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Principles and Practices in Supporting Clients with a Dual Diagnosis

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Learning Outcomes Assessed:

A. Analyse the theoretical concepts that underpin dual diagnosis
C. Evaluate current contexts and models used in contemporary practice


This assessment aims to demonstrate your ability to present an analytical essay on dual diagnosis theoretical concepts.


Students are required to write an essay analysing the following case study implementing dual diagnosis theoretical concepts. Student will assume the role of an AOD counsellor. Make sure to practice within your scope and reference any necessary ethical guidelines that may need to be mentioned. Students will need to use the following stepped approach:

Step 1: Students will need to select a theoretical orientation to approach the case study from (i.e. person-centred, strength- based, CBT, psychoanalytic, holistic, etc.). Student will then utilise strategies, supports, and theoretical approaches that align with these orientations (feel free to use the below resources as a guide).

Step 2: Discuss and evaluate current contexts and models used in contemporary practice applicable to the case study. This may include assessments or plans depending on what your theoretical orientation would suggest.

Step 3: Bring them together and conclude with focus on tools that can be developed to address challenges related to clients with complex needs; and providing integrated services that address multiple presenting needs. This means creating a short treatment plan, discussing referrals necessary, highlighting supports outside your scope that may be appropriate for the client.

Students may choose to utilise the following resources:

  1. Queensland Health Dual Diagnosis Clinical Guidelines. (2011).
  2. Comorbid mental disorders and substance use disorders: Epidemiology, prevention and treatment. Department of Health, Australian Government (2008). 
  3. Marel, C., Mill, K. L., Kingston, R., Gournay, K., Deady, M., KayLambkin, F., Baker, A., & Teesson, M. (2016). Centre of Research Excellence in Mental Health and Substance Use at NDARC (National Drug and Alcohol Research Centre). UNSW Australia. Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings.  
  4. Summary of literature and systematic reviews for comorbidity treatment. (2009). Retrieved from   

  5. Here are some of theoretical orientations you may wish to explore:   

Case Study: Laura

Laura is a very successful businesswoman in the high-stress, high-powered world of corporate finance. She is in Australia on a temporary work visa from the United States. Her husband and three children remained in the US as her current visa is linked to a 6-month contract with a highly recognised corporate finance firm. She has been referred to you by the company’s employee assistance program. Laura presents herself as a no nonsense business professional. She is frank and honest about the events that has brought her to your office. Laura tells you that although she tells herself that she will only have one or two glasses with dinner, she usually finishes the whole bottle.

“About five years ago, I started having trouble sleeping and started to take a tranquilizer (5mg Valium). I normally take one or two pills two to four times a week to help me sleep through the night”.

In the morning, she drinks at least 3 to 4 cups of coffee daily, even on the weekends. She noticed that her sleep problems developed around the same time her Dad died. He was only in his early 50’s and they were very close. His death hit her hard and she says she wanted to give in to a big depression. However, she fought it and lost herself in her work. She makes it a point to work out at least three times a week in the morning before going to work. In addition to the above medication, Laura is also prescribed Xanax as needed for panic attacks and diet pills (amphetamine congeners) to control her weight, a problem she had since she was a child. Over the last year, she has noticed that she has been steadily increasing her use of wine, especially since migrating to Australia. Before, she would only have a few glasses with dinner but now

“…more often than not I finish off the bottle before going to bed. I just can’t seem to stop. A lot of times I will come home and tell myself that I’ll only have one glass and no more but by the time I go to bed, the bottle is empty and I’m deciding whether I should open another or not. I never used to drink to excess or take anti-anxiety medication before. Now, I can’t seem to stop drinking or taking these ‘downers’ at social events. I can’t seem to control when I take them and things are happening that I’m not too happy about. Of course the alcohol adds to my weight problem which then causes me to take more of my Redux. Then I have to increase my Xanax to calm my nerves and also take my Valium to make sure I get a full nights sleep. It has become a very vicious circle. All this has been going on for about a year but last week put the “cheery on the pie”.

Laura tells you that since moving to Australia, she has started using cocaine in addition to the above mentioned substances. She mentioned that, “This is the norm with the company. Stay out partying all night, then taking coke to make it through the business day and stay awake”. She mentioned that she initially was hesitant to partake but as her husband and children are not with here in Australia, she feels she has more freedom to “let loose and forget about being a parent”. She then discloses that she had her first child at 18 and married her husband before the birth of their first child. She expressed that she feels like she missed out on the typical college experience that most Americans get and wants to utilise her time here in Australia to at least have a sliver of the partying and fun she missed out on. She quickly mentions that she does not regret having her children and wants to reiterate that she loves and cares about them but that she sometimes wishes her and her husband had done things differently.

Laura tells you that last week she was to meet the firm’s top client at a business luncheon. She could not get out of bed that morning. It took all her willpower to get up and get dressed, taking a Xanax to help with her nerves. As it was, she was still 20 minutes late, “which was inexcusable”. She was so nervous and sick, she had to excuse herself in the middle of her presentation. In the bathroom, she took another Xanax to calm her nerves. Then at the luncheon she could not stop herself from ordering several glasses of wine and had to be assisted to her car after the meeting was over.

“My client spoke to my boss and staff and then cancelled his account with me. The next day I met with my boss and he recommended (ordered) I make an appointment with our EAP program (or be terminated). I’m really scared. Work is all I have. I can’t afford to blow it. Do you mind if I smoke?”

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