Case Story 2
Tanya was abused physically and sexually when she was growing up, which caused her to feel depressed and anxious a lot of the time. She experimented with drugs and alcohol to try to feel better. Sometimes this would help for a little while, but she always felt worse when she came down from drugs. When she was a teenager, she ran away to get away from the abuse. She had no way to support herself so she ended up exchanging sex for money. She did not like the way this made her feel, but she did not know how else to support herself.
People also would pay her with drugs or alcohol, which she would use to try to get rid of her bad feelings. Soon she got hooked on crack and would do anything to get high. Whenever she wasnt high, she felt very depressed, and this seemed to get worse every time she came
down. She also started to need more and more crack to get high, and the highs seemed to be
shorter each time. She hardly ever ate and became very skinny. She often had to use alcohol
or heroin to get to sleep because she was so wired from the cocaine. She often got beat up or
abused by her clients or pimps, which made her even more anxious and depressed, and she
started to feel like everyone was out to get her.
Soon she turned to dealing drugs herself because it seemed an easier way to get
money, but she got arrested for possession. Withdrawal in jail felt like hell at first, and she
became so depressed that she felt like dying sometimes. Her body was a mess and her mind
just didnt seem to work right at first. Her memory of the past several years just seemed like
a blur, and she could not figure out how she had ended up so messed up.
Question: Identify Tanyas symptoms of depression.
Question: What is the connection between Tanyas depression and her substance abuse?
Treatment
There are several good treatments for depression. They include medications,
psychotherapy, and other complementary treatments.
Medication
Special medications called antidepressants are used to treat the symptoms of
depression. More severe cases of depression may require antidepressant medication in
combination with psychotherapy. Antidepressants may also be helpful in preventing future
relapses into depression.
Basic Facts about Antidepressants
Antidepressants need to be taken daily as prescribed for at least 2-4 weeks to start
being effective. Typically, they are taken continually to maintain their effect. When
used as prescribed, they are very safe.
Some people have side effects from antidepressants, but there are several new
medications that have far fewer side effects.
If a person has any side effects from an antidepressant medication, his or her doctor
or nurse should be told right away. They may be able to adjust the dosage or switch
the person to a different antidepressant to get rid of the side effects. On occasion, the
side effects simply go away over time. Not all people experience the same side
effects.
Antidepressants are not addictive but usually should be stopped gradually (by taking a
lower dose each day) when they are discontinued. It is important to follow a doctors
directions for tapering off medications. A client should not do it on his or her own.
Although the 12-step philosophy states that it is fine to take antidepressants or other
non-addictive medications for psychiatric disorders, not everyone in 12-step groups
will understand someone in recovery taking any drug even if it is medication. As a
result, people taking such medications may want to keep that private.
Once a person is taking an adequate dose of these medications, he or she does not
always need to increase the amount taken over time. People do not always develop a
tolerance to antidepressants, requiring higher doses over time.
Antidepressant medications are more effective when combined with other effective
treatments such as counseling or psychotherapy, getting social support, and other
positive changes in behavior and lifestyle.
Co-occurring Disorders Treatment Workbook 26
For many antidepressants, it may be better to continue taking them even during a
relapse into using alcohol or drugs. This is because the antidepressant can still help to
control the depression. However, continuing the use of antidepressants while using
drugs or alcohol should be discussed with a doctor because the safety and
effectiveness of the antidepressant may depend on which antidepressant (or other
medications) is being taking.
Other commonly used treatments for mild depression include exercise, both aerobic
and strength training, and St. Johns Wort, an herbal supplement. One should check
with a doctor about using herbal supplements because, like medications, they can
have side effects and may affect the outcome of other prescribed medications.
Psychotherapy
Most people with depression have mild to moderate depression. For these people,
individual psychotherapy, counseling, or talk therapy may be effective in treating
depression, even without medication. Psychotherapy helps the depressed person deal with
social, relationship, or work problems as well as change negative patterns of thinking and
behavior. Group or family therapy can also play important roles in helping the person
overcome depression. If a person is recovering from an addiction and is depressed, the most
effective treatments combine treatment for both depression and substance abuse in one
program.
One type of therapy that has been shown to be effective in treating depression (and
substance abuse) is cognitive-behavioral therapy. Cognitive-behavioral therapy (CBT)
focuses on a clients thoughts and behaviors. Much time in therapy is spent examining and
changing inaccurate thoughts the client has about himself or herself, about relationships, and
about the world in general. These inaccurate (or maladaptive) thoughts often lead to
depression. Cognitive-behavioral therapy also involves changing the behaviors of a client
that might be causing problems in his or her life. One example of such behavioral change
would be to decrease or discontinue problematic drug or alcohol use.
Complementary Treatments
In addition to medication and psychotherapy, certain activities can help to lift
depression naturally, especially mild to moderate cases. These activities include regular
cardiovascular exercise, such as running, swimming, walking, or riding a bicycle. Strength
training with weights or exercise machines can also help. Relaxing activities such as yoga
stretches, postures, and breathing exercises and meditation or relaxation training can also
help to lift depression naturally. Any of these activities can be added to psychotherapy
and/or medication to help treat depression. Severe depression may not respond to any of
these activities alone, in which case medication and psychotherapy should be pursued.
Co-occurring Disorders Treatment Workbook 27
Summary
Depression is a psychiatric disorder in which a person experiences a very low or
depressed mood.
Depression differs from normal sadness or feeling blue in that it causes severe
enough problems to interfere with a person’s day-to-day functioning.
Between fifteen and twenty percent of people experience an episode of depression
during their lifetimes.
Research suggests that there may be more than one cause for depression.
Environmental and biological causes can include chemical imbalances in the brain,
experiencing losses early in life, experiencing major losses or stress as adults, and
lack of social support.
Use of alcohol or drugs can be risk factors for depression. A person may become
depressed either while drunk or high, or during withdrawal from alcohol or other
drugs.
Depression can also be a risk factor for substance abuse. People are more likely to
use or relapse when they are experiencing negative feelings, and because depression
includes negative feelings, being depressed may make some people more likely to use
alcohol or other drugs in an attempt to make themselves feel better.
There are several good treatments for depression including medications,
psychotherapy, and other complementary treatments. Seeking these treatments could
be a protective factor against both substance abuse and mental health problems.
References
American Psychiatric Association. (1994). Diagnostic and statistical manual of
mental disorders (4th ed.). Washington, DC: Author.
Directions
For your Final Project, you will apply the information you have learned in this course to
critically analyze a specific case study from the Co-occurring Disorders Treatment
Workbook (The Louis de la Parte Florida Mental Health Institute, 2002) and develop an
assessment and intervention plan based on it. Your Final Project must include rationale
based on learning resources and scholarly material. All work should be supported with
scholarly references from the professional literature contained within the Lamar
University Library.
Your Final Project should include all of the following sections:
1. Overview of the Case Study (2 paragraphs). 10 points
2. A description of procedures and process you would use for assessment and diagnosis
in the selected case study. Be sure to include rationale for your selections (bullet points
with rationale). 10 points
3. Include an analysis of the pharmacodynamics and pharmacokinetics of the
substance(s) used in the case study (provide a chart that summarizes the information).
15 points
4. Develop a diagnosis based on the DSM-5. Specify the degree of the disorder (current
level of severity – mild, moderate, or severe), and include a rationale (2 paragraphs). 20
points
5. Analyze and discuss how the mental health issues in the case study are either caused
by or exacerbated by substance use (1-2 pages). 25 points
6. Discuss etiology: the genetic, biological, environmental, social, psychological, and/or
philosophical elements that might impact the case (1-2 pages). 20 points
7. Discuss the special needs and treatment recommendations related to dual
diagnosis/co-occurring disorders (1-2 pages). 25 points
8. Analyze and apply the main techniques, strategies, or approaches of common treatment
options for the case study selected (include a chart with short rationale). 15 points
9. Explain the typical risk and protective factors that impact the individual in the case study
(2-3 paragraphs). 15 points
10.Describe the efforts you would include toward relapse and prevention and structure a
treatment plan (chart) that incorporates these concepts (1-2 pages). 25 points
11.Analyze and discuss any ethical or legal issues inherent in this case (1-2 paragraphs).
10 points
12.Grammar and APA style. 10 points
Reference:
