Chemical Dependency and Mental Health

Online Discussion Questions and Ideas Module 3
Physical, Psychological, and Pharmacological Effects of Substance use (cont’d)

Remember the specification from the syllabus on these discussions:

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Were the assigned questions/topics responded to?
Was the initial post over 250 and under 500 words?
Was a citation included in the post? [One outside scholarly citation/source (not provided, but one you search out) is required for each original post.]
Were three peers responded to each week? [[To clarify: you choose the peers]]
Student’s written work demonstrates graduate level skill including critical thinking.
Please be careful and be sure your spell check is on, thank you.
For Module 3 let’s have a good discussion of these questions and ideas:

We read about pharmacokinetic and pharmacodynamic principles and the chapters concerning alcohol and then non-alcohol sedative hypnotics. 

Let’s apply some of that reading to a case; you were given the case on this weeks readings page but here it is again:

Let’s discuss the following questions and ideas about the Santos case

How do you help Jonathan come to grips with the neurological consequences of his use? 
What are three things you would not want to say to the client? (For example “Oh flailing is really tweaking”. !)
What are two principles of good counseling that you would employ throughout the clinical interaction?  What EBP do you think would work?
Make 3 connections to the reading; challenge 2 assumptions; and provide 1 question for your colleagues and your instructor to respond to.

Read:  Miller et al. (2019). Electronic Book. The ASAM Principles of Addiction Medicine (6th ed). Philadelphia, PA: Wolters Kluwer
All readings are from section 2: Pharmacology. chpt: 8,9,10,11,12,13,14,15

Video lectures: .

Clinical and Research Consulting, PLLC Timothy
B. Conley, Ph.D., L.C.S.W., C.A.S.
High Line Montana
Chemical Dependency and Mental Health Assessment
Name: Jonathan Santos
Date of Birth: 10/20/87
Date: 10/10/19
Referral Information: This client was referred by the Montana Department of Correction Parole and
Probation Department (PPD) for both substance abuse and mental health assessments following both
previous drug related convictions and current new charges. He is represented by the Office of Public
Defender (OPD) in High Line, MT.
Background/Presenting Information: Mr. Santos was seen for 5 hours of assessment and
evaluation in the High Line office. Appropriate consent forms were signed for both PPD and OPD. I
spoke on several occasions with his probation officer Kate Swanson.
Mr. Santos is a 30-year-old married mixed race American male who lives with his girlfriend in a
motel in High Line. He described being raised by his grandmother, as his biological mom was about
13 when she had him. He has 4 sisters and 3 children of his own, a boy and 2 girls all under the age
of 8. He earned his GED in 2005 and has mostly worked general labor jobs as an adult. Mr. Santos is
currently on probation following conviction of a felony possession of methamphetamine. He is
currently facing new felony charges.
Chemical Use Assessment and Testing: The Diagnostic and Statistical Manual of the American
Psychological Association delineates 11 criteria for Substance Use Disorder. With regards to
methamphetamine Mr. Santos meets all criteria, he scored 18 on the drug abuse screening test, well
above the high cut point of 11 indicating a drug use disorder, primarily methamphetamine. He does
not score positive for substance use disorder on alcohol. He has recently taken oxycontin in an
attempt to achieve sleep and rest. Other reported abuse includes marijuana and bath salts. He has a
history of IV injection of methamphetamine.
Mental Health Assessment and Testing: The client was administered the Generalized Anxiety
Disorder Seven Item Scale and scored 14, well above the cut point indicating an elevated level of
anxiety. the client was also administered the Center for Epidemiologic Studies Depression Scale and
scored 29, more than twice the cut point above which it is considered that there is depressive
disorder. Clinical interviewing indicated and revealed that the client was depressed, his lack of
animation and increased amount of time it takes to respond to direct questions indicate that his mood
is low. He is exhausted, not sleeping well, and he reports that he has never slept well. He states that
he is unable to concentrate and to focus on where he is supposed to be and when he is supposed to be
there. He has an elevated level of anxiety when he is required to do two things at once, for example
be at work and be at an appointment for probation – let alone if a third thing like making a required
Case study example for teaching only. Please do not copy or share.
Case study example for teaching only. Please do not copy or share.
phone call is happening at the same time. He has low frustration tolerance level for this kind of
conflict. Moreover, clinical interviewing and questioning resulted in his disclosing that he sometimes
“flails” and he was asked to describe this. He describes this as sometimes having paranoid ideation in
which he is sure that things are going on around him that aren’t. He reports that at times he has run to
the police station to get help because he thought he was going to be assaulted, another time he fled
his motel room sure that people were closing in on him, later he comes to his senses and realize that
everything he was thinking is not correct. This is likely a methamphetamine related parapsychosis. It
will not be possible to differentially diagnose the presence of a stable underlying mental health
condition until Mr. Santos achieves sustained abstinence from substances.
Integrated Dimensional Assessment/ Treatment Placement and Recommendations.
Dimension I (Acute Intoxication/Withdrawal Potential)
Identified Problems: The client has experienced a physical and psychological withdrawal syndrome
in the past. Given the high level of tolerance he has for substances and his current use pattern he is at
high risk for withdrawal.
Assessment: The client currently is at risk for withdrawal and should be treated in an inpatient
Recommendations: level 3.7 clinically monitored intensive inpatient services for this dimension.
Dimension II (Bio/Medical Conditions and Complications)
Identified Problems: The client reports that within the past three weeks he visited the emergency
room, sick to his stomach with flulike symptoms and states further that he was diagnosed with a
fungal infection under the skin on his arm which is causing discoloration and elevated self
Assessment: The client is in need of a general medical evaluation.
Recommendations: Level 3.5 clinically managed high intensity residential services
Dimension III (Emotional/Behavioral/Cognitive Conditions and Complications):
Identified Problems: The client meets diagnostic criteria for psychoactive substance dependence
disorder on methamphetamine; he has also recently taken oxycontin, a powerful opiate and is unclear
of the degree of involvement there. Probation reported a positive test 10/30/19. He has a history of
bath salt abuse and marijuana abuse. Moreover, the client is showing pathologically elevated levels
of anxiety, depression, and intermittent parapsychosis likely secondary to his substance use, but he
needs to be reassessed further for this when he is substance free.
Assessment: The client meets the diagnostic criteria for psychoactive substance use disorder
methamphetamine in early remission, psychoactive substance use disorder also for opiates, not in
remission; and a use disorder for bath salts and marijuana apparently in remission. He needs a full
psychiatric workup.
Recommendations: Level 3.7 clinically monitored intensive inpatient services for this dimension.
Dimension IV (Readiness for Change)
Stage of Change: The client is in the contemplation stage of change, currently trying to decide what
to do about his substance use.
Identified Problems: As recently as 10/19/19 the client indicates that using opiates was the solution
to the problem of not being able to sleep or relax from all the legal stress that he has in his life.
Case study example for teaching only. Please do not copy or share.
Case study example for teaching only. Please do not copy or share.
Assessment: Mr. Santos is convinced that the substances which are causing him problems will solve
them. At this point he has a fairly encapsulated delusional belief that substances are what will get
him through the hard times. Nonetheless, he turned 30 years old on October 20, 2019 and expresses a
larger existential sense that he needs to stop using substances and accomplish something in his life in
order to honor his family.
Recommendations: Level 3.7 clinically managed high intensity residential services
Dimension V (Relapse/Continued Use/Continued Problem Potential)
Identified Problems: Mr. Santos has exhibited some self-deception in the past. He has been
working (unsuccessfully) to maintain a drug free lifestyle since before his most recent arrest, he is
actively using.
Assessment: His substance use disorder is not in remission and he is relapsing frequently. Potential
remains very high. He is willing to commit to a longer course of treatment that will help his treat his
addiction and the underlying co-occurring issues.
Recommendations: Level 3.1 clinically managed low intensity residential services
Dimension VI (Recovery Environment)
Identified Problems: Client is living in a motel, paying rent by working for them. His girlfriend who
lives with him sometimes is not abstinent or in treatment.
Recommendations: Mr. Santos should become involved with other individuals pursuing abstinence
in recovery from addiction to learn environmental coping strategies. Level 3.1 clinically managed
low intensity residential services
Overall Impressions/Recommendations:
Mr. Santos is a personable and likable character who appears for the most part to have a developing
and increasing level of insight into both his substance use disorder and mental health problems. He is
in the contemplation stage of change and is too disorganized at this time to take the action steps
necessary to achieve and maintain a recovery lifestyle. He has relapsed frequently, has relapsed
recently, and is at highest risk to continue to do so in the absence of a residential treatment
placement. If he continues to use and relapse, he will be held likely at High Line County Detention
Facility where he reports that he has spent 3 out of the last 10 years of his life mostly in 4-6 month or
shorter periods of time. Incarceration and punitive/sanction type approaches have failed to instill a
level of motivation necessary to seek treatment to the degree that his substance abuse disorder will go
into remission. At this time, I strongly recommended that he pursue admission to a level 3.7
clinically monitored intensive inpatient service for his substance use disorder.
Timothy B. Conley, Ph.D., LCSW, CAS. For more information on Chemical Dependency and Mental Health visit this:

Chemical Dependency and Mental Health

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