Area 7 - Substance Abuse


Due to a lack of adequate coping skills, John uses alcohol on a regular basis in an attempt to manage his anxiety and symptoms of depression. This is a problem because alcohol consumption causes John to become more aggressive and prone to engaging in high-risk behavior. Last month, for example, John challenged his apartment manager to a fight after the manager asked him to quit yelling at people on an upstairs balcony and return to his apartment. John denies having a drinking problem and attributes his alcohol-related problems to "other people being stupid."

Phyllis injured her back 2 years ago and started taking larger doses of narcotic pain medications than were prescribed to her. Soon she was getting these meds from multiple sources, some legal and some not. Phyllis continues to abuse pain medications regularly and reports that she cannot deal with her pain and depression without them. Phyllis is continuously engaged in med-seeking, and activities related to obtaining or using narcotics (such as going to emergency rooms) consume much of her waking time.

Jessie began using drugs in his early teens and has continued using them throughout his adult life. He states that he uses methamphetamine and cannabis to reduce the intensity of his auditory hallucinations, although methamphetamine tends to increase the intensity of Jessie's A/H and delusions, and makes him more aggressive and prone to engaging in fights.

Armando was an alcoholic for many years until 2009, when he become sober. He remained sober for 4 years, until a breakup with his girlfriend in 2013 caused him to start drinking again. Armando reports that he drinks as a way of dealing with anxiety and depression. When he drinks, he drinks heavily, and is often drunk for weeks on end. Armando has been hospitalized or treated in ERs multiple times over the last 5 months for acute alcohol intoxication and/or suicidality related to his depression and drinking. Despite this, Armando denies that alcohol is a problem for him. "If I could just get my problems straightened out," Armando says, "this alcohol thing would go away."

Maria reports that she's been “clean and sober” for 2 years, but due to a lack of effective coping skills, she continues to seek sedative-hypnotic medications such as Xanax and Vicodin from several different doctors in order to reduce her anxiety and symptoms of depression. This is a problem because overuse of these medications further reduces Maria's motivation, and when she runs out, or when her doctor refuses to prescribe them for her, she becomes anxious, irritable, and prone to arguing.

Terrence reports using meth to reduce the intensity of his auditory hallucinations and paranoia. The effect is short-lived, however, and within a few hours Terrence reports an increase in his A/H and paranoia, often leading to a trance-like state in which he lies on his bed for days and is unresponsive to others. During these periods, Terrence reports that the voices in his head are so loud and intrusive that he cannot hear anything else. He wants to quit using, but says he's tried many times and has never been successful.

Ross smokes at least one pack of cigarettes a day, and becomes agitated and argumentative if he runs of out cigarettes and is unable to obtain them from others. Due to the mood component of his mental illness, Ross already has trouble controlling his temper. His addiction to nicotine and accompanying withdrawal symptoms exacerbate this problem and make it even harder for him to control his temper. Last month, Ross threatened a housemate who refused to give him any more cigarettes. Ross also has a chronic lung condition and is at risk of serious health problems if he continues to smoke.

Tiffany began drinking at the age of 13 and was an alcoholic by the time she graduated from high school. She currently drinks on a daily basis. Tiffany reports drinking to calm herself down, although in reality alcohol tends to make Tiffany more belligerent. Tiffany says that after she drinks, she often “goes around looking for a fight.” Alcohol has been a major factor in most of her evictions, job losses, arrests, and incarcerations. Despite this, Tiffany denies having a problem with alcohol and says she can quit anytime she wants.

Willard reports attempting to self-treat the symptoms of his mental illness by using drugs that make him feel happier, more inclined to interact with others, and more motivated to do things. This is a problem because in reality, the drugs cause him to feel extremely paranoid, exacerbate his normally-mild A/H, and make him very confused. His use of drugs also results in angry outbursts, arrests, and incarcerations.

Perry reports using alcohol and marijuana from the age of 11 to self-treat his symptoms of depression. When Perry uses alcohol, he becomes aggressive, belligerent, and prone to fighting. All of Perry's arrests were related to his consumption of alcohol and its effect on his behavior. Perry risks being arrested and/or exited from his R&B if he gets drunk and becomes combative again.

Although Eduardo claims to be sober, collateral from persons who know and work with him suggests he may drink from time to time, although not heavily. Eduardo has refused on multiple occasions to take a drug test as requested by his psychiatrist. Because Eduardo denies any form of substance abuse, his recovery plans contain no provisions for guarding against relapse. This is a problem because if Eduardo begins using again, his symptoms of depression are likely to intensify rapidly.

Andrea has a history of abusing and being dependent upon a number of different substances. Although Andrea has been sober for 17 months, her substance abuse spanned many decades, so the potential for relapse remains an ongoing concern. Andrea attends AA meetings and has a sponsor, and appears committed to her sobriety.

Duane is currently using alcohol, methamphetamine, and cannabis on a regular basis. Meth makes Duane more irritable and prone to engaging in arguments, and increases his already-high levels of paranoia. Drug and alcohol purchases further diminish Duane’s ability to meet his basic needs with his limited income. Duane is at the precontemplation stage of recovery, however, and does not feel that substance use is a problem for him.

Isaac uses methamphetamine on a continual basis in an attempt to self-treat his depression. Meth use further increases the intensity of Isaac's emotional responses, making them even more difficult for him to control. Also, Isaac risks violating the terms of his probation and being arrested if he does not comply with court orders relating to substance abuse treatment.

Alberto reports using meth 2 or 3 times a month as a "pick-me-up." According to Alberto, meth helps him focus and gives him energy for a few hours or days. When he starts coming down, however, he become extremely irritable and gets into fights "at the drop of a hat." Alberto tries to use alcohol "to put on the brakes," but says this makes him even more prone to fighting, and makes him say things he later regrets.

Veronica has used illicit substances for many years in an attempt to improve her mood and reduce her anxiety. This is a problem for several reasons: When Veronica relapses, she feels ashamed and angry at herself. After she uses, she inevitably “crashes” and feels even more depressed and anxious. When she feels depressed and anxious, all she can think about is using again. "It's a vicious cycle," says Veronica. Veronica tries to avoid using, but any additional stress she encounters is a trigger for substance use.


All PHI has been de-identified per HIPAA Privacy Rule