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The complexity of dual diagnosis

Jerome is a 48-year-old gay-identified African American male who is seeking housing services at the state facility at which you work. Jerome has a long history of homelessness, a 20-year addiction to crack cocaine, and a history of minor arrests. He has supported himself primarily by repairing old, discarded bicycles and selling them.

When Jerome comes to the facility, he states he has not used crack for three days. During the initial interview, he does not maintain eye contact, constantly moves and shifts in his seat, and uses a very unique sentence structure that often derails: "I am on top of this whole planet, and it's hot! I feel like... you ever eat yogurt?" He describes hearing voices that direct him to deliver "the message of the good" to people he meets, and uses religious references in a number of statements about daily living.

Jerome expresses his desire to stop using crack, but his concern is that "when I stop, the Devil comes after me." You learn from Jerome's caseworker that Jerome has had connections to a street gang from whom he buys crack, and that a large part of the reason he is seeking housing at your facility is for safety because of some trouble he has gotten into with a gang member.

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About the Case

Jerome is a 48 year old gay African-American who is addicted to crack cocaine. His addiction has been going on for 20 years. He supports himself by repairing old or thrown out bicycles and sells them once serviceable for a profit. While he has a history of homelessness, Jerome through this appears to be able to find means of supporting himself and of course, his addiction. He is seeking housing in a state facility primarily because he feels unsafe and insecure where he lives. This is because due to this addiction and substance abuse, he has come into contact with a street gang. While he has had minor arrests which suggests that he has come into trouble with the law primarily because of his uncontrollable desire to abuse crack cocaine, he feels that his current situation is most pressing - he believes that it is only by being housed in the facility that he will be able to find safety and security from the threat of the street gang. In the intake, he indicates that he has not taken cocaine for 3 days which results to him being extremely anxious - he appears to have problematic thought processes and his emotional response is poor. But he reveals that he desires to overcome his addiction - but if he does not take crack cocaine, he soon sees the 'Devil' after him which to him means that to keep himself safe and the Devil at bay, he has to take the drugs.

Diagnosis 1: Drug Addiction

It is clear here that Jerome is addicted to drugs. While his entire history is not revealed, we know that he has been abusing the ...

Solution Summary

The complexity of dual diagnosis is determined.