Published
- Patients
- Households
- Primary-care teams
- People continuing mental-health or substance-use treatment
Prepared · sources accessed (UTC) · physician review still to be recorded
A positive screen can open a useful conversation, but it can also leave someone with a telephone number and no clear plan. Effective follow-through requires an assessment, a treatment decision, a way to review progress, and a contact when something changes.
This guide helps patients and supporters organize those steps for depression, alcohol-use concerns, and opioid-use disorder. It extends the existing guides to depression screening, substance-use screening, and finding an affordable therapist.
If there is a crisis now: in the United States, call or text 988 for suicidal thoughts or a mental-health crisis. Call 911 for a life-threatening emergency. A public website or routine portal message cannot provide immediate crisis care. NIMH lists these routes.
A screen starts assessment; it does not finish it
Ask what the screen suggests and what still needs evaluation. Bring a description of symptoms, duration, effect on daily life, medicines, alcohol or other substance use, and previous treatment. Tell the clinician about periods of unusually elevated or irritable mood, major sleep changes, and any safety concerns rather than assuming they are unrelated.
NIMH explains that depression assessment considers symptoms and functioning, and that medical conditions or medicines can sometimes produce similar symptoms. Treatment is selected with attention to needs, preferences, and the clinical situation. See NIMH’s depression overview.
Before leaving, clarify whether an assessment is complete, another appointment is needed, or a referral is pending. Ask who will contact you and by when. If the referred service is unavailable, tell the original team; an unfilled appointment slot should remain an unresolved care task, not appear as completed treatment.
Know who does what in the treatment plan
Psychotherapy, medicines, and combinations of approaches may be considered for depression. NIMH describes psychotherapy as treatment with a trained professional and notes that the choice of care depends on the individual. A support group, an app, and a clinical treatment appointment can serve different purposes.
Ask each professional to explain their role. Who provides therapy? Who prescribes? Who checks progress? Who can respond between visits? If care is described as collaborative, ask how the professionals communicate and what you should do when their instructions differ. A program name is less useful than a reachable contact and an agreed next step.
Discuss practical constraints early: work schedule, privacy for video visits, language, transport, cost, and accessibility. Ask what can be adjusted and what alternatives are clinically appropriate. Supporters can help with tasks if you want them involved, but your preferences about participation and information sharing should be explicit.
Follow a treatment trial with more than “better” or “worse”
Choose a few indicators that matter in daily life: getting out of bed, attending work, sleeping more consistently, spending time with others, or reducing episodes of substance use. Ask when to review benefit and what changes should prompt earlier contact.
For medication, record the start date, actual use, missed doses, and possible side effects. Ask about interactions and what to do if a dose is missed or the supply runs low. NIMH advises discussing medicines with the prescriber before starting or stopping them; an unsupervised change can make the next assessment harder and may be unsafe.
If treatment is not helping, say what has happened rather than concluding that all treatment has failed. Was the medicine obtained? Were appointments available? Did side effects prevent use? Did the plan address the main problem? Those are different reasons for reassessment. The results and referral guide can help organize the unfinished steps.
Alcohol-use treatment has several routes
Alcohol-use disorder can be treated through behavioral care, medication when appropriate, and recovery support. NIAAA describes outpatient, more intensive, and residential settings and emphasizes matching care to the person. A mutual-support group may add support, but it does not answer every medical question. See NIAAA’s treatment guide.
Tell the clinician about drinking patterns, previous attempts to stop, and any withdrawal symptoms. Suddenly stopping after prolonged heavy use can cause dangerous withdrawal; seek medical help to plan a safe approach. Seizures, fever, severe confusion, hallucinations, or an irregular heartbeat during alcohol withdrawal are emergencies: call 911 or go to the emergency department.
Ask how the program handles a return to drinking and whether it provides or coordinates medication treatment. Discuss the outcome you want and how progress will be assessed. A setback is information for revising care, not a reason to conceal symptoms or assume you are no longer entitled to help.
Protect continuity for opioid-use treatment
SAMHSA’s medications for opioid-use disorder resource identifies methadone, buprenorphine, and naltrexone as approved treatment options. They are not interchangeable for every person, and treatment initiation or changes require an appropriate clinician. This guide does not provide a self-starting or tapering protocol.
Ask who handles prescriptions or dosing, what happens during travel or hospitalization, and which contact can help if access is interrupted. Tell a receiving hospital or new clinician about existing treatment so continuity can be planned. Do not assume a referral alone transfers the prescribing responsibility.
Discuss naloxone and how household members can recognize an overdose. If someone cannot be awakened or has dangerously slowed breathing and opioid overdose is suspected, administer naloxone if available and call 911; follow product instructions and emergency guidance. CDC explains naloxone and emergency response. See also the existing opioid-safety guide.
Make discharge a handover with a backup route
After crisis care, detoxification, or hospitalization, ask for a plain-language summary of what happened and the current plan. Confirm the medication supply, the next appointment, transport, and which team will respond before that appointment. Identify what remains pending, including tests or referrals.
Work with the treating team on an individualized safety plan where appropriate. It should identify warning signs, useful actions, people or services to contact, and emergency routes. A promise to “call if things get worse” is less practical than a plan the person can find and use when distressed.
If the follow-up service cancels or cannot accept the referral, contact the discharging or coordinating team promptly for an alternative. Household support can help with the mechanics without replacing treatment. The home-care handoff guide and sleep and fatigue assessment guide address related tasks.
Fictional worked example: a referral that never became treatment
Sam, 35, has a positive depression screen and agrees to counseling. Two weeks later, the referred office says it does not accept the insurance plan. Sam has not received therapy and worries that the record will show a missed appointment.
Sam contacts primary care, explains the access problem, and asks for the record to reflect that the referral was not completed. The team reassesses current symptoms and safety, identifies another option, and agrees on a follow-up contact while access is arranged. Sam writes down who is responsible for each action.
This example does not prescribe a treatment or assume a particular level of risk. It shows why a logistical barrier needs to remain visible to the clinical team instead of being mistaken for a completed course of care.
Printable treatment-continuity worksheet
Complete this with the treating team. Keep crisis instructions immediately accessible and other personal information private.
| Item | My plan |
|---|---|
| Main problem and daily-life goal | ______ |
| Assessment completed / question still open | ______ |
| Therapy or recovery contact | ______ |
| Prescriber and refill contact | ______ |
| Changes to monitor and review date | ______ |
| Side effects or urgent changes to report | ______ |
| Appointment, transport, or cost barrier | ______ |
| Backup contact if care is interrupted | ______ |
| Crisis and emergency instructions | ______ |
Questions readers ask
Does a positive screen mean I must take medication?
No. It indicates a need to discuss the result and, when appropriate, complete an assessment. Treatment decisions depend on that assessment, your preferences, expected benefits and burdens, and safety needs.
What if I do not connect with the first therapist?
Explain what is not working: the approach, communication, scheduling, or another concern. Ask about adjustment or another referral while maintaining any needed interim care. Do not let a poor fit become an unexplained end to follow-up.
Can a supporter call for me?
A supporter can help with practical tasks or share concerns, subject to the service’s privacy and authorization process. Agree on their role with your team. Their help does not replace your own participation or give automatic access to every record.
Sources and scope
Primary sources: NIMH depression and help routes; NIAAA alcohol treatment; SAMHSA opioid-use treatment; CDC naloxone.
Prepared November 5, 2026, Pacific. human clinical review pending. This guide supports treatment navigation. Individual psychiatric diagnosis, withdrawal management, prescribing, and crisis care require qualified clinical assessment.