Mental health articles

OF mental health care and mentally ill

substance use case study format

 Case study: Ray

The following case study highlights some of the risks associated with substance use and mental illness. Ray is a 29-year-old British man with a diagnosis of paranoid schizophrenia. He also has a drink problem and takes drugs if they are available, mainly cannabis, ecstasy and cocaine, but in the past he has used heroin (someone else injected him), and amphetamine. Ray also has a gambling problem. Ray’s schizophrenia makes him feel that people are plotting to kill him. He believes he is ‘in the frame’ for a crime which he did not commit and that people are out to get him because of this. Sometimes he thinks people are watching him. Ray believes he has some protection from his parents and that as long as they are alive, the people plotting to kill him will not act. Ray lived in the family home until recently but the situation there was difficult. His mother also had a mental illness and his father an alcohol problem.

Violence in the home was not uncommon and, eventually Ray moved on because of his violence to his father, always at times when he (Ray) was intoxicated. Ray has one brother and one sister, both married with families of their own. He has some contact with them but they will not see him when he is drinking. When drinking Ray frequently gets himself into difficult and dangerous situations, but because he experiences blackouts, he often cannot remember what has happened. On occasions he has had ‘one-night stands’ during which he has had unprotected sexual intercourse. He also has criminal convictions for aggravated burglary, being drunk and disorderly, criminal damage and shoplifting, all related to his drinking. When Ray receives his benefits he usually spends money on drinking and gambling before meeting other financial commitments (for example, paying off debts and buying food). Ray’s mother has had a heart problem. She recently experienced a serious heart attack and died. Ray was very close to his mother and believed that she was able to protect him from the people plotting to kill him. He had always said that if anything happened to his mother he would kill himself.

Although Ray had made good progress in moderating his drinking, he began drinking heavily again (a two-litre bottle of strong cider and 4–6 pints of standard strength lager each day). He said that he was drinking so that he didn’t have to feel anything – in particular, the sadness of his mother’s death and the feeling that he has not got much of a life. He has never held down a paid job, he does not have a girlfriend, he lives in a large hostel, he has debts of over £2500 and although he has drinking ‘friends’ he recognizes that they do not have his best interests at heart. When he is drinking heavily Ray tends to forget to go to the depot clinic and on occasions he has been so intoxicated that staff have felt it would be unsafe to give his medication. Despite periods of heavy use Ray does not appear to become physically dependent and can stop drinking without adverse physical effects.

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