 The intervention evaluated through this program of research includes training lay health worker or facility support staff to screen patients presenting to the facility. Those support staff then refer those who are at moderate or high risk from tobacco, alcohol or other substance use to trained PHC clinician for brief intervention BI related to any of the substances they use at risky level. The training intervention includes teaching the clinicians to deliver BI, and identify and manage co-morbidities or complications. The program of research around that intervention includes 1 a developmental evaluation of the on-line training through a pilot with students and clinical faculties in educational institutions, followed by the assessment of the training of already practicing health care providers in the field; 2 pre and post training assessment of clinicians and non-clinicians knowledge, attitudes and skills including assessing their level of stigma toward those who use psychoactive substances; 3 RCTs to assess the impact of the BI on alcohol consumption and other health and social variables of interest in public and private facilities; and 4 the assessment of the impact of quality improvement training on sustainability of the screening and BI. This trial registration is only for the RCTs. 