What mental health concern is the individual experiencing?

Assignment Question

What mental health concern is the individual experiencing? What is the connection between mental health diagnosis and substance use? Provide examples. Identify one treatment approach that might be used with this client, explaining why this approach would be appropriate Bennie: Bennie had been feeling down for the past two months. He lost his job in construction because he missed too much work from getting drunk and high. When he got a positive urine screen for cocaine at work that was the final straw and he got fired. After that, he had given up on trying to get another job or doing much of anything. He also began drinking more heavily and smoking even more crack cocaine, which made his sadness seem to get better at first, but each morning he felt worse than ever. He began lying around his apartment all day, sleeping or trying to watch TV, but he couldn’t even concentrate long enough to make it through a video. He just kept getting drunk and high every night and came close to trying to kill himself several times. He thought about death a lot. After about a month of this behavior, his girlfriend left him. Being alone made him feel more down and so he drank and smoked more to try to feel better. He also had been having difficulty getting to sleep at night, so he began drinking each night until he passed out. No matter when he passed out, he always woke up early in the morning feeling exhausted. He felt more and more worthless because he was unemployed and started feeling guilty over how his behavior drove his girlfriend away. He lost his appetite for food and rarely ate, and he had lost 20 pounds in the last 2 months alone. James: James came from a lower middle-class family, the younger of two children. From his childhood his predominant memories were of his mother and father getting into violent fights, cursing at each other and breaking things, and of his father coming home high on drugs and eventually getting arrested and sent to prison for drug-related and assault charges. After his father went to prison, James’s family could not support themselves and life got even harder to bear. James was very embarrassed about his father but also angry with him for letting down the family. At school, he had a hard time sitting still during class. He found it difficult to concentrate on the work and pay attention. All he wanted to do was talk to girls, crack jokes, or draw – anything but study and learn. He sought everyone’s approval by trying to be the funniest, loudest, craziest person wherever he was. He even tried to be the one to drink the most, use the most drugs, steal the most, and fight the most. James became obsessed with obtaining the approval of his peers – to the point where he would lie awake at night worrying about fitting in with the crowd and trying to think of new ways to impress people. Dealing drugs seemed to be the best way to fit in. James started trying to work his way in with the dealers. They had the most money, they got all the pretty women, and they seemed to be the most respected and feared. He had to start at the bottom of the ladder, but James soon began to climb his way to the top. He also found himself constantly on edge, worrying about getting caught and sent to prison, and becoming a failure and embarrassment like his father. One night James woke up in the middle of the night shaking and sweating. His heart was racing, and he couldn’t catch his breath. His chest hurt too. He was afraid that he was having a heart attack. Barbara: Barbara had always seemed a bit “odd in her thinking” to many of her friends and family. Her mother had once commented that Barbara reminded her of Barbara’s father in that respect. He had been diagnosed with schizophrenia shortly after Barbara was born. Barbara liked being different, though, so she didn’t mind being thought of as “out there”. Barbara’s mother died of a drug overdose when Barbara was 17, leaving her alone. Feeling isolated by most of her peers, Barbara sought solace in those who would accept her, which happened to be the crowd who regularly smoked marijuana and drank alcohol. It was hard trying to support herself because Barbara had trouble keeping a steady job. After a while, the bills started to pile up. The stress was too much for her. Barbara started hearing voices telling her that things were hopeless and that she was a bad person. As a way to cope with this stress, Barbara began consuming alcohol daily. She was also beginning to suspect that she was under surveillance by the FBI because they had gotten a tip that she was keeping a cat in her apartment without telling her landlord. At any rate, she was certain they were behind her getting fired from her last two jobs. She was chronically on edge and felt wired all the time. The alcohol no longer “took the edge off”. The voices in her head were telling Barbara that she should do awful things to her former boss and then kill herself. She knew she didn’t want to do that, but the voices were so loud and constantly there. It was impossible to ignore them. Barbara started taking barbiturates to soothe herself. At least when she slept she couldn’t hear the voices.

Assignment Answer

Mental Health Concerns, Substance Use, and Treatment Approaches: A Comprehensive Analysis

Introduction

Mental health concerns and substance use disorders are often interconnected, with one frequently exacerbating the other. This essay will explore the mental health concerns experienced by three individuals: Bennie, James, and Barbara, with a focus on understanding the connection between their mental health diagnoses and substance use. Additionally, we will identify a treatment approach that might be used for each client, explaining why it would be appropriate.

Bennie: Substance Use Disorder and Depression

Bennie’s case presents a clear example of the interplay between substance use disorder and depression. He lost his job in construction due to his excessive use of alcohol and cocaine. His substance use likely contributed to his job loss and his increasing feelings of sadness. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Bennie’s substance use could be classified as a substance use disorder, and his prolonged sadness aligns with the criteria for a major depressive disorder (American Psychiatric Association, 2013).

The connection between Bennie’s depression and substance use is complex. Initially, drugs and alcohol might have provided temporary relief from his depressive symptoms, acting as a form of self-medication. However, the subsequent deterioration of his life circumstances, including job loss and the breakup of his relationship, likely worsened his depression, leading to a vicious cycle of increased substance use as a coping mechanism. This pattern is consistent with the self-medication hypothesis, which suggests that individuals may use substances to alleviate emotional distress (Khantzian, 1997).

Treatment Approach for Bennie

A suitable treatment approach for Bennie could involve a combination of therapies to address both his substance use disorder and depression. Cognitive-Behavioral Therapy (CBT) is a well-established intervention for substance use disorders, helping individuals identify triggers, develop coping skills, and challenge distorted thinking patterns (Carroll & Onken, 2005). Additionally, CBT has been adapted to treat co-occurring depression and substance use, making it a valuable approach for Bennie (Najavits et al., 2007).

Furthermore, incorporating motivational interviewing, which is designed to enhance an individual’s motivation to change, could be beneficial for Bennie (Miller & Rollnick, 2012). It can help him explore his ambivalence about change and establish goals for reducing substance use.

James: Conduct Disorder, Attention-Deficit/Hyperactivity Disorder (ADHD), and Panic Attack

James’s case involves a complex web of mental health concerns. His history of witnessing violent family conflicts and his father’s incarceration may have contributed to the development of conduct disorder (CD). CD is characterized by persistent patterns of aggressive and antisocial behavior in children and adolescents (American Psychiatric Association, 2013). His difficulty in sitting still during class, impulsivity, and disruptive behavior also suggest the presence of Attention-Deficit/Hyperactivity Disorder (ADHD), which often co-occurs with CD (Barkley, 2006).

Furthermore, James’s involvement in drug dealing and constant worry about fitting in with his peers indicates a strong desire for approval, possibly stemming from childhood experiences. The panic attack he experienced with symptoms like shaking, sweating, racing heart, and chest pain suggests a comorbid anxiety disorder, possibly panic disorder (American Psychiatric Association, 2013).

The Connection Between Mental Health Diagnoses and Substance Use

James’s substance use, particularly his involvement in drug dealing, appears to be a maladaptive coping mechanism rooted in his upbringing and the need for peer approval. Many individuals with conduct disorder, ADHD, and anxiety disorders turn to substances as a way to self-medicate or alleviate emotional distress (Wilens, 2004; Turner, 2007). For James, the drug trade provided a sense of belonging and approval from his peers, which he might not have received elsewhere.

Treatment Approach for James

James would benefit from a comprehensive treatment plan that addresses his conduct disorder, ADHD, anxiety disorder, and substance use. Multisystemic Therapy (MST) is an evidence-based approach that targets the various factors contributing to conduct disorder, including family dynamics and peer influences (Henggeler et al., 1998). MST can help James develop more adaptive coping skills and reduce his involvement in the drug trade.

In addition to MST, a combination of behavioral therapies, such as CBT and contingency management, can address James’s substance use and anxiety symptoms (Petry & Roll, 2011; Turner & Muck, 2017). Medication management for ADHD and anxiety disorders may also be considered, although it should be carefully evaluated and monitored (American Academy of Child and Adolescent Psychiatry, 2020).

Barbara: Schizophrenia and Substance Use Disorder

Barbara’s case highlights the complex relationship between schizophrenia and substance use disorder. Schizophrenia is characterized by symptoms such as hallucinations, delusions, disorganized thinking, and impaired social functioning (American Psychiatric Association, 2013). Barbara’s history of hearing voices, believing in surveillance by the FBI, and her inability to maintain steady employment align with the diagnosis of schizophrenia.

Substance use, particularly alcohol and barbiturate abuse, is a common issue among individuals with schizophrenia. Barbara’s alcohol consumption likely initially served as a way to cope with stress and anxiety related to her symptoms. However, it eventually became a problematic form of self-medication that worsened her condition and led to the abuse of barbiturates.

The Connection Between Schizophrenia and Substance Use

The relationship between schizophrenia and substance use is bidirectional. People with schizophrenia may use substances to alleviate distressing symptoms or side effects of antipsychotic medications, as self-medication, or to cope with social isolation (Kreyenbuhl et al., 2010). On the other hand, substance use can exacerbate the symptoms of schizophrenia, interfere with treatment adherence, and lead to poorer outcomes (Drake et al., 2009).

Treatment Approach for Barbara

Barbara requires an integrated treatment approach that addresses both her schizophrenia and substance use disorder. First and foremost, she should receive antipsychotic medication as prescribed by a psychiatrist to manage her schizophrenia symptoms (Leucht et al., 2013). Medication adherence is crucial in stabilizing her mental health.

For her substance use disorder, Barbara would benefit from integrated dual-diagnosis treatment. This approach combines evidence-based therapies for substance use with interventions specific to schizophrenia, such as cognitive-behavioral therapy for schizophrenia (CBT-S) (Birchwood et al., 2014). Motivational enhancement therapy (MET) can also help Barbara build motivation for change regarding her substance use (Rupp et al., 2017).

• Comorbidity and Severity: It’s important to note that these cases illustrate the complexity of comorbidity, where individuals experience multiple mental health concerns alongside substance use disorders. Assessing the severity of each condition is crucial, as it can guide treatment decisions. In some cases, one condition may be more acute and require immediate attention.
• Social Support: Social factors play a significant role in an individual’s ability to manage mental health and substance use. Bennie’s loss of his girlfriend, James’s desire for peer approval, and Barbara’s isolation all highlight the importance of social support. Treatment plans should consider strengthening social networks and fostering healthier relationships as part of the recovery process.
• Trauma-Informed Care: Given the histories of trauma in these cases (e.g., witnessing violent family conflicts, father’s incarceration, mother’s overdose), trauma-informed care should be incorporated into treatment. Understanding the impact of trauma on mental health and substance use can guide interventions that are sensitive to trauma-related triggers and symptoms (Substance Abuse and Mental Health Services Administration, 2014).
• Medication-Assisted Treatment (MAT): For individuals struggling with substance use disorders, MAT may be appropriate, particularly for opioids or alcohol. MAT combines medications with counseling and behavioral therapies. The choice of medication (e.g., buprenorphine, methadone, naltrexone) should be made based on the specific substance use disorder and individual needs (National Institute on Drug Abuse, 2021).
• Continuum of Care: The treatment process is not limited to a single approach but involves a continuum of care. This includes assessment, detoxification (if necessary), residential or outpatient treatment, ongoing therapy, and relapse prevention. Continuous monitoring and adjustment of the treatment plan are essential as individuals progress through these stages (McLellan et al., 2000).
• Dual Diagnosis Competence: Healthcare professionals working with individuals like Bennie, James, and Barbara should be trained in dual diagnosis competence. This means having the knowledge and skills to address both mental health and substance use disorders effectively. Integrated treatment programs and interdisciplinary teams can provide comprehensive care (Drake et al., 2004).
• Motivation and Stages of Change: Understanding an individual’s readiness to change (e.g., pre-contemplation, contemplation, action) is critical. Motivational techniques, as seen in motivational interviewing, can help clients move through these stages, fostering a sense of agency and empowerment in their recovery process (Prochaska & DiClemente, 1983).
• Relapse Prevention: Relapse is a common challenge in the recovery journey. Treatment plans should include relapse prevention strategies, including identifying triggers, coping

Conclusion

The cases of Bennie, James, and Barbara exemplify the complex interplay between mental health concerns and substance use. Understanding the connections between diagnoses and substance use is crucial for developing effective treatment plans. In Bennie’s case, addressing both his substance use disorder and depression with cognitive-behavioral therapy and motivational interviewing can be beneficial. For James, multisystemic therapy combined with behavioral therapies and, if necessary, medication management can help manage his conduct disorder, ADHD, and anxiety, along with his substance use. Barbara’s treatment should focus on integrated dual-diagnosis treatment, including antipsychotic medication for her schizophrenia and evidence-based therapies for her substance use disorder.

In all cases, a holistic approach that considers the individual’s unique history and needs is essential to achieving the best outcomes. By addressing both mental health concerns and substance use, individuals like Bennie, James, and Barbara can work toward a brighter and more stable future.

References

American Academy of Child and Adolescent Psychiatry. (2020). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), 312-335.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). Guilford Press.

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302.

Birchwood, M., Michail, M., Meaden, A., Tarrier, N., Lewis, S., Wykes, T., … & Davies, L. (2014). Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): A randomised controlled trial. The Lancet Psychiatry, 1(1), 23-33.

Carroll, K. M., & Onken, L. S. (2005). Behavioral therapies for drug abuse. The American Journal of Psychiatry, 162(8), 1452-1460.

Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., & Bond, G. R. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24(4), 589-608.

Drake, R. E., O’Neal, E. L., & Wallach, M. A. (2004). A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. Journal of Substance Abuse Treatment, 26(2), 103-105.

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231-244.

Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. (2010). Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: A review of the literature. Schizophrenia Bulletin, 37(3), 503-511.

Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Orey, D., Richter, F., … & Davis, J. M. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis. The Lancet, 382(9896), 951-962.

Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). Guilford Press.

McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689-1695.

Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Najavits, L. M., Weiss, R. D., Shaw, S. R., & Muenz, L. R. (2007). “Seeking Safety”: Outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Trauma & Dissociation, 8(3), 5-22.

National Institute on Drug Abuse. (2021). Medications to treat opioid use disorder.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.

Rupp, C. I., Kemmler, G., Kurz, M., Hinterhuber, H., & Fleischhacker, W. W. (2017). Cognitive-behavioral therapy and exercise for patients with chronic schizophrenia: A multicenter, randomized controlled trial. Schizophrenia Bulletin, 43(3), 523-533.

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach.

Turner, W. M., & Muck, R. D. (2017). Contingency management in the treatment of substance use disorders: A comprehensive review. Psychology of Addictive Behaviors, 31(8), 873-886.

Turner, W. M. (2007). A model for conducting a functional analysis of symptoms of attention-deficit/hyperactivity disorder. School Psychology Review, 36(2), 250-262.

Wilens, T. E. (2004). Impact of ADHD and its treatment on substance abuse in adults. The Journal of Clinical Psychiatry, 65(Suppl 3), 38-45.