Welcome to the November edition of Tips and Topics and a happy Thanksgiving to all in the USA. In SAVVY, when clients present with mental health problems and are also using alcohol and other drugs, there could be three diagnostic possibilities. When mental health clinicians are not savvy about addiction and vice versa, misdiagnosis is easy to do. In SKILLS, assessment guidelines on timelines and drug-free periods can help tease apart what is going on in the relationship between substance use and mental health signs and symptoms. In SOUL, I invite you to ponder what you might say at the Thanksgiving dinner table when someone says: “Let’s share what you are grateful for this year.” Try out Marshall Rosenberg’s modified 3-step process. David Mee-Lee, M.D. DML Training and Consulting SAVVY Recently a friend introduced me to his 36 year old daughter who had just started seeing a therapist for anxiety. I talked briefly with the young woman who knew I am a psychiatrist and she was surprisingly quite open saying, unsolicited, that she was a “functional alcoholic”.  She has quite a demanding job with much responsibility and is doing well in her work.  But she went on to tell me that she often opens a bottle of wine at night and ends up drinking the whole bottle. She felt a good connection with her therapist who is doing cognitive behavioral therapy (CBT) with her. It wasn’t my place to do a clinical evaluation, but her drinking raised a red flag for me and got me wondering: Did her therapist do a substance use history? Are they even knowledgeable about addiction and have the skills to explore addiction? If they do discover her drinking, will they know how to engage her into a change plan for risky drinking; or will they explain away the drinking as a symptom of anxiety disorder? Unfortunately too many mental health trained clinicians are not savvy about addiction, believing that substance use is just a self-medication coping skill for unresolved mental health issues.        Tip 1 Risky substance use can be a self-medication coping mechanism. But it can be an indicator of a co-occurring substance use disorder that needs evaluation. When clients present with mental health problems and are also using alcohol and other drugs, there could be three (not mutually exclusive) diagnostic possibilities: The person may be attempting to self-medicate a psychiatric disorder with substance use. The mental health problems may be signs and symptoms of the addiction illness e.g., depression because of the crash after a cocaine binge or mood swings because they are getting high on uppers and downers. The person may indeed have both a co-occurring mental and substance use disorder.   Tip 2 It is easy to label people with mental health signs and symptoms as having a mental disorder and prescribe medication. It is better to medicate diagnoses not signs and symptoms. When mental health clinicians are not savvy and skilled in addiction diagnosis and treatment, the tendency is to fall back on what you know; and not …