case study 1 for substance related disorders jack

Module 9: Substance-Related and Addictive Disorders

Case studies: substance-abuse disorders, learning objectives.

Identify substance abuse disorders in case studies

Case Study: Benny

The following story comes from Benny, a 28-year-old living in the Metro Detroit area, USA. Read through the interview as he recounts his experiences dealing with addiction and recovery.

Q : How long have you been in recovery?

Benny : I have been in recovery for nine years. My sobriety date is April 21, 2010.

Q: What can you tell us about the last months/years of your drinking before you gave up?

Benny : To sum it up, it was a living hell. Every day I would wake up and promise myself I would not drink that day and by the evening I was intoxicated once again. I was a hardcore drug user and excessively taking ADHD medication such as Adderall, Vyvance, and Ritalin. I would abuse pills throughout the day and take sedatives at night, whether it was alcohol or a benzodiazepine. During the last month of my drinking, I was detached from reality, friends, and family, but also myself. I was isolated in my dark, cold, dorm room and suffered from extreme paranoia for weeks. I gave up going to school and the only person I was in contact with was my drug dealer.

Q : What was the final straw that led you to get sober?

Benny : I had been to drug rehab before and always relapsed afterwards. There were many situations that I can consider the final straw that led me to sobriety. However, the most notable was on an overcast, chilly October day. I was on an Adderall bender. I didn’t rest or sleep for five days. One morning I took a handful of Adderall in an effort to take the pain of addiction away. I knew it wouldn’t, but I was seeking any sort of relief. The damage this dosage caused to my brain led to a drug-induced psychosis. I was having small hallucinations here and there from the chemicals and a lack of sleep, but this time was different. I was in my own reality and my heart was racing. I had an awful reaction. The hallucinations got so real and my heart rate was beyond thumping. That day I ended up in the psych ward with very little recollection of how I ended up there. I had never been so afraid in my life. I could have died and that was enough for me to want to change.

Q : How was it for you in the early days? What was most difficult?

Benny : I had a different experience than most do in early sobriety. I was stuck in a drug-induced psychosis for the first four months of sobriety. My life was consumed by Alcoholics Anonymous meetings every day and sometimes two a day. I found guidance, friendship, and strength through these meetings. To say early sobriety was fun and easy would be a lie. However, I did learn it was possible to live a life without the use of drugs and alcohol. I also learned how to have fun once again. The most difficult part about early sobriety was dealing with my emotions. Since I started using drugs and alcohol that is what I used to deal with my emotions. If I was happy I used, if I was sad I used, if I was anxious I used, and if I couldn’t handle a situation I used. Now that the drinking and drugs were out of my life, I had to find new ways to cope with my emotions. It was also very hard leaving my old friends in the past.

Q : What reaction did you get from family and friends when you started getting sober?

Benny : My family and close friends were very supportive of me while getting sober. Everyone close to me knew I had a problem and were more than grateful when I started recovery. At first they were very skeptical because of my history of relapsing after treatment. But once they realized I was serious this time around, I received nothing but loving support from everyone close to me. My mother was especially helpful as she stopped enabling my behavior and sought help through Alcoholics Anonymous. I have amazing relationships with everyone close to me in my life today.

Q : Have you ever experienced a relapse?

Benny : I experienced many relapses before actually surrendering. I was constantly in trouble as a teenager and tried quitting many times on my own. This always resulted in me going back to the drugs or alcohol. My first experience with trying to become sober, I was 15 years old. I failed and did not get sober until I was 19. Each time I relapsed my addiction got worse and worse. Each time I gave away my sobriety, the alcohol refunded my misery.

Q : How long did it take for things to start to calm down for you emotionally and physically?

Benny : Getting over the physical pain was less of a challenge. It only lasted a few weeks. The emotional pain took a long time to heal from. It wasn’t until at least six months into my sobriety that my emotions calmed down. I was so used to being numb all the time that when I was confronted by my emotions, I often freaked out and didn’t know how to handle it. However, after working through the 12 steps of AA, I quickly learned how to deal with my emotions without the aid of drugs or alcohol.

Q : How hard was it getting used to socializing sober?

Benny : It was very hard in the beginning. I had very low self-esteem and had an extremely hard time looking anyone in the eyes. But after practice, building up my self-esteem and going to AA meetings, I quickly learned how to socialize. I have always been a social person, so after building some confidence I had no issue at all. I went back to school right after I left drug rehab and got a degree in communications. Upon taking many communication classes, I became very comfortable socializing in any situation.

Q : Was there anything surprising that you learned about yourself when you stopped drinking?

Benny : There are surprises all the time. At first it was simple things, such as the ability to make people smile. Simple gifts in life such as cracking a joke to make someone laugh when they are having a bad day. I was surprised at the fact that people actually liked me when I wasn’t intoxicated. I used to think people only liked being around me because I was the life of the party or someone they could go to and score drugs from. But after gaining experience in sobriety, I learned that people actually enjoyed my company and I wasn’t the “prick” I thought I was. The most surprising thing I learned about myself is that I can do anything as long as I am sober and I have sufficient reason to do it.

Q : How did your life change?

Benny : I could write a book to fully answer this question. My life is 100 times different than it was nine years ago. I went from being a lonely drug addict with virtually no goals, no aspirations, no friends, and no family to a productive member of society. When I was using drugs, I honestly didn’t think I would make it past the age of 21. Now, I am 28, working a dream job sharing my experience to inspire others, and constantly growing. Nine years ago I was a hopeless, miserable human being. Now, I consider myself an inspiration to others who are struggling with addiction.

Q : What are the main benefits that emerged for you from getting sober?

Benny : There are so many benefits of being sober. The most important one is the fact that no matter what happens, I am experiencing everything with a clear mind. I live every day to the fullest and understand that every day I am sober is a miracle. The benefits of sobriety are endless. People respect me today and can count on me today. I grew up in sobriety and learned a level of maturity that I would have never experienced while using. I don’t have to rely on anyone or anything to make me happy. One of the greatest benefits from sobriety is that I no longer live in fear.

Case Study: Lorrie

Lorrie, image of a smiling woman wearing glasses.

Figure 1. Lorrie.

Lorrie Wiley grew up in a neighborhood on the west side of Baltimore, surrounded by family and friends struggling with drug issues. She started using marijuana and “popping pills” at the age of 13, and within the following decade, someone introduced her to cocaine and heroin. She lived with family and occasional boyfriends, and as she puts it, “I had no real home or belongings of my own.”

Before the age of 30, she was trying to survive as a heroin addict. She roamed from job to job, using whatever money she made to buy drugs. She occasionally tried support groups, but they did not work for her. By the time she was in her mid-forties, she was severely depressed and felt trapped and hopeless. “I was really tired.” About that time, she fell in love with a man who also struggled with drugs.

They both knew they needed help, but weren’t sure what to do. Her boyfriend was a military veteran so he courageously sought help with the VA. It was a stroke of luck that then connected Lorrie to friends who showed her an ad in the city paper, highlighting a research study at the National Institute of Drug Abuse (NIDA), part of the National Institutes of Health (NIH.) Lorrie made the call, visited the treatment intake center adjacent to the Johns Hopkins Bayview Medical Center, and qualified for the study.

“On the first day, they gave me some medication. I went home and did what addicts do—I tried to find a bag of heroin. I took it, but felt no effect.” The medication had stopped her from feeling it. “I thought—well that was a waste of money.” Lorrie says she has never taken another drug since. Drug treatment, of course is not quite that simple, but for Lorrie, the medication helped her resist drugs during a nine-month treatment cycle that included weekly counseling as well as small cash incentives for clean urine samples.

To help with heroin cravings, every day Lorrie was given the medication buprenorphine in addition to a new drug. The experimental part of the study was to test if a medication called clonidine, sometimes prescribed to help withdrawal symptoms, would also help prevent stress-induced relapse. Half of the patients received daily buprenorphine plus daily clonidine, and half received daily buprenorphine plus a daily placebo. To this day, Lorrie does not know which one she received, but she is deeply grateful that her involvement in the study worked for her.

The study results? Clonidine worked as the NIDA investigators had hoped.

“Before I was clean, I was so uncertain of myself and I was always depressed about things. Now I am confident in life, I speak my opinion, and I am productive. I cry tears of joy, not tears of sadness,” she says. Lorrie is now eight years drug free. And her boyfriend? His treatment at the VA was also effective, and they are now married. “I now feel joy at little things, like spending time with my husband or my niece, or I look around and see that I have my own apartment, my own car, even my own pots and pans. Sounds silly, but I never thought that would be possible. I feel so happy and so blessed, thanks to the wonderful research team at NIDA.”

Liquor store. Authored by : Fletcher6. Located at : https://commons.wikimedia.org/wiki/File:The_Bunghole_Liquor_Store.jpg . License : CC BY-SA: Attribution-ShareAlike
Benny Story. Provided by : Living Sober. Located at : https://livingsober.org.nz/sober-story-benny/ . License : CC BY: Attribution
One patientu2019s story: NIDA clinical trials bring a new life to a woman struggling with opioid addiction. Provided by : NIH. Located at : https://www.drugabuse.gov/drug-topics/treatment/one-patients-story-nida-clinical-trials-bring-new-life-to-woman-struggling-opioid-addiction . License : Public Domain: No Known Copyright

SS543 Seminar Group 3 – Seminar C – Charlotte Wilcox

Just another university of brighton blog network site, jack case study ( systemic approach ).

While Jack does have concerning issues on his own, such as the bouts of low moods, drinking, substance abuse, and delusions, many of these circumstances seem to be a response to the issues that were prevailing within his home life and how he absorbed the dynamics and roles of his family. By understanding the complexity of Jack’s family history and the situations they endured with their turbulent home life, one could suggest possible solutions to help Jack in the unresolved issues found in his coping methods. An important figure in Jack’s life is his father. As the other male in the household and the prime caretaker of their family in Jack’s early life, Jack would be seen as close to him by both himself and his family members, which would be distressing considering the father’s abusive behavior. Due to the abuse being prevalent throughout the majority of Jack’s childhood, and worsening when the father was in some form of distress–such as when the father’s business was beginning to go down the drain– the father’s alcoholism would be introduced as the only “healthy” way for Jack to cope with the trauma of being sexually abused alongside the distress of having his parents separate, especially considering how violent his father was to Jack’s mother and his siblings. With this in mind, Jack’s sisters’ dislike towards their father could possibly lead to them not feeling emotionally available to Jack, whether to give him comfort during their parents’ split or to help him with the distress he felt concerning his abuse. This distrust or disdain from his sisters could lead to Jack’s already conflicting feelings towards his father being distressing and hard to accept, seen with his fear and self-loathing when seeing his resemblance to his father, and it pushes him further away from the rest of his family. While the father’s abusive behavior is important to note when considering the family dynamic, another important aspect that he brought to Jack was the traditional role a man was supposed to have in an Italian family. As his father was often seen as the primary caretaker, Jack was given the expectation for him to do the same, with him being expected to run his father’s business once he was old enough. With this role ingrained in Jack’s mind, Jack likely felt inadequate and worthless when being unable to hold down a job or having his mother take care of the finances, especially since it went against the figure that he likely related to more. This role of caretaker and provider also could lead to Jack acting protectively towards his mother and sisters, likely also being distressed with the amount of harassment and burgling that they endured in the midst of Jack’s spiral in alcoholism and substance abuse. With Jack being unable to care for the family in terms of financial contribution, and their father–the prime caretaker at the time– being out of the picture, Jack’s family was also stretched unbearably thin with the financial strain. With losing their house and becoming financially unstable, the stress of that financial strain was likely felt by every member of the house, especially the mother who had taken on multiple jobs in order to sustain the whole family. The unfortunate circumstances of their home life with being burgled and harassed often would likely lead to the sisters and mother feeling unsafe and exhausted, and would keep Jack from confiding in them due to both the expectation of Jack needing to be the “strong man” of the house, as well as them not having the energy to give the emotional support that every member of the family likely needed. With no one to depend on and his tendency to lash out violently coming to a head in their home life, Jack likely isolated himself from his family due to not knowing any other healthy way to cope with the amount of stress and trauma he was enduring, feeling rejected, angry, and fearful. With Jack being forced out of the house and later being admitted to the psychiatric ward by his family, this fear of rejection would be fulfilled. While Jack was diagnosed with depression, paranoia, and persistent delusion disorder in the times that he was given psychiatric services, it is difficult to say whether or not that’s truly the case. While it could give him the benefit that there is someone who won’t reject him and that there is someone who shares his experiences, it could become harmful where he may think that his diagnosis means that it won’t ever change or get better, which may only exacerbate his alcoholism and self-medication. He acknowledges that he thinks “he and his life are a mess”, and while this could be seen as a symptom of depression, considering the circumstances that he came from could lead to the therapist deciding that it’s instead a symptom of his home life. In persisting with these delusions, he’s able to escape the unbearable reality that he lives in, and would be able to protect himself or project realities upon those, such as his sister being raped by Robbie Williams, to cast the trauma he feels elsewhere so he doesn’t need to acknowledge it. In using the systemic approach, it’d be essential to first establish a good relationship with every member of the family before considering a conversation between Jack and the rest of his family, since the lack of conversation about emotional issues may lead to them either not being open to discussing these issues or lashing out at one another. Before opening that conversation, it’d be important that Jack would first be able to identify the roles each member had in the family, how he saw himself with his family, and better understand the anxieties he had concerning his issues. Along with this, collaborating with the mother and sisters to better understand what they feel anxious about would be necessary. Due to them requesting that he be admitted into the hospital, it is evident that they are still concerned for his safety and well-being. Once they would be mentally prepared and open to jointed sessions, the therapist would utilize the trusting relationship they built with the family to mediate the discussion, guiding the family through the complexities of their dynamic, concerns, and overall feelings throughout the turbulence of their home life. Acknowledging positive aspects about the family, such as their resilience, strength, and open mindedness to consider these therapy sessions would be essential in letting the group feel comfortable and capable of continuing through the difficulty of these sessions. These discussions would definitely be made easier and more fruitful if the family eventually spent time with one another outside of these therapy sessions, whether as a group or one-on-one with one another. Concerning the issues Jack had himself, it’d be important for him to identify certain issues within the family before connecting them to some of the issues Jack may be having on his own. For instance, it would be important for him to consider the burden that was placed on him from the heavy expectations set from his father’s role in the family, whether it be due to their culture or within the family dynamic, and to reassure Jack of what he can do to contribute to the family with the amount of effort he can give at that time. Along with this, it would be important to have a separate discussion about Jack’s feelings towards his father, and to better understand the link between his father and his methods to cope with stress and how Jack uses alcohol and substances. By acknowledging these connections and how they contribute to the distress and issues that he may be having in the present, it can establish a starting point for them to work off of in terms of unraveling the feelings he may have about these experiences and guide him to work to improve his situation in the present.

One thought on “ Jack Case Study ( Systemic Approach ) ”

Good start Caroline, some really good reflections on Jack’s difficulties and devising a systemic intervention. Tips for the summative assignment: Add some further basic background information and further detail on thoughts feelings and behaviours that demonstrate his difficulties. Expand on the core features of the approaches used for your case study (e.g. for a psychodynamic approach underlying, core conflicts, defence mechanisms etc. for systemic, problem maintaining patterns and feedback loops etc). Also ensure to account for why his problems are continuing, not just the cause of them. Highlight the pros and cons of diagnosis. Explicitly link your intervention plan to your formulation (you started this well). Structure using the marking criteria.

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April 01, 2024 | VOL. 181, NO. 4 CURRENT ISSUE pp.255-346
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DSM-5 Clinical Cases

Rachel A. Davis , M.D.

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DSM-5 Clinical Cases makes the rather overwhelming DSM-5 much more accessible to mental health clinicians by using clinical examples—the way many clinicians learn best—to illustrate the changes in diagnostic criteria from DSM-IV-TR to DSM-5. More than 100 authors contributed to the 103 case vignettes and discussions in this book. Each case is concise but not oversimplified. The cases range from straightforward and typical to complicated and unusual, providing a nice repertoire of clinical material. The cases are realistic in that many portray scenarios that are complicated by confounding factors or in which not all information needed to make a diagnosis is available. The authors are candid in their discussions of difficulties arriving at the correct diagnoses, and they acknowledge the limitations of DSM-5 when appropriate.

The book is conveniently organized in a manner similar to DSM-5. The 19 chapters in DSM-5 Clinical Cases correspond to the first 19 chapters in section 2 of DSM-5. As in DSM-5, DSM-5 Clinical Cases begins with diagnoses that tend to manifest earlier in life and advances to diagnoses that usually occur later in life. Each chapter begins with a discussion of changes from DSM-IV. These changes are further explored in the cases that follow.

Each case vignette is titled with the presenting problem. The cases are formatted similarly throughout and include history of present illness, collateral information, past psychiatric history, social history, examination, any laboratory findings, any neurocognitive testing, and family history. This is followed by the diagnosis or diagnoses and the case discussion. In the discussions, the authors highlight the key symptoms relevant to DSM-5 criteria. They explore the differential diagnosis and explain their rational for arriving at their selected diagnoses versus others they considered as well. In addition, they discuss complicating factors that make the diagnoses less clear and often mention what additional information they would like to have. Each case is followed by a list of suggested readings.

As an example, case 6.1 is titled Depression. This case describes a 52-year-old man, “Mr. King,” presenting with the chief complaint of depressive symptoms for years, with minimal response to medication trials. The case goes on to describe that Mr. King had many anxieties with related compulsions. For example, he worried about contracting diseases such as HIV and would wash his hands repeatedly with bleach. He was able to function at work as a janitor by using gloves but otherwise lived a mostly isolative life. Examination was positive for a strong odor of bleach, an anxious, constricted affect, and insight that his fears and behaviors were “kinda crazy.” No laboratory findings or neurocognitive testing is mentioned.

The diagnoses given for this case are “OCD, with good or fair insight,” and “major depressive disorder.” The discussants acknowledge that evaluation for OCD can be difficult because most patients are not so forthcoming with their symptoms. DSM-5 definitions of obsessions and compulsions are reviewed, and the changes to the description of obsessions are highlighted: the term urge is used instead of impulse so as to minimize confusion with impulse-control disorders; the term unwanted instead of inappropriate is used; and obsessions are noted to generally (rather than always) cause marked anxiety or distress to reflect the research that not all obsessions result in marked anxiety or distress. The authors review the remaining DSM-5 criteria, that OCD symptoms must cause distress or impairment and must not be attributable to a substance use disorder, a medical condition, or another mental disorder. They discuss the two specifiers: degree of insight and current or past history of a tic disorder. They briefly explore the differential diagnosis, noting the importance of considering anxiety disorders and distinguishing the obsessions of OCD from the ruminations of major depressive disorder. They also point out the importance of looking for comorbid diagnoses, for example, body dysmorphic disorder and hoarding disorder.

This brief case, presented and discussed in less than three pages, leaves the reader with an overall understanding of the diagnostic criteria for OCD, as well as a good sense of the changes in DSM-5.

DSM-5 Clinical Cases is easy to read, interesting, and clinically relevant. It will improve the reader’s ability to apply the DSM-5 diagnostic classification system to real-life practice and highlights many nuances to DSM-5 that one might otherwise miss. This book will serve as a valuable supplementary manual for clinicians across many different stages and settings of practice. It may well be a more practical and efficient way to learn the DSM changes than the DSM-5 itself.

The author reports no financial relationships with commercial interests.

Cited by None

case study 1 for substance related disorders jack

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85 Substance-Related and Addictive Disorders: A Special Case

Learning outcomes.

By the end of this section, you will be able to:

Recognize the goal of substance-related and addictive disorders treatment
Discuss what makes for effective treatment
Describe how comorbid disorders are treated

Addiction is often viewed as a chronic disease ( Figure ). The choice to use a substance is initially voluntary; however, because chronic substance use can permanently alter the neural structure in the prefrontal cortex, an area of the brain associated with decision-making and judgment, a person becomes driven to use drugs and/or alcohol (Muñoz-Cuevas, Athilingam, Piscopo, & Wilbrecht, 2013). This helps explain why relapse rates tend to be high. About 40%–60% of individuals relapse , which means they return to abusing drugs and/or alcohol after a period of improvement (National Institute on Drug Abuse [NIDA], 2008).

A chart labeled “Prevalence of Drug Use by Age Group” graphs “Age (years)” on the x axis and “Percentage of use” on the y axis. Note that the following percentages are estimates. According to this chart, 10 percent of people in the age range of 12–17 use illicit drugs, compared to 22 percent usage in the age range of 18–25, and 7 percent usage in the age range of 26 and older. 7.5 percent of people in the age range of 12–17 use marijuana, compared to 18 percent usage in the age range of 18–25, and 5 percent usage in the age range of 26 and older. 3 percent of people in the age range of 12–17 use psychotherapeutics, compared to 6 percent usage in the age range of 18–25, and 2.5 percent usage in the age range of 26 and older. 1 percent of people in the age range of 12–17 use inhalants. This number steadily drops off to 0 percent in the 26 and older age group. 1 percent of people in the age range of 12–17 use hallucinogens, compared to 2.5 percent usage in the age range of 18–25, and almost 0 percent usage in the age range of 26 and older. Cocaine use in the age range of 18–25 is around 2 percent, and it drops off to nearly 0 percent by the age range of 26 and older.

The goal of substance-related treatment is to help an addicted person stop compulsive drug-seeking behaviors (NIDA, 2012). This means an addicted person will need long-term treatment, similar to a person battling a chronic physical disease such as hypertension or diabetes. Treatment usually includes behavioral therapy and/or medication, depending on the individual (NIDA, 2012). Specialized therapies have also been developed for specific types of substance-related disorders, including alcohol, cocaine, and opioids (McGovern & Carroll, 2003). Substance-related treatment is considered much more cost-effective than incarceration or not treating those with addictions (NIDA, 2012) ( Figure ).

A photograph shows a person injecting heroin intravenously with a hypodermic needle into her ankle.

WHAT MAKES TREATMENT EFFECTIVE?

Specific factors make substance-related treatment much more effective. One factor is duration of treatment. Generally, the addict needs to be in treatment for at least three months to achieve a positive outcome (Simpson, 1981; Simpson, Joe, & Bracy, 1982; NIDA, 2012). This is due to the psychological, physiological, behavioral, and social aspects of abuse (Simpson, 1981; Simpson et al., 1982; NIDA, 2012). While in treatment, an addict might receive behavior therapy, which can help motivate the addict to participate in the treatment program and teach strategies for dealing with cravings and how to prevent relapse. Also, treatment needs to be holistic and address multiple needs, not just the drug addiction. This means that treatment will address factors such as communication, stress management, relationship issues, parenting, vocational concerns, and legal concerns (McGovern & Carroll, 2003; NIDA, 2012).

While individual therapy is used in the treatment of substance-related disorders, group therapy is the most widespread treatment modality (Weiss, Jaffee, de Menil, & Cogley, 2004). The rationale behind using group therapy for addiction treatment is that addicts are much more likely to maintain sobriety in a group format. It has been suggested that this is due to the rewarding and therapeutic benefits of the group, such as support, affiliation, identification, and even confrontation (Center for Substance Abuse Treatment, 2005). For teenagers, the whole family often needs to participate in treatment to address issues such as family dynamics, communication, and relapse prevention. Family involvement in teen drug addiction is vital. Research suggests that greater parental involvement is correlated with a greater reduction in use by teen substance abusers. Also, mothers who participated in treatment displayed better mental health and greater warmth toward their children (Bertrand et al., 2013). However, neither individual nor group therapy has been found to be more effective (Weiss et al., 2004). Regardless of the type of treatment service, the primary focus is on abstinence or at the very least a significant reduction in use (McGovern & Carroll, 2003).

Treatment also usually involves medications to detox the addict safely after an overdose, to prevent seizures and agitation that often occur in detox, to prevent reuse of the drug, and to manage withdrawal symptoms. Getting off drugs often involves the use of drugs—some of which can be just as addictive. Detox can be difficult and dangerous.

Watch this video to find out more about treating substance-related disorders using the biological, behavioral, and psychodynamic approaches.

COMORBID DISORDERS

Frequently, a person who is addicted to drugs and/or alcohol has an additional psychological disorder. Saying a person has comorbid disorders means the individual has two or more diagnoses. This can often be a substance-related diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia. These individuals fall into the category of mentally ill and chemically addicted (MICA)—their problems are often chronic and expensive to treat, with limited success. Compared with the overall population, substance abusers are twice as likely to have a mood or anxiety disorder. Drug abuse can cause symptoms of mood and anxiety disorders and the reverse is also true—people with debilitating symptoms of a psychiatric disorder may self-medicate and abuse substances.

In cases of comorbidity , the best treatment is thought to address both (or multiple) disorders simultaneously (NIDA, 2012). Behavior therapies are used to treat comorbid conditions, and in many cases, psychotropic medications are used along with psychotherapy. For example, evidence suggests that bupropion (trade names: Wellbutrin and Zyban), approved for treating depression and nicotine dependence, might also help reduce craving and use of the drug methamphetamine (NIDA, 2011). However, more research is needed to better understand how these medications work—particularly when combined in patients with comorbidities.

Addiction is often viewed as a chronic disease that rewires the brain. This helps explain why relapse rates tend to be high, around 40%–60% (McLellan, Lewis, & O’Brien, & Kleber, 2000). The goal of treatment is to help an addict stop compulsive drug-seeking behaviors. Treatment usually includes behavioral therapy, which can take place individually or in a group setting. Treatment may also include medication. Sometimes a person has comorbid disorders, which usually means that they have a substance-related disorder diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia. The best treatment would address both problems simultaneously.

Review Questions

What is the minimum amount of time addicts should receive treatment if they are to achieve a desired outcome?

When an individual has two or more diagnoses, which often includes a substance-related diagnosis and another psychiatric diagnosis, this is known as ________.

bipolar disorder
comorbid disorder
codependency
bi-morbid disorder

John was drug-free for almost six months. Then he started hanging out with his addict friends, and he has now started abusing drugs again. This is an example of ________.

re-addiction

Critical Thinking Question

You are conducting an intake assessment. Your client is a 45-year-old single, employed male with cocaine dependence. He failed a drug screen at work and is mandated to treatment by his employer if he wants to keep his job. Your client admits that he needs help. Why would you recommend group therapy for him?

Personal Application Question

What are some substance-related and addictive disorder treatment facilities in your community, and what types of services do they provide? Would you recommend any of them to a friend or family member with a substance abuse problem? Why or why not?

[glossary-page] [glossary-term]comorbid disorder:[/glossary-term] [glossary-definition]individual who has two or more diagnoses, which often includes a substance abuse diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia[/glossary-definition]

[glossary-term]relapse:[/glossary-term] [glossary-definition]repeated drug use and/or alcohol use after a period of improvement from substance abuse[/glossary-definition] [/glossary-page]

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107 Substance-Related and Addictive Disorders: A Special Case

Learning Objectives

By the end of this section, you will be able to:

Recognize the goal of substance-related and addictive disorders treatment
Discuss what makes for effective treatment
Describe how comorbid disorders are treated

Addiction is often viewed as a chronic disease. The choice to use a substance is initially voluntary; however, because chronic substance use can permanently alter the neural structure in the prefrontal cortex, an area of the brain associated with decision-making and judgment, a person becomes driven to use drugs and/or alcohol (Muñoz-Cuevas, Athilingam, Piscopo, & Wilbrecht, 2013). This helps explain why relapse rates tend to be high. About 40%–60% of individuals relapse , which means they return to abusing drugs and/or alcohol after a period of improvement (National Institute on Drug Abuse [NIDA], 2008).

What Makes Treatment Effective?

Comorbid Disorders

Test Your Understanding

Review Questions

Critical thinking question.

The rationale behind using group therapy for addiction treatment is that addicts are much more likely to maintain sobriety when treatment is in a group format. It has been suggested that it’s due to the rewarding and therapeutic benefits of the group, such as support, affiliation, identification, and even confrontation. Because this client is single, he may not have family support, so support from the group may be even more important in his ability to recover and maintain his sobriety.

Personal Application Question

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Introduction to Psychology (A critical approach) Copyright © 2021 by Rose M. Spielman; Kathryn Dumper; William Jenkins; Arlene Lacombe; Marilyn Lovett; and Marion Perlmutter is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Substance-Related and Addictive Disorders: First Wave Case Conceptualization

First Online: 18 October 2022

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Hendrik G. Roozen 3 &
Jane Ellen Smith 4

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This chapter discussed the theoretical, preclinical, and clinical accumulation of evidence with respect to the underlying behavioral mechanisms employed in Community Reinforcement Approach (CRA) and its novel variants as exemplars of first wave behavior therapy for substance use problems. This ‘family’ of CRA [i.e. Adolescent version of Community Reinforcement Approach (ACRA) & Community Reinforcement and Family Training (CRAFT)] targets specific populations with various substance use disorders, including comorbid psychiatric conditions and/or patients that reside in the (juvenile) justice system. Also the surplus value in term of therapeutic efficacy of the combination of CRA and contingency management (CM), another notable exemplar of first wave behavior therapy for those with substance use problems, has been highlighted in this chapter. The ‘family’ of CRA is applied to individuals with a wide range of ethnic populations and different age groups such as adults (CRA) and adolescents (A-CRA), but also targets family members (CRAFT). Since this comprehensive and complementary treatment package does not exclusively reduce substance abuse but also addresses psychiatric and forensic problems, it has certainly transdiagnostic value. That said, it has shown efficacy in both in- and outpatient facilities and outreach teams and the dissemination of the ‘family’ of CRA is moving forward in many places throughout the world.

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A Brief Review of Gambling Disorder and Five Related Case Vignettes

The loss of control over urges and behaviors may be the central component of gambling disorders, but there is so much more to consider. Individuals with these problems have exponentially higher rates of suicide attempts and completions.

Nearly 4% of the population has gambling-related problems, and 6% will experience harm from gambling during their lifetime-including financial, legal, relational, and health problems. 1 In addition, individuals with gambling problems have exponentially higher rates of suicide attempts and completions. One study found that 81% of pathological gamblers in treatment showed some suicidal ideation, and 30% reported one or more suicide attempts in the preceding 12 months. 2

DSM-5 criteria for gambling disorder represent the most common symptoms experienced by those with gambling problems. These symptoms characterize 3 heterogeneous dimensions related to gambling disorder: damage or disruption, loss of control, and dependence. The loss of control over urges and behaviors may be the central component of gambling disorders, and the inability to control gambling may be a component of a progressively worsening process in the life span of some gamblers.

Individuals who encounter gambling-related problems but who do not reach the diagnostic threshold (subthreshold gambling disorder meets only 1 to 3 criteria) are referred to as problem gamblers. For the most part, those with subthreshold gambling disorder continue to experience social, psychological, and health repercussions but to a lesser degree. They are also at increased risk for progression to gambling disorder compared with non-gamblers.

Gambling disorder is referred to as a hidden addiction because of the minimal signs and symptoms associated with this condition. 3 The level of severity can also be concealed and involve multiple components. For example, a gambler who “hits rock bottom” (or one who has lost everything, including financial assets and social relationships) may have stopped gambling because of the lack of finances, but he or she may be severely depressed and suicidal because of the ongoing repercussion. Other components of severity include gambling behavior (frequency, duration, amount gambled), extent of gambling desires (cravings, urges), repercussions (eg, employment, legal, relationships), level of control, and comorbid symptoms (eg, suicidality, impulsivity, depression). These factors help predict treatment outcome and determine the appropriate treatment (ie, brief intervention, intensive outpatient, hospitalization). In research, severity is usually assessed using the total number of criteria endorsed, which can also be a quick and straightforward method in the clinical setting.

Comorbidity

Gambling disorders are strongly associated with comorbid psychopathology. A meta-analysis of 11 population surveys found high mean prevalence for nicotine dependence (60.1%), a substance use disorder (57.5%), mood disorders (37.9%), and anxiety disorders (37.4%). 1 A longitudinal 3-year study also found that any mood, anxiety, or substance use–related disorder was more likely to develop in individuals with either subthreshold gambling disorder or gambling disorder than in those who did not gamble. 4

Clinically, it may be helpful to assess sleep. Those with gambling problems have an increased risk of difficulty in initiating sleep, maintaining sleep, and more and early awakenings. 5 Sleep disturbances can impair self-control and decision making, increase impulsivity, degrade cognition in executive functioning tasks, attenuate responses to losses, and increase expectations of gains that can affect gambling behavior.

There are no FDA-approved pharmacological treatments for gambling disorder, but several studies have evaluated the effects of medications on gambling behavior and comorbid symptoms. Grant and colleagues 6 reviewed 18 double-blind placebo-controlled studies that included antidepressants, antipsychotics, mood stabilizers, glutamatergic agents, and opioid antagonists. Although the results were mixed and conclusions were limited because of the small sample sizes, opioid antagonists and glutamatergic agents ( N -acetylcysteine) seemed to have the most promising results, especially for those with intense gambling urges.

A number of psychosocial strategies have shown promise in controlling aberrant gambling behavior, including self-help manuals, brief one-session interventions (motivational therapy), psychodynamic therapy, cognitive-behavioral therapy (CBT), and referrals to 12-step support groups. 7 Research findings indicate that the treatment for gambling disorder not only reduces gambling behavior but can also help reduce comorbid psychiatric symptoms, such as anxiety and depression; improve quality of life; decrease psychological stress; and decrease the likelihood of comorbid psychopathology. 8

CASE VIGNETTE 1

Jack, a 16-year-old 10th grader, is brought by his mother for evaluation of his “excessive online gaming.” Jack’s mother is concerned that her son plays casino-based “freemium” games 5 hours every day. (Freemium games are free to download but require tokens that are purchased with real money and gambled among players.) He buys approximately $30 worth of tokens every day and has spent more than $5000 on tokens in the past 6 months. He constantly argues with his parents regarding his playing time, his school work has deteriorated, and he no longer has any social interactions.

Jack admits that he lies to his parents about the extent of his playing-he sometimes plays more than 10 hours a day. He has a hard time stopping and usually plays until he loses all his tokens. He uses his mother’s credit card to buy tokens without permission. He is proud of his online accomplishments and enjoys the winning and competition with real adults. Although he now has no desire to interact with peers outside of school, he had enjoyed participating in a recreational sports league in the past.

Jack does not appear to suffer from any other disorder. He has never had problems with alcohol or drugs, and he has never seen a mental health professional or received psychotropics. His childhood and development have been without incident. Last year, his mother returned to work and Jack started taking care of his 7-year-old sister after school (during which he games the most).

During the initial session, gaming patterns and repercussions are discussed (financial, educational, and developmental). Recommendations are made that include changing passwords to the app store and limiting Internet access to supervised sessions, and Jack’s access to his mother’s credit card is cut off. After-school activities for both children are also highly encouraged, possibly restarting recreational sports competitions for Jack. Potential positive reinforcement methods for complying with clean Internet play are also discussed. The family is referred to a family therapist to continue working on family dynamics.

CASE VIGNETTE 2

A 19-year-old college sophomore is referred by student health for evaluation of his gambling problems. Michael’s gambling has become pathological in the past year: he either bets on sports online or spends about 6 hours at a local casino daily. Although he does not work, he lost $50,000 in the past year, using money from his sports scholarship and financial aid. His mother has bailed him out multiple times by paying his credit card bills. He still has a credit card debt and owes money to his friends, which totals $25,000. He usually chases his losses, has strong cravings to gamble during the day, and experiences anxiety trying to find money to use for gambling. The time he spends on academics and team practices has become significantly reduced.

His primary care physician (PCP) prescribed stimulants after a diagnosis of ADHD in middle school, which Michael took until 12th grade. He has never seen a mental health professional or taken any psychotropic medication. He started binge drinking at college parties (probably twice a month, enough to black out); in addition, he smokes one blunt of marijuana every week.

Michael started gambling recreationally with friends in middle school, but he acknowledges that his problem controlling gambling started last year. Although he is disheartened by his gambling problem (and its repercussions), he is not depressed, still enjoys hobbies (which he indicates is gambling), and has fun with his girlfriend. He seems intelli-gent and brags about knowing the poker odds. He is seeking treatment because he wants to control his gambling (make only smart bets or play the good hands). His biggest problem is “losing a few bets in a row and going on tilt!”

During the first session, gambling patterns and repercussions are discussed, which he had initially minimized (ie, the possibility of losing his scholarship and being kicked off the team). He agrees to restart treatment with a stimulant, to include his mother in the next session via phone, and to go to Gamblers Anonymous. He agrees to continue CBT at the student health center to work on his aberrant alcohol use.

During the second session (3 weeks later), he reports that he has restarted the stimulant, which helps his impulsivity and studying habits. He has completed 8 sessions of CBT at the student center. He went to a Gamblers Anonymous meeting but did not agree with their tenet for abstinence. His mother agrees to stop bailing him out, control his credit cards and scholarship checks, and provide a limited allowance.

For the next few months, his gambling decreases (both in duration and frequency), but he places larger bets and loses more. Since his mother stopped bailing him out, he borrows money from a loan shark. He is kicked off the team and his scholarship is terminated. He decides to contact a state-funded mental health professional for more regular therapy sessions. He also agrees to ask the loan shark for a repayment plan.

By the fifth session (4 months after his initial presentation), he has stopped gambling and has a part-time job. He is making regular payments to his loan shark, studying more, drinking less alcohol, and playing more sports recreationally. He still enjoys gambling but now is aware of the repercussions. He is more focused on raising his grade point average and returning to the sports team.

CASE VIGNETTE 3

James, a depressed 40-year-old poker player, is referred by his wife. He was laid off from work 8 months earlier. Since then he plays poker for 8 hours a day at a nearby casino. He gambles “out of boredom” and enjoys the social atmosphere. Although he is well-off financially, he has lost more than $200,000 in the past year. He now plays at higher-limit tables and chases his bets. He lies to his wife regarding his gambling and is on the brink of getting a divorce. He started playing poker as a teenager and had weekly poker games with his colleagues at work.

He lacks motivation, has stopped taking care of himself, and has gained 30 pounds in the past year. He has a hard time falling asleep and at times is restless in the mornings. James has had 3 episodes of depression in the past; he has been taking aripiprazole, citalopram, and bupropion (prescribed by his PCP) for the past 6 months. There is no his-tory suggestive of mania, hypomania, suicidality, or aberrant substance use.

During the first session with James and his wife, his recent gambling winnings/losses are reviewed, including bank statements that his wife brings in. He is surprised at the total amount of losses. He loves poker, but he does not want a divorce. He agrees to give all his bank cards to his wife, ban himself from local casinos, and work on saving his marriage. The couple are given a self-help workbook and listings for Gamblers Anonymous and Gam-Anon, and proper sleep hygiene is emphasized. The couple are also referred to the state-funded gambling provider network to receive therapy to work on their relationship.

Mirtazapine is started to help with depression, and aripiprazole is tapered. (Case report findings suggest a potential correlation between aripiprazole and excessive gambling, which is similar to the association between dopamine replacement therapy for Parkinson disease and gambling.9)

By the next session, James has stopped gambling because he no longer has easy access to money. He has also started attending Gamblers Anonymous several times a week and enjoys their camaraderie. He appreciates how attending Gamblers Anonymous has helped diminish his strong urges to play poker.

By the fourth session (third month), he has completed his rÃ©sumÃ© and started exercising again. His sleep is improved, he regularly attends meetings of Gamblers Anonymous, and he has a sponsor in addition to making a commitment to the group. He is also in the process of completing 12 sessions with the marriage and family therapist. He misses playing poker, but realizes how abstaining has improved his relation-ship with his wife.

CASE VIGNETTE 4

Jackie, a 34-year-old nurse, is referred by her coworker for gambling at work. Compelled by her colleague, Jackie came to the addiction clinic to receive help for her uncontrollable need to gamble at work. She plays online slots on her phone for about 6 hours during her night shifts; after work, she usually tries to win back her losses at the local casino. Although she has lost $50,000 in the past 6 months, with an annual salary of $150,000, she does not have any financial difficulties and is still well regarded at work.

Six months earlier, Jackie called off her wedding after discovering her fiancÃ©’s infidelity. Since that time, gambling has been a great escape for her, specifically helping with ruminations. She is sad, has almost daily crying spells, lacks motivation to care for herself, has problems falling asleep and sustaining sleep, and has some thoughts that she may be better off dead. She is also irritable, easily snapping at colleagues and difficult patients at work. She drinks several glasses of wine every day to “help her nerves.”

Jackie describes some history suggestive of hypomania (not sleeping for a few days, very energetic, happy, impulsively shopping, gambling, and having sex). She carries diagnoses of bipolar disorder, depression, borderline personality disorder, and ADHD. When she was 17, she had a psychiatric hospitalization after breaking up with her boyfriend; she had suicidal ideations and self-injurious behavior (cutting). Jackie saw a therapist for 3 years, went to an accelerated nursing school, and currently works full-time at the hospital. She sees a psychiatrist (about twice a year), who prescribes quetiapine extended-release. Her PCP also prescribes trazodone, fluoxetine, methylphenidate (twice daily), clonazepam (3 times daily), and zolpidem.

During the first session, Jackie is ambivalent about treatment for her gambling, but she does want help for her insomnia, irritability, and anxiety. She agrees to consolidate her prescriptions to one prescriber to optimize medications. She receives psychoeducation regarding the importance of sleep hygiene, especially the effects of smoking, alcohol, stimulants, and shift work. The repercussions of her gambling are also discussed, and she is given a self-help workbook with listings for Gamblers Anonymous meetings. She agrees to taper off most of her medications and to start lamotrigine.

During the second session (10 days later), she reports that her gambling at work has decreased significantly because she was being monitored by her colleagues, but her gambling outside of work has increased. She also started melatonin and diphenhydramine on her own to help with insomnia. Her passive suicidal ideations are stronger, because she thinks that she is not doing anything productive with her life. She does not have a specific plan to hurt herself; she believes that suicide is immoral; and she does not want to voluntarily admit herself to an intensive outpatient program, a residential treatment program, or an inpatient unit.

Jackie continues to be irritable and to have poor self-care and low self-esteem. She enjoys talking during the session and wants to come more often. She has not been to any Gamblers Anonymous meetings because she does not believe that she has a gambling problem. Medications continue to be optimized, and the benefits of sleep hygiene are reinforced. She is also referred to a state-funded therapist to help with her gambling problems.

During her third and fourth sessions (weekly), she reports that the new medication regimen is finally working and she feels less irritable. She has not gambled at work during the past week and feels good, and she has started working more shifts (about 90 hours per week). Consequently, she is usually exhausted af-ter work and does not have the energy to go gambling.

At the seventh session (about 10 weeks after intake), Jackie reports that her work shifts have become more irregular. She works subsequent day and night shifts, and then has a few days off. During her most recent off days, she accepted an invitation for free accommodations and a spa package at a casino/hotel. In those 3 days, she lost $30,000 and gambled for 40 hours. She maxed out her credit cards and emptied her savings account. She finally agrees that she has a gambling problem. She plans to remove herself from the casino’s mailing list, ban herself from the local casinos, close her online casino gambling accounts, schedule an appointment with the state-funded therapist, and ask her brother to start controlling her finances.

During the next 6 months (about 15 sessions), she stops gambling. She completes 10 sessions of gambling treatment with the state therapist and decides to continue the therapy out-of-pocket. Her sleep has improved, and her irritability and anxiety have decreased. Jackie also has started working only regular day shifts and has started exercising and socializing with old friends.

CASE VIGNETTE 5

Mrs Kim, a 60-year-old manic gambler, is brought to the emergency department by her daughter for bizarre behavior. For the past month, Mrs Kim has been gambling more than usual and today she returned from the casino after gambling for 48 continuous hours. She had maxed out her credit cards and emptied her savings account. A family friend saw her at the casino acting provocatively toward random strangers. Apparently, she has not slept for the past 3 days. Her family has never seen her act this way.

Mrs Kim has no psychiatric history other than complaining of boredom and lack of motivation to her PCP last month, who prescribed an antidepressant.

Gambling has been a significant part of her life for years; she has been going to the local casino at least once a week for the past 16 years and playing for 5 to 8 hours each time. Before this past incident, she has never gambled more money than she could afford or chased her bets. She has also never experienced gambling-related repercussions.

On evaluation, Mrs Kim is restless but alert and oriented. She is talkative with rapid speech. She reports that she feels “amazing”; her affect is labile-she cries when discussing her deceased husband and then suddenly starts making jokes. She is fixated on leaving the hospital and returning to Thailand to see her deceased mother (whom she believes is still alive).

She is admitted to the inpatient unit after a negative medical workup. Medication-induced bipolar and related disorder are suspected. Her antidepressant is discontinued and a low-dose antipsychotic is started. Fourteen days later, she is discharged: her delusions and manic symptoms have resolved, including her urges to gamble uncontrollably.

These fictional case vignettes represent samples of individuals with gambling problems that any practicing psychiatrist may encounter. Although each patient suffered gambling-related problems, treatments were unique and personalized. It is also not uncommon to include significant others to help control finances, professionals (eg, accountants, lawyers), and health care workers (eg, counselors, therapists) in treatment plans. Specifically, free resources are available and can be used as part of the treatment plan, including self-help manuals and referrals to state-funded provider treatments and 12-step support groups ( Table ).

Disclosures:

Dr Parhami, is a PGY 3 Psychiatry Resident at the Delaware Psychiatry Residency Program, New Castle. He has completed a postdoctoral research fellowship at UCLA and will start a Child and Adolescent Psychiatry Fellowship at Johns Hopkins, Baltimore, in July. Dr Fong is Associate Psychiatry Professor, Co-Director of the UCLA Gambling Studies Program, Director of the UCLA Addiction Medicine Clinic, and Program Director for the UCLA Addiction Psychiatry Fellowship. Dr Parhami reports no conflicts of interest concerning the subject matter of this article; Dr Fong has received funding from the California Office of Problem Gambling.

References:

1. Lorains FK, Cowlishaw S, Thomas SA. Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys. Addiction . 2011;106:490-498.

2. Battersby M, Tolchard B, Scurrah M, Thomas L. Suicide ideation and behaviour in people with pathological gambling attending a treatment service. Int J Ment Health Addict . 2006;4:233-246.

3. Ladouceur R. Gambling: the hidden addiction. Can J Psychiatry . 2004;49:501-503.

4. Parhami I, Mojtabai R, Rosenthal RJ, et al. Gambling and the onset of comorbid mental disorders: a longitudinal study evaluating severity and specific symptoms. J Psychiatr Pract . 2014;20:207-219.

5. Parhami I, Siani A, Rosenthal RJ, Fong TW. Pathological gambling, problem gambling and sleep complaints: an analysis of the National Comorbidity Survey: Replication (NCS-R). J Gambl Stud . 2013;29:241-253.

6. Grant JE, Odlaug BL, Schreiber LR. Pharmacological treatments in pathological gambling. Br J Clin Pharmacol . 2014;77:375-381.

7. Hodgins DC, Stea JN, Grant JE. Gambling disorders. Lancet . 2011;378:1874-1884.

8. Fink A, Parhami I, Rosenthal RJ, et al. How transparent is behavioral intervention research on pathological gambling and other gambling-related disorders? A systematic literature review. Addiction . 2012;107:1915-1928.

9. Gaboriau L, Victorri-Vigneau C, GÃ©rardin M, et al. Aripiprazole: a new risk factor for pathological gambling? A report of 8 case reports. Addict Behav . 2014;39:562-565.

10. National Center for Responsible Gaming. Brief Biosocial Gambling Screen. http://www.ncrg.org/resources/brief-biosocial-gambling-screen. Accessed March 5, 2015.

11. Gamblers Anonymous. US meetings. http://www.gamblersanonymous.org/ga/locations . Accessed March 5, 2015.

12. California Department of Public Health. Freedom From Problem Gambling. http://problemgambling.securespsites.com/ccpgwebsite/help-available/publications.aspx . Accessed March 5, 2015.

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Jack, aged 25, has mental health issues related to substance abuse and also has limited funds, and needed someone to manage his finances.

Jack is a 25 year old man whose health has deteriorated due to substance abuse. He receives Centrelink benefits and has a small amount of savings. The effects of substance abuse have meant Jack is not able to act rationally and is no longer able to manage his own affairs.

Due to the mental health issues arising from his long-term substance abuse, Jack’s social worker made an application to SACAT for an Administration Order that would enable an independent authority to administer Jack’s financial affairs.

Although Jack had family, they were reluctant to take up the role of Jack’s administrator. SACAT appointed the Public Trustee to the role instead.

When we were appointed we developed a budget in consultation with his support network, including his family and primary social worker.

Arrangements were made for us to collect his Centrelink benefit and make sure he was receiving other entitlements, such as rental assistance.

We now collect the funds from his bank account and these are held by us in our Cash Common Fund account. From these funds we ensure that all his expenses are paid, which include rent, insurance for furniture and other personal items, and services such as electricity, gas, and water.

Jack also receives a weekly allowance which gives him some control over his own money. He develops special savings goals from time to time which might include purchasing a special item, participating in an important event, or going on holidays.

Jack and his family now have the security of knowing that he no longer has to worry about trying to manage his finances.

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Answered by judyannmonteheart. Jack has a history of alcohol and drug abuse. He was first diagnosed with alcohol dependence when he was 25 years old. He has been in and out of treatment for his addiction, but has never been able to stay sober for more than a few months at a time. Jack has been married for 10 years and has two young children.
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Case study 11: Substance use disorder - Jack Name: Jack Age: 31 Sex: Male Family: In a relationship with live-in girlfriend Occupation: Computer programmer Presenting problem: Driving under the influence (DUI) arrest Jack was charged with driving under the influence (DUI) of alcohol and possession of cocaine. Three weeks ago, Jack was on his way home following a Tuesday evening at the local ...
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Case study - Jack's story. Jack, aged 25, has mental health issues related to substance abuse and also has limited funds, and needed someone to manage his finances. Jack is a 25 year old man whose health has deteriorated due to substance abuse. He receives Centrelink benefits and has a small amount of savings.
Substance Use Disorders and Recovery
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A Brief Review of Gambling Disorder and Five Related Case Vignettes

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Case study - Jack's story

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