Course SyllabusSubstance Use Disorders in Primary Care

Substance Use Disorders in Primary Care


Substance Use Disorders in Primary Care Home Page


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


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

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


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

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

For publications on this course’s efficacy, see “Online Learning Improves Substance Use Care in Kenya: Randomized Control Trial Results and Implications,” (2016), Annals of Global Health https://www.sciencedirect.com/science/article/pii/S2214999616306129?via%3Dihub; see also “Peer and Mentored Enhanced Web-Based Training on Substance Use Disorders: A Promising Approach in Low-Resource Settings to Teach Knowledge and Skills and Decrease Stigma,” (2019), Psychiatric Services, https://www.ncbi.nlm.nih.gov/pubmed/31551043. In addition, see “Building Public Health Capacity through Online Global Learning,” (2018), Open Praxis, https://openpraxis.org/index.php/OpenPraxis/article/view/746/427; to see more research related to NextGenU.org’s educational model, check out NextGenU.org’s publication page.


Approximate time required for the required readings for the course is 26 hours at an average reading rate of 144 words/minute; in addition, there are required activities.

This course was created in 2012 for a global audience and will be updated in 2021 with modules that include information on pharmacotherapy, opioids, and other topics.

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

Competency covered in this module: 
  • Understand and be receptive to including mental health and substance use disorder services in primary care

Required readings
    Optional readings
      Peer Activities
        Quizzes
          Assignments
            Discussions
              Questionnare

                Module 1: Lesson 1: General Information

                Learning Objectives:

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

                • Know how primary health care can be involved in lessening the burden of mental illness, including substance use disorders
                • Understand the concept of 'task-shifting'
                • Be familiar with the WHO mhGAP principles of care and priority conditions
                • Understand the science behind substance abuse and its possible effects on health and social functioning
                Approximate time required for the readings for this lesson (at 144 words/minute): 2 hours.

                Click here to start this lesson

                Module 2: Addressing Stigma and Protecting Human Rights

                Competencies covered in this module:
                • Being aware of and being able to address stigma
                • Promoting and protecting the human rights of those you serve

                Click here to start for breif module introduction

                Required readings
                  Optional readings
                    Peer Activities
                      Quizzes
                        Assignments
                          Discussions
                            Questionnare

                              Module 2: Lesson 1: Policies and Legislation

                              Learning Objectives:

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

                              • Understand stigma and its potential impact, as well as the practical strategies to address it
                              • Develop awareness of how physician/clinician attitudes toward patients with substance use disorders can impact recognition, diagnosis, and treatment of patients
                              • Provide care in a way that respects the dignity of the person and is culturally sensitive and appropriate
                              • Provide care that is free from discrimination on the basis of race, color, sex, language, religion, political or other opinion, nationality, ethnicity, indigenous or social origin, property, birth, age, or other status
                              • Minimize stigma, marginalization, and discrimination, and promote the social inclusion of people with mental, neurological, and substance use disorders by fostering strong links with the employment, educational, social (including housing), and other relevant sectors.
                              Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour.

                              Click here to start this lesson


                              Required readingsOptional readingsPeer Activities
                                QuizzesAssignments
                                  DiscussionsQuestionnare

                                    Module 2: Lesson 2: International and National Standards

                                    Learning Objectives:

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

                                    • Understand international and national standards, legislation, and policies on mental health and human rights
                                    • Pay special attention to confidentiality, as well as the right of the patient to privacy
                                    • Ensure that the patient (or their designated decision-maker) understands the proposed treatment and provides free and informed consent to treatment
                                    Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour.

                                    Click here to start this lesson

                                    Module 3: Substance Use Disorders and Primary Health Care

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

                                    Click here for brief module introduction


                                    Required readings
                                      Optional readings
                                        Peer Activities
                                          Quizzes
                                            Assignments
                                              Discussions
                                                Questionnare

                                                  Module 3: Lesson 1: Tobacco Specific Information and Approaches

                                                  Learning Objectives:

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

                                                  • Know the effectiveness of tobacco cessation interventions
                                                  • Be familiar with quick, in-practice resources to support tobacco cessation interventions
                                                  • Understand the personal health disease risks (cardiovascular, respiratory and cancer) associated with tobacco use
                                                  • Understand the general benefits of quitting smoking
                                                  • Understand the symptoms of tobacco withdrawal and the methods of dealing with those symptoms
                                                  • Understand the health consequences of involuntary (second hand) exposure to tobacco smoke
                                                  • Understand the link between tobacco and Chronic Obstructive Pulmonary Disorder (COPD) and be familiar with best practices for the management of COPD
                                                  Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour.

                                                  Click here to start this lesson

                                                  Required readingsOptional readingsPeer Activities
                                                    QuizzesAssignments
                                                      Discussions
                                                        Questionnare

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

                                                          Learning Objectives:

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

                                                          • Understand the general approaches to address alcohol, tobacco and other substance use in primary care
                                                          • Take a thorough medical history, including the history of the presenting complaint(s), past history and family history (as relevant), and know the red flags for substance use disorders
                                                          • Recognize the symptoms of acute intoxication for a substance and treat or refer accordingly. Assess the person for substance withdrawal symptoms and treat or refer accordingly
                                                          • Be familiar with the evidence-based model of brief intervention in primary care for other psycho-active substances
                                                          Approximate time required for the readings for this lesson (at 144 words/minute): 2 hours.

                                                          Click here to start this lesson

                                                          Required readingsOptional readingsPeer Activities
                                                            QuizzesAssignments
                                                              Discussions
                                                                Questionnare

                                                                  Module 3: Lesson 3: Alcohol Use Disorder Specific Information

                                                                  Learning Objectives:

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

                                                                  • Understand the impact of alcohol on overall health
                                                                  • Understand the specific effects of alcohol on the liver
                                                                  • Assess the person for alcohol withdrawal symptoms and treat or refer accordingly
                                                                  Approximate time required for the readings for this lesson (at 144 words/minute): 2 hours.

                                                                  Click here to start this lesson

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

                                                                  Competencies covered in this module:
                                                                  • Understand how to effectively screen for substance use disorders using the ASSIST package
                                                                  • Be able to deliver an effective brief intervention to address substance abuse

                                                                  Click here for brief module introduction


                                                                  Required readings
                                                                    Optional readings
                                                                      Peer Activities
                                                                        Quizzes
                                                                          Assignments
                                                                            Discussions
                                                                              Questionnare

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

                                                                                Learning Objectives:

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

                                                                                • Acquire the interviewing skills necessary to screen for substance disorders using the ASSIST Screening Tool
                                                                                • Demonstrate skills for evaluating patients’ stage of change, readiness to accept the diagnosis, and readiness to undertake behavior change
                                                                                • Clearly and supportively recommend treatment to patients with substance use disorders
                                                                                • Acquire the skills required for addiction prevention counseling
                                                                                • Demonstrate the skills that help set respectful limits on patient requests for prescription medication
                                                                                Approximate time required for the readings for this lesson (at 144 words/minute): 2 hours.

                                                                                Click here to start this lesson

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

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

                                                                                 
                                                                                Required readings
                                                                                  Optional readings
                                                                                    Peer Activities
                                                                                      Quizzes
                                                                                        Assignments
                                                                                          Discussions
                                                                                            Questionnare

                                                                                              Module 5: Lesson 1: Mental Health Comorbidities

                                                                                              Learning Objectives:

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

                                                                                              • Be able to recognize the link between various mental health conditions and substance use disorders
                                                                                              • Be able to identify and manage depression in all who have a tobacco, alcohol or other substance use disorders
                                                                                              • Recognize and observe 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
                                                                                              • Ask about self-harm or suicidal thoughts and care for people in those situations, including offering or activating psychosocial support
                                                                                              • Know how to maintain regular contact and follow-up with patients as needed
                                                                                              Approximate time required for the readings for this lesson (at 144 words/minute): 3 hours.

                                                                                              Click here to start this lesson

                                                                                              Required readingsOptional readingsPeer Activities
                                                                                                QuizzesAssignments
                                                                                                  Discussions
                                                                                                    Questionnare

                                                                                                      Module 5: Lesson 2: Substance Use and HIV

                                                                                                      Learning Objectives:

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

                                                                                                      • Understand how substance use (including alcohol and tobacco) interacts with HIV
                                                                                                      • Be aware of the relationship between alcohol use and HIV including the increased risk of HIV infection in those who consume alcohol
                                                                                                      Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour.

                                                                                                      Click here to start this lesson

                                                                                                      Required readingsOptional readingsPeer Activities
                                                                                                        QuizzesAssignments
                                                                                                          DiscussionsQuestionnare

                                                                                                            Module 5: Lesson 3: Substance Use and Pregnancy

                                                                                                            Learning Objectives:

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

                                                                                                            • Understand the links between alcohol and other substance use and reproduction, and be able to discuss pregnancy planning and contraception methods with men, and with women of childbearing age
                                                                                                            • Assess the potential risks of medications and substance use on 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
                                                                                                            Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour.

                                                                                                            Click here to start this lesson

                                                                                                            Required readingsOptional readingsPeer Activities
                                                                                                              QuizzesAssignments
                                                                                                                Discussions
                                                                                                                  Questionnare

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

                                                                                                                    Learning Objectives:

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

                                                                                                                    • Know when to refer patients
                                                                                                                    • Know how, at follow-up, to reassess the person’s expectations of treatment, clinical status, understanding of treatment and adherence to the treatment and correct any misconceptions
                                                                                                                    • Continually monitor for treatment effects and outcomes, drug interactions with substances (alcohol and illicit drugs) and medicines (both naturopathic and traditional) and adjust accordingly
                                                                                                                    • Encourage involvement in self-help and family support groups, where available
                                                                                                                    • Learn to identify and mobilize possible sources of social and community support in the local area, including educational, housing and vocational supports
                                                                                                                    • Encourage self-monitoring of symptoms and explain when to seek care immediately
                                                                                                                    • Know when it is appropriate to involve the carer or family member in the person’s care
                                                                                                                    • Use family and community resources to contact people who have not returned for regular follow-up. (Keeping in mind Modules 1 and 2)
                                                                                                                    • Promote autonomy and independent living in the community and discourage institutionalization
                                                                                                                    • 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)
                                                                                                                    Approximate time required for the readings for this lesson (at 144 words/minute): 3 hours.

                                                                                                                    Click here to start this lesson

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

                                                                                                                    Competency covered in this module:
                                                                                                                    • Communicate effectively with those to whom you provide care, their family and caregivers

                                                                                                                    Required readings
                                                                                                                      Optional readings
                                                                                                                        Peer Activities
                                                                                                                          Quizzes
                                                                                                                            Assignments
                                                                                                                              Discussions
                                                                                                                                Questionnare

                                                                                                                                  Module 6: Lesson 1: Communication Strategies

                                                                                                                                  Learning Objectives:

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

                                                                                                                                  • Use simple and clear language
                                                                                                                                  • 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
                                                                                                                                  • Understand that you must be friendly, respectful and nonjudgmental at all times
                                                                                                                                  • Ensure that communication is clear, empathic, and sensitive to age, gender, culture and language differences
                                                                                                                                  • Gain the consent of the person to keep carers informed about the person’s health status, including issues related to assessment, treatment, follow-up, and any potential side effects
                                                                                                                                  • Anticipate the typical families' reaction to knowledge of 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
                                                                                                                                  Approximate time required for the readings for this lesson (at 144 words/minute): 2 hours.

                                                                                                                                  Click here to start this lesson

                                                                                                                                  Required readingsOptional readingsPeer Activities
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                                                                                                                                      DiscussionsQuestionnare

                                                                                                                                        Final Exam

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                                                                                                                                                    Course and Self Evaluation & Certificate

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

                                                                                                                                                    Click here give your feedback

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                                                                                                                                                                Questionnare

                                                                                                                                                                Course Activities

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                                                                                                                                                                            Questionnare