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This page contains links to external Web sites.  CSAT TIPs
The Treatment Improvement Protocols (TIPs) are best practice guidelines for the treatment of substance abuse. CSAT's Office of Evaluation, Scientific Analysis, and Synthesis draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPs, which are distributed to a growing number of facilities and individuals across the country. The audience for the TIPs is expanding beyond public and private substance abuse treatment facilities as alcohol and other drug disorders are increasingly recognized as a major problem. The TIPs Development Process
The TIPs Editorial Advisory Board, a distinguished group of substance abuse experts and professionals in such
related fields as primary care, mental health, and social services, and the State Alcohol and Other Drug Abuse
Directors generate topics for the TIPs based on the field's current needs for information and guidance.
After selecting a topic, CSAT invites staff from pertinent Federal agencies and national organizations to a
Resource Panel that recommends specific areas of focus as well as resources that should be considered in
developing the content for the TIP. Soon after that a consensus panel is held: non-Federal experts who are
familiar with the topic and are nominated by their peers participate in panel discussions over five days. The
information and recommendations on which they reach consensus form the foundation of the TIP. The members of
each Consensus Panel represent substance abuse treatment programs, hospitals, community health centers,
counseling programs, criminal justice and child welfare agencies, and private practitioners. A panel chair
ensures that the guidelines mirror the results of the group's collaboration.
A large and diverse group of experts closely reviews the draft document. Once the changes recommended by the
field reviewers have been incorporated, the TIP is prepared for publication. While each TIP strives to include
an evidence base for the practices it recommends, CSAT recognizes that the field of substance abuse treatment
is evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each
TIP is to convey "front-line" information quickly but responsibly. For this reason, recommendations proffered
in the TIP are attributed to either Panelists' clinical experience or the literature. If there is research to
suggest a particular approach, citations are provided. Anyone interested in becoming involved in the TIPs
development process (as a field reviewer, panelist, or writer) should send email
to chris.currier@samhsa.hhs.gov. Ordering InformationTIPs with highlighted titles are available online. Others can be ordered from the National Clearinghouse for Drug and Alcohol Information (NCADI) by accessing its electronic catalog or by calling 1-800-729-6686. You may order up to five free hard copies, using the NCADI order number following the title.
1.Psychoeducational groups-educate clients about substance abuseTIP 41 also offers information about specialized types of groups that do not fit neatly into the five-model classification. BKD507 TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction This TIP provides consensus - and evidence -based guidance on the use of buprenorphine, a new option for the treatment of opioid addiction. The goal of this TIP is to provide information that physicians can use to make practical and informed decisions about the use of buprenorphine to treat opioid addiction. The Guidelines address a number of topic areas related to this goal, including the physiology and pharmacology of opioids, opioid addiction, and treatment with buprenorphine; the screening and assessment of opioid addiction problems; detailed protocols for opioid addiction treatment with buprenorphine; management of special populations; and policies and procedures related to office -based opioid addiction treatment under the paradigm established by the Drug Addiction Treatment Act of 2000. This TIP represents another step by CSAT toward its goal of bringing national leaders together to improve substance use disorder treatment in the United States. BKD500 TIP 39 : Substance Abuse Treatment and Family Therapy This TIP addresses how substance abuse affects the entire family and how substance abuse treatment providers can use principles from family therapy to change the interactions among family members. The TIP provides basic information about family therapy for substance abuse treatment professionals and basic information about substance abuse treatment for family therapists. The TIP presents the models, techniques and principles of family therapy, with special attention to the stages of motivation as well as to treatment and recovery. Discussion also focuses on clinical decisionmaking and training, supervision, cultural considerations, specific populations, funding and research. The TIP further identifies future directions for both research and clinical practice. BKD504 TIP 38: Integrating Substance Abuse Treatment and Vocational Services Employment has been positively correlated with retention in treatment. By holding a job, a client establishes a legal source of income, structured use of time, and improved self-esteem, which in turn may reduce substance use and criminal activity. Years of research show that the best predictors of successful substance abuse treatment are Gainful employment Adequate family support Lack of coexisting mental illness Unemployment and substance abuse may be intertwined long before an individual seeks treatment. Although the average educational level of individuals with substance abuse disorders is comparable to that of the general U.S. population, people who use substances are far more likely to be unemployed or underemployed than people who do not use substances. According to the U.S. Census Bureau, employment rates for the non-substance-using population ranged from 72.3 percent in 1980 to 76.8 percent in 1991. However, employment rates of the population with substance abuse problems before admission or at admission to treatment have remained at relatively stable, low levels since 1970, ranging from 15 to 30 percent. Most of the research on the employment rates of persons with substance abuse disorders has focused on opiate-dependent persons (usually heroin), and employment rates for other substance users may vary. The data clearly indicate the need for interventions to improve employment rates among this population in treatment and recovery. 247 pages (BKD381) TIP 37: Substance Abuse Treatment for Persons With HIV/AIDS While AIDS remains a deadly disease, since TIP 15 was published in 1995 new treatment approaches have extended the length and quality of survival for those with HIV. This longer term survival requires innovative substance abuse treatment that encourages people with HIV/AIDS to seek substance abuse treatment and maintain recovery. TIP 37, Substance Abuse Treatment for Persons With HIV/AIDS, provides a comprehensive overview of how the HIV/AIDS epidemic requires substance abuse treatment professionals to attend to the multiple needs of their clients with HIV/AIDS: substance abuse and other medical, behavioral, psychological, and social needs. TIP 37 reviews the history, transmission, and progression of HIV/AIDS and describes the changes in epidemiology since 1995. It reports on the current state of medical and mental health treatment and how this affects people with substance abuse disorders and HIV/AIDS. Counseling issues are addressed, including staff attitudes, screening, and issues specific to the client with substance abuse disorders and HIV/AIDS. The TIP also examines ethical and legal issues of particular import to both substance abuse treatment providers and their clients with HIV/AIDS, and concludes with an overview of funding sources and grantwriting guidelines. Several alternative products have been developed to accompany TIP 37, including a TIP Preview (MS677), a Quick Guide(MS678), and a Fact Sheet (MS676). Free copies of these products can be ordered through NCADI 316 pages (BKD359) TIP 36: Substance Abuse Treatment Responding to Child Abuse and Neglect Issues The effects of childhood abuse and neglect perpetrated by family members and the intergenerational transmission of the cycle of substance abuse and child abuse and neglect are the focus of this TIP. The seven chapters discuss working with child abuse and neglect issues; screening and assessing adults for childhood abuse and neglect; comprehensive treatment for adult survivors; therapeutic issues for counselors; the substance-dependent client as parent/caregiver; legal responsibilities; and emerging and continuing issues. The closing recommendations include screening assessment protocol and issues for counselors. 181 pages (BKD343) TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment This TIP shows how substance abuse treatment staff can influence change by developing a therapeutic relationship that respects and builds on the client's autonomy and, at the same time, makes the treatment clinician a partner in the change process. 243 pages (BKD342) TIP 34: Brief Interventions And Brief Therapies for Substance Abuse Treatment An increasing number of individuals are presenting with substance abuse disorders while at the same time, recent changes in the healthcare delivery system are placing funding and time constraints on clinicians. The need for cost-effective services to address substance use disorders is great. As a result, clinicians, researchers, and policymakers are turning their attention toward brief interventions and therapies. An increasing body of literature confirms the effectiveness of brief approaches in substance abuse treatment. This TIP links research to practice by providing clinicians with information on these innovative and shorter forms of treatment for selected populations of substance-using individuals. 234 pages (BKD341) TIP 33: Treatment for Stimulant Use Disorders Over the past 20 years, stimulant use in the United States has risen dramatically. Consequently, clinicians, treatment program administrators, and criminal justice system officials must be prepared to address problems and needs specific to this population. This TIP presents information on the nature and extent of cocaine and methamphetamine abuse, and translates findings from clinical studies into practical treatment guidelines. 226 pages (BKD289) TIP 32: Treatment of Adolescents With Substance Use Disorders Adolescents differ from adults both emotionally and physiologically. Therefore, treatment of adolescent substance use disorders must reflect their unique needs. In addition to gender, age, and cultural background, treatment providers must address issues that play significant roles in an adolescent's life, such as cognitive, emotional, physical, social, and moral development, and family and peer environment. This TIP, a companion to TIP 31, Screening and Assessing Adolescents for Substance Use Disorders, focuses on how to tailor treatment for adolescents, as well as on common and effective treatment components being used today. 126 pages (BKD307) TIP 31: Screening and Assessing Adolescents For Substance Use Disorders Substance use among adolescents is occurring at younger ages while perceived risk of harm from substance use is declining among youth. As a result, professionals who regularly work with adolescents should be able to recognize the signs of substance use. This TIP presents information on current procedures and instruments for detecting substance use disorders in adolescents, conducting comprehensive assessments, and beginning treatment planning. 136 pages (BKD306) TIP 30: Continuity of Offender Treatment for Substance Use Disorders From Institution to Community A large percentage of offenders in prison today are there because of drug-related offenses, and it is clearly in the public interest for offenders with substance use disorders to receive appropriate treatment both in prison or jail and in the community after release. Numerous studies show that those who remain dependent on substances are much more likely to return to criminal activity. This TIP presents guidelines for ensuring continuity of care as offenders with substance use disorders move from incarceration to the community. 121 pages (BKD304) TIP 29: Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities People with coexisting disabilities are more likely than the general population to also have a substance use disorder. This TIP provides detailed information on the screening, assessment and treatment needs of this population. It also informs treatment programs about how to comply with federal legislation concerning people with disabilities. 156 pages (BKD288) TIP 28: Naltrexone and Alcoholism Treatment Naltrexone, a narcotic antagonist marketed under the name "ReVia," is the first new medication in 50 years approved for the treatment of alcohol dependence. This TIP aims to educate clinicians about the value and appropriate use of naltrexone, help break down resistance to supplementing standard treatment for alcoholics with pharmacotherapies, and enlarge understanding of basic neurological and preclinical research about the addictive process. 94 pages (BKD268) TIP 27: Comprehensive Case Management for Substance Abuse Treatment Research and clinical experience indicate that substance abusers have better treatment outcomes if their other problems are addressed concurrently. TIP 27, Comprehensive Case Management for Substance Abuse Treatment, gives treatment providers the information they need to perform case management for their multi-problem clients. The TIP outlines all the leading case management models, explains how to establish linkages, and details how case management fits into a managed care environment. 121 pages (BKD251) TIP 26: Substance Abuse Among Older Adults This TIP presents treatment providers and other health care professionals with practical advice for identifying, screening, assessing, and treating substance abuse among people 60 and older. The TIP details how disorders typical in an aging person, such as dementia and delirium, can mask or mimic the effects of alcohol and prescription drug abuse. Elderly-specific screening and assessment instruments are included, along with adjustments to the DSM-IV criteria for substance abuse and dependence. 173 pages (BKD250) TIP 25: Substance Abuse Treatment and Domestic Violence This TIP presents treatment providers with an introduction to the field of domestic violence. It gives providers useful information on the role of substance abuse in domestic violence -- both among the men who batter and the women who are battered. Useful techniques for detecting and eliciting such information are supplied, along with ways to modify treatment to ensure victims' safety and to stop the cycle of violence in both parties' lives. 152 pages (BKD239) TIP 24: A Guide to Substance Abuse Services for Primary Care Physicians This TIP presents best practice guidelines for primary care clinicians to follow in caring for patients with substance use disorders. 168 pages (BKD234) TIP 23: Treatment Drug Courts: Integrating Substance Abuse Treatment With Legal Case Processing This TIP provides clinicians, administrators, and policymakers with the information they need to plan, implement, monitor, and evaluate treatment drug courts. The number of programs that integrate drug treatment into the pretrial processing of criminal cases has grown exponentially in the last several years: this TIP highlights the most successful of them and presents relevant information on financial, legal, and ethical issues. 65 pages (BKD205) TIP 22: LAAM in the Treatment of Opiate Addiction This TIP presents current knowledge about the use of levo-alpha-acetyl-methadol (LAAM), an opioid agonist medication approved by the Food and Drug Administration in 1993. This TIP describes the medication itself, its modes of action, possible side effects, and interactions with other medications. Separate chapters describe treatment planning, program administration, and regulatory and ethical issues. 66 pages (BKD170) TIP 21: Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System This TIP introduces a new definition of diversion, concentrating on diverting youth already involved with the juvenile justice system. The TIP provides hands-on information about community collaboration to establish a diversion program for youth whose court involvement is associated with substance abuse. 131 pages (BKD169) TIP 20: Matching Treatment to Patient Needs in Opioid Substitution Therapy Opiate-addicted persons often need a broad range of services in addition to opioid substitution therapy. Research has shown that providing these services as part of the therapy program greatly increases retention in treatment and improves outcomes. The TIP outlines a comprehensive assessment process for identifying patient needs and describes core treatment elements to address those needs. 136 pages (BKD168) TIP 19: Detoxification From Alcohol and Other Drugs This TIP presents comprehensive guidelines useful to individuals involved in planning, evaluating, and providing detoxification services. 95 pages (BKD172) TIP 18: The Tuberculosis Epidemic: Legal and Ethical Issues for Alcohol and Other Drug Abuse Treatment Providers This TIP, which summarizes the latest advice and recommends protocols for dealing with the threat of tuberculosis (TB) in the AOD setting, is intended to encourage collaboration among State, local, and private agencies. The TIP includes guidelines for AOD treatment providers about cooperating with public health officials and others in preventing the transmission of TB in AOD treatment facilities. 132 pages (BKD173) TIP 17: Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System This TIP will help criminal justice and AOD treatment systems promote the acceptance of AOD treatment for criminal offenders and enhance its effectiveness. The CSAT Criminal Justice Treatment Planning Chart is included in an appendix to assist policymakers and planners. 116 pages (BKD165) TIP 16: Alcohol and Other Drug Screening of Hospitalized Trauma Patients This TIP describes the significant role that AODs play in traumatic injury, especially reinjury. The TIP recommends alcohol and drug screening (blood and urine) of injured patients age 14 and older at hospital admission. A comprehensive AOD assessment is outlined, and some brief intervention techniques are described. 96 pages (BKD164) TIP 15: Treatment for HIV-Infected Alcohol and Other Drug Abusers This TIP provides recommendations and guidelines for quality care for AOD abusers who are in treatment and who are infected with HIV. The guidelines identify a spectrum of core services and treatment approaches that ideally should be available to all HIV-infected AOD abusers, regardless of the setting in which they receive care. 171 pages (BKD163) TIP 14: Developing State Outcomes Monitoring Systems for Alcohol and Other Drug Abuse Treatment This TIP is designed to help single State agencies and their staff develop, implement, and manage outcomes monitoring systems for local substance abuse treatment programs to increase accountability for AOD treatment expenditures. It also can be of service to direct service providers, third-party payers, utilization reviewers, quality assurance personnel, and staff of managed care programs. 96 pages (BKD162) TIP 13: The Role and Current Status of Patient Placement Criteria in the Treatment of Substance Use Disorders This TIP addresses the establishment of standardized patient placement criteria (PPC) as an objective of the substance abuse treatment field. 74 pages (BKD161) TIP 12: Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System This TIP provides the AOD and criminal justice systems with information to enhance the linkage of treatment services for offenders assigned to intermediate sanctions. Planning, policy, ethical, and legal issues are discussed. 101 pages (BKD144) TIP 11: Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases This TIP presents information on two screening instruments, one for substance abuse and one for infectious diseases, their development, and guidelines for their use. The instruments are designed for linking AOD treatment with treatment for HIV/AIDS, TB, and STDs. 74 pages (BKD143) TIP 10: Assessment and Treatment of Cocaine-Abusing, Methadone-Maintained Patients This TIP addresses the treatment needs of methadone patients using opioids and stimulants, especially cocaine and crack cocaine. 117 pages (BKD157) Additional Resources: CSAT/KAPT10, Keys for Clinicians, Based on TIP 10 CSAT/QGCT10, Quick Guide, Based on TIP 10 To order, please call NCADI at 1-800-729-6686 TIP 9: Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse This TIP provides practical treatment recommendations for enhancing services to individuals dually diagnosed with mental health and substance abuse problems. 114 pages (BKD134) TIP 8: Intensive Outpatient Treatment for Alcohol and Other Drug Abuse This TIP provides an overview of Intensive Outpatient Treatment (IOT), documenting the clinical viability and utility of IOT and stressing the range of IOT services within the local continuum of care. 104 pages (BKD139) TIP 7: Screening and Assessment for Alcohol and Other Drug Abuse Among Adults in the Criminal Justice System This TIP provides guidelines to criminal justice and substance abuse treatment personnel on effective procedures and instruments to ensure appropriate program referral, treatment, and enhanced outcomes. 129 pages (BKD138) TIP 6: Screening for Infectious Diseases Among Substance Abusers This TIP guides AOD treatment providers in developing and improving on-site and referral patient services regarding infectious diseases, including screening, medical services, and preventive counseling. 160 pages (BKD131) TIP 5: Improving Treatment for Drug-Exposed Infants This TIP offers guidelines for monitoring and evaluating programs that treat drug-exposed infants. 94 pages (BKD110) TIP 4: Guidelines for the Treatment of Alcohol and Other Drug-Abusing Adolescents (See TIP 32) Treatment of substance-abusing adolescents is covered in this TIP, which reflects state-of-the-art scientific and clinical knowledge. 109 pages (BKD109) TIP 3: Screening and Assessment of Alcohol- and Other Drug-Abusing Adolescents (See TIP 31) This TIP guides practitioners through screening and assessing substance-abusing adolescents and ensuring treatment and other social services. 270 pages (BKD108) TIP 2: Pregnant, Substance-Using Women The guidelines in this TIP reflect state-of-the-art research and clinical knowledge on effective treatment practices and care for pregnant substance abusers. 90 pages (BKD107) TIP 1: State Methadone Treatment Guidelines This TIP provides guidelines for State Alcohol and Other Drug (AOD) agencies and methadone treatment providers on effective treatment practices and care. 222 pages (Out of Print)
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