Screening for Substance Use Disorders in Primary Care
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 NextGenU.org 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 NextGenU.org Alcohol, Tobacco, and Other Substance Use Disorders in Primary Care training (which provides more detailed information about how to intervene once alcohol, tobacco, or other substance use problem has been identified).
This course is co-sponsored by the Africa Mental Health Foundation, the Annenberg Physician Training Program in Addiction Medicine, 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). 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.
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 52 hours at an average reading rate of 144 words/minute; in addition, there are required activities.
This course was created in 2012 for use in low resource settings and relies on WHO resources and programs for screening and brief interventions based on the ASSIST, as well as the mhGAP.
Begin the course with Module 1 - Introduction
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
Competency covered in this module:
- Be competent in addressing stigma, and promoting and protecting the human rights of those you serve
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.
10 URLs, 1 Quiz
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
5 URLs, 1 Assignment, 1 Quiz
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
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
15 URLs, 1 Forum, 1 Quiz
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
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 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
2 Forums, 14 URLs, 1 Quiz
Module 5: Lesson 2: Physical activities, diet, and healthy living in relation to substance use and mental health
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)
13 URLs, 1 Quiz
Competency covered in this module:
- Be proficient in effective communication with those to whom you provide care, their family, and their caregivers
Upon completion of the first lesson of Module 6, students should be able to:
9 URLs, 2 Forums, 1 Quiz
- 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