Substance Abuse Counseling: Case Study Jerome

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.

• Analyze the complexity of dual diagnosis as it relates to the case study.

• Explain how specific symptoms illustrated by the client indicate more than one disorder and make diagnosis difficult.

• Provide specific examples and use current scholarly sources to back up your ideas.