Dual Diagnosis

Arlene’s case as was explained by her husband, revealed that she underestimated the risk posed by behaviours, such as self-injury, excessive gambling and aggression. These symptoms are often exhibited by patients on the impulsive end of this kind of behaviour. The impulsive end is characterized by a lack of care/consideration for the negative consequences of actions such as self-injury due to aggression and is typified by antisocial personality disorders. As is Arlene’s case, impulsive patients are not aware and neither do they evaluate the harm that could be caused by their actions, instead they engage in such actions because to them, the excitement or thrill they get from their actions far outweighs the possible risks of their behaviours. With regards to her erratic behaviour, Arlene’s husband has explained that she has no regular course; that she lacks regularity, wanders constantly and has an erratic heartbeat. Her husband further stated that this was not her usual behaviour, that unlike in the past, now she seemed to have erratic and impulsive behaviour (Berlin & Hollander, 2008).

Patients being treated for substance abuse, especially those who had past or have current mental health problems, as is exemplified in Arlene’s case, are often unwilling or unable to accurately report their past or present circumstances. Therefore, it is recommended that during all assessments, efforts should be made to identify and contact family members or very close friends (in Arlene’s case it was her husband), because they can provide useful and more accurate information about the patient. This is important, especially in cases where the client may be showing symptoms of mental health conditions, or when the client is impaired or when he/she cannot provide accurate information about his or her condition (SAMHSA, 2013).

As was highlighted in the vignette, Methamphetamine is an additive stimulant. It is usually in the form of powder and can be eaten or snorted. It can also be mixed with liquids and taken intravenously. The drug causes an increase in the amount of dopamine (a neurotransmitter) in the brain. High levels of dopamine are associated with the feeling of excitement, motivation, pleasure, rewards and increase in motor functions. Taking methamphetamine rapidly releases dopamine in “reward locations” of the brain, producing the euphoric “flash” or “rush” that many abusers often experience. The drug is, however, very addictive. Arlene had been repeatedly taking the drug, which caused her to become an addict. This changed her behaviours, thus, straining their marital relationship. The changes in Arlene’s behaviour can be explained by the fact that individuals who have repeatedly taken methamphetamine start experiencing mood disturbances, insomnia, confusion and anxiety. Other symptoms that may be exhibited by such individuals include symptoms of psychosis such as: delusions; hallucinations; and paranoia as was shown in Arlene’s vignette. Repeated use of the drug also has negative long-term effects on the health of thee user, including dental problems, weight loss and skin injuries from scratching. Arlene was already exhibiting some of these symptoms, for instance, she had a scarring on her wrist. In her case, there was the need to use the Diagnostic and Statistical Manual of Mental Disorders to identify and classify the mental condition she was ailing from. The criteria in the manual are direct and aimed at providing an objective evaluation of the symptoms presented in the patient in a wide range of clinical settings, namely private practice, clinical practice, in-patient, outpatient, consultation-liaison, partial hospital and primary care, as was Arlene’s case (National Institute on Drug abuse, 2014).

Treatment for Persons with Co-Occurring Disorders.

The six-dimension checklist presented in appendix E, under the title The Addiction Treatment Planner explains the consequences of drug abuse and trade between Arlene and her handlers.

1. Acute intoxication/withdrawal potential: as was revealed by her husband, Arlene has been repeatedly taking drugs for a long time and thus she was addicted. This means that a complete and successful withdrawal from the drug could only be possible if she sought professional help.

2. Biomedical complications and conditions: In Arlene’s case, there is a need to evaluate and treat co-occurring health disorders/complications. For instance, Arlene was already exhibiting symptoms of erratic and impulsive behaviours, which might have led to her unfaithfulness. Thus, the treatment of the physical conditions could lead to Arlene and her husband being reconciled.

3. Cognitive, Behavioural or Emotional conditions/complications: there is a need to evaluate and treat co-occurring mental health condition and/or complications. As was stated by her husband, Arlene was unfaithful, exhibited impulsive and aggressive behaviours, thus, there is a need to provide her with counselling and to treat her mental complications to help her go back to living a normal life.

4. Readiness to change: Though Arlene’s husband suspects she is unfaithful, he believes that the root cause of the problem is the substance abuse problem she has and that she still loves him. Thus, Arlene is likely to want to change also. However, if she is not ready to commit herself to full recovery, there might be a need to use motivational strategies to convince her to do so. If she is ready for change, it is evident that she can change her behaviour.

5. Relapse: There is a need to assess the readiness for relapse prevention and to guide the patient through the early stages of recovery when it is most difficult to stick to treatment.

6. Recovery Environment: Arlene is in a good environment that could enable her to effectively recover; this is owing to the fact that her husband is very supportive and want to see her change (Jongsma & Perkinson, 2013).

In our case, there would also be a need to determine whether the patient wants or doesn’t want further care with regards to a specific disorder, which might be co-occurring with the substance abuse disorder. This is referred to as screening. The screening procedure for co-occurring disorders is one that seeks to get clarity on whether or not there is a need for further evaluation. For instance, a substance abuse patient could be screened to check if they have symptoms of a possible mental disorder or vice versa. A screening procedure can be designed such that it can be conducted by counsellors. There are no legal restrictions as to who can do screening. Any particular screening procedure should be methodical and have a threshold measure above which patients ought to be recommended for further evaluations. Furthermore, screening procedures should also highlight what is to be done if the patient scores above the threshold and also have standard forms where the answers of the screening text ought to be entered and later given to those responsible for further evaluations. Thus, counselling and further screening ought to be part of Arlene’s treatment, this is to help treat her mental health condition and also help her reconcile with her husband (SAMHSA, 2013).

Screening, Treatment and Pharmacological Interventions

Screening would help determine whether or not Arlene has a co-occurring disorder, given that her symptoms, signs, conduct, treatment and recovery could be influenced by a co-occurring disorder. The purpose of screening isn’t to diagnose a mental or physical health disorder; instead it is to determine if there is a need for further assessments. This is why screening procedures are often brief and occur soon after patients come in for services. The screening assessment in this case would help engage Arlene in a process that would help the therapist assess whether or not there is a co-occurring disorder. Engaging Arlene in this way could also help determine her readiness for change and identify her strengths and problem areas and to take these into account in the treatment process. The screening process, if done well, could also form a solid treatment relationship that could help Arlene recover quickly.

Treatment planning creates a comprehensive set of staged, integrated program treatment and placement interventions for every disorder that is altered, as required to take into consideration matters associated with the other disorder. The arrangement is matched to the personal needs, likings, readiness, and individual goals of the client. Integrated Screen-Screening, evaluation, and treatment planning deal with both mental health and maintenance, evaluate abuse, all in the context of the other disorder and Treatment Planning (SAMHSA, 2013).

Screening is simply a procedure for assessing the possible availability of a particular issue. Assessment is a procedure for describing the nature of that specific issue and coming up with particular treatment suggestions for dealing with the issue. Thorough assessment acts as the foundation for individualized treatment arrangement. The treatment arrangement ought to be matched to the individual needs. A competently designed screening protocol or procedure determines exactly how any screening device or questions are scored and what makes up scoring positive for a certain probable problem. What actually takes place when a client scores in the positive range and presents the standard forms to record results of all later assessments is that every personnel member has conducted his/her duties in the procedure. The procedure of treating a state of mental disorder as caused by drugs entails numerous steps. The steps involved are; involving the client, taking into consideration empathic detachment, person-centered evaluation, sensitivity to gender, culture, and sexual orientation as well as sensitivity to trauma. In the screening procedure for Arlene’s case, clients might be unwilling or not capable of correctly reporting past or present situations. It is advised that all assessments entail routine procedures for discovering and contacting any family together with other security that might be helpful information. The procedure of looking for such data ought to be conducted strictly according to suitable guidelines and policies concerning confidentiality and with the permission of the client. Screening for substance use issues starts with inquiry regarding past and present substance use as well as substance-associated issues and disorders. If the client’s response is yes to having issues and/or a disorder, additional treatment is guaranteed. It is very crucial to keep in mind that if the client accepts a past substance problem, but mentions that it is currently solved, assessment is still needed. Careful exploration of the current tactics that the client is applying in order to prevent relapse is guaranteed and assists in making sure that those tactics still continue during mental health treatment (SAMHSA, 2013).

In Arlene’s case, pharmacological interventions could be engaged in varying phases of treating mental disorders caused by drug abuse and its repercussions. People presented for treatment based on the misuse of methamphetamine might also show other features of other psychiatric disorders, like depression or anxiety. Medication is known as a supplement to psychosocial treatment to offer optimal package to enhance both mental and physical health. Prescribed medicines are not a stand-alone treatment choice and are only advised as a portion of care-planned treatment (National Collaborating Centre for Mental Health (UK), n.d).

References

Berlin, H., & Hollander, E. (2008, July 1). Understanding the Differences Between Impulsivity and Compulsivity. Retrieved January 27, 2016, from http://www.psychiatrictimes.com/impulse-control-disorders/understanding-differences-between-impulsivity-and-compulsivity

Jongsma, A. E., & Perkinson, R. R. (2013). The addiction treatment planner. Hoboken, N.J: Wiley.

National Collaborating Centre for Mental Health (UK). (n.d.). PHARMACOLOGICAL INTERVENTIONS. Retrieved January 27, 2016, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0042175/

National Institute on Drug abuse. (2014, January). Methamphetamine. Retrieved January 27, 2016, from http://www.drugabuse.gov/publications/drugfacts/methamphetamine

Substance Abuse and Mental Health Services Administration (SAMHSA) (2013). Substance Abuse Treatment for Persons with Co-Occurring Disorders: Treatment Improvement Protocol Series

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