The following protocol, TIP 48 Management of Depressive Symptoms in Substance Abuse Clients in Early Recovery, will be discussed in conjunction with the course notes in order to discern ways to work effectively with clients with co-occurring disorders. Clinicians must be able to accurately assess mental health disorders, substance use, and readiness for change. First, when working with a population with co-occurring disorders it is critical that they can be accurately assessed quickly so that they are able to be placed on treatment that meets their needs as quickly as possible. Diagnosis of patients with depression and substance abuse/dependence must meet current DSM criteria. Substance abuse and dependence in the DSM tend to be confusing due to the fact that the doctor makes the diagnosis based on his or her limited "snapshot" of information and context. The arduous task of evaluating as accurately as possible is vital to meeting the placement criteria. Working with patients with co-occurring diagnoses may require the doctor to have specific training due to the nature of the different complications. Training may require these to have a multi-issue perspective to cover multi-dimensional problems that may or have occurred. Clients diagnosed with depression and substance abuse/dependence need a client-centered treatment plan. “A client-centered treatment plan is based on a careful, comprehensive assessment of immediate needs, motivation to change, and readiness to change.” (p 23). Creating the therapeutic alliance and sustaining it is vital so that the client can trust and rely on the clinician's help. "An early and strong therapeutic alliance is critical to successful treatment."...... half of the article ...... possible adverse interactions between an antidepressant medication and substances a patient abuses (such as the potential for increased sedation or intoxication).” (page 29). Working with any type of disorder can be challenging, let alone working with co-occurring disorders. It takes an experienced doctor to separate symptoms from diagnoses to best treat them. One way to assist the client in managing these symptoms is to educate them about the brain's slow repair process, post-acute withdrawal symptoms, and depressive symptoms. Active and non-judgmental listening techniques help build a strong therapeutic alliance with the client by altering their experience. Recovery from substance use and depression is very challenging and requires collaboration from the doctor and the client to have a lasting recovery.