ANNOTATIONS

  1. Person with active substance use presenting in primary care

  2. Obtain history, physical examination, laboratory tests, MSE, and medication including OTC.

  3. Is patient medically or psychiatrically unstable or acutely intoxicated?

  4. Provide appropriate care to stabilize or consult. Follow legal mandates

  5. Does patient exhibit hazardous substance use or abuse or dependence or risk of relapse?

  6. Initiate concurrent physiological stabilization, if required. Use module S.

  7. Summarize and educate the patient about the problem.

  8. Is specialty referral indicated or mandated?

  9. Does patient agree to referral or is referral mandated?

  10. Refer to specialty care with attention to engagement barriers

  11. Provide brief intervention

  12. Follow-up in primary care: monitor substance use, monitor biological indicators, encourage continued reduction or abstinence, and  provide motivational support.

  13. Educate about substance use, associated problems, and prevention of relapse