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In the patient with a substance use problem

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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.

Adapted from: Agnes Kwasnicka and Peter Selby, The patient with a substance use problem Psychiatry in Primary Care (CAMH, 2011)

Psychiatry in primary care toolkit

The Psychiatry in Primary Care App has been decommissioned. 

The revised print version of Psychiatry in Primary Care is avaible through the CAMH store. 

We have posted a number of revised chapters from the book in Treating Conditions and Disorders in the new Professionals section of camh.ca. 

Clinical guidelines

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (NICE guideline CG115, 2011)

BC Guidelines: Problem Drinking

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (National Opioid Use Guideline Group (NOUGG), 2010)

Buprenorphine/Naloxone for opioid dependence: Clinical practice guideline (CAMH, 2012)

Canadian Smoking Cessation Clinical Practice Guideline (CAN ADAPTT, 2011)

Supporting smoking cessation: a guide for health professionals (Royal Australian College of General Practitioners, 2011, 2014)