Dual Diagnosis for Andrea Considering a differential diagnosis, what is your initial assessment and diagnostic impressions of Andrea and why? Consider the psychotic spectrum disorders and bi-polar disorders concurrent with substance related disorders in your response. Please present other ideas that you have for Andrea.

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), polysubstance or polydrug abuse is considered a substance disorder. This manual is the guide book that is used by the experts in mental health to classify disorders. The depression and the personality problems that the patient Andrea is exhibiting can be attributed to the problem of polydrug abuse. Andrea clearly has a mental disorder and the addition of drugs to this can only aggravate the situation. The polydrug use may have escalated from the use of alcohol or marijuana and then later involved the addition of other substances. This is what is typical with adult substance abusers. Some of the substances that are put together in a polydrug use situation include alcohol and marijuana, to which drugs such as cocaine, heroin and other drugs accessible over the counter are added. Some of the possible consequences of this combination of many drugs are delusions of paranoia, mood changes, hallucinations and psychosis, which may result in engaging in behavior that is criminal such as in the case of Andrea. Her mental stability is put at risk by these substances. The consequences for polydrug use vary among various people with some being unable to work, socialize or even show an interest in their health and appearance. In Andrea's case, the addiction has led her to unsavory activities like shoplifting. She does not make time to work, engage in social activities or even pursue her interests. Drugs have become the center of her life. The drugs have affected her mental state and this is a disease. Mental illness is typified by constant drug cravings, compulsive behavior, the searching for and continued use of drugs to such an extent that the person's brain function is affected. The changes that are brought about in the structure of the brain by drugs, are the same ones that are affected in certain mental illnesses like schizophrenia and depression (National Institute on Drug Abuse & United States of America, 2008).

Shoplifting thus comes as a form of psychological disorder in the case of Andrea as is the case with many other people with the problem of drug addiction. This is a common way of dealing with the conflict inside rather than actually looking to meet a physical need for the object. It is not typical for shoplifters to thus engage in this behavior as in Andrea's case, in order to fulfil her need for drugs. However, there are other drug addicts who look for money for drugs in this way. Andrea has actually been put into custody a few times because of the shoplifting behavior, which is associated with her drug abuse tendency. Hers is therefore not the case of a shoplifting addict who does it compulsively (Top 10 reasons, 2011). Psychosis is a term used to describe a wide range of mental disorders, one of which is schizophrenia. Some of the signs that Andrea is exhibiting fall within the description of schizophrenia. For example, her mood changes, her auditory and visual hallucinations, paranoia and violent behavior. These symptoms many times are dealt with through the use of medications with good outcomes for the patients (Tillman, 2015).

In cases such as this one for Andrea, it is accepted that recovery will be a journey, which will require time, and transformation from the inside. It happens in stages and thus cannot be a process that is rushed through. This needs to be acknowledged even as a plan for her

The process of treatment can be done in various places such as at home or as an outpatient case will take time. The clinician first understands this and also that other forces not in the treatment plan, contribute to the recovery such as the involvement of the patient in groups that are mutually beneficial. Some of the stages that clinicians use in the treatment include engaging the patient, bringing them to a point of stability, initial or primary treatment stage and the stage of aftercare. These phases are the same for mental disorder or substance abuse. The division of treatment into these phases is for the purpose of allowing the professional to step-by-step develop and utilize treatment protocols. Screening is essential to set apart those patients who are substance abusers and also display symptoms of mental illness. The counsellors can use instruments to determine this so that specialized care can be given to these patients (SAMHSA, 2013).
Information on Andrea's family could be sought for this purpose as well as on any relevant question on sexual orientation, sex, or culture, her finances, any background of trauma, issues from her schooling and her employment. Other information that is needed is at what age she first used a substance, what substances she typically uses, when she uses them and any treatment that she has had in the past or is currently on. Where there have been extended periods of keeping off drugs, there can be an assessment of her mental health and any issues she suffered during these periods. Andrea can also be evaluated for the presence of psychiatric problems through an examination of her family history of the same, and hers as well, in case she was ever treated for a psychiatric problem. Another issue that will be of importance in her case is whether she has had periods when her mental health was okay, or when treatment was successful for her and the disorder questions that were seen during these times (SAMHSA, 2013).

For Andrea, consider the Six Dimensions Checklist in Appendix E in "The Addiction Treatment Planner" and the Mental Health Screening Form III and Simple Screening Instrument for Substance Abuse in Appendix H of "Substance Abuse Treatment For Persons With Co-Occurring Disorders"

Assessment

The Assessment and Addictions Treatment Planner for Andrea checklist is as below:

1. Acute Intoxication and Withdrawal Potential- it is clear that Andrea's substance abuse began early in her life. Her case is typical of early use of alcohol and abuse of other substances.

2. Biomedical Issues- Andrea has some medical issues and they need to be evaluated so that her health situation, physically, is treated.

3. Assess the Mental Condition, the Emotional Wellbeing and the Cognition-This will be required for the case of Andrea so that the condition and any challenge in her mental state can be diagnosed. This will allow for the treatment of this or the addressing of the same through care and even coordinating with the mental health care she is receiving.

4. Assess Andrea's Inclination to Change- Andrea should be ready and willing to change. There should be the employment of strategies to increase her motivation for this, if she is not ready. If, however she has the willingness to change, bring together and broaden the requirements for change.

5. Andrea may have the inclination to revert to her problem so that there is a potential for continued use. Thus, assess the inclination to revert and employ services to prevent this so that she is assisted in her recovery.

6. The Environment for Recovery- there will be an assessment of the necessity for services for her family, her spouse, and whether she needs residential services, financial, legal or even the services for childcare (Jongsma & Perkinson, 2013).

A psychiatrist may require to be engaged in the case of Andrea because she may be having schizophrenia. A psychiatrist will assist where it is difficult to have a meaningful interaction with Andrea because of the typical challenge in expressing herself, or her inability to focus on the question at hand and even the fact that in a case of schizophrenia, there may not be a logical flow of sentences. Thus, disorganized speech can be deciphered through psychiatric care. There may also be disorganized behavior such as a patient drawing around their mouth or making gestures that do not make sense. This may signify catatonia, which reveals that the patient is not responding to their environment. Some of the actions of a patient typifying this include staying in one position for long periods of time, inability to respond to prompts and even motor activity that is too much and extended. This may all be caused by the extensive abuse of substances such as is the case with Andrea (Jongsma & Perkinson, 2013).

Treatment and Pharmacological Interventions

Andrea can be screened using the Mental Health Screening Form-III so that any problems that she has can be revealed as well as the requirement for a more intensive evaluation. The instrument used for this assessment must be highly sensitive so that a person who is abusing a substance of any kind can be identified. The screening instrument must also accommodate a wide range of symptoms exhibited by those suffering from substance abuse disorders. Some of the things that must be accommodated are those that are typical…