Drug Policies

Working With Clients With Dual Diagnosis: The Case of Joe

Joe is a 34-year-old, Caucasian male who came to the County Division of Social Services to

apply for General Assistance (GA) benefits. The GA program provides cash assistance, Medicaid

coverage, and housing for homeless single adults. Joe is in need of Medicaid benefits in order to

remain active in his treatment program. Joe is receiving treatment at the Mentally Ill Chemical

Abuser (MICA) partial hospitalization program at the local community mental health center for

clients who are dually diagnosed.

Joe has a dependence on marijuana, although he has stopped using it for approximately six

months, and has been diagnosed with major depressive disorder. He is being prescribed

medication. Joe reports that he is unable to work due to mental illness, and without an income or

health insurance, he is unable to obtain his medication. Joe reports that while he was enrolled as

a student at the state university, he would sell marijuana to other college students. Eventually, he

was arrested and convicted of possession with intent to distribute a controlled dangerous

substance (CDS) and served 3 years in prison. Joe has had no further arrests; however, he has not

been able to secure permanent housing or employment since his release. Joe reports that this

event has ruined his life. His lack of employment results from an inability to pass most

background checks. If he discloses that he was arrested, Joe reports that he is never called for

interviews. But when he once failed to disclose the information to the prospective employer, Joe

was terminated for lying on his application. Joe believes that he has little hope for future

employment.

Joe has few natural supports in his life. He reports that following the incarceration, his family

distanced itself from him and his girlfriend at the time broke up with him. He reports that his

only supports are his local Narcotics Anonymous (NA) sponsor and his mental health counselor.

Joe reports that his housing situation has been unstable and sporadic for the past 10 years. Joe’s

mental health counselor from the MICA program has contacted me to advocate for Joe’s

approval for benefits. I explained that under the current state regulations, Joe is ineligible for

benefits due to his CDS distribution conviction. The only program options that I can offer him

are food stamps and access to a homeless shelter outside of the county. The counselor explained

that relocation would cause a disruption to Joe’s mental health treatment and would cause him to

lose contact with his local NA sponsor. In response to the counselor’s concerns, I suggested that

Joe contact the local faith-based organization for assistance. Although they do not house single

males, they have an extensive network of volunteers, mentors, and donors who may financially

support people in need. I referred Joe to a program that offers bonding to people seeking

employment who have been previously incarcerated. Finally, I suggested that the counselor

research Joe’s ability to remain in treatment at the hospital despite his lack of Medicaid

coverage. The counselor agreed to assist Joe with these suggestions.