How This TIP Is Organized

Publication Details

This TIP is divided into three parts:

  • Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery, Part 1.
  • Managing Depressive Symptoms: An Implementation Guide for Administrators, Part 2.
  • Managing Depressive Symptoms: A Review of the Literature, Part 3.

Parts 1 and 2 are presented in this publication; Part 3 is available only online at Each part is described below.

Part 1 of the TIP is for substance abuse counselors and consists of two chapters. Chapter 1 presents the “what” and “why” of working with clients with substance use disorders who have depressive symptoms. It covers:

  • Background issues such as the nature and extent of depressive symptoms in clients receiving substance abuse treatment, an introduction to counseling approaches, issues related to the setting in which you work, cultural concerns, and your role and responsibilities.
  • Preparing yourself to work with clients with depressive symptoms.
  • Understanding the client with depressive symptoms and his or her world.
  • Screening and assessment and knowing when to refer.
  • Client-centered treatment planning.
  • The treatment process.
  • Continuing care.

Chapter 2 presents the “how to” of working with clients with depressive symptoms. Chapter 2 contains:

  • Representative vignettes of counseling sessions with clients with depressive symptoms.
  • How-to descriptions of specific counseling techniques.
  • Master clinician notes and comments that help you understand the client, his or her issues related to depressive symptoms, and approaches you can take in your counseling work with clients with depressive symptoms.
  • Decision trees that will assist you at key points in working with clients with depressive symptoms (e.g., when to refer and when to use a variety of differing counseling approaches).

It is strongly recommended that you read chapter 1 before reading chapter 2.

Part 2 is an implementation guide for program administrators and consists of two chapters. Chapter 1 lays out the rationale for the approach taken in chapter 2 and will help you understand the processes of organizational change and the factors that can facilitate or impede such change. Your understanding of these processes and factors will help you set reasonable goals and ensure that your journey is a rewarding one for all involved. Chapter 2 provides detailed information on how to achieve high-quality implementation of the recommendations in Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery, Part 1 .

Part 2 addresses:

  • Why SAMHSA created an implementation guide as part of this TIP.
  • Thinking about organizational change.
  • The reasons for addressing depressive symptoms in treatment.
  • The challenges of implementing new clinical practices.
  • The role of the administrator in introducing and supporting new clinical practices.
  • The steps of organizational change.

Part 3 of this TIP is a literature review on the topic of depressive symptoms, available for use by clinical supervisors, interested counselors, and administrators. Part 3 consists of three sections: an analysis of the available literature, an annotated bibliography of the literature most central to the topic, and a bibliography of other available literature. It includes literature that addresses both clinical and administrative concerns. To facilitate ongoing updates (which will be performed every 6 months for up to 5 years from first publication), the literature review will be available only online at

And finally, a note about terminology. Throughout the TIP, the term “substance abuse” has been used to refer to both substance abuse and substance dependence (as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th editing, Text Revision [DSM-IV-TR] [American Psychiatric Association 2000]). This term was chosen partly because substance abuse treatment professionals commonly use the term “substance abuse” to describe any excessive use of addictive substances. In this TIP, the term refers to the use of alcohol as well as other substances of abuse. Readers should attend to the context in which the term occurs in order to determine what possible range of meanings it covers; in most cases, however, the term will refer to all varieties of substance use disorders described by DSM-IV.