Person with active substance use presenting in primary care [ A ]
Obtain history, physical examination, laboratory tests, MSE, and medication (including OTC) [ B ]
Is patient medically or psychiatrically unstable or acutely intoxicated? [ C ] Provide appropriate care to stabilize or consult Follow legal mandates [ D ]
Does patient exhibit hazardous substance use or abuse or dependence or risk of relapse? [ E ]
Initiate concurrent physiological stabilization if required Use Module S [ F ]
Summarize and educate the patient about the problem [ G ]
Is specialty referral indicated or mandated? [ H ]
Provide brief intervention [ K ]
Is hazardous use/abuse still present? Does patient agree to referrral or is referral mandated? [ I ]
Follow-up in primary care: - Monitor substance use - Monitor biological indicators - Encourage continued reduction or abstinence - Provide motivational support L ] Go to Care Management Module C
Refer to specialty care with attention to engagement barriers [ J ]
Go to Specialty care Module R
Educate about substance use, associated problems and prevention of relapse [ M ]
Indications for referral to specialty care