think should be done to manage mental health disorders among HIV-infected clients in your community. Post at least one of your answers in the forum.
To post your answer click on the button at the bottom of the screen labeled 'Add a new discussion topic.' Also comment on at least one other posting made by your peers in a respectful and professional manner. If a peer comments on your posting, please reply back. Click on the particular discussion, then click on 'reply'.
This guide titled "Recreational Drugs and HIV Antiretrovirals" contains tables that indicate interactions between HIV medications and many other psychoactive substances. Use it as a review if you treat patients taking HIV medications.
Read this entire resource by clicking on the tabs on the left of the web page. The resource provides information on counseling.
Read the "Conclusions" section of this article titled "The Association Between HIV Infection and Alcohol Use." If you are interested, read the whole article.
This article titled "Substance Use, Sexual Risk, and Violence" provides an overview of issues faced by female sex workers in relation to violence, substance abuse, and HIV, as well as an intervention to prevent the transmission of HIV that seemed promising in Pretoria, South Africa.
Upon completion of the third lesson of Module 5, students should be able to:
On the website titled "Fetal Alcohol Spectrum Disorders" review Module 2 (Effects of Alcohol on the Fetus), Module 3 (Risk Factors for FASD), Module 4 (FASD Signs and Symptoms) and Module 5 (FASD Prevention). The other modules are supplementary, review them if you are interested.
Read the entire article to learn about the effects of psychotropic medication during pregnancy.
Click on the tab titled "Screening". Then, click on the link titled "Screening for Alcohol Use in Pregnancy" and read the content of that link. Then, under the tab titled "Treatment", click on the link titled "Managing alcohol use in pregnancy" and read the content of that link. Note: It is possible that your setting has decided to prioritize screening pregnant women for only a few substances (such as alcohol or tobacco) rather than use the ASSIST. If that is the case, you will need to familiarize yourself with those other modalities of screening.
If you would like further information, this resource titled "Substance Abuse Treatment" gives detailed information regarding providing health care to women who may abuse substances.
Upon completion of the fourth lesson of Module 5, students should be able to:
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.
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
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.
Click here for the brief module introduction
The final module of this course focuses on communication. With the stigma surrounding many of the topics discussed in this training, it is important that primary care providers are sensitive, nonjudgmental, and able to communicate in a language that their
patients understand. Effective communication builds trust and rapport between patients and their health care providers and provides the opportunity to dispel myths and common misconceptions held by patients and their families. This in turn can strengthen
both the community at large and the social support for those affected, as well as increase the patients’ acceptance and adherence to treatment.
Read the entire article titled "Patient-Physician Communication: Why and How." Focus on the section titled "How to Communicate with Patients."
In this chapter from the WHO, scroll down and read the "Interventions" section (pp. 159 - 163), which reviews various ways to communicate information in relation to smoking cessation. The section on women's issues in relation to smoking cessation is supplementary (pp. 166 - 170).
Read this entire resource, which covers how to talk to children of adults who drink too much. The way the questions are answered in the resource can be applied to other types of substance use as well (besides alcohol), providing that the relevant information for the substance is given instead. You should have become more familiar with the relevant information about the other substances as you have progressed through this NextGenU training. When treating someone with psychoactive substance use disorder, address the families’, caregivers’, and children's questions and concerns, and involve them in the care plan and support when the patient has provided their consent (as needed).
For this resource titled "Parental Substance Misuse" we recommend that you click on text only button at the bottom of the webpage. Use the full audio-visual version only if you have a sufficient Internet connection, and then click on the various pictures to hear the participants speak rather than reading the transcripts.
Review "Section Five: Relationships with Family" by clicking on the blue tile with that title. In the text only version, read all pages by clicking next on each one. On p. 2 (see the bottom right corner), click on the various links for the various transcripts. Please note that each parent's reaction is not right or wrong. This resource does not cover how you can support the families of those who care about someone with a substance use issue, it simply explains that they benefit from support. It is very important that you do not judge how the family or others are reacting. The best conduct to adopt is that of empathy and a sharing of scientific information about substances. The sharing of personal information of patients outside of the circle of professional care may be done only with the consent of the patient, as explained in prior modules.
On this website titled "Talking to Patients About Sensitive Topics" scroll down to the heading "Resource Materials" and download 'Powerpoint Slides' (4.2MB). This version has lecture notes. Review slides 1-19, 23-39 and 44-58, and be sure to read the speaker notes as well. The rest of the slides are supplementary and not necessary for this training.
In this exercise, you will practice effectively communicating with patients and their families/caregivers. Step 1: Form groups of three with two of your fellow NextGenU trainees. Using the sample case scenarios from the WHO (Appendix 1, p. 41), perform the following simulation.
Scroll down in Chapter 7 titled "Counseling Clients With HIV And Substance Abuse Disorders" and examine Figure 7-3: Guidelines To Minimize Cultural Clashes". This box reviews tips on how to avoid cultural clashes when communicating with people of other cultures.
Click here to start Final Examination
To take the final exam, you must complete all quizzes and complete all the required activities. The final exam consists of 30 questions, and you will have 30 minutes to complete it. When the time is over, you will have two minutes to submit your attempt before it expires, and your progress is discarded. You will not be able to answer additional questions in the grace period.
To access the exam, click on the name of the exam provided above. On the following screen, click the Preview quiz now button to respond to the questions.
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