Treatment Improvement Protocols (TIPs) are a series of best-practice manuals for the treatment of substance use and other related disorders. The TIP series is published by the Substance Abuse and Mental Health Services Administration (SAMHSA), an operational division of the U.S. Department of Health and Human Services.
SAMHSA convenes panels of clinical, research, and administrative experts to produce the content of TIPs, which are distributed to public and private substance abuse treatment facilities and individuals throughout the United States and its territories. TIPs deal with all aspects of substance abuse treatment, from intake procedures to screening and assessment to various treatment methodologies and referral to other avenues of care. TIPs also deal with administrative and programmatic issues such as funding, inter-agency collaboration, training, accreditation, and workforce development. Some TIPs also cover ancillary topics that tend to be associated with substance abuse treatment, such as co-occurring mental health problems, criminal justice issues, housing, and primary care. Once the content of a TIP has been finalized and approved by SAMHSA, the publications are printed through the U.S. Government Printing Office.
As of October 2023, 63 TIPs have been published (although the most recently published is numbered #64; see below). Most are available through the SAMHSA 'Store.' SAMHSA also makes newer TIPs available for download in Portable Document Format (PDF), or accessible online through the National Library of Medicine. Although TIPs frequently show up on internet auction sites and through used book sellers for varying costs, they are intended to be available for free to the public. SAMHSA does not charge for them.
TIP 1: State Methadone Treatment Guidelines (replaced by TIP 43)
TIP 2: Pregnant, Substance-Using Women (replaced by TIP 51)
TIP 3: Screening and Assessment of Alcohol- and Other Drug-Abusing Adolescents (replaced by TIP 31)
TIP 4: Guidelines for the Treatment of Alcohol- and Other Drug-Abusing Adolescents (replaced by TIP 32)
TIP 5: Improving Treatment for Drug-Exposed Infants
TIP 6: Screening for Infectious Diseases Among Substance Abusers
TIP 7: Screening and Assessment for Alcohol and Other Drug Abuse Among Adults in the Criminal Justice System (replaced by TIP 44)
TIP 8: Intensive Outpatient Treatment for Alcohol and Other Drug Abuse (replaced by TIPs 46 and 47)
TIP 9: Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse
TIP 10: Assessment and Treatment Planning for Cocaine-Abusing Methadone-Maintained Patients
TIP 11: Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases
TIP 12: Combining Substance Abuse Treatment with Intermediate Sanctions for Adults in the Criminal Justice System (replaced by TIP 44)
TIP 13: Role and Current Status of Patient Placement Criteria in the Treatment of Substance Use Disorders
TIP 14: Developing State Outcomes Monitoring Systems for Alcohol and Other Drug Abuse Treatment
TIP 15: Treatment for HIV-Infected Alcohol and Other Drug Abusers (replaced by TIP 37)
TIP 16: Alcohol and Other Drug Screening of Hospitalized Trauma Patients
TIP 17: Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System (replaced by TIP 44)
TIP 18: The Tuberculosis Epidemic: Legal and Ethical Issues for Alcohol and Other Drug Treatment Providers
TIP 19: Detoxification From Alcohol and Other Drugs (replaced by TIP 45)
TIP 20: Matching Treatment to Patient Needs in Opioid Substitution Therapy (replaced by TIP 43)
TIP 21: Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System
TIP 22: LAAM in the Treatment of Opiate Addiction (replaced by TIP 43)
TIP 23: Treatment Drug Courts: Integrating Substance Abuse Treatment With Legal Case Processing
TIP 24: A Guide to Substance Abuse Services for Primary Care Clinicians
TIP 25: Substance Abuse Treatment and Domestic Violence
TIP 26: Substance Abuse Among Older Adults (updated 2020)
TIP 27: Comprehensive Case Management for Substance Abuse Treatment
TIP 28: Naltrexone and Alcoholism Treatment
TIP 29: Substance Use Disorder Treatment For People With Physical and Cognitive Disabilities
TIP 30: Continuity of Offender Treatment for Substance Use Disorders from Institution to Community
TIP 31: Screening and Assessing Adolescents for Substance Use Disorders
TIP 32: Treatment of Adolescents with Substance Use Disorders
TIP 33: Treatment for Stimulant Use Disorders
TIP 34: Brief Interventions and Brief Therapies for Substance Abuse
TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment (updated 2019)
TIP 36: Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues
TIP 37: Substance Abuse Treatment for Persons with HIV/AIDS
TIP 38: Integrating Substance Abuse Treatment and Vocational Services
TIP 39: Substance Abuse Treatment and Family Therapy (updated 2020)
TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction
TIP 41: Substance Abuse Treatment: Group Therapy
TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders (updated 2020)
TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs
TIP 44: Substance Abuse Treatment for Adults in the Criminal Justice System
TIP 45: Detoxification and Substance Abuse Treatment
TIP 46: Substance Abuse: Administrative Issues in Outpatient Treatment
TIP 47: Substance Abuse: Clinical Issues in Intensive Outpatient Treatment
TIP 48: Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery
TIP 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice
TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
TIP 51: Substance Abuse Treatment: Addressing the Specific Needs of Women
TIP 52: Clinical Supervision and Professional Development of the Substance Abuse Counselor
TIP 53: Addressing Viral Hepatitis in People With Substance Use Disorders
TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders
TIP 55: Behavioral Health Services for People Who Are Homeless
TIP 56: Addressing the Specific Behavioral Health Needs of Men
TIP 57: Trauma-Informed Care in Behavioral Health Services
TIP 58: Addressing Fetal Alcohol Spectrum Disorders (FASD)
TIP 59: Improving Cultural Competence
TIP 60: Using Technology-Based Therapeutic Tools in Behavioral Health Services
TIP 61: Behavioral Health Services for American Indians and Alaska Natives
TIP 63: Medications for Opioid Use Disorders (updated 2021)
TIP 64: Incorporating Peer Support into Substance Use Disorder Treatment Services
TIP 65: Counseling Approaches to Promote Recovery From Problematic Substance Use and Related Issues (Publication Date November 2023)
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.
Alcohol abuse encompasses a spectrum of unhealthy drinking behaviors which range from consuming more than 2 drinks per day on average for men, or more than 1 drink per day on average for women, to binge drinking or alcohol use disorder.
The Substance Abuse and Mental Health Services Administration is a branch of the U.S. Department of Health and Human Services. SAMHSA is charged with improving the quality and availability of treatment and rehabilitative services in order to reduce illness, death, disability, and the cost to society resulting from substance abuse and mental illnesses. The Administrator of SAMHSA reports directly to the Secretary of the U.S. Department of Health and Human Services. SAMHSA's headquarters building is located outside of Rockville, Maryland.
Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.
Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.
Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.
Partial hospitalization, also known as PHP, is a type of program used to treat mental illness and substance abuse. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. Partial hospitalization focuses on the overall treatment of the individual and is intended to avert or reduce in-patient hospitalization.
Phoenix House is a nonprofit drug and alcohol rehabilitation organization operating in ten states with 150 programs. Programs serve individuals, families, and communities affected by substance abuse and dependency.
Pine Rest Christian Mental Health Services is a psychiatric hospital and behavioral health provider, with the main treatment campus located in Gaines Township, Michigan. The Chief Executive Officer and President is Dr. Mark Eastburg, appointed December, 2006.
An intensive outpatient program (IOP), also known as an intensive outpatient treatment (IOT) program, is a structured non-residential psychological treatment program which addresses mental health disorders and substance use disorders (SUDs) that do not require detoxification through a combination of group-based psychotherapy, individual psychotherapy, family counseling, educational groups, and strategies for encouraging motivation and engagement in treatment. IOP operates on a small scale and does not require the intensive residential or partial day services typically offered by the larger, more comprehensive treatment facilities.
Substance abuse prevention, also known as drug abuse prevention, is a process that attempts to prevent the onset of substance use or limit the development of problems associated with using psychoactive substances. Prevention efforts may focus on the individual or their surroundings. A concept that is known as "environmental prevention" focuses on changing community conditions or policies so that the availability of substances is reduced as well as the demand. Individual Substance Abuse Prevention, also known as drug abuse prevention involves numerous different sessions depending on the individual to help cease or reduce the use of substances. The time period to help a specific individual can vary based upon many aspects of an individual. The type of Prevention efforts should be based upon the individual's necessities which can also vary. Substance use prevention efforts typically focus on minors and young adults – especially between 12–35 years of age. Substances typically targeted by preventive efforts include alcohol, tobacco, marijuana, inhalants, coke, methamphetamine, steroids, club drugs, and opioids. Community advocacy against substance use is imperative due to the significant increase in opioid overdoses in the United States alone. It has been estimated that about one hundred and thirty individuals continue to lose their lives daily due to opioid overdoses alone.
Drug detoxification is variously construed or interpreted as a type of “medical” intervention or technique in regards to a physical dependence mediated by a drug; as well as the process and experience of a withdrawal syndrome or any of the treatments for acute drug overdose (toxidrome). The first definition however, in relation to substance dependence and its treatment is arguably a misnomer and even directly contradictory since withdrawal is neither contingent upon nor alleviated through biological excretion or clearance of the drug. In fact, excretion of a given drug from the body is one of the very processes that leads to withdrawal since the syndrome arises largely due to the cessation itself and the drug being absent from the body; especially the blood plasma, not from ‘leftover toxins’ or traces of the drug still being in the system.
The CRAFFT is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents. CRAFFT stands for the key words of the 6 items in the second section of the assessment - Car, Relax, Alone, Forget, Friends, Trouble. As of 2020, updated versions of the CRAFFT known as the “CRAFFT 2.1” and "CRAFFT 2.1+N" have been released.
Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences as a result of their use. The National Institute of Mental Health (NIMH) states that “Substance use disorder (SUD) is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD”. Substance use disorders (SUD) are considered to be a serious mental illness that fluctuates with the age that symptoms first start appearing in an individual, the time during which it exists and the type of substance that is used. It is not uncommon for those who have SUD to also have other mental health disorders. Substance use disorders are characterized by an array of mental/emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance(s) despite repeated attempts; operating vehicles while intoxicated; and physiological withdrawal symptoms. Drug classes that are commonly involved in SUD include: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics or anxiolytics, stimulants, tobacco
Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behaviour that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in addiction's development. Classic signs of addiction include compulsive engagement in rewarding stimuli, preoccupation with substances or behavior, and continued use despite negative consequences. Habits and patterns associated with addiction are typically characterized by immediate gratification, coupled with delayed deleterious effects.
The adolescent community reinforcement approach (A-CRA) is a behavioral treatment for alcohol and other substance use disorders that helps youth, young adults, and families improve access to interpersonal and environmental reinforcers to reduce or stop substance use.
John R. Knight is an Associate Professor of Pediatrics at Harvard Medical School (HMS) and the Associate Director for Medical Education at the HMS Division on Addictions. In 1999, he founded the Center for Adolescent Substance Abuse Research (CeASAR) and its companion outpatient clinic, the Adolescent Substance Abuse Program (ASAP). CeASAR and ASAP were the first programs of their kind to be located at a children’s hospital. He is best known as the clinical scientist who developed and validated the CRAFFT substance abuse screen for adolescents. In 2008 he was named the inaugural incumbent of the Boston Children’s Hospital Endowed Chair in Developmental Medicine
Screening, Brief Intervention and Referral to Treatment (SBIRT) is a model that encourages mental health and substance use screenings as a routine preventive service in healthcare.
Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.