Addressing Suicidal Thoughts and Behaviors
New Resource for Counselors, Administrators
Treatment Improvement Protocol (TIP) 50, Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment, is a new resource from SAMHSA for substance abuse treatment professionals and administrators.
Designed to increase understanding about this issue, TIP 50 describes the reasons individuals with substance use disorders who are in treatment are at high risk of suicidal thoughts and behaviors, including:
- They enter treatment at a point when their substance abuse is out of control, increasing a variety of risk factors for suicide.
- They enter treatment when any number of life challenges (e.g., a pending divorce, run-in with the law, or loss of a job) may be happening.
- They enter treatment at a peak in their depressive symptoms.
- Mental health problems associated with suicidality—such as depression, post-traumatic stress disorder (PTSD), anxiety disorders, and some personality disorders—often co-occur among people who have been or are being treated for substance use disorders.
- Crises that are known to increase suicide risk sometimes occur during treatment (e.g., relapse, treatment transitions).
According to the TIP, screening clients routinely for suicidal thoughts and behaviors is important for substance abuse treatment providers. The risk for a client’s potentially suicidal behavior may escalate at any point in the treatment process.
There is a relationship between a client’s suicidality and his or her substance abuse. Understanding that clients with suicidal thoughts and behaviors can benefit from intervention and treatment can make a huge difference in a client’s overcoming a suicidal crisis and staying in recovery.
Suicidal thoughts and behaviors are a significant indicator of other co-occurring disorders—such as major depression, bipolar disorder, PTSD, schizophrenia, and some personality disorders. To improve outcomes in substance abuse treatment, these thoughts need to be explored and addressed.
Part 1 of TIP 50, designed specifically for substance abuse counselors, offers a four-step process for addressing suicidal thoughts and behaviors—identified by the acronym “GATE.”
The four steps are:
- Gather information.
- Access supervision.
- Take responsible action.
- Extend the action.
This section also offers valuable background information about suicide and substance use disorders, including risk factors and warning signs for suicide, and competencies to be incorporated into treatment.
In addition, vignettes of realistic counseling sessions demonstrate the “how to” of working with clients with suicidal thoughts. These sample scenarios include possible responses to suicidal comments and descriptions of specific counseling techniques.
Part 2 of TIP 50 is a user’s guide to help administrators provide support for substance abuse treatment programs and counselors. Topics addressed include the benefits of—and the role of administrators and mid-level staff in—addressing suicidality in substance abuse treatment programs, different levels of program involvement, and legal and ethical issues.
Part 3 of this TIP, online only, is a literature review on the topic of depressive symptoms and is recommended for use by clinical supervisors, counselors, and administrators. Part 3 will be available soon on SAMHSA’s Knowledge Application Program Web site.
To order print copies of TIP 50, call SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). Ask for inventory number SMA09-4381.
A PDF version of TIP 50 and the accompanying literature review will be available soon online. Visit SAMHSA’s Knowledge Application Program Web site.