The Mentally Ill Chemical Abuser: Whose Client?

Mentally ill chemical abusers have long been approached much as the elephant in the proverbial story of the blind men: practitioners in the fields of mental health, drug abuse, and alcohol abuse are apt to examine only the symptoms with which they are most familiar and make diagnoses from those. As the blind man holding the elephants tail was certain it was a piece of rope, the mental health practitioner faced with a MICA client might see only the mental illness and overlook an equally important need to treat the client's alcohol or drug dependence.
The MICA population continues to grow for several reasons, including an increase in the number of homeless people; decreased funding for alcohol, drug, and mental health treatment; mental health hospital deinstitutionalization; and the rise in crack use. MICA - or dually diagnosed - clients invariably fall through the cracks of the standard treatment options for mental illness, alcohol abuse, and drug abuse, in large part because the systems often are uncoordinated. For example, since all use of "mood-altering substances" is forbidden to members of Alcoholics Anonymous, an alcohol-dependent schizophrenic would have to forego needed medication in order to attend AA meetings. At the same time, a client who is being treated for alcohol dependence might not find the anticipated lessening of depression after abstinence but may nevertheless be denied access to psychiatric assessment and antidepressant medication. In another case, psychiatric emergency workers might easily fail to identify drug ingestion as the cause for psychotic episodes in a chronic patient.
It is not always the fault of misdiagnosis, however: MICA clients often manipulate mental health and alcohol and drug abuse professionals into fulfilling the need of the moment. A MICA client might appear one day as an alcohol abuser, the next as a drug addict, and the third as a mental patient in order to receive food, shelter and clothing.
The Mentally Ill Chemical Abuser is the first book to close the gaps among the three systems and thereby help practitioners understand the complexities that interfere with progressive treatment of the MICA client. Cohen and Levy examine assessment issues and treatment planning problems that arise out of inaccurate assessment. They also give an integrated view of the client based on their own practical experience and offer solutions to issues associated with the MICA population. Any practitioner interested in the correlation between substance abuse and psychopathology will find this book's clear guidelines essential for better serving the mentally ill, chemical abusing patient.