A Risk Assessment Checklist for a Client with a Co-Occurring Disorder

A Risk Assessment Checklist for a Client with a Co-Occurring Disorder


Institutional affiliation

Persons with a co-occurring disorder are most likely to cause significant harm to both themselves and others depending on the level of risk that they may be in. According to the Centre for Substance Abuse Treatment (2005), risk of harm to either oneself or others in clients with co-occurring disorders can be rated based on the criteria outlined below.

Minimal Risk Of Harm

There is a possibility that a client may be under minimal risk of harming other people if he or she demonstrates a clear ability to take care of him/her both now and this was also true in the recent past. Moreover, if he/she admits that they have not thought of committing suicide or murder in the past and they have no such intentions for the future, then they are under minimal risk of harm. The same is also true if he/she shows no indication of distress.

Low Risk Of Harm

A client may be under low risk of causing harm to oneself or others if the following conditions holds true.First, if he/she is able to admit that they have in the past planned, thought or had an idea of committing suicide or homicide but  the case is not the same currently.Secondly,if there are no current signs of serious distress  which was present in the past, it also indicates that the level of risk is low.Thirdly,if  a client  admits that they have abused drugs in the past but did not lead to any harmful behaviours,then they may be under low risk of harm.Finally,if a client admits that he/she has in the past showed signs of inability to take care of oneself but which doesn’t hold for now, then they may be under a low risk of harm.



Moderate Risk Of Harm

A client is said to be under a moderate risk of harm if the following conditions are observed during a risk assessment. First, if a client admits that he/she is currently contemplating suicide or homicide but, has neither intent nor a conscious plan of executing it but had not thought of it in the past.Secondly,if a client shows no active suicidal or homicidal ideation but is under significant distress and but a history of suicidal or homicidal behavior exists. Thirdly, if a client admits that he/she at past had abused drugs excessively that resulted in potentially harmful behaviors but he /she is not currently exhibiting such behaviours, then he/she is under moderate risk of harm. Some evidence of neglecting or lack of ability to care for oneself in the current situation is also interpreted to mean that a client may be at a moderate risk of harm. Moreover, if a client has a history of chronic urge of suicidal or homicidal behavior or threats thereof which holds the same in the current situation, then he/she is under moderate risk.

Serious Risk Of Harm

A client will be assessed as under a serious risk of harm if he/she portrays the following mannerisms.First, he/she has in the recent past demonstrated a clear lack of ability to care for oneself or to understand the environment around him/her.Secondly,he/she presents a history of chronic impulsive behavior to commit suicide/homicide or threatened the same with a current indication of the rise in the same.Thirdly,he/she admits of a recent trend of excessive substance use which resulted in inability to avoid harmful behaviors and there is no demonstrated ability to avoid it usage. Moreover,a client clearly shows a current intent to commit suicide or homicide with an expression of intention  of  a past history of executing the plan but lacks the means for carrying out the plan or with ability to seek for safety.

Risk of Harm

If a risk assessment finds out that a client is exhibiting the behaviors outlined below, then he or she is likely to be at an extreme risk of harm.First, he/she shows recurrent episodes of violence directed towards oneself or others or shows other behaviors that result in harm while under the influence of drugs with a pattern that indicates there is no hope of controlling the use of the substances. Presence of current suicidal of homicidal behaviors or similar intentions with a plan and a means of carrying out the behavior without a significant hindrance of doing so, or presence of hallucinations which tends to overcome one’s ability to avoid the dangerous urge to kill. There may be also evidence of extreme inability to care for oneself or to monitor one’s environment adequately with evidence of injury resulting from these deficits.

Based on the criteria outlined above, a risk assessment checklist can be developed to assess whether a client is at risk of causing harm to oneself or others as shown below.

Ref Probing questions Yes No Minimal risk of harm Low risk of harm Moderate risk of harm Serious risk of harm Extreme risk of harm
1 Have you ever used alcohol or other drugs in the past six months?
2 Have you ever felt that you were excessively using drugs?
3 Have you ever tried abstaining from substance use and you found it difficult quitting?
4 Has substance use caused problems between you And others?
5 Have you ever lost your temper or gotten into serious fights while you were udder the influence of drugs?
6 Have you ever thought of killing oneself or someone else in the past?
7 Have you been under significant distress because of something you were thinking about?
8 Have you ever devised a plan of killing yourself or another person?
9 Have you ever yielded to an aggressive impulse on several occasions that resulted in serious harm to others or led to the destruction of property?
110 Do you feel safe when you are with people or when in any given environment?
11 Have you ever felt that people around you were talking ill about you even though you never found the doing that?


Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons with Co-

Occurring Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 42.).Retrieved on 20th October 2014 from: http://www.ncbi.nlm.nih.gov/books/NBK64187/


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