TIP 50: Addressing suicidal thoughts and behaviors in substance abuse treatment

Date: 2017
(For resources, this is the publication date. For programs, this is the date posted.)


Type:  Manual
Author:  Substance Abuse and Mental Health Services Administration (SAMHSA)
Publisher:  Substance Abuse and Mental Health Services Administration (SAMHSA)

Part of SAMHSA's Treatment Improvement Protocol (TIP) series, this manual provides guidelines to help substance abuse treatment counselors work with suicidal adult clients. Covers risk factors and warning signs for suicide, core counselor competencies, clinical vignettes, and information for administrators and clinical supervisors.

A literature search for the period between 2009 (when TIP 50 was first published) and 2017 found little information that would affect the recommendations in this TIP. However, This revision includes the following updates:
Funding for healthcare systems to implement “zero suicide” prevention and intervention programs has become available through SAMHSA.
Several states and credentialing organizations have mandated or recommended training to ensure that healthcare professionals assess and address suicide risk.
It was observed that past-year prescription opioid misuse was significantly associated with past-year frequency of suicidal ideation and misuse at weekly or more intervals was significantly associated with past-year frequency of suicide planning and suicide attempts.

Program Description: 

Research consistently shows a high prevalence of suicidal thoughts and suicide attempts among persons with substance abuse problems who are in treatment. The Substance Abuse and Mental Health Services Administration publication TIP 50, Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment, is designed to assist substance abuse counselors in working with adult clients who may be suicidal, and will help clinical supervisors and administrators support the work of substance abuse counselors. Part I, for counselors, provides the "what" and the "why" and the "how" of working with clients in substance abuse treatment with suicidal thoughts and behaviors. It covers background information about suicide and substance use disorders, including risk factors and warning signs for suicide and a four-step process for addressing suicidal thoughts and behaviors. Part 2, for administrators, clarifies why program administrators should be concerned about this clinical issue. Part 3 contains an analysis of the available literature, an annotated bibliography and a general bibliography.

The recommendations contained in each TIP (Treatment Improvement Protocol) are grounded in evidence that a particular practice will produce a specific clinical outcome (measurable change in client status). Evidence includes scientific research findings and the opinion of the TIP consensus panel of experts. In making recommendations, the consensus panel engages in a process of “evidence-based thinking” in which they consider scientific research, clinical practice theory, practice principles and practice guidelines, as well as their own individual clinical experiences. Citations to relevant research outcome reports, theoretic formulations, and practice principles and guidelines are provided.

A companion training video, developed by the U.S. Department of Veterans Affairs (VA) in collaboration with SAMHSA, is included in this record.

Program Objectives: 

Users of Addressing Suicidal Thoughts and Behavior in Substance Abuse Treatment should have:

  1. Increased knowledge of best practices for working with clients in substance abuse treatment who have suicidal thoughts and behaviors.