Co-Occurring Diagnosis Practice Ungraded, 100 Possible Points

Catherine is a 38-year old married Native American female with no children who lives in rural New

Mexico. She was court-ordered to attend outpatient mental health and substance use treatment after

spending 6 weeks in a city jail. She does not have any history of being in treatment for or diagnosed with

mental health or substance use disorders, but the judge suspected that support would be more helpful

than punishment and is offering her treatment instead of jail time. Catherine’s attitude about the

judge’s offer is mixed. On the one hand, she is glad she is not in jail for the next 10 months. On the other

hand, she is confused about the judge thinking she’s “crazy”. She reports, “how can I have a diagnosis? I

have a job and friends. I’m not some homeless druggie on the street” and “you gotta do what you gotta

do to stay out of jail; you get it, right?.”

Two months ago, Catherine’s husband charged her with assault after she stabbed him in the shoulder

with a steak knife during an argument at a local restaurant. She then left the scene and drove her car

while under the influence of cannabis and methamphetamine. Catherine reports that she has no

memory of the event. Her husband has filed for legal separation but has stated that he is open to

reuniting with her if she gets help.

Catherine is in generally good physical health and reports that she is in regular contact with her family

physician. She has kept a full time job at the post office for the past 15 years where she works as a mail

sorter and occasionally as a deliverer.

Catherine reports she has had irritable “up and down” moods for most of her adult life. She describes

extended periods of time when she becomes “hyperactive” and easily annoyed by people around her.

Catherine says that she has “incredible energy” at those times and “gets a lot done.” At those times, she

likes delivering the mail, working out at the local recreation center, eating out in restaurants, and

shopping. She also reports that she has a strong relationship with spirits during this time and that they

speak to her about the future, which is a gift she enjoys. She rests primarily with “short naps” during her

energy bursts. Catherine uses cannabis regularly and in large amounts to help her sleep. She reports she

may need to take “several puffs” from her high-THC vape pen to get rest. She makes no apologies for

her use, stating, “it’s the only thing that helps”. Upon further questioning, she admits that she only uses

cannabis when she is in a “high energy” phase. Otherwise she abstains.

Catherine reports that she “wears herself out” after about a month of this hyperactivity, becoming

“shaky and disoriented” from lack of sleep. This causes her to lose her temper and argue with “almost

anyone” who gets in the way of her activities. She reports that during these times, she gets into physical

fights, often with her husband, and sees this as acceptable behavior. Despite her erratic behaviors, she is

“accepted for who I am” in her rural community. She has a small group of friends and she reports that

they spend time “smoking pot and doing puzzles” together.

Catherine explains that when she is “worn out”, it is difficult to get out of bed in the mornings. She often

wants to sleep for days and weeks. Because she cannot afford to lose her job during the extended

periods of time in which she struggles to get out of bed and go to work, she relies on methamphetamine

use to regulate her moods. She reports that she sometimes sees spirits who talk to her about the future

when she is under the influence, and she reports that she likes this. She reports that “one puff gets me

out the door” and describes methamphetamine as a positive influence in her life. She later described it

as a problematic influence because it sometimes makes it difficult for her to sleep for days at a time; she

also recalled having “bad episodes” where she saw demons that instructed to harm her spouse. She

attributes this to a “bad batch”.

Reference: case study is adapted from Corcoran, J. & Walsh, J. (2014). ​Mental health in Social Work: A Casebook in Diagnosis and Strengths-based Assessment ​(2nd edition). New Jersey: Pearson Education.