CASE STUDY: COUNSELING AN SUD TREATMENT CLIENT WITH SCHIZOPHRENIA

Adolfo M. is a 40-year-old Latino man who began using cannabis and alcohol at 15. He was diagnosed as having schizophrenia when he was 18 and began using cocaine at 19. Sometimes, he lives with his sister or with temporary girlfriends; sometimes, on the street. He has never had a sustained relationship, and he has never held a steady job. He has few close friends. He has had periods of abstinence and freedom from hallucinations and major delusions, but he generally has unusual views of the world that emerge quickly In conversation.

Adolfo M. has been referred to an SUD treatment counselor, who was hired by the mental health center to do most of the group and Individual drug/alcohol work with clients. The first step the counselor takes Is to meet with Adolfo M. and his case manager together. This provides a clinical linkage and allows them to get the best history. The clinical history reveals that Adolfo M. does best when he Is sober and on medications, but there are times when he will be sober and not adhere to a medical regimen, or when he is both taking medications and drinking (although these periods are becoming shorter in duration and less frequent). His case manager often is able to redirect him toward renewed sobriety and adherence to medications, but Adolfo M. and the case manager agree that the cycle of relapse and the work of pulling things back together is wearing them both out. After the meeting, the case manager, counselor, and Adolfo M. agree to meet weekly for a while to see what they can do together to increase the stable periods and decrease the relapse periods. After a month of these planning meetings, the following plan emerges. Adolfo M. will attend SUD treatment groups for people with CODs (run by the counselor three times a week at the clinic), see the team psychiatrist, and attend local dual disorder AA meetings. The SUD treatment group he will be joining is one that addresses not only addiction problems but also difficulties with treatment follow-through, life problems, ways of dealing with stress, and the need for social support for clients trying to get sober. When and if relapse happens, Adolfo M. will be accepted back without prejudice and supported in recovery and treatment of both his substance misuse and mental disorders; however, part of the plan is to analyze relapses with the group. His goal is to have as many sober days as possible with as many days adhering to a medical regimen as possible. Another aspect of the group is that monthly, 90-day, 6-month, and yearly sobriety birthdays are celebrated. Part of the employment program at the center is that clients need to have a minimum of 3 months of sobriety before they will be placed in a supported work situation, so this becomes an incentive for sobriety as well.