Mid-Twenties Client with Cooccurring Mental Illness and Substance Abuse
Client was a mid-twenties male from the West Coast. He presented for treatment to address problem areas such as Schizoaffective Disorder, Bipolar Type, with symptoms of rage, anger, physical aggression and substance abuse issues. The client has a history of being administratively discharged from previous treatment centers. The client reported “I am trying to get my life right.” Client struggled with communicating and interacting positively with others as evidenced by verbal and physical abuse of others, disrespect for others, throwing chairs and increased profanity. Client reported that he had a history of abusing substances daily for the previous 5 years. Client presented with mental health symptoms related to depression and anxiety. The client lacked coping skills and had very little insight into his substance abuse/mental health issues. The client realized he was homeless, had no finances and had burned his bridges with his family and friends. Initially, the client denied needing treatment, but realized he would like to work on “having a successful and happy life.” Client then realized the importance of building a positive sober support network.
The client began his treatment at the Residential level of care, and eventually was able to complete the PHP and IOP levels of care while residing at the Cottages Transitional Living. Therapeutic interventions used in treatment were role playing techniques and Cognitive Behavioral Therapy to address the client’s addiction, mental health symptoms of Depression and Anxiety with special emphasis on coping with feelings of shame and guilt. Coping skills utilized identifying forgiveness of self in order to release feelings of shame and guilt relating to disappointing his family and friends during his addiction to substances and with his legal issues.
The client’s motivation to be successful and live a life like his father served him well. The client had a brief relapse during treatment. Through the use of therapeutic interventions, the client was able to improve his motivation, communication, judgement and insight for treatment. The client was more open and cooperative with attending and participating in groups and in individual therapy sessions, was motivated to get a job, was open to attend church services weekly, he picked up reading and attended AA/NA meetings. The client was able to remove all negative peers and past friends, focused on building his relationship with his parents and began to build relationships with those who are sober and who he felt would be a good influence and support. The client was able to rekindle his relationship with a spiritual higher power for support. His mood, affect and cognitive functioning improved throughout the treatment process and he was able to interact better with peers and staff, speak more clearly, respectfully and appropriately. He improved the relationship with his family, learned how to avoid negativity from others and gained insight into his past.
Client made progress in decreasing his anxious, irritable and depressive symptoms and he had no cravings or dreams to abuse substances and the client felt “ready” to return back to the West coast upon discharge. The client’s father participated in weekly family therapy sessions. The client’s plan for discharge was moving back to a structured living on the West coast where he reunited with his family and slowly returned back to work. Client returned home and continued treatment with Outpatient Therapy and Psychiatric Services after completion of his PHP programming.
Client was motivated to attend weekly AA/NA meetings, looking for work, rebuilding his support network, continuing with medication management and therapy services and following through with aftercare recommendations.
Client has since been in touch with his therapist and reports currently working, attending AA/NA meetings and going to church.