Skip to main content SAMHSA News - SAMHSA's Award Winning Newsletter SAMHSA News - SAMHSA's Award Winning Newsletter
SAMHSA’s Award-Winning Newsletter
May/June 2009, Volume 17, Number 3 

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:

cover of TIP 50 - click to view KAP Web site
  • 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.

logo for SAMHSA’s Lifeline - click to view the National Suicide Preventin Web site

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.

A Four-Step Process

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.

President’s Budget

President’s Budget

FY2010 Budget sustains critical programs.

  Treatment Improvement  
Addressing Suicidal Thoughts & Behaviors

Addressing Suicidal Thoughts & Behaviors

From CSAT, TIP 50 offers guidance to substance abuse counselors on how to help clients who may be in crisis.

  Medication-Assisted Treatment  
Buprenorphine: Guide for Nurses

Buprenorphine: Guide for Nurses

Specific guidance for nurses and nurse care managers.

Methadone Safety

Methadone Safety

Safe use of methadone, a medication for opioid addiction, is the focus of a new campaign.

  Data on Depression  
MDE and Youth

MDE and Youth

In 2007, 2 million adolescents had a major depressive episode.

MDE and Adults

More than 16 million adults struggle with depression.

  Focus on Children  
Mental Health Awareness Day

Mental Health Awareness Day

Eight young people take center stage in a celebration of the arts as a way to cope with mental health problems. Photo Gallery.

Data on Children, Parents, Drugs

More than 8.3 million children lived with a parent who was dependent on or abused alcohol or drugs during the past year.

  Women’s Behavioral Health  
Mental Health Publications

Mental Health Publications

“Action Steps” for professionals and “What It Means To You” for consumers are available to order.

Pregnancy & Substance Abuse

Pregnancy & Substance Abuse

How much are alcohol and drugs used during pregnancy and after childbirth?

  Recovery Month  
20th Anniversary Includes TV Spots, PSAs

20th Anniversary Includes TV Spots, PSAs

With a few months to go, the Recovery Month Web site offers flyers, banners, and more.

  Also in this Issue  
PRISM Awards

PRISM Awards

Celebrating excellence in Hollywood. Photo Gallery.

ADDERALL® & College Students

ADDERALL® & College Students

Full-time college students are twice as likely to use Adderall® nonmedically.

Real Warriors Campaign

Real Warriors Campaign

Helping service members break through stigma to ask for help.

Sign up for SAMHSA email updates on topics of your choice, including SAMHSA News.


Substance Abuse & Mental Health Services Administration – 1 Choke Cherry Road – Rockville, MD 20857
AdobeTM PDF and MS OfficeTM formatted files require software viewer programs to properly read them.
Click here to download these FREE programs now.