Use this when seeking specialist input on a substance-use concern, co-occurring complexity or an unresolved treatment question.
Lead with the question
State what you would like the specialist assessment to clarify. This might concern the contribution of substance use to overlapping symptoms, difficulty progressing with current care, or advice about the next phase of treatment. A concrete question is more informative than a diagnostic label alone.
A chronic-disease approach means continuing care is shared: specify what you will continue to manage and which decisions need consultation. Note what the patient understands the referral to be for. Use person-first language and describe barriers or observations rather than labels such as 'non-compliant' or assumptions about motivation.
Summarise the relevant trajectory
Include the recent pattern of use, changes over time, consequences and previous attempts to reduce or stop. Record what is known about recent or last use, previous withdrawal or overdose, and the reliability or limits of the available history. A concise timeline can help distinguish a persistent concern from a recent change.
Add relevant physical and mental-health findings, current medicines, investigations already available and social circumstances affecting care. Avoid assuming that all distress is substance-induced, or that a co-occurring diagnosis explains the substance use. Clearly distinguish the patient's report, collateral information and your own observations.
Make current action and continuity clear
State current concerns about intoxication, withdrawal, overdose, self-harm or other immediate safety issues, together with assessment and action already taken. Where information is missing, say so rather than leave a gap. An outpatient referral does not manage an acute emergency, and referral acceptance should not be assumed to transfer responsibility for interim care.
Summarise previous and current care, the response and practical barriers. Record the patient's priorities, relevant consent for information sharing and other clinicians involved. Use the existing referral pathway and check its requirements separately. This optional brief is a way to organise the clinical question; it is not a complete assessment, formal risk instrument or new mandatory form.
For health professionals
Using the sheet in practice
Select information proportionate to the question and your assessment. Use established clinical-record and referral systems, apply usual privacy requirements, and confirm receipt and follow-up through normal processes. The website does not provide clinical review of completed briefs.
Use the brief alongside your clinical assessment. It does not produce a diagnosis, measure risk or determine treatment.