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.
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)
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)