DH Case Study: Co-occurring Substance Abuse with Depression
Today we discuss the case of a male client in his early 30s. He presented for treatment for alcohol use disorder, substance use disorder, depression, and a history of suicide attempts. He reported abusing substances before the age of 10 and being diagnosed with depression after being admitted to treatment for the first time. He also suffered a history of suicidal thoughts and attempts due to carrying the burden of guilt and shame caused by the death of a close family member. The client took a leave of absence from work to seek treatment, had run-ins with law enforcement several times and had been to treatment twice before.
The Therapeutic Process
The client was placed in the PHP level of care. He was honest with his therapist about relapsing while in treatment. He was planning on returning back home to complete his probation. This, despite clinical concerns related to his history of relapsing in his home environment. This is exacerbated by a toxic relationship with his spouse and lack of sober support. Client’s mindset was to leave after 45 total days of treatment. Therapy was focused on how this client functioned internally and dealing with his emotions externally resulting in him having negative consequences. Client was able to get honest about his mental health, specifically feeling depressed and suicidal, along with being in an abusive relationship. After some time, he was able to speak more about his relationship with his loved one, and eventually the client was able to grieve properly, gain closure, and come to a state of acceptance. He was able to make connections that he drank alcohol, abused substances, and self-harmed to cope with his depression and grief.
Client addressed his depression, substance abuse, legal issues, employment, and his past SI in collaboration with his therapist, case management, and psychiatrist. Through his course of treatment, he was able to recognize that he was abusing substances to self-medicate, accept the psychiatrist’s recommendation of incorporating anti-depressants and anti-craving medications into his treatment plan, and commit to re-locating to prevent his continued cycle of relapses. The therapist utilized Motivational Interviewing, Cognitive Behavioral Therapy, psychoeducation on the 12-step of Alcoholics Anonymous, and group interventions such as role-playing utilizing the “empty chair” format where he was properly able to say goodbye to his mother.
Client was discharged into local sober living and aftercare treatment with a structured relapse prevention plan, a sponsor, and connections to the alumni programming to encourage continued progress and engagement in his recovery.