1. (1)
As a starting point, we
High might think of any given
population as including
people with the different
levels of risk for harms
from their substance use
(low, moderate and high).
Risk for More on specific
Substance Mod substance use risk
Use Harms thresholds later.
Low
Low Med High
Risk for Mental Health Harms

2. (2)
And we can think of the
High same people as having
different levels of mental
health problem risk or
severity (low, moderate
and high).
More on specific mental
Risk for health risk or severity
Substance Mod thresholds later.
Use Harms
Low
Low Med High
Risk forMental Health Harms

3. (3)
High SU Risk High SU Risk High SU Risk Bringing these two kinds
High and and and of risk together, we can
Low MH Risk Mod MH Risk High MH Risk envision people in a given
population distributed
across nine possible
combinations.
Risk for Mod SU Risk Mod SU Risk Mod SU Risk
Substance Mod and and and
Use Harms Low MH Risk Mod MH Risk High MH Risk
Low SU Risk Low SU Risk Low SU Risk
Low and and and
Low MH Risk Mod MH Risk High MH Risk
Low Med High
Risk for Mental Health Harms

4. (4)
High SU Risk High SU Risk High SU Risk Most people will be at
High and and and relatively low risk for
Low MH Risk Mod MH Risk High MH Risk both substance and
mental health issues.
The relative size of this
group will vary
depending on the nature
Risk for Mod SU Risk Mod SU Risk Mod SU Risk of your local population.
Substance Mod and and and
Use Harms Low MH Risk Mod MH Risk High MH Risk Individual risk or severity
levels can change over
time as a result of
multiple factors,
including the relative
effectiveness of
Low SU Risk Low SU Risk Low SU Risk prevention programs.
Low and and and
Low MH Risk Mod MH Risk High MH Risk
Low Med High
Risk for Mental Health Harms

5. (5)
High SU Risk High SU Risk High SU Risk A somewhat smaller
High and and and share of the population
Low MH Risk Mod MH Risk High MH Risk will be at moderate risk
for either substance use
or mental health issues,
or both (e.g., moderate
levels of depression or
non-dependent binge
Risk for Mod SU Risk Mod SU Risk Mod SU Risk drinking).
Substance Mod and and and
Use Harms Low MH Risk Mod MH Risk High MH Risk The relative size of this
group will vary
depending on the nature
of your local population.
Individual severity levels
Low SU Risk Low SU Risk Low SU Risk can change over time as a
Low and and and result of many factors,
Low MH Risk Mod MH Risk High MH Risk
including effectiveness of
interventions and
supports.
Low Med High
Risk for Mental Health Harms

6. (6)
High SU Risk High SU Risk High SU Risk And the smallest part of
High and and and the population will be at
Low MH Risk Mod MH Risk High MH Risk high risk for either
substance use or mental
health issues, or both.
The relative size of this
group will vary
Risk for Mod SU Risk Mod SU Risk Mod SU Risk depending on the nature
Substance Mod and and and of your local population.
Use Harms Low MH Risk Mod MH Risk High MH Risk
Individual severity levels
can change over time as a
result of many factors,
including effectiveness of
interventions and
Low SU Risk Low SU Risk Low SU Risk supports.
Low and and and
Low MH Risk Mod MH Risk High MH Risk
Low Med High
Risk for Mental Health Harms

7. (7)
High SU Risk High SU Risk High SU Risk People will of course also
High and and and have different levels of
Low MH Risk Mod MH Risk High MH Risk complexity in terms of
biopsychosocial and
spiritual strengths and
challenges affecting their
health and healing
journeys.
Risk for Mod SU Risk Mod SU Risk Mod SU Risk
Substance Mod and and and
Use Harms Low MH Risk Mod MH Risk High MH Risk
Low SU Risk Low SU Risk Low SU Risk
Low and and and
Low MH Risk Mod MH Risk High MH Risk
Low Med High
Risk for Mental Health Harms

8. High SU Risk High SU Risk High SU Risk
High and and and
Low MH Risk Mod MH Risk High MH Risk
Risk for Mod SU Risk Mod SU Risk Mod SU Risk
Substance Mod and and and
Use Harms Low MH Risk Mod MH Risk High MH Risk
Low SU Risk Low SU Risk Low SU Risk
Low and and and
Low MH Risk Mod MH Risk High MH Risk
Low Med High
Risk for Mental Health Harms

9. High SU Risk High SU Risk High SU Risk
High and and and
Low MH Risk Mod MH Risk High MH Risk
Risk for Mod SU Risk Mod SU Risk Mod SU Risk
Substance Mod and and and
Use Harms Low MH Risk Mod MH Risk High MH Risk
Low SU Risk Low SU Risk Low SU Risk
Low and and and
Low MH Risk Mod MH Risk High MH Risk
Low Med High
Risk for Mental Health Harms

10. (8)
High SU Risk High SU Risk High SU Risk Screening is used in
High and and and clinical settings to
Low MH Risk Mod MH Risk High MH Risk identify a given patient’s
substance use and mental
health risk levels, in order
to determine the most
effective care pathway.
Risk for Mod SU Risk Mod SU Risk Mod SU Risk
Substance Mod and and and
Use Harms Low MH Risk Mod MH Risk High MH Risk
Low SU Risk Low SU Risk Low SU Risk
Low and and and
Low MH Risk Mod MH Risk High MH Risk
Low Med High
Risk for Mental Health Harms

11. (9)
High SU Risk High SU Risk High SU Risk Assessment is in turn
High and and and used with higher risk
Low MH Risk Mod MH Risk High MH Risk patients to discern
complexity in terms of
biopsychosocial and
spiritual strengths and
challenges, in order to
develop a care plan.
Risk for Mod SU Risk Mod SU Risk Mod SU Risk
Substance Mod and and and
Use Harms Low MH Risk Mod MH Risk High MH Risk
Low SU Risk Low SU Risk Low SU Risk
Low and and and
Low MH Risk Mod MH Risk High MH Risk
Low Med High
Risk for Mental Health Harms

12. (10)
For patients screened to
High be at low risk in terms of
both mental health and
substance use, the care
pathway may involve
reinforcement, health
education and routine
annual re-screening.
Risk for
Substance Mod
Use Harms
Reinforcement
Low Health Education
Re-Screening
Low Med High
Risk for Mental Health Harms

13. (11)
For patients screened to
High be to be at moderate
risk in terms of either
mental health or
substance use, the care
pathway may involve
early (brief) intervention,
ongoing motivational
Risk for Early Intervention Early Intervention support and possibly
Substance Mod Motivational Support Motivational Support more in-depth
Use Harms Assessment Assessment assessment.
Reinforcement Early Intervention
Low Health Education Motivational Support
Re-Screening Assessment
Low Med High
Risk for Mental Health Harms

14. (12)
Assessment Assessment Assessment For patients screened to
High Treatment Referral Treatment Referral Treatment Referral be to be at high risk in
Continuing Care Continuing Care Continuing Care terms of either mental
health or substance use,
the care pathway may
involve in-depth
assessment, referral to
specialized treatment and
Risk for Early Intervention Early Intervention Assessment continuing aftercare.
Substance Mod Motivational Support Motivational Support Treatment Referral
Use Harms Assessment Assessment Continuing Care
Reinforcement Early Intervention Assessment
Low Health Education Motivational Support Treatment Referral
Re-Screening Assessment Continuing Care
Low Med High
Risk for Mental Health Harms