While these findings indicate that several psychological, pharmacological, and alternative approaches for the treatment of co-occurring depression and AOD use disorders appear promising, further research is required to establish which therapeutic approaches are particularly effective. It is suggested that clinical efforts be focused on the provision of client-centred, evidence-based treatment, taking into account the client’s needs and preferences, in a collaborative partnership.
Box 17 illustrates the continuation of case study D, following Sheryl after the identification of her co-occurring depressive and AOD use disorder.
Box 17: Case study D: Treating co-occurring depression and AOD use: Sheryl’s story continued
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Case study D: Sheryl’s story continued
When Sheryl’s GP received her blood test results, they showed Sheryl had an underactive thyroid, for which her GP immediately organised medication. Sheryl’s GP contacted the local addiction medicine specialist to advise on the most appropriate method of benzodiazepine titration and withdrawal and organised an appointment for Sheryl. One of Sheryl’s daughters accompanied her to the appointment. Through the AOD service, Sheryl heard about a group therapy that is run on Tuesday evenings that didn’t sound too bad, and with the encouragement of her daughter, started attending.
After a few weeks taking thyroxin medication, Sheryl’s energy increased but she continued experiencing very low mood. Upon telling her GP of her continued periods of depression, they discussed treatment options including psychological therapy and medications. Sheryl was reluctant to take another medication and preferred to see a psychologist. She was referred to a clinical psychologist who began CBT. Sheryl’s GP began organising regular case management meetings between herself, Sheryl, the addiction medicine specialist, the clinical psychologist and Sheryl’s daughters. It was decided in the first meeting that given Sheryl’s medical condition her GP was the appropriate person to take on the role of the primary case manager. At one of these meetings, Sheryl asked to revisit the idea of taking antidepressants. Although she was making progress, Sheryl was still feeling very low and was having trouble fully engaging in therapy.
As part of Sheryl’s psychotherapy, Sheryl was encouraged to rediscover things she was genuinely interested in and re-establish a sense of purpose. Over time, she reconnected with her friends and enrolled in some online classes through her local community college.
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Key Points
- People with co-occurring disorders may not necessarily present in obvious ways. The need for careful history taking regarding AOD use cannot be overemphasised.
- Underlying medical conditions may resemble or disguise symptoms of mental disorders, and it is vital to conduct comprehensive medical assessments.
- It is common for symptoms of both AOD and mental health conditions to be exacerbated by major life events.