____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
I’m asleep, I sleep through the night. But when I wake up with my alarm clock, it starts all over again. Therapist : I can see how that would be exhausting. Do you have any other problems because of all these worries? Client : Well, I can’t concentrate like I used to, and I seem to forget things. I’ve started making lists of things to remember because I worry that I will forget something important. I feel tired all the time, and I have started having pains in the back of my neck and headaches as well. Therapist : How long have you been experiencing these constant wor- ries? Client : It seems like it’s been going on for about a year. It wasn’t as bad at the beginning as it is now. But I would say it’s got to be at least a year. It took me a while to get up the courage to talk to somebody about it; it all seems so stupid. Therapist : It must be confusing and frustrating for you, and I admire your willingness to begin confronting this problem and the courage it does take to talk about it. Help me understand: Over the past year, have you done anything to help yourself in dealing with these worries? Client : Well, I have been drinking more wine. I’ve always been a wine drinker, but in the past 6 months or so I’ve been having several glasses every evening. Therapist : So that I can be clear, when you say, “several glasses,” would that be two or three or four or more? Client : It used to be just two or three, but lately it’s been four or more. In the last couple of months, sometimes I drank the whole bottle. Therapist : So in order to help you cope with all your worries, you have begun drinking more wine and have found that over the last several months you are drinking more and more. Is that correct? Client : Yes, I’m afraid it is. Therapist : Have you found that drinking more wine was helpful? Client : Well, it seems to help a little bit, at least at first. I feel more relaxed and don’t care as much about what might happen. But I think that in the long run it just makes me feel more anxious. I’ve always liked good wine, not the cheap stuff, so drinking more has cost me more, and I worry about my finances. To tell you the truth, I worry about my drinking, too. Therapist : What things about your drinking most concern you? Client : I worry that I won’t be able to stop. I’ve tried to stay away from the wine several times over the last 3 months, but I can’t seem to manage to do it for more than a few days and then I’m back drinking as much or more than I was. It’s just all so scary. Sometimes I feel like I’m losing my mind. Is there anything that can help? Therapist : First, let me say how much I admire your willingness to talk so frankly about your problems. I know it’s not easy. Let me just recap. For about the past year, you’ve found yourself worrying all the time about all sorts of things, some of which you don’t think are realistic. All this worry has disturbed your sleep, affected your ability to concentrate and remember, and caused you to feel fatigued and
Interest in the co-occurrence of disorders began in the 1980s with several large population studies that demonstrated that there is a high rate of co-occurrence of psychiatric disorders in the general population, particularly in combination with SUDs (Grant et al., 2016). The presence of a SUD was found to increase the likelihood of an individual also having a psychi- atric disorder by a factor of two or more. Studies also indicated that individuals with co-occurring SUDs and psychiatric dis- orders had a poorer outcome from treatment than individuals who had only SUDs. Strangely enough, these same studies also indicated that having both a SUD and a co-occurring psychiatric disorder seemed to play some role in motivating individuals to seek treatment (Morisano et al., 2014). Several methods are employed to treat co-occurring disorders. These include staged treatments, in which one disorder is treated first and then the next disorder is treated. They also include integrated treatment, in which the co-occurring dis- orders are treated simultaneously. It would seem that the use of a treatment protocol of proven effectiveness, together with the development of a therapeutic alliance between client and therapist, is the most critical indicator of a successful outcome (Clarke et al., 2013). Successful treatment hinges on the ability of a clinician to focus on holistic wellness of lifestyle, past treatment history, accurate diagnoses, the recognition of past traumas, and a number of other important characteristics. Also, on the cutting edge of treatment techniques are new testing protocols that detect genetic predispositions toward particular drugs and detect new designer drugs that may produce dramatic negative outcomes for those with co-occurring disorders. The following case vignette is an example of a client presenting with a co-occurring disorder: Therapist : Ms. Campbell, can you tell me a bit about what brings you here today? Client : Well, Dr. Kraus, I have been feeling very anxious and worried all the time. It seems that worry is all I do anymore. Therapist : I see. So, you have found yourself worrying a great deal. About what kinds of things do you worry? Client : Well, it seems almost silly when I say it, but I worry that I might lose my job, and I worry that the apartment will catch on fire, and I worry that my mother will get sick. I just worry about everything, even though, when I stop and think about it, a lot of the things I worry about are not likely to happen, at least not in the short run. But when I’m worrying, all these concerns seem very real. Therapist : So, if I understand you correctly, you worry about all sorts of things that in one way seem very real to you, but in another way seem not much worth worrying about. Is that it? Client : Yes. And I can’t seem to stop doing it. Every time I’m not completely occupied with something, these worries come into my mind and I can’t seem to set them aside. It’s worse at night. When I go to bed, I’m exhausted, but I just lie there and worry about what might happen. It takes me at least an hour before I can go to sleep. Once
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