Hypothetical Client Example

Derek, an African American male, aged 40 deal with mental illness (depression) and a substance (alcohol).  Derek is married and works at the local Piggly Wiggly as the Assistant Manager. His wife reports that he spends more time at the bar after work then he does at home. Derek also has two sons age 12 and 15. He sons say that their dad has missed several of their games or when he comes he is drunk and embarrassing.  Derek has received several DUI’s and has missed some of his appointments with his mental health counselor. Derek declares that his drinking is under control and that he drinks to ease his sad moods. An integrative treatment approach would work for Derek since he displays signs of a mental illness coupled with a substance use issue. The evidence for mental health and addiction service integration is strong (Woods & Drake, 2011) so getting Derek into such a program will help him tremendously.  It would be important to get him services that will allow him to focus on his behavior, his substance use, and to help him connect with community resources.  In process this would include a multidisciplinary team engaging him in the community using outreach, support, motivational interviewing, and other techniques.  Bond, Drake, Mueser, and Latimer (2001) discuss a holistic approach known as Assertive Community Treatment (ACT) that is geared towards providing services like helping with medications and finances or any need the client may present. This treatment seems to fulfill the needs that Derek need to help him with his depressive symptoms and alcohol use.

References

Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness. Disease management and health outcomes, 9(3), 141-159.

Torrey, W. C., Tepper, M., & Greenwold, J. (2011). Implementing integrated services for adults with co-occurring substance use disorders and psychiatric illnesses: A research review. Journal of Dual Diagnosis, 7(3), 150–161.
Retrieved from the Walden Library databases.

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.

Woods, M. R., & Drake, R. E. (2011). Treatment of a young man with psychosis and polysubstance abuse. Journal of Dual Diagnosis, 7(3), 175–185.

Retrieved from the Walden Library databases.

3. Classmate (L. Sim)

It is important to understand the presentation of an individual with co-occurring addiction and mental health issues. Different concerns will arise, requiring specific treatment. Van Wormer and Davis (2018) shared that treatment of individuals with coexisting disorders needs a supportive, long-term commitment and a combination of substance abuse and mental health treatment approaches. There must be an understanding of how to treat all aspects of an individual. Utilizing an integrated approach will be beneficial, even with presented weaknesses.

Strengths and Weaknesses

There are both strengths and weaknesses with an integrated treatment approach. Utilizing an integrated approach suggests treatment of an individual entirely. It allows for the individual to be looked at as an individual, as different treatment needs are addressed. Further, Van Wormer and Davis (2018) shared that simultaneous treatment is provided for mental health and substance abuse, also meaning an individual only must travel to one location. This may be a huge benefit for someone, certainly if they are struggling with their mental health and addiction. Another strength of this approach is how it looks at individuals through a strengths-based perspective (Van Wormer & Davis, 2018). Treating individuals with a strength perspective will provide support and encourage personal motivation to be successful in treatment.

Services should include specifically trained employees, including 24-hour availability (Van Wormer & Davis, 2018), which is a weakness of integrated treatment. The specialist needed may not be available, requiring other staff members. There is a potential need for many staff members to be employed. Additionally, Torrey, Tepper, and, Greenwold (2011) stated that integrated treatment is long term and the process can be long to successful treatment. This extensive time frame for treatment can present as a weakness, where individuals may struggle to remain engaged and committed.

Client

Jack is a 35-year-old man, who is presenting with symptoms suggesting a mental health disorder and substance abuse disorder. He reports hearing voices, the inability to speak clearly and in an organized manner, and behaviors which have caused him to be unable to maintain a job. Jack is diagnosed with schizophrenia. In addition to this diagnosis, Jack has been utilizing drugs. Van Wormer and Davis (2018) shared that 50% of those diagnosed with schizophrenia have comorbid substance abuse. Jack presents with significant symptoms related to his mental health diagnosis. Due to his presentation, working with Jack from the quadrant model, he fits into category II (Van Wormer & Davis, 2018) as his schizophrenia is more severe.

Assessment and treatment need to be appropriate for Jack. Lubman, King, and Castle (2010) shared that there needs to be comprehensive assessment with access to a large range of interventions. Assessment can assist with understanding the severity of the disorders Jack presents with. This can allow clinicians to understand where Jack is and help him receive treatment in the best environment. As stated, he fits in category II, where he would receive treatment in a mental health system. Lubman et al. (2018) shared that psychopharmacological intervention is appropriate for treating schizophrenic symptoms with comorbid substance use. This is important for Jack, as medication can work to limit his experienced schizophrenic symptoms. Further, psychosocial interventions are appropriate, which is a must in conjunction with medication (Lubman et al., 2018). It is important to note the need for different interventions and the concept of the impact on both disorders. Lubman et al. (2018) shared that one intervention alone was not successfully, but including cognitive behavioral therapy (CBT), motivational interviewing (MI), and family work prove to be successful. Again, this speaks to the need for an integral approach. Utilizing CBT and MI with Jack can assist him with understanding presenting symptoms, potential warning signs for psychosis and relapse, and help him to understand how his disorders impact his life. His understanding of the negative impact can support his want to change, impacting his dedication and commitment.

Conclusion

Individuals presenting with co-occurring disorders need to receive integral treatment, as they need to be addressed in their entirety. Understanding the needs of individuals with co-occurring disorders is important. Integral treatment approaches encourage the best treatment, as both disorders and their specific impacts are addressed.

References

Lubman, D. I., King, J. A., & Castle, D. J. (2010). Treating comorbid substance use disorders in schizophrenia. International Review of Psychiatry, 22(2), 191. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edb&AN=50872258&site=eds-live&scope=site

Torrey, W. C., Tepper, M., & Greenwold, J. (2011). Implementing integrated services for adults with co-occurring substance use disorders and psychiatric illnesses: A research review. Journal of Dual Diagnosis, 7(3), 150–161.

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.

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Required Resources

• Van      Wormer, K., & Davis, D. R. (2018). Addiction treatment: A      strengths perspective (4th ed.). Boston, MA: Cengage.
  • Chapter       4, “Substance Misuse with a Co-occurring Mental Disorder or Disability”       (pp. 151-190)
• Drapalski,      A., Bennett, M., & Bellack, A. (2011). Gender differences in substance      abuse, consequences, motivation to change, and treatment seeking in people      with serious mental illness. Substance Use & Misuse, 46(6),      808–818. Retrieved from the Walden Library databases.
• Kennedy,      K., & Gregoire, T. K. (2009). Theories of motivation in addiction      treatment: Testing the relationship of the transtheoretical model of      change and self-determination theory. Journal of Social Work      Practice in the Addictions, 9(2), 163–183. Retrieved from the Walden      Library databases.
• Kerfoot,      K., Petrakis, I. L., & Rosenheck, R. A. (2011). Dual diagnosis in an      aging population: Prevalence of psychiatric disorders, comorbid substance      abuse, and mental health service utilization in the Department of Veterans      Affairs. Journal of Dual Diagnosis, 7(1/2), 4–13. Retrieved      from the Walden Library databases.
• Lachman,      A. (2012). Dual diagnosis in adolescence—An escalating risk. Journal      of Child & Adolescent Mental Health, 24(1), pv–vii. Retrieved from      the Walden Library databases.
• Torrey,      W. C., Tepper, M., & Greenwold, J. (2011). Implementing integrated      services for adults with co-occurring substance use disorders and      psychiatric illnesses: A research review. Journal of Dual      Diagnosis, 7(3), 150–161. Retrieved from the Walden Library databases.
• Woods,      M. R., & Drake, R. E. (2011). Treatment of a young man with psychosis      and polysubstance abuse. Journal of Dual Diagnosis, 7(3),      175–185. Retrieved from the Walden Library databases.