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Assessment and Management of Substance Use Disorders in Primary Care
SUD Module A: Assessment and Management of Substance Use Disorders in Primary Care
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Continuum of Care for Addictions
None Use & Problems Moderate Severe Extreme Care Mgmt. Rehabilitation 2º Prevention Modality 1º Prevention
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Person with active substance use presenting in primary care
Obtain history, physical examination, laboratory tests, MSE and medications, including OTC [B]
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Y N Provide appropriate care to stabilize or consult
Is patient medically or psychiatrically unstable or acutely intoxicated? [C] Provide appropriate care to stabilize or consult Follow legal mandates For DOD active duty, keep CO informed [D] Y N
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Does patient exhibit hazardous use or abuse or dependence or risk of relapse?
Screen for: Hazardous use Abuse/Dependence Don’t forget tobacco Instruments: CAGE (+ Quantity/frequency) MAST (+ Quantity/frequency) AUDIT DAST (non-alcohol drugs) Biological indicators: GGT, Urine toxicology screen
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Does patient exhibit hazardous use or abuse or dependence or risk of relapse?
Educate about substance use, associated problems and prevention of relapse [M] N
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Continuum of Care for Addictions
None Use & Problems Moderate Severe Extreme Care Mgmt. Rehabilitation 2º Prevention Modality 1º Prevention
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Y Does patient exhibit hazardous use or abuse or dependence or risk of relapse? [E] Initiate concurrent physiological stabilization if necessary use Module S [F] Summarize and educate the patient about the problem [G] Is specialty care referral indicated or mandated? [See side bar] [H]
![Y Does patient exhibit hazardous use or abuse or dependence or risk of relapse [E]](http://slideplayer.com./slide/16711512/97/images/8/Y+Does+patient+exhibit+hazardous+use+or+abuse+or+dependence+or+risk+of+relapse+%5BE%5D.jpg "Initiate concurrent physiological stabilization if necessary use Module S. [F] Summarize and educate the patient about the problem. [G] Is specialty care referral indicated or mandated [See side bar] [H]")
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Indications for referral to specialty care
Needs further evaluation Meets diagnostic criteria for current substance dependence* [H] Is specialty care referral indicated or mandated? [See side bar] [H]
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N Feedback Inform & Advise Negotiate goals Follow-up
Is specialty care referral indicated or mandated? [See side bar] [H] N Feedback Inform & Advise Negotiate goals Follow-up Provide brief intervention [K]
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Continuum of Care for Addictions
Use & Problems None Moderate Severe Extreme Care Mgmt. Rehabilitation 2º Prevention Modality 1º Prevention
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Provide brief intervention Is hazardous use/abuse still present?
[K] Is hazardous use/abuse still present? N Follow up in primary care: Monitor substance use Monitor biological indicators Encourage continued reduction or abstinence Provide motivational support [L] Educate about substance use, associated problems and prevention of relapse [M]
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Y Y Is specialty care referral indicated or mandated? [See side bar]
[H] Y Provide brief intervention [K] Does patient agree to referral or is it mandated? [I] Is hazardous use/abuse still present? Y
![Y Y Is specialty care referral indicated or mandated [See side bar]](http://slideplayer.com./slide/16711512/97/images/13/Y+Y+Is+specialty+care+referral+indicated+or+mandated+%5BSee+side+bar%5D.jpg "[H] Y. Provide brief intervention. [K] Does patient agree to referral or is it mandated [I] Is hazardous use/abuse still present Y.")
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Y N Care Management Rehabilitation
Does patient agree to referral or is it mandated? [I] Y Refer to specialty care with attention to engagement barriers [J] N Go to Module C Go to Module R Care Management Rehabilitation
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? Y N Care Management Rehabilitation
Does patient agree to referral or is it mandated? [I] Y Refer to specialty care with attention to engagement barriers [J] N Go to Module C Go to Module R ? Care Management Rehabilitation
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Rehabilitation Indications
Moderate to severe dependence Willing to commit to change (action-oriented) Able to participate in program
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Rehabilitation Goals Remission or substantial improvement of SUD
Improvement or resolution of other problems
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Continuum of Care for Addictions
Use & Problems None Moderate Severe Extreme Care Mgmt. Rehabilitation 2º Prevention Modality 1º Prevention
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Care Management Goals Reduction in substance use or harm from substance use Prevention of deterioration Improvement or stabilization of other problems Coordination of care Enhance motivation to change
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Continuum of Care for Addictions
None Use & Problems Moderate Severe Extreme Care Mgmt. Rehabilitation 2º Prevention Modality 1º Prevention
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N Care Management Rehabilitation
Does patient agree to referral or is it mandated? [I] Refer to specialty care with attention to engagement barriers [J] N Go to Module C Go to Module R Care Management Rehabilitation
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