This assignment will focus on one case from the authors ownpractice. It will set out the background information relevant to the case withthe aim of discussion being dual diagnosis. There will be specific focus onPost Traumatic Stress Disorder (PTSD) and opioid dependency. Two theories ofaddiction with be discussed and a critical analysis using current research willbe undertaken with particular reference to the case study. Relevant legislationand policies will be referred to and how this underpins professional practiceand values.

The authors own practice will be explored and reflected upon toidentify future learning needs.Casework overviewTo maintain the confidentiality of the service user, for thepurposes of this assignment she will be referred to as X. No furtheridentifying information will be used and verbal consent was obtained prior tothe completion of the assignment.X is a 17 year old female who was placed in residential careat the age of 14 after a three month period in secure accommodation. X wasengaged in high risk behaviours and daily substance misuse prior to admission.  The author was X’s keyworker for her three anda half years, and worked alongside Drug and Adolescent Mental Health Services(DAMHS).

To manage her chronic substance misuse and deteriorating mental health.A harm reduction approach was used alongside medication to alleviate symptomsof PTSD.X’s mother was alcohol dependent and also experienced poormental health.

X was removed from her care and placed with family members untilshe was fourteen and was deemed to be beyond parental control. X continued toexperience trauma in residential care as a result of Child SexualExploitation.  X’s substance misuse escalated at a correlating rate as hermental health deteriorated, self- injurious behaviour was more prevalent and fluctuatingemotional and aggressive outbursts were exacerbated by the cycle of ‘high’s’and withdrawals.

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X reached crisis point in which she attempted to completesuicide on two occasions, both requiring becardiopulmonaryresuscitation (CPR) before she was willing to accept support. X disclosed thatshe had experienced significant adverse childhood experiences and was self-medicating to reduce auditory hallucinations of her abuser. X was detainedunder the Mental Health (Northern Ireland) Order 1986 25(5)(b)as she was at immediate risk of causing herself harm.

 X was diagnosed with symptoms of depression,anxiety and PTSD further compounded with an attachment disorder. X presentedwith feelings of despair due to her perceived rejection by her family which contributedto thoughts of ‘life is not worth living’ and helplessness. Critical analysis of theory using current researchThe expression ‘dual diagnosis’ is used to describethe co-occurrence of at least one mental disorder in persons with substance usedisorders.

Recurrent use of a single/poly drug use, meets the diagnosticcriteria for a substance use disorder.