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Substance use problems: The primary care provider role

What to expect of a primary care clinician

Primary care providers can follow the five As with patients who have substance use problems. The World Health Organization describes these how-to guidelines as:

a sequential series of steps to use during health care interactions, which facilitate patient-centred care and patient self-management. They represent an approach that emphasizes collaborative goal setting, patient skill-building to overcome barriers, self-monitoring, personalized feed-back, and systematic links to community resources.

Here is an example of the five As applied to smoking cessation:

Ask: Screen for substance use disorders.

Advise: Provide brief advice to patients presenting with an addiction-related complaint and offer harm reduction for those not ready to quit.

Assess: Re-evaluate the patient's stage of change at every appointment.

Assist: When patients are ready to address their addiction, give them support and intervention strategies.

Arrange: Be aware of community resources and refer to a specialist when necessary.


Psychiatry in primary care toolkit

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Frequently asked questions