According to SAMHSA’s guidelines on prescribing for individuals with SMI and COD, it is important to welcome and engage these patients as they are, and to develop a relationship in which you – and their treatment team – can help them make progress over time, including making progress toward reducing substance use. However, the process of reducing and eliminating substance use may commonly take years, during which time the person will need to continue any necessary non-addictive medication for known serious mental illness or medical condition. Therefore, you should continue prescribing necessary medications for these patients’ mental illnesses. If the patients are engaging in risky behavior, it is important to monitor them more closely, not to extrude them from needed care.