Alex Dual Diagnosis Case Study

Introduction

Alex was born in a poor black South African family. His parents belong to the working class, wherein his father was an accountant, and his mother was a lecturer in the education department. He was raised and got his early education in the UK. He was well in his education and had started training in nursing, but due to the no support from his parents because of their separation, he got stress and depression. It was difficult for him to continue his study with a depressed mind. To cope with the stress, he overuses the drinking, which causes his homelessness and snatching of the material from the shops. The police caught him and, in jail, provided him counseling for his relaxation, but after his release from jail, he again started drinking. He was introduced to IV drug use, which is comprised of cocaine and heroin mixed with the speedball. The respiratory depression and the collapse of the veins in his arms are the result of the regular use of speedball. Due to his repeated negligence of self-caring, he was admitted to the psychiatric center to provide him with necessary care and anti-psychotic medication. He also receives a diagnosis of schizophrenia during his admission to the care center.

Discussion

Alex is now facing multiple diseases with his single body, and he needs regular care and medication to recover from the disastrous state of weakness. Various diseases operating in his body as he knew b, but he was not aware of the attack of HIV antibody positive. It was because of the regular injections of drugs like cocaine and a mixture of heroin. Specialists are of the view that people like Alex are having a high risk of blood-borne viruses and infections. The sharing of the injections and the needles provided HCV and HIV viruses. Various approaches are used to limit and diagnose hard drugs, and certain countries have taken serious steps as the Netherlands, which has applied harm harm-reducing approach. Reducing the harm posed the positive result of the epidemic of HIV and HCV.^[1] The aim of the harm reduction tools is to stop drug users like Alex from excessive and harmful use. Amsterdam health service is providing methadone in collaboration with social health care and the exchange of needle facilities. To detoxify Alex from overuse of drugs and related issues, a comprehensive program through the clinic of addiction can play a very important in recovering his health.

Studies have calculated the results of the methadone program with different and conflicting results. The declining ratio of HCV was reported through the diagnosis of drug addicts through a needle exchange program. Among the participants of the program, very few of them have described the effects of HIV. For a long period, the methodology can help Alex to remain at the lower stage of HIV and HCV diseases. The intervention of the Amsterdam Cohort Study is prospective research on the factors involved in the viruses of HIV and those infections that enter the body through blood-borne transmission. The research was started in the late nineteen eighties, and the intervention program is still going on with an increased focus on young people like Alex. It is a notable point that Western countries are facing an increasing number of young’s addicted to drugs with dangerous formulas.

Alex visits the Academy of the Amsterdam health service can easily recover his present state of the condition caused by the over drinking. With every visit, he can have a blood test for HIV. The health service will also complete the questionnaire regarding the health recovery from the drug use and the risk he takes after drinking. Through a systematic process and the combination of drug injections, NEP usage and the methadone dosage in the laboratory, testing can reveal the actual results of the disease faced by him. Better results can cure the problem more efficiently than those tests, which are not clear and most sophisticated. In the same way, his problems of stress and depression, which were the primary causes of his conversion to make him an uncivilized and weak person, also need due attention.

Researchers confirm that stress places an overdue burden on the individual personality and mostly makes them drug addicts. The effects of the depression disturb the wellbeing of the people physically and mentally. However, the notable point is that stress is not as bad as the problem of how to deal with it effectively. There are cases that unfolded the positives of stress, like convincing individuals towards work or towards active life. The problem with Alex was that he did not use the stress positively and drove himself to a more destructive and abnormal life. He can consult a psychologist or have the opportunity to do part-time work or some pleasure activity, which might decrease his depression and help him to continue his studies.^[2] The use of alcohol in eradicating stress is not a long-term solution, but it is actually a tool to get relief for a short span of time. The self-defeating techniques used by him drive him to a more complex life. There are certain useful techniques that drug addicts can use to improve their lives. It is necessary to discuss those interventions that are helpful for Alex in recovering from his health and mental problems.

He must breathe long and use visualization techniques, which can relax his body. Engagement in certain hobbies or listening to songs will also dramatically reduce his stress level. For the waves of anger disorders like stress, psychotherapy has been widely used to decrease and lessen the depression of individuals. The same therapy can apply to him through clinical interventions. A young man of thirty-eight years has gone through therapy with depressive fits of anger and problems. The man was hospitalized to cope with his depressive condition into an active and mindful life. The intervention approach applies to the person by following procedures of stress inoculation. There were three stages of the process: preparation of the cognition, skill base acquisition and rehearsal. The assessments before the intervention of anger entries reveal a ratio of three hundred and one. After the discharge from the hospital and with the twenty-five days of regular intervention, the assessment score was calculated as two fifty-eight. The same case and the therapy can apply to Alex in order to recover him from the stress full life. Regular exercise also has the potential to normalize and enhance the endorphins, which will relax his mood. A brisk walk, along with yoga, can provide a calm state of mind and can reduce muscular tension.

Alex had a diverse effect of continuous usage of speedballing on his personality. It was destructive and more than ending his enjoyable life. The original speedball comprises morphine sulfate and hydrochloride cocaine. It is also used for the pharmaceutical opium along with different stimulants. The use of the speedball provides numbness and drowsiness to the individual. Flex uses heroin and cocaine to counter side effects, but the said use resulted in the overdose and failure of his respiratory system.^[3] Other than his problems and issues there, are numerous people directly affected by the use of cocaine and heroin? In the year two thousand fifteen, around thirteen thousand people lost their lives with the use of speedballs. Even cocaine has sent seven thousand people into the Valley of Death. In the years between two thousand ten and fifteen, there were twenty thousand people killed by the destructive drugs. Numerous organizations have coping techniques and therapies for addicts of speedballs. They include evaluation, detoxifying the individual, medicated assisted therapy, group and individual therapy, contingency management, and dialectical behavior therapy.

An educational programme can best apply to the intervention of Alex. Test and teach case methodology is an approach designed to manage the issues related to the excessive use of the drugs. With the background of hypertension, Alex can use daily treatment of itraconazole. After the time of three weeks, he might have pain in his neck. With the discovery of brown color urine, he can discontinue all of his medication and the required medical attention. When he is examined again, he could have tenderness in his muscles, and his blood pressure could rise to the level of ninety.^[4] His blood cells and renal function will be normal. The urinalysis might be amber colored which is positive for occult blood and for the myoglobin. The time for tests in the laboratory will take time of around one and a half days. He will be diagnosed and treated with the hydration and anti-hypertensive approach to resolving his issue of mental problems. He can manage through certain drug management techniques and can increase normality in his life.

The intervention of dialectical behavior therapy can have a positive impact on the cognition of Alex. The therapy was developed by Marshal Linehan. The basic phenomena of the intervention are the psychotherapy of the individual along with the strategies to enhance life experiences. The skills implied over the people are full-mindedness, regulation of emotions, tolerance of distress, and efficient interpersonal techniques. Comprises of the five basic components, the therapy focuses on the enhancement of the abilities of the client in behavioral moves. Alex can learn those group-teaching skills and the homework given by the teacher to apply them in his everyday life. Group meets after the break of one week for the time of three hours and he can interact with other people facing the same problem. In the model individual therapy consisted of the one week, programme which is also useful for him. To provide the necessary support, the therapy can incorporate Alex’s coaching via telephone on how will use the DBT skills at home. Wherever he needs help from his coach, he can frequently use the telephone to resolve the hurdles or issues not understood by him.

The management of the case will help Alex to take care of his social and physical life without having the support of any other. Coach uses the same techniques, validations, and problem-solving methodologies in order to make the person capable of becoming case head of his own problem. In these strategies, the coach will provide independent decision power to Alex’s case and will not intervene during the process of solving the problem. The focus of the therapist team is on those individuals, leaders or supervisors helping the client in intervention. To provide the best possible intervention, the team will help Alex at every stage of operations and actions. Dialectical behavioral therapy has a history of rehabilitating many people like Alex facing the problem of mental disorders. Studies confirm that DBT is effective in decreasing suicidal behaviors, injury of self, depression, and anger and enhancing the global and social functioning of one’s life. Proper treatment and regular consultation with the respective coaches can help Alex in improving his life and health. The discussion on the case of Alex reveals that his poor parents might have problems related to mental health or cognitive issues. Genetic transmission of the virus is possible, especially in poor people belonging to developing countries. Africa, in this regard, has a history full of diseases and international migration to eliminate and spread those diseases attacking people due to poor clothing, food and lifestyle.

Stigma regarding the psychotic disorder is infrequent among the families. Other than this disorder, it can be in any form or in any family. The general and the associative kinds of stigma are applicable to every individual. The process by which a single person is stigmatized through the virtue of associative stigma. The World Health Organization, an international health agency, has revealed that stigma is one of the major hurdles in treating problems related to mental health. According to the WHO, it is a process in society whereby imbalances in power, separation, stereotyping, loss of status and discrimination operating the respective society. All over the world, mental health related to mental health stigma causes numerous sufferings for people. Social relations, limitations in opportunities, education and employment, psychiatric morbidity and stress are included in the result of the stigma. The problem of schizophrenia that is also operating in Alex is a major target for discrimination and stigma. Due to the disruptive behaviour, distinctive symptoms it is frequently spread n members of the families.

Those individuals facing the problem of schizophrenia, along with their families, are easily attacked by the stigma. In the year nineteen ninety-six, the Association of World Psychiatrists campaigned to stop and to counter the stigma along with the discrimination overriding the problem of stigma.^[5] Years after the campaign, studies were conducted and concluded that negative influence is posed on the families and patients attacked by the problem of schizophrenia. For example, their relative Alex was stigmatized through social exclusion experiences and the guilt assignments faced by every individual in the family as a patient of schizophrenia. Around seventy percent of specialists associated with the interventions of people like Alex believe that people generally devalue patients and extend this discrimination to the family of the individual. The OMI scales are mostly used to assess the condition of the families and patients associated with mental illness. The scale easily incorporates those elements of the stigma, which includes the labels of mental ill health to stereotypes like people who are ill by mind let them control their emotions in their own way. Loss of status and the discrimination attached to an individual admitted to the hospital should be banned from playing any role in the election process. The OMI was changed to decrease bias on social desire. For example, to decrease the bias of response, entities were given positive and negative words with the same score for each as zero as for the stigmatize response. The reduced rate of scores reveals negativity towards the health of the mind and produces more stigma.

Along with the issue of stigmatization, there is the problem of increased death among those people released from prison. Alex then left the prison to join the atmosphere of taking drugs in a more speedy way, which could have caused his death if he had not been admitted to the hospital. Inside the prison life, he was given regular counseling and related interventions for her recovery from drug addiction. The period was comprised of around nine months. Time in the prison has also provided an activity managed by the staff of prison to Alex for his hopeful life. However, if we look at the research and the studies conducted by several institutes conclude that overdose death after the release of drug-related prisoners is very unacceptable. The key factor to this is the less tolerant behaviour after a long period passed in the closed house. The second leading factor can be the use of concurrent drugs with every extra drug used as opioids, which significantly increases the risk related to the loss of individual life. However, the prisons have the facility of counseling during the time of the person in prison life, but pre-release counseling is very much necessary.^[6] It must include the observation and monitoring of those young people released from prison. Long-term interventions are often required for chronic disorders, which are caused due to the opioid dependency. Different trials and cohort studies concluded that opioid substitution therapy decreases the risk of overdose among the members of opioid users.

During the time when the prevalence of the illicit use of drugs is present among prisoners, they try to learn about the issues related to the diagnosis of excessive use of drugs. In the years between two thousand and two thousand eleven, research documented the lifetime prevalence of around fifty percent of imprisoned people in the region of the European Union and the state of Norway. In other states, sixty percent of the prisoners accept that they use heroin, cocaine and related drugs after their release. In Asian American societies, dependency on the use of opioids is high, which affects around eighty percent in Asia; the drug of favorite choice is also high among American prisoners.^[7] Different harm-reducing and preventive responses can be applied to the criminal justice system. By doing this, it is hopeful news that the rate of overdose death might decrease after the immediate post-release time of prisoners. The same calculations apply to patients like Alex, who needs surveillance by the police and observation regarding his activities after his release from prison. Pre-release counseling is essential and important for such kind of drug addicts who have destroyed their lives by overusing the drugs.

Conclusion

Concluding the detailed discussion on the case of poor Alex, it is worth mentioning that individuals like him need regular counseling and education to prevent them from destroying their lives. Disturbance of his family life and lack of support from his parents, who also have problems, led him to prison and then to the hospital. His story does not stop here, and after he releases, he faces the same situation of increased stress, which he copes through the speedballing. The most important aspect is that he is poor but does not know how to change the stress for the achievement of positive goals. Theories, methodologies and interventions are frequently available for Alex to adopt for the renewal of his life. Belonging to the poor society of the African continent will not restrain him from using exercise, regular consultation with the psychologist and the tools to relax his mind and breathe. By applying these, he can have a prosperous, happy and positive life.

End Notes

Douglas, Thomas, Jonathan Pugh, Illini Singh, Julian Savulescu, and Seena Fazel. “Risk assessment tools in criminal justice and forensic psychiatry: the need for better data.” European Psychiatry 42 (2017): 134-137.

World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. World Health Organization, 2016.

Kolodny, Andrew, David T. Courtwright, Catherine S. Hwang, Peter Kreiner, John L. Eadie, Thomas W. Clark, and G. Caleb Alexander. “The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction.” Annual review of public health 36 (2015): 559-574.

Tsui, Judith I., Jennifer L. Evans, Paula J. Lum, Judith A. Hahn, and Kimberly Page. “Association of opioid agonist therapy with the lower incidence of hepatitis C virus infection in young adult injection drug users.” JAMA internal medicine174, no. 12 (2014): 1974-1981.

Conner, Mark, and Paul Norman. Predicting health behaviour. McGraw-Hill Education (UK), 2005.

Schwarzer, Ralf, and Britta Renner. “Social-cognitive predictors of health behaviour: action self-efficacy and coping self-efficacy.” Health Psychology 19, no. 5 (2000): 487.

Sipe, Theresa Ann, Terrika L. Barham, Wayne D. Johnson, Heather A. Joseph, Maria Luisa Tungol-Ashmon, and Ann O’Leary. “Structural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review.” AIDS and Behavior 21, no. 12 (2017): 3366-3430.

1. Douglas, Thomas, Jonathan Pugh, Illini Singh, Julian Savulescu, and Seena Fazel. “Risk assessment tools in criminal justice and forensic psychiatry: the need for better data.” European Psychiatry 42 (2017): 134-137. ↑
2. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. World Health Organization, 2016. ↑
3. Kolodny, Andrew, David T. Courtwright, Catherine S. Hwang, Peter Kreiner, John L. Eadie, Thomas W. Clark, and G. Caleb Alexander. “The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction.” Annual review of public health 36 (2015): 559-574. ↑
4. Tsui, Judith I., Jennifer L. Evans, Paula J. Lum, Judith A. Hahn, and Kimberly Page. “Association of opioid agonist therapy with the lower incidence of hepatitis C virus infection in young adult injection drug users.” JAMA internal medicine174, no. 12 (2014): 1974-1981. ↑
5. Conner, Mark, and Paul Norman. Predicting health behaviour. McGraw-Hill Education (UK), 2005. ↑
6. Schwarzer, Ralf, and Britta Renner. “Social-cognitive predictors of health behaviour: action self-efficacy and coping self-efficacy.” Health Psychology 19, no. 5 (2000): 487. ↑
7. Sipe, Theresa Ann, Terrika L. Barham, Wayne D. Johnson, Heather A. Joseph, Maria Luisa Tungol-Ashmon, and Ann O’Leary. “Structural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review.” AIDS and Behavior 21, no. 12 (2017): 3366-3430. ↑