Application: Dual Diagnosis

Many clients who are diagnosed with substance abuse and addiction disorders also exhibit a psychological disorder. The prevalence and complexity of this phenomenon, known as a dual diagnosis, make it imperative that you, as a counselor, know how to properly diagnose and work with substance abuse clients who also exhibit psychological disorders.

For this Application, you will examine the complexities of dual diagnosis in relation to a specific case. (see below for case sudy)

To prepare for this assignment:

• Review this week's Learning Resources, focusing on the client symptoms and characteristics that may indicate a dual diagnosis.

• Consider how the symptoms of substance abuse and those of psychological disorders make dual diagnosis particularly complex.

• Review the following case study: Jerome.

• Consider how the case study reflects the complexities of dual diagnosis.

The assignment: (1-2 pages)

• Analyze the complexity of dual diagnosis as it relates to the case study.

• Explain how specific symptoms illustrated by the client indicate more than one disorder and make diagnosis difficult.

• Provide specific examples as well as evidence from the Learning Resources to support your ideas.

Substance Abuse Counseling

Case Study

Jerome

Jerome is a 48-year-old gay-identified African American male who is seeking housing services at the state facility at which you work. Jerome has a long history of homelessness, a 20-year addiction to crack cocaine, and a history of minor arrests. He has supported himself primarily by repairing old, discarded bicycles and selling them.

When Jerome comes to the facility, he states he has not used crack for three days. During the initial interview, he does not maintain eye contact, constantly moves and shifts in his seat, and uses a very unique sentence structure that often derails: "I am on top of this whole planet, and it's hot! I feel like...you ever eat yogurt?" He describes hearing voices that direct him to deliver "the message of the good" to people he meets, and uses religious references in a number of statements about daily living.

Jerome expresses his desire to stop using crack, but his concern is that "when I stop, the Devil comes after me." You learn from Jerome's caseworker that Jerome has had connections to a street gang from whom he buys crack, and that a large part of the reason he is seeking housing at your facility is for safety because of some trouble he has gotten into with a gang member.

Learning Resources

Readings

• Course Text: Substance Abuse Counseling

o Chapter 5, "Assessment and Diagnosis" (pp. 122-154)

• Article: Bride, B. E., MacMaster, S. A., & Webb-Robins, L. (2006). Is integrated treatment of co-occurring disorders more effective than nonintegrated treatment? Best Practices in Mental Health: An International Journal, 2(2), 43-57.
Retrieved from the Walden Library databases.

• Article: Modesto-Lowe, V., Brooks, D., & Ghani, M. (2006). Alcohol dependence and suicidal behavior: From research to clinical challenges. Harvard Review of Psychiatry, 14(5), 241-248. Retrieved from the Walden Library databases.