2 Training Frontline StaffModule 1 2 Basic Elements and Practice PrinciplesModule 2 2 Practical Knowledge of Common SubstancesModule 3 2 Stages of Treatment and Core Processes
He has used alcohol and marijuana since adolescence.
Since his discharge from the Marines 20 years ago,
he has experienced symptoms of racing thoughts,
flashbacks, anxiety, and social avoidance.
Kevin worked as a heavy-equipment operator until 5
years ago when he was in an automobile accident and
sustained a brain injury. He was charged with driving
while intoxicated, lost his driver’s license, and lost his
job. Since then, he has not had stable housing, has
not worked, and has experienced poor memory and
concentration in addition to his other symptoms.
As his use of alcohol and marijuana increased over
time, he has become more and more paranoid.
Kevin has been arrested a number of times for
criminal threatening and assault.
He refused treatment at the local Veterans
Administration Hospital and at the local mental
health center, but was willing to meet with mental
health practitioners at the homeless shelter.
Kevin’s behavior at the shelter has been paranoid
and aggressive. During his last court hearing,
the judge ruled, “This man needs mental health
treatment. See that he gets treatment and is not a
threat to the community.” The judge wrote a court
order requiring Kevin to participate in treatment
at the mental health center.
Kevin’s integrated treatment specialist began meeting
with him at the homeless shelter every day. They
usually went for a walk and had coffee. Over the next
month, they had many conversations. The integrated
treatment specialist started by asking Kevin what
he thought about the judge’s order. Kevin thought,
“He has it in for me,” and refused to go to the mental
health center.
The integrated treatment specialist continued to
meet with him at the shelter or a coffee shop, and
Kevin agreed. Asked about the good things in his life
right now, Kevin identified having a warm, dry place
to sleep, his five children, his drinking buddies, and
a good disability income check from the VA.
The integrated treatment specialist then asked
Kevin what was “not so good” in his life right now.
Kevin listed the judge’s order requiring him to be
in treatment, living with the “crazy” people in the
shelter, and running out of money during the month.
The integrated treatment specialist asked Kevin to
tell him more about his concern about living with
the “crazy” people and running out of money during
the month. He learned that Kevin wanted to have his
own place, but that his confidence in being able to
keep housing was low. With his integrated treatment
specialist’s help, Kevin listed the following pros and
cons of having his own apartment.
Pros Cons
Privacy Trouble managing
his money
Nothing gets stolen Isolation and loneliness
Control of when to sleep,
eat, etc.
Drinks more
Something that is his Friends want to move in
No money for furnishings
Not eligible for
housing supplement
After looking over the list, Kevin began to talk more
about his use of substances and how much he had lost
because of drinking. When he was taking medication,
he was able to concentrate better and felt more
hopeful about life.
Kevin’s integrated treatment specialist said that Kevin
was presenting an interesting picture and wondered
if Kevin would like feedback on his impressions, noting
that the feedback could be taken or thrown out. Kevin
agreed to hear the feedback. The integrated treatment
specialist suggested that there could be a connection
between Kevin’s use of substances, taking medication,
and his capacity to live on his own. The case manager
also wondered if Kevin’s desire to be in control has
actually left him out of control in most areas of
his life. He then asked for Kevin’s reaction to the
feedback. Kevin agreed he wanted control of his life
and that until recently he believed he was in control.
Kevin’s integrated treatment specialist asked him what
he wanted to do next. Kevin decided to begin working
on a plan that included reducing his drinking to every
other day, attending a money management group
once, and thinking about opening a bank account
to work on saving money for housing.
After 4 months, Kevin was taking medication. After
two more months, he decided to apply for and got
into a residential treatment setting where he was able
to stop substance use, take some classes, and become
involved in Alcoholics Anonymous. He stayed there for
2 years and then transitioned into his own apartment.
He had reconnected with one of his children and was
proud to be involved with her family.
Module 4 2 Practical Skills for Integrated Treatment