In diagnosing and treating substance use, which sequence best describes the physician's role?

• A. Screen and identify early; establish a nonjudgmental, therapeutic alliance; provide or coordinate evidence-based care; promote harm reduction via patient education and safety; ensure longitudinal follow-up and care coordination
• B. Screen; judge harshly; provide disconnected care; ignore safety education; sporadic follow-up
• C. Diagnose and treat only after referrals; avoid follow-up
• D. Wait for patient to present symptoms; no plan

Answer: (A)

Treating substance use as a chronic, relapsing condition requires proactive screening, a nonjudgmental and collaborative relationship, and continuous care coordination. Start with screening to catch use early, then build a therapeutic alliance that invites honest discussion and engagement. Next, provide or coordinate evidence-based treatments tailored to the individual, including appropriate medications, behavioral therapies, and integration with primary care and mental health services. Include harm-reduction elements through patient education and safety planning—overdose prevention, safer-use guidance, vaccination, and infectious-disease screening as indicated. Finally, ensure longitudinal follow-up and care coordination across settings, recognizing that management is ongoing and relapses may occur. This approach contrasts with punitive, fragmented, or passive strategies, which undermine engagement and outcomes.