Richard is a 62-year-old single man who says that his substance dependence and his bipolar disorder both emerged in his late teens.  He says that he started to drink to “feel better” when his episodes of depression made it hard for him to interact with his peers.  He also states that alcohol and cocaine are a natural part of his manic episodes.  He also notes that coming off the cocaine and binge drinking contribute to low mood, but he has not responded well to referrals to AA and past inpatient stays have led to only temporary abstinence.  Yet, Richard is now trying to forge a closer relationship with his adult children, and he says he is especially motivated to get a better handle on both his bipolar disorder and his substance use.  He has been more compliant with his mood stabilizing and antidepressant medication, and his psychiatric provider would like his dual diagnoses addressed with psychotherapy.

What diagnostic information would be most critical to collect in the first visit?
Which diagnostic measures are recommended by the US clinical guidelines for the treatment of this patient’s family problem?
Which evidence based harm reduction strategies would you recommend to treat this patient?
Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient.  (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?
 

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