U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

Knowledge Application Program 

KAP Keys 

For Clinicians
 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for 

Persons With Co-Occurring Disorders 

Based on TIP 42 

Substance Abuse 

Treatment for Persons With 

Co-Occurring 

Disorders 

CO-OCCURRING 

DISORDERS 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Introduction 

KAP Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and 

Mental Health Services Administration (SAMHSA). These KAP 

Keys are based entirely on TIP 42 and are designed to meet 

the needs of the busy clinician for concise, easily accessed 

“how-to” information. 

For more information on the topics in these KAP Keys, readers 

are referred to TIP 42. 

Other Treatment Improvement Protocols (TIPs) 

that are relevant to these KAP Keys: 

TIP 27: Comprehensive Case Management for Substance 

Abuse Treatment BKD251 

TIP 36: Substance Abuse Treatment for Persons With Child 

Abuse and Neglect Issues BKD343 

TIP: Substance Abuse Treatment for Adults in the Criminal 

Justice System (Expected publication date 2005) 

TIP: Substance Abuse Treatment: Addressing the Specific 

Needs of Women (Expected publication date 2005) 

TIP: Substance Abuse Treatment and Trauma (Expected publication date 2005) 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Assessment for Co-Occurring 

Disorders 

1 

Twelve Steps in the Assessment Process 

Step 1: Engage the client.
 

Step 2: Identify and contact collaterals (family, friends, other
 

treatment providers) to gather additional information.
 

Step 3: Screen for and detect COD.
 

Step 4: Determine quadrant and locus of responsibility.
 

Step 5: Determine level of care.
 

Step 6: Determine diagnosis.
 

Step 7: Determine disability and functional impairment.
 

Step 8: Identify strengths and supports.
 

Step 9: Identify cultural and linguistic needs and supports.
 

Step 10: Identify problem domains.
 

Step 11: Determine stage of change.
 

Step 12: Plan treatment.
 

Do’s and Don’ts 

1. Do keep in mind that assessment is about getting to know a 

person with complex and individual needs. Do not rely on 

tools alone for a comprehensive assessment. 

2. Do always make every effort to contact all involved parties, 

including family members, persons who have treated the 

client previously, other mental health and substance abuse 

treatment providers, friends, significant others, and probation officers as quickly as possible in the assesment 

process. 

3. Don’t allow preconceptions about addiction to interfere with 

learning about what the client really needs (e.g., “All mental 

health symptoms tend to be caused by addiction unless 

proven otherwise”). Co-occurring disorders are as likely to 

be under-recognized as over-recognized. Assume initially 

that an established diagnosis and treatment regimen for 

mental illness is correct, and advise clients to continue with 

those recommendations until careful reevaluation has taken 

place. 

Continued on back 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

4. Do become familiar with the diagnostic criteria for common 

mental disorders, including personality disorders, and with 

the names and indications of common psychiatric medications. Also become familiar with the criteria in your own 

State for determining who is a mental health priority client. 

Know the process for referring clients for mental health 

case management services or for collaborating with mental 

health treatment providers. 

5. Don’t assume that there is one correct treatment approach 

or program for any type of COD. The purpose of assessment 

is to collect information about multiple variables that will 

permit individualized treatment matching. It is particularly 

important to assess stage of change for each problem and 

the client’s level of ability to follow treatment recommendations. 

6. Do become familiar with the specific role that your program 

or setting plays in delivering services related to COD in the 

wider context of the system of care. This will clarify which 

clients your program will best serve, and will help you to 

facilitate access to other settings for clients who might be 

better served elsewhere. 

7.	 Don’t be afraid to admit when you don’t know, either to the 

client or yourself. If you do not understand what is going on 

with a client, acknowledge that to the client, indicate that 

you will work with the client to find the answers, and then 

ask for help. Identify at least one supervisor who is knowledgeable about COD who can answer your questions. 

8. Do remember that empathy and hope are the most valuable 

components of your work with a client. When in doubt about 

how to manage a client with COD, stay connected, be 

empathic and hopeful, and work with the client and the 

treatment team to try to figure out the best approach over 

time. 
Potential Risk of Harm 2 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

This dimension of the assessment considers a person’s potential to cause significant harm to self or others. While this may 

most frequently be due to suicidal or homicidal thoughts or 

intentions, in many cases unintentional harm may result from 

misinterpretations of reality, from inability to care adequately 

for oneself, or from altered states of consciousness due to use 

of intoxicating substances. 

Note: Staff without the appropriate training should not attempt 

to make determinations related to potential risk of harm. 

Properly trained staff should be called upon to conduct such 

an interview; if necessary, call 911 or implement the emergency procedures followed by your agency. 

Risk of harm may be rated according to the following criteria: 

Minimal Risk of Harm 

(a) No indication of suicidal or homicidal thoughts or impulses, no history of suicidal or homicidal ideation, and no indication of significant distress. 

(b) Clear ability to care for self now and in the past. 

Low Risk of Harm 

(a) No current suicidal or homicidal ideation, plan, intentions 

or serious distress, but may have had transient or passive 

thoughts recently or in the past. 

(b) Substance use without significant episodes of potentially 

harmful behaviors. 

(c)	 Periods in the past of self-neglect without current evidence 

of such behavior. 

Moderate Risk of Harm 

(a) Significant current suicidal or homicidal ideation without 

intent or conscious plan and without past history. 

(b) No active suicidal/homicidal ideation, but extreme distress 

and/or a history of suicidal/homicidal behavior exists. 

(c)	 History of chronic impulsive suicidal/homicidal behavior or 

threats and current expressions do not represent significant change from baseline. 

(d) Binge or excessive use of substances resulting in potentially harmful behaviors without current involvement in 

such behavior. 

(e) Some evidence of self neglect and/or compromise in ability to care for oneself in current environment. 

Continued on back 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Serious Risk of Harm 

(a) Current suicidal or homicidal ideation with expressed 

intentions and/or past history of carrying out such behavior but without means for carrying out the behavior, or with 

some expressed inability or aversion to doing so, or with 

ability to contract for safety. 

(b) History of chronic impulsive suicidal/homicidal behavior or 

threats with current expressions or behavior representing 

a significant elevation from baseline. 

(c)	 Recent pattern of excessive substance use resulting in disinhibition and clearly harmful behaviors with no demonstrated ability to abstain from use. 

(d) Clear compromise of ability to care adequately for oneself 

or to be aware adequately of environment. 

Extreme Risk of Harm 

(a)	 Current suicidal or homicidal behavior or such intentions with a plan and available means to carry out this 

behavior... 

—	 without expressed ambivalence or significant barriers to 

doing so, or 

—	 with a history of serious past attempts which are not of 

a chronic, impulsive, or consistent nature, or 

—	 in presence of command hallucinations or delusions 

which threaten to override usual impulse control. 

(b) Repeated episodes of violence toward self or others, or 

other behaviors resulting in harm while under the influence of intoxicating substances with pattern of nearly continuous and uncontrolled use. 

(c)	 Extreme compromise of ability to care for oneself or to 

monitor adequately the environment with evidence of deterioration in physical condition or injury related to these 

deficits. 

Source: American Association of Community Psychiatrists. 

LOCUS-Level of Care Utilization System, Psychiatric and 

Addiction Services. Adult Version. 2000. 

www.wpic.pitt.edu/aacp/finds/LOCUS2000.pdf [Accessed 

1/1/05]. 
Motivational Enhancement 3

Approaches 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Stage of 

Readiness 

Motivational Enhancement 

Approaches 

Precontemplation • Express concern about the client’s 

substance use, or the client’s mood, 

anxiety, or other symptoms of mental 

disorder. 

• State nonjudgmentally that substance 

use (or mood, anxiety, self-destructiveness) is a problem. 

• Agree to disagree about the severity of 

either the substance use or the psychological issues. 

• Consider a trial of abstinence to clarify 

the issue, after which psychological 

evaluation can be reconsidered. 

• Suggest bringing a family member to 

an appointment. 

• Explore the client’s perception of a 

substance use or psychiatric problem. 

• Emphasize the importance of seeing 

the client again and that you will try to 

help. 

Contemplation • Elicit positive and negative aspects of 

substance use or psychological 

symptoms. 

• Ask about positive and negative 

aspects of past periods of abstinence 

and substance use, as well as periods 

of depression, hypomania, etc. 

• Summarize the client’s comments on 

substance use, abstinence, and psychological issues. 

• Make explicit discrepancies between 

values and actions. 

• Consider a trial of abstinence and/or 

psychological evaluation. 

Preparation • Acknowledge the significance of the 

decision to seek treatment for one or 

more disorders. 

• Support self-efficacy with regard to 

each of the COD. 

• Affirm the client’s ability to seek treatment successfully for each of the COD. 

Continued on back 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

• Help the client decide on appropriate, 

achievable action for each of the COD. 

• Caution that the road ahead is tough 

but very important. 

• Explain that relapse should not disrupt 

the client–clinician relationship. 

Action • Be a source of encouragement and 

support; remember that the client may 

be in the action stage with respect to 

one disorder but only contemplation 

with respect to another; adapt your 

interview approach accordingly. 

• Acknowledge the uncomfortable 

aspects of withdrawal and/or psychological symptoms. 

• Reinforce the importance of remaining 

in recovery from both problems. 

Maintenance • Anticipate and address difficulties as 

a means of relapse prevention. 

• Recognize the client’s struggle with 

either or both problems, working with 

separate mental health and substance 

abuse treatment systems, and so on. 

• Support the client’s resolve. 

• Reiterate that relapse or psychological 

symptoms should not disrupt the 

counseling relationship. 

Relapse • Explore what can be learned from the 

relapse, whether substance-related or 

related to the mental disorder. 

• Express concern and even disappointment about the relapse. 

• Emphasize the positive aspect of the 

effort to seek care. 

• Support the client’s self-efficacy so 

that recovery seems achievable. 

Source: Samet, J.H., Rollnick, S., and Barnes, H. Beyond CAGE: 

A brief clinical approach after detection of substance abuse. 

Archives of Internal Medicine 156(20):2287–2293, 1996 

(reproduced with permission). 
Engagement Interventions 4 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Element Description 

Client Assistance 

Counseling 

• Emphasizes client responsibility, 

coaching and guiding the client, and 

using the client’s senior peers to provide assistance. 

Medication • Begins with psychiatric assessment 

and medication prescription, then 

monitors for medication adherence, 

side effects, and effectiveness. 

Active Outreach 

and Continuous 

Orientation 

• Builds relationships and enhances 

program compliance and acceptance 

through multiple staff contacts. 

Token Economy • Awards points (redeemable for tangible rewards such as phone cards, 

candy, toiletries) for positive behaviors including medication adherence, 

abstinence, attendance at program 

activities, follow-through on referrals, 

completing assignments, and various 

other activities essential to the development of commitment. 

Pioneers— 

Creating a 

Positive Peer 

Culture 

• 

r 

Facilitates program launch by forming a core group of selected residents (pioneers) to transmit the pee

mutual self-help culture and to 

encourage newly admitted clients to

make full use of the program. 

Client Action 

Plan 

• Formulated by clients and staff to 

specify, monitor, and document client 

short-term goals under the premise 

that substantial accomplishments 

are achieved by attaining smaller 

objectives. 

Preparation for 

Housing 

• Entitlements are obtained—a Section 

8 application for housing is filed, 

available treatment and housing 

options are explored, work readiness 

skills are developed, and household 

management skills are taught. 

Source: Adapted from Sacks, S., Skinner, D., Sacks, J., and 

Peck, A. Manual for Engaging Homeless MICAs in a Shelter 

Program. New York: National Development and Research 

Institutes, 2002. 
Key Questions in a Suicide 

Risk Review 

5 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Note: Staff without the appropriate training should not attempt 

to make determinations related to suicide risk. Properly 

trained staff should be called upon to conduct such an interview; if necessary, call 911 or implement the emergency procedures followed by your agency. 

What is wrong? 

• Personal narrative about how bad things are and the nature 

of the problem(s) 

• Personal construction of reasons for suicide 

• Personal measure of psychological pain and suffering 

Why now? 

• Elements of the current crisis 

• History of real or imagined losses or rejections 

• Sudden and unacceptable changes in life circumstances; 

for example, the client just received a serious or terminal 

diagnosis, relapse, onset of possible symptoms (e.g., sleeplessness) 

With what? 

• The means of suicide under consideration 

• Access to the means selected 

Where and when? 

• Possible location and timing of a suicide attempt 

• Degree of planning 

• Possible anniversary phenomena 

When and with what in the past? 

• Past history of suicidal behavior 

• Past history of intense suicidal ideation and/or planning 

• Whether rescue was avoided 

• Timing of past attempts 

• Social response to past attempts 

• Potential protective factors (reasons for living) 

• Comparison of current method versus old method 

Continued on next page 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Who’s involved? 

• Others who may know or be involved 

• Persons who may or may not be helpful in managing the 

client 

• Names of potentially helpful third parties 

• Possible presence of a suicide pact or murder-suicide plan 

Why not now? 

• One or more protective factors (reasons for living) 

• Spiritual or religious prohibitions 

• Duties to others or pets 

• Residual tasks to be completed before the attempt; for 

example, making out a will 
Residential Interventions 6 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Community Enhancement 

Morning Meeting Increase motivation for the day’s 

activities and create a positive family 

atmosphere. 

Concept Seminars Review the concept of the day. 

General Interest 

Seminars 

Provide information in areas of 

general interest (e.g., current 

events). 

Program-Related 

Seminars 

Address issues of particular relevance (e.g., homelessness, HIV prevention, and psychotropic 

medication). 

Orientation Seminars Orient new members and introduce 

all new activities. 

Evening Meetings Review house business for the day, 

outline plans for the next day, and 

monitor the emotional tone of the 

house. 

General Meetings Provide public review of critical 

events. 

Continued on next page 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Therapeutic/Educative 

Individual Counseling Incorporates both traditional mental 

health and unique modified TC goals 

and methods. 

Psychoeducational 

Classes 

Are predominant, using a format 

to facilitate learning among clients 

with COD; address topics such as 

entitlements/money management, 

positive relationship skills training, 

triple trouble group, and feelings 

management. 

Conflict Resolution 

Group 

Modified encounter groups designed 

specifically for clients with COD. 

Medication/ 

Medication Monitoring 

Begins with psychiatric assessment 

and medication prescription, continues with psychoeducation classes 

concerning the use and value of 

medication, then monitors using 

counselor observation, the peer 

community, and group reporting for 

medication adherence, side effects, 

and effectiveness. 

Gender-Specific 

Groups 

Combine features of “rap groups” 

and therapy groups focusing on gender-based issues. 

Community and 

Clinical Management 

Policies 

A system of rules and regulations to 

maintain the physical and psychological safety of the environment, 

ensuring that resident life is orderly 

and productive, strengthening the 

community as a context for social 

learning. 

Social Learning 

Consequence 

A set of required behaviors prescribed as a response to unacceptable behavior, designed to enhance 

individual and community learning 

by transforming negative events into 

learning opportunities. 

Continued on back 
Residential Interventions 6 (cont’d) 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Vocational 

Peer Work Hierarchy A rotating assignment of residents to 

jobs necessary to the day-to-day 

functioning of the facility, serving to 

diversify and develop clients’ work 

skills and experience. 

World of Work A psychoeducational class providing 

instruction in applications and 

interviews, time and attendance, 

relationships with others at work, 

employers’ expectations, discipline, 

promotion, etc. 

Recovery and 

World of Work 

A psychoeducational class that 

addresses issues of mental disorders, substance abuse, and so on, in 

a work context. 

Peer Advocate 

Training 

A program for suitable clients offering role model, group facilitator, and 

individual counseling training. 

Work Performance 

Evaluation 

Provides regular, systematic feedback on work performance. 

Job Selection and 

Placement 

Individual counseling after 6 months 

to establish direction and to determine future employment. 

Source: Sacks, S., Sacks, J.Y., and De Leon, G. Treatment for 

MICAs: Design and implementation of the modified TC. 

Journal of Psychoactive Drugs 31(1):19–30, 1999. 
Borderline Personality 

Disorder–Step Work Handout 

7 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Step One: “We admitted we were powerless over alcohol, that 

our lives had become unmanageable.” 

• Describe five situations where you suffered negative consequences as a result of drinking or using other drugs. 

• List at least five “rules” that you have developed to try to 

control your use of alcohol or other drugs. (Example: “I 

never drink alone.”) 

• Give one example describing how and when you broke each 

rule. 

• Check the following that apply to you: 

� I sometimes drink or use drugs more than I plan. 

� I sometimes lie about my use of alcohol or drugs. 

� I have hidden or stashed away alcohol or drugs so I could 

use them alone or at a later time. 

� I have had memory losses when drinking or using drugs. 

� I have tried to hurt myself when drinking or using drugs. 

� I can drink or use more than I used to, without feeling 

drunk or high. 

� My personality changes when I drink or use drugs. 

� I have school or work problems related to using alcohol or 

drugs. 

� I have family problems related to my use of alcohol or
 

drugs.
 

� I have legal problems related to my use of alcohol or
 

drugs.
 

• Give two examples for each item that you checked. 

Continued on back 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Step Two: “We came to believe that a Power greater than ourselves could restore us to sanity.” 

• Give three examples of how your drinking or use of drugs 

was “insane.” (One definition of insanity is to keep repeating 

the same mistake and expecting a different outcome.) 

• Check which of the following mistakes or thinking errors 

that you use: 

� Blaming 

� Lying 

� Manipulating 

� Excuse making 

� Beating up yourself with “I should have” statements 

� Self-mutilation (cutting on yourself when angry) 

� Negative self-talk 

� Using angry behavior to control others 

� Thinking “I’m unique” 

• Explain how each thinking error you checked above is harmful to you and others. 

• Give two examples of something that has happened since 

you stopped drinking or using drugs that shows you how 

your situation is improving. 

• Who or what is your Higher Power? 

• Why do you think your Higher Power can be helpful to you? 

Continued on next page 
7 (cont’d) 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Borderline Personality 

Disorder–Step Work Handout 

Step Three: “We made a decision to turn our will and our lives 

over to the care of God as we understood Him.” 

• Explain how and why you decided to turn your will over to a 

Higher Power. 

• Give two examples of things or situations you have “turned 

over” in the last week. 

• List two current resentments you have, and explain why it is 

important for you to turn them over to your Higher Power. 

• How do you go about “turning over” a resentment? 

• What does it mean to turn your will and life over to your 

Higher Power? 

• Explain how and why you have turned your will and life over 

to a Power greater than yourself. 

Continued on back 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

Step Four: “We made a searching and fearless moral inventory 

of ourselves.” 

• List five things you like about yourself. 

• Give five examples of situations where you have been helpful to others. 

• Give three examples of sexual behaviors related to your 

drinking or use of other drugs, which have occurred in the 

last 5 years, about which you feel bad. 

• Describe how beating yourself up for old drinking and drugusing behaviors is not helpful to you now. 

• List five current resentments you have, and explain how 

holding on to these resentments hurts your recovery. 

• List all laws you have broken related to your drinking and 

use of other drugs. 

• List three new behaviors you have learned that are helpful 

to your recovery. 

• List all current fears you are experiencing, and discuss how 

working the first three Steps can help dissolve them. 

• Give an example of a current situation you are handling 

poorly. 

• Discuss how you plan to handle this situation differently the 

next time the situation arises. 

Source: Adapted with permission from Evans, K., and 

Sullivan, J.M. Step Study Counseling with the Dual 

Disordered Client. Center City, MN: Hazelden Educational 

Materials, 1990. 
Antisocial Thinking-Error Work 8 

KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

The group facilitator presents thinking errors and then asks 

each group member to identify two thinking-error examples 

that apply to him or her and to choose one to focus on with the 

group’s help. 

1.	 Excuse making. Excuses can be made for anything and 

everything. Excuses are a way to justify behavior. For example: “I drink because my mother nags me,” “My family was 

poor,” “My family was rich.” 

2.	 Blaming. Blaming is an excuse to avoid solving a problem 

and is used to excuse behavior and build up resentment 

toward someone else for “causing” whatever has happened. For example: “They forced me to drink it!” 

3.	 Justifying. To justify an antisocial behavior is to find a reason to support it. For example: “If you can, I can,” “I 

deserve to get high, I’ve been clean for 30 days.” 

4.	 Redefining. Redefining is shifting the focus on an issue to 

avoid solving a problem. Redefining is used as a power 

play to get the focus off the person in question. For example: “I didn’t violate my probation. The language is confusing and the order is full of typos.” 

5.	 Superoptimism. “I think; therefore it is.” Example: “I don’t 

have to go to AA. I can stay sober on my own.” 

6.	 Lying. There are three basic kinds of lies: (1) lies of commission, or making things up that are simply not true; (2) 

lies of omission, or saying partly what is true but leaving 

out major sections; and (3) lies of assent, or pretending to 

agree with other people or approving of their ideas despite 

disagreement or having no intention of supporting the 

idea. 

7.	 “I’m Unique.” Thinking one is special and that rules 

shouldn’t apply to one. 

8.	 Ingratiating. Being nice to others, and going out of one’s 

way to act interested in other people, can be used to try to 

control situations or get the focus off a problem. Also 

known as “apple polishing.” 

Continued on back 
KAP KEYS Based on TIP 42 

Substance Abuse Treatment for Persons 

With Co-Occurring Disorders 

9.	 Fragmented personality. Some people may attend church 

on Sunday, get drunk or loaded on Tuesday, and then 

attend church again on Wednesday. They rarely consider 

the inconsistency between these behaviors. They may feel 

that they have the right to do whatever they want, and that 

their behaviors are justified. 

10. Minimizing. Minimizing behavior and action by talking 

about it in such a way that it seems insignificant. For 

example: “I only had one beer. Does that count as a 

relapse?” 

11. Vagueness. This strategy is to be unclear and nonspecific 

to avoid being pinned down on any particular issue. Vague 

words or phrases such as: “I more or less think so,” “I 

guess,” “Probably,” “Maybe,” “I might,” “I’m not sure about 

this,” “It possibly was,” etc. 

12. Power play. This strategy is to use power plays whenever 

one isn’t getting one’s way in a situation. Examples include 

walking out of a room during a disagreement, threatening 

to call an attorney or to report the group facilitator to 

higher-ups. 

13. Victim playing. The victim player transacts with others to 

invite either criticism or rescue from those around him. 

14. Grandiosity. Grandiosity is minimizing or maximizing the 

significance of an issue, and it justifies not solving the 

problem. For example: “I was too scared to do anything 

else but sit,” “I’m the best there is, so no one else can get 

in my way.” 

15. Intellectualizing. Using an emotionally detached, datagathering approach to avoid responsibility. For example, 

when faced with a positive urine drug screen the client 

states, “When was the last time the laboratory had its 

equipment calibrated?” or “What is the percentage of error 

in this testing procedure?” 

Source: Adapted with permission from Evans, K., and 

Sullivan, J.M. Step Study Counseling with the Dual 

Disordered Client. Center City, MN: Hazelden Educational 

Materials, 1990. 
Ordering Information 

TIP 42 

Substance Abuse Treatment for Persons
 

With Co-Occurring Disorders
 

Three Ways to Obtain Free Copies 

of All TIPs Products 

1. Call SAMHSA’s National Clearinghouse for Alcohol and 

Drug Information (NCADI) at 800-729-6686, 

TDD (hearing impaired) 800-487-4889. 

2. Visit NCDI’S Web site at www.ncadi.samhsa.gov. 

3. You can also access TIPs online at: 

www.kap.samhsa.gov. 

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of 

Communications, Substance Abuse and Mental Health 

Services Administration, U.S. Department of Health and 

Human Services. 

DHHS Publication No. (SMA) 05-4036 

Printed 2005