When to refer patients for substance abuse assessment and treatment

Despite the prevalence of substance use problems in psychiatric and primary care settings, many physicians feel unprepared to engage, assess, or treat patients with such problems. Substance abuse and low-risk drinking have distinct diagnostic criteria, and therefore require different methods of assessment. For patients with substance-related problems, the "Stages of Change" model of behavior change can be useful for formulating referral strategies tailored to a patient's readiness for, or stage of, change. Referral resources must be developed for a range of interventions, treatment intensities, and availabilities. Nevertheless, problems with substance use are as treatable as many chronic illnesses, either in the office or by referral to specialized assessment and treatment resources.