Co-occurring Disorders Worksheets for Therapists

Authored by Dr. Hannah Lin, counseling psychologist trained in CBT, ACT, and IFS, with over a decade of clinical practice in anxiety and complex trauma.

Marcus slides two completed pages across the desk. The thought record is tidy: late meeting, “I will get fired,” anxiety 8. The craving log is tidy too: two vodka sodas after work, urge 7, “stressed.” Neither page names the parking garage.

The hour you both skipped sits between those sheets. Chest tightness in the garage, then the liquor store, then sleep. A GAD form that never names the drink will keep treating worry. A use log that never names the panic will keep counting ounces.

Fill one joined row in the room, then send co-occurring disorders worksheets as a single high-risk log, not a week of blank grids.

For other presenting concerns, start with the mental health worksheets hub.

Use the pack when you want a printable clinician assignment sheet, cue-and-function map, high-risk day log, and next-session review beside these fields.

Educational content for licensed therapists, not clinical or legal advice. Format selection sits inside formulation, consent, window of tolerance, and medical risk. An integrated cue log is not a SAMHSA protocol, not detox, and not a 12-step fellowship form.

Put both tracks on one row

SAMHSA uses co-occurring disorder for a mental illness and a substance use disorder in the same person, and it recommends integrated care rather than treating one track while the other waits. TIP 42 makes the same clinical bet: treat the SUD and the mental disorder concurrently when you have the competence and the setting to do it.

The paper has to make that bet visible. One row has to hold:

Field	Client writes	Therapist watches for
Setting	Where, when, with whom. Facts.	A story that skips the parking garage
Mental health cue	Mood, anxiety, trauma body, sleep, shame	”Stressed” with no texture
Urge	0-10 for use, plus what they wanted	A drink count with no urge
Response	Used, delayed, or refused. What, how much.	Moral language instead of behavior
Function	What the use (or the ritual) did for the cue	Insight poetry with no short-term payoff
Cost	What happened to the symptom, sleep, or risk after	Only the hangover, or only the guilt

The cue is the first link, not a lecture. Use is often the solution that worked for twenty minutes. Function is the clinical target. Cost tells you whether last night’s “help” is still running today’s depression.

Older chart language still says dual diagnosis. Keep that phrase in the note if your setting uses it. On the page in front of the client, name the two problems in their words: the panic and the vodka, the low Sunday and the cannabis, the nightmare and the leftover benzos.

Why a thought record plus a craving log still misses

A thought record can be the right CBT tool for GAD. A craving log can be the right SUD tool for alcohol use disorder. Stapled together, they still miss the join if the client fills them on different nights, in different rooms, with different honesty.

The mood page hides the substance. The client is often not lying. They learned that therapy is for feelings and that use is for the other program, the sponsor, or nobody.

The use page hides the cue. “I drank because I drank” is a closed loop. You cannot intervene on a loop that starts at the bottle.

The function never gets written. Without it you will assign urge surfing to a client whose drink is doing sleep, or sleep hygiene to a client whose drink is doing shame. Wrong tool, clean homework, no change.

If the job next hour is really “did they do the worksheet,” the therapy worksheet follow-up companion is the review craft.

How to assign co-occurring disorders worksheets in the hour

Do not send blank co-occurring disorders worksheets home after a two-minute explanation. Catching a function in writing is harder than catching a drink count.

Walk one complete cue-to-cost row in session, in the client language, before you ask for a week of logs. If they can say “my chest got tight in the garage” and cannot yet say what the first drink did, write that gap. The gap is the work.

Consent belongs in the same hour. Recording use on paper is not a small ask. Who sees the page. Where it lives. What happens if a partner, a roommate, or a probation officer finds it. If the housing is not private, keep the writing in session. If you still need the ethics of handing anyone a form, use the therapy worksheets guide. If the next hour is a clinician-led adult recovery group rather than a homework sheet, use fun substance abuse group activities for adults. When the homework is turning toward a fact that will not change this week rather than another cue-to-cost row, use a radical acceptance assignment.

Then assign a single between-session log, not a week’s worth. One high-risk window they already expect: after work, after the kids are down, after the nightmare. Bring the page back.

Say out loud why this sheet, what done looks like, when to stop, and what you will review next hour.

In session, fill one cue-and-function map together: setting, cue, urge, response, function, cost. If they cannot yet name a function, stop. That hour was an awareness task. Homework can be cue and response only.

Between sessions, three lines, not fourteen. Morning body and mood. Afternoon cue. Evening urge and what they did. One skill attempt, named. Write a stop rule at the top in their language: if withdrawal, if suicidal intensity, if the paper is not private, they stop writing and use the safety plan you already built.

You hold the review. Did both tracks move. Did a skill land between cue and use. Did the writing conceal either side. Keep, adapt, or retire.

When the form fits, and when it does not

Check fit before you hand over co-occurring disorders worksheets. Fit is a formulation call, not a default homework move.

Presentation	These worksheets fit?	Notes
GAD plus evening alcohol that drops arousal	Yes	Function is often shutdown, not “addiction insight”
Depression plus cannabis that fills empty hours	Often	Pair with activation so the log is not another hour in bed
PTSD nightmares plus leftover hypnotics or alcohol	After stabilization	Grounding and safety first; the log can wait a week
Panic in the moment	No	Body-led skill first; write the row after arousal drops
Active withdrawal, seizure history, or unsupervised detox	No	Medical care first. Paper does not manage withdrawal.
OCD with drinking as a ritual	Careful	A log can become a compulsion; ERP leads
Active crisis or dissociation	No	Safety and orientation first
Forensic, custody, or probation-mandated writing	Usually no	Wrong audience for an honest function statement

A second stop is relational. Some clients hear “write down what you used” as “prove you are not lying.” That is not a reason to abandon integrated work. It is a reason to slow down, name the alliance, and sometimes keep the first rows in the room until the paper is not a test.

IFS language can help when a protector is doing the using. Do not hand that part a thought record and ask it to dispute itself. Name the job: this part is trying to end the panic. Then decide whether a function row is kinder than a debate.

Worksheet fields you can copy into the chart

Keep the client page to one side. Your review sheet stays in the file.

Documentation language

Your note can carry the join without redrawing the grid.

That note is readable to a covering clinician. It names both diagnoses in play, the function, the privacy plan, and the next look, which is what utilization review can actually use.

Where Emosapien fits

Integrated rows move fast once the join is on the table: the cue surfaces, the function gets named, the client tries one delay, and you still have to write the note. Emosapien’s Scribe Agent can keep the cue in the client words, the substance response, the function you agreed, and the log you assigned in the intervention section so you are not reconstructing the sequence from memory at 7pm.

You still choose whether an integrated form is safe, whether the paper can be private, and whether the next hour keeps the sheet or retires it. The product holds the thread between this row and the next review. See the AI clinical notes overview for modality-aware documentation, or start a trial if you want that sequence in your own chart.

If you want the pack on paper, the form below sends the same four sheets.

References

• SAMHSA. Managing life with co-occurring disorders.
• Substance Abuse and Mental Health Services Administration. (2020). Substance Use Disorder Treatment for People With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series, No. 42. NCBI Bookshelf chapter 1.
• SAMHSA. Advisory: Substance Use Disorder Treatment for People with Co-Occurring Disorders (based on TIP 42).