Box 9: Case study I: What does comorbid ASPD and AOD use look like? Luke’s story

Luke is a 28-year-old man who was referred into AOD treatment from his local court as part of a diversionary program. Luke was assessed on the day of his court appearance, where he was to face charges for burglary. Luke was assigned to AOD treatment through the referral program, and his burglary charges adjourned pending his involvement in the program. Luke had a history of heroin use dating back at least 10 years. He had been on methadone a number of times in the past, but his compliance was always short lived.

Luke had an abusive stepfather and at times, experienced abuse from his mother. He spent some time in foster care before being returned to his mother when he was around 10 years old. Luke began sniffing solvents and smoking cannabis, frequently wagged school before leaving school early (during year 9), and worked casually on building sites. He joined a boxing club and later indicated that he would often look for people to fight on nights out, and that he enjoyed inflicting injury on others. He told his therapist that he often acted impulsively, destroying public property, and getting into fights.

Over the past 10 years, Luke had been in two long-term relationships, both with women who also used heroin. During these relationships, Luke was sometimes violent towards his partner, but showed little remorse. Following the breakup of his latest relationship, Luke had been sleeping in shelters and ‘couch surfing’ at friends’ houses. He continued to have sporadic part-time work in the building industry but much of his income was derived from shoplifting and opportunistic theft of mobile phones, wallets, and so on.

Case study I continues in Chapter B6.