John, a 23-year-old unemployed man, is addicted to cocaine. John lives with his mother and sister and has been stealing money from them to pay for his cocaine.


Case Study, Mohr

CHAPTER 30, Substance Use Disorders

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In completing the case study, students will be addressing the following learning objectives:

Identify the two main components of interdisciplinary treatment for clients with substance abuse disorders.

Explain the importance of recognizing co-occurring disorders.

1. John, a 23-year-old unemployed man, is addicted to cocaine. John lives with his mother and sister and has been stealing money from them to pay for his cocaine. His mother persuaded John to voluntarily commit himself to the hospital for treatment of his substance abuse. In the initial assessment interview, the nurse learns that John began smoking marijuana at age 19 and occasionally consumes alcohol. John said that he started on cocaine after his father, who had a history of alcoholism, committed suicide. John says that he began to feel anxious then and still has periods of anxiety. John is cooperative with his treatment program and stated that he wants to get completely off drugs and get a good job to help his mother and sister. John also said that if he experienced anxiety, he would take a stiff drink like his father had done when he was anxious.

(Learning Objectives: 2)

a. How can the psychiatric staff counsel with John to avoid his turning to alcohol as substance?

b. With what other co-occurring disorders could John be diagnosed?


Co-Occurring Disorders in Substance Use: A Case Study Analysis


In the realm of substance use disorders, recognizing and addressing co-occurring disorders is of utmost importance. This case study focuses on John, a 23-year-old man struggling with cocaine addiction, whose experiences shed light on the significance of identifying and treating co-occurring disorders. By delving into John’s background, his substance use patterns, and his mental health symptoms, healthcare professionals can develop an effective interdisciplinary treatment plan that accounts for both the substance use disorder and any co-occurring conditions.

Identifying and Addressing Co-Occurring Disorders

Co-occurring disorders refer to the simultaneous presence of a substance use disorder and one or more mental health disorders (Yule & Kelly, 2019). In John’s case, it is crucial to address not only his cocaine addiction but also the potential co-occurring disorders that contribute to his overall well-being.

The Role of Counseling in Preventing Alcohol Relapse

John’s case highlights the need for psychiatric staff to counsel him effectively, preventing him from substituting alcohol as a coping mechanism for his anxiety. By providing John with evidence-based information about the negative consequences of alcohol use, healthcare professionals can educate him about the risks associated with using alcohol to manage anxiety. Offering alternative coping strategies, such as relaxation techniques or referring him to support groups, empowers John to develop healthier methods of managing anxiety without resorting to substances.

Possible Co-Occurring Disorders

Alongside his substance use disorder, John may potentially be diagnosed with co-occurring disorders. Considering the information provided, several conditions warrant consideration:

Generalized Anxiety Disorder (GAD): John’s reported periods of anxiety indicate the possibility of GAD. Symptoms such as excessive worry, restlessness, difficulty concentrating, and sleep disturbances align with this diagnosis (Munir, 2022). By identifying and treating GAD, healthcare professionals can support John’s overall recovery process.

Major Depressive Disorder (MDD): The traumatic event of John’s father’s suicide, coupled with his ongoing anxiety, suggests the potential presence of MDD. Symptoms such as persistent sadness, loss of interest, sleep disturbances, and recurrent thoughts of death or suicide necessitate thorough evaluation and treatment.

Post-Traumatic Stress Disorder (PTSD): John’s traumatic experience of his father’s suicide may also lead to the development of PTSD. Symptoms encompass intrusive thoughts, avoidance behaviors, negative mood, and changes in cognition and arousal. By recognizing and addressing PTSD, healthcare professionals can facilitate healing and recovery for John.

Substance-Induced Anxiety Disorder: Considering the causal relationship between substance use and anxiety, it is crucial to determine if John’s anxiety stems solely from his cocaine use. Substance-induced anxiety disorder occurs when substance use or withdrawal leads to significant anxiety symptoms (Smith, 2008). Identifying this disorder is crucial to tailor the treatment approach accordingly.


In conclusion, addressing co-occurring disorders is vital when treating individuals with substance use disorders. By counseling patients on the risks of substituting one substance for another and offering alternative coping mechanisms, healthcare professionals can guide them toward healthier paths. In John’s case, potential co-occurring disorders such as GAD, MDD, PTSD, and substance-induced anxiety disorder require careful assessment and integrated treatment approaches. Recognizing the interplay between substance use and mental health disorders paves the way for effective interdisciplinary treatment that enhances the chances of successful recovery and improved overall well-being for patients like John.


Munir, S. (2022, October 17). Generalized Anxiety Disorder. StatPearls – NCBI Bookshelf. 

Yule, A., & Kelly, J. M. (2019). Integrating Treatment for Co-Occurring Mental Health Conditions. Integrating Treatment for Co-Occurring Mental Health Conditions, 40(1). 

Smith, J. P. (2008, October 1). Anxiety and Substance Use Disorders: A Review. PubMed Central (PMC). 

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