Tanya Abuse Case Study
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 wasn’t 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 didn’t 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 Tanya’s symptoms of depression.
Question: What is the connection between Tanya’s depression and her substance abuse?
There are several good treatments for depression. They include medications, psychotherapy, and other complementary treatments.
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 doctor’s 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.
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- 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. John’s 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.
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 client’s 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.
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- 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.
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
The Louis de la Parte Florida Mental Health Institute (2002). Co-occurring disorders treatment workbook. Retrieved from: http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=1593&context=mhlp_facpub