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Garland, A., Kruse, M., & Aaron, G. (2003). Clinicians and outcome measurement: What s the use Journal of Behavioral Health Services and Research, 20(4), 393 405. Hayes, R., Andrews, N., Baron-Jeffrey, M., Conley, C., Gridley, K., Norman, R., et al. (2003). Service enhancement to a dual-diagnosis population: Mental illness/substance abuse. Quality Management in Health Care, 12(3), 133 150. Lohr, K. N., Brook, R. H., Kamberg, C. J., Goldberg, G. A., Leibowitz, A., Keesey, J., et al. (1986). Use of medical care in the Rand Health Insurance Experiment. Diagnosis and servicespecific analysis in a randomized controlled trial. Medical Care, 24, S1 S87. Mart nez, J., Ruthazer, R., Hansjosten, K., Barefoot, L., Snydman, D. R., et al. (2003). Role of environmental contamination as a risk factor for acquisition of Vancomycin-Resistant Enterococci in patients treated in a medical intensive care unit. Archives of Internal Medicine, 163, 16. Rosen, A., Proctor, E. E., Morrow-Howell, N., & Staudt, M. (1995). Rationales for practice decisions: Variations in knowledge use by decision task and social work service. Research on Social Work Practice, 5, 501 523. Rowland, N., & Goss, S. (Eds.). (2000). Evidence-based counselling and psychological therapies: Research and applications. London: Routledge. Small, H. (1998). Florence Nightingale: Avenging angel. New York: St. Martin s Press. Stolley, P. D., & Lasky, T. (1995). Investigating disease patterns: The science of epidemiology. New York: Scientific American Library. U.S. Department of Health and Human Service. (1999). Mental health: A Report of the Surgeon General. Rockville, MD: Author. Wennberg, J. E., & Gittelsohn, A. (1973). Small-area variation in health care delivery. Science, 182, 1102 1108.

Some people have a seasonal pattern to their depression, meaning that the degree of depression changes throughout the year The pattern of depression revolves around the relative amount of sunlight available, so that depression onset may occur in the fall, worsen in the winter, diminish with the return of spring, and subside completely in the summer This type of condition is called Seasonal Affective Disorder (SAD), and it is much more commonly seen in northern latitudes in this hemisphere (or in far southern latitudes in the southern hemisphere) Researchers have tracked changes in substance use among people who have SAD, and have found a profound increase in use during the depressive cycle (winter) for a great many people Many clients with SAD told me they were using more during the darker months to self-medicate their symptoms (recall the discussion about self-medicating in 1).

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When marketing themselves and communicating who they are, people too often include unnecessary information that clutters their self-marketing sound bite. Extraneous detail or information that can be seen as negative should always be left out. If you re making a transition to a field you ve never worked in but have transferable skills for, talk about those skills before getting into details of your work history. If you re a recent grad applying for jobs that are not related to your major, for example, don t mention your major, at least not right off the bat. In other words, be strategic. Information that is not directly relevant to your goals should not be offered until after you ve stated the more positive, relevant aspects of your qualifications and experience. Then when the less relevant points are raised, de-emphasize them as much as possible. To make sure that you re putting your best and most relevant foot forward, write out a script of your sound bite, and then edit, edit, and edit some more.

Professionals should be aware that a cyclical pattern of substance use that seems to mirror changes in seasons may suggest underlying SAD, even if this condition has not been previously diagnosed This would be especially true for people who live in the northernmost areas of the United States SAD may be missed if a professional is not actively looking for a seasonal pattern to drug use If a family member notices any of the symptoms previously mentioned in a loved one, then it may be that the loved one is depressed and should be evaluated by a mental health professional If a loved one is expressing suicidal thoughts, or it is discovered that he or she has put his or her affairs in order (has sold or given away significant amounts of personal property, written a will, settled debts, etc.

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), then it would be critical to get help for that person as quickly as possible Suicide is a major concern with people who abuse drugs, since a majority of suicides in the United States are attempted under the influence of drugs or alcohol Mental health professionals are legally bound in many states to assess for possible harm to self Because of the high comorbidity of depression and suicidal behavior with drug use, clinicians working with drug users need to be aware of the particular laws and procedures for reporting possible harm to self within the states in which they are practicing Generally speaking, it is important to assess all clients with drug problems for possible depression and suicidal ideations, as well as for a history of suicidal behavior (see 4 for more details on assessing depression).

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