Course SyllabusAlcohol, Tobacco, and other Substance Use Disorder Screening - old

Course home page

This course teaches about 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. All components of this training (like all trainings) are free, including registration, learning, testing, and a certificate of completion.

There are 6 modules to complete through online study, as well as mentored activities and peer activities. All are mandatory and need to be performed satisfactorily to receive a certificate of course completion. 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 screening for substance use disorders in primary care; additional information on substance use disorders, screening, and intervention; a brief overview of urgent situations; common co-morbidities with substance use disorders; and strategies to communicate with people seeking care and their families and caregivers.

There are practice quizzes in each module, and at the end of the course you will have a final exam and a chance to give your assessment of this training. We will give you all the results of your assessments, such as your final exam, mentored activities, mentored evaluations, 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 should be used to train about screening and referral of those with substance use issues to professionals with further education in substance use interventions, such as the Alcohol, Tobacco, and Other Substance Use Disorders in Primary Care training (which provides more detailed information about how to intervene once an alcohol, tobacco, or other substance use problem has been identified).

This course is cosponsored by: the Africa Mental Health Foundation, the Annenberg Physician Training Program in Addiction Medicine, and the University of Florida. This course uses competencies adapted from the WHO Mental Health Gap Action Programme (mhGAP).  The course uses 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 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 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 (Anatomy), MBChB; and Jackson N. Njoroge, MBChB.

Module 1: Introduction

There is one lesson in this module. This module will act as a foundation for the rest of the course, providing you with information on how primary health care can be used to lessen the burden of mental illness (including substance use disorders) and introducing key terms such as ‘task-shifting’. You will also learn about and become familiar with the WHO mhGAP principles of care and priority conditions. Finally, you will begin to understand the science behind substance abuse and its effect on human health and social functioning.

Competency covered in this module:

  • Be receptive to including mental health and substance use disorder services in primary care

Module 1: Lesson 1:

Learning Objectives

Upon completion of the first lesson of Module 1, students should be able to:

  • Learn how primary health care can be involved in lessening the burden of mental illness, including substance use disorders, and understand the idea of task-shifting
  • Learn what substances are used and abused and how they affect people’s health and social functioning
Required readingsOptional readings
    Peer Activities

          Module 2: Addressing Stigma and Protecting Human Rights

          There is one lesson in this module. This module will introduce stigma and illustrate its effect on human health (especially mental health), as well as the measures that can be taken for its elimination. It will introduce international standards and regulations on mental health and human rights. In addition, the module will help individuals appreciate the impact that stigmatizing attitudes or words can have on patient outcomes. It will assist individuals to pay closer attention to the rights of patients/clients so as to provide better quality service in their practice.

          Competency covered in this module:

          • Be competent in addressing stigma, and promoting and protecting the human rights of those you serve

          Module 2: Lesson 1:

          Learning Objectives

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

          • Understand international and national standards, legislation and policies on mental health and human rights
          • Understand stigma and its impact, as well as practical strategies to address it
          • Prevent stigma, marginalization, and discrimination, and promote the social inclusion of people with mental, neurological, and substance use disorders by fostering strong links with employment, education, social (including housing), and other relevant sectors
          • Provide care in a way that: respects the dignity of the person, is culturally sensitive and appropriate, and 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
          • Pay special attention to matters of confidentiality, as well as the patient's right to privacy
          • Ensure that the patient understands the proposed treatment and provides free and informed consent for treatment
          Required readingsOptional readings
            Peer Activities

                  Module 3: Screening for Substance Use Disorders

                  This module will introduce you to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) package. You will gain a general understanding of the problems related to substance use. In addition, you will learn the recommended interviewing techniques, as well as how to score and interpret the results from the ASSIST questionnaire. The mhGAP model of care for alcohol and substance use will also be discussed in detail. Other evidence-based models of care will be covered briefly as well.

                  Becoming competent in using the ASSIST is the core competency of this course. Please pay special attention to the ASSIST resources. There is one lesson in this module. 

                  Competency covered in this module:

                  • Be competent in administering the ASSIST questionnaire

                  Module 3: Lesson 1:

                  Learning Objectives

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

                  • Familiarize yourself with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), its background and rationale for use in primary care
                  • Understand general and health-related problems related to substance use
                  • Acquire the interviewing skills necessary to screen for substance disorders using the ASSIST Screening Tool
                  • Accurately score the answers to the ASSIST questionnaire
                  • Accurately categorize a patient using an ASSIST Scorecard and give appropriate feedback
                  • Be familiar with the mhGAP model of care for alcohol and substance use disorders
                  • Be familiar with other evidence-based models of screening and brief intervention in primary care
                  Required readingsOptional readings
                    Peer Activities

                        Module 4: Other Information on Substance Use Disorders, Screening, and Intervention

                        This module will give you insights on alcohol and tobacco use cessation and how you can go about initiating and managing the process. It includes an overview of the personal health risks associated with alcohol and tobacco use, as well as the benefits of quitting. There will be specific emphasis on tobacco use during pregnancy and breastfeeding, in addition to substance use among older adults. The use of the mhGAP model of care will be demonstrated in practice, while community support systems and their role will be introduced. An overview of patient self-management, which is a key strategy in sustaining substance use cessation, will be given.

                        Competencies covered in this module:

                        • Deepen your understanding of aspects related to tobacco use cessation
                        • Deepen your understanding of alcohol and other substance use disorders, including their impact and care

                        Module 4: Lesson 1:

                        Learning Objectives

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

                        • Know the effectiveness of tobacco cessation interventions
                        • Be aware of how brief advice is given in practice
                        • Be aware of the personal health disease risks (e.g. cardiovascular, respiratory, and cancer) associated with tobacco use and involuntary (secondhand) exposure to tobacco smoke
                        • Be aware of the general benefits and challenges of quitting smoking
                        • Be familiar with the impact of alcohol on overall health and be able to educate people about harmful alcohol use, including during pregnancy and breastfeeding
                        • Be aware of resources (including community support) and tips to encourage self-monitoring of symptoms and be able to explain when to seek care immediately
                        • Understand common consequences of other substance use
                        Required readingsOptional readingsPeer Activities

                            Module 5: Urgent situations and co-morbidities with substance use disorders

                            This module will introduce various, severe mental health risks that are often associated with alcohol and substance use. It will give an overview of the effects of substance use on general reproductive health (especially among women) including sexuality and HIV risk. Special emphasis will be placed on Fetal Alcohol Spectrum Disorders (FASD). The module also includes overviews on various aspects of leading a healthy lifestyle, ranging from nutrition and stress management to exercise and relaxation.

                            Competencies covered in this module:

                            • Be able to recognize severe mental health risks that are sometimes associated with substance use
                            • Be aware of how substance use can affect sexuality and the risk of HIV infection
                            • Be aware of alcohol comorbidities relating to HIV, depression, psychosis, and reproduction (Fetal Alcohol Spectrum Disorders)
                            • Be aware of special reproductive health issues for women in relation to substance use, comorbidity, and pharmacological treatment
                            • Be able to assist patients in leading healthy lifestyles

                            Module 5: Lesson 1:

                            Learning Objectives

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

                            • Observe for evidence of severe self-injury, such as signs of poisoning or intoxication, or signs/symptoms requiring urgent medical treatment such as bleeding from self-inflicted wounds, loss of consciousness, or extreme lethargy. Ask appropriately and professionally about recent poisoning or other self-harm. Be able to refer if there is any identified risk of self-injury
                            • Be aware of how substance abuse can impact HIV-related risks
                            • Be aware of the need for education and support for those with mental illness and/or substance use disorders, in relation to risky behavior (e.g., unprotected sex)
                            • Be aware of the increased risk of HIV infection for those who consume alcohol
                            • Be aware of the impact of alcohol use on HIV
                            • Be aware of the links between alcohol use and depression
                            • Discuss plans for contraception and pregnancy with women of childbearing age
                            • Assess potential risks of medications for the fetus or baby when providing care to a pregnant or breastfeeding woman. Ensure that the babies being breastfed by women on medications are monitored for adverse effects or withdrawal, and undergo comprehensive examinations if required
                            Required readingsOptional readings
                              Peer Activities

                                  Module 5: Lesson 2: Physical activities, diet, and healthy living in relation to substance use and mental health

                                  Learning Objectives

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

                                  • Assist patients in acquiring healthy lifestyles, which may improve mental health and help manage substance use triggers, such as stress
                                  • Perform a general healthy weight assessment (BMI, weight, and height)
                                  Required readingsOptional readingsPeer Activities

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

                                        The final module of this course is on communication. With the stigma surrounding many of the topics discussed in this training, it is important that health workers 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. In turn, this can strengthen the community and social support for those affected, and increase patients’ acceptance of and adherence to treatment.

                                        Competency covered in this module:

                                        • Be proficient in effective communication with those to whom you provide care, their family, and their caregivers

                                        Module 6: Lesson 1:

                                        Learning Objectives

                                        Upon completion of the first lesson of Module 6, students should be able to:

                                        • Use simple and clear language, and ask the person for his or her own understanding of the condition. Provide information to the person on their health status in terms that they can understand, and be friendly, respectful and non-judgmental at all times
                                        • Ensure that communication is clear, empathic, and sensitive to age, gender, culture, and language differences
                                        • With the patient's consent, keep caregivers informed about the person’s health status, including issues related to assessment, treatment, follow-up, and any potential side effects
                                        • Be familiar with common reactions regarding substance use issues in a family member
                                        • Respond to the disclosure of private and distressing information (e.g., regarding sexual assault or self-harm) with sensitivity
                                        Required readingsOptional readingsPeer ActivitiesQuizzesAssignments

                                            Final Evaluation Folder