Clinical Case Study IV

Ruel was admitted to SELF on September 15, 2007 at the age of 24 due to substance abuse, paranoia and hallucinations. He had been abusing methamphetamines on and off for the last eight years. Two weeks prior to his admission, Ruel had asked for his father’s help as he could no longer cope with paranoid delusions that a camera was filming him around the clock. In response, his father immediately brought him to The Medical City hospital. There, Ruel was diagnosed with psychosis secondary to methamphetamine dependence. He was prescribed Zyprexa, and shortly before his transfer to SELF, it was discontinued.

Background

Ruel was around six years old when he was adopted by an Italian doctor. While growing up, Ruel craved love and affection from his father and his siblings but this was largely unsatisfied as his father was constantly abroad and his only companions at home were helpers and his stepmother. To assuage his loneliness, he turned to friends for comfort and in the process grew distant from his brothers and sisters.

At the age of 16, Ruel was in 3rd year High School when he joined his siblings in doing drugs. In doing so, he experienced a connection with them that he had never felt before. These, according to Ruel, were the only times he truly bonded with and got to know them.

At 4th year High School, Ruel transferred to a boarding school in Thailand. There, aside from doing drugs, Ruel also became a heavy gambler. He finally wound up becoming exploited by a teacher and learned to sell his own body just to earn money. He was eventually kicked out of the boarding school for keeping drugs in the dormitory.

As an intervention his father moved the family from Thailand to New Zealand and enrolled his kids in another boarding school. It was there, Ruel said, that he developed a closer relationship with his siblings. They would often go out together during weekends and he was able to feel that he had a loving and supportive family.

Despite this, the trauma of the sexual abuse he suffered in Thailand kept haunting him. He started having dreams that put into question his gender identity. To address this, he underwent professional counseling with a psychiatrist. Ruel, however, bounced around from one relationship to another and it was not until he turned 22 that he was able to enter into a more permanent relationship. He met a woman who became his live-in partner and he eventually decided to settle down in Manila with her.

It went well for a couple of months but soon the issue of the woman earning more than Ruel began to strain the relationship. He was unable to meet his partner’s demand that he get a better paying job because he had lost interest in studying and failed to earn a college degree. This is when he once more turned to drugs to alleviate his feelings of insecurity. His situation worsened as his father, disappointed with his behavior, stopped giving financial support. So, at the age of 23, Ruel found himself suffering from a broken intimate relationship and a serious drug problem that was causing him severe episodes of paranoid delusions.

Initial Intervention

After allowing Ruel to settle down in the Pre-admission Department (PREAD) for several days, he underwent the standard medical and clinical assessments by the facility doctor and psychiatrist. Among other things, it was established that Ruel suffered from dyslexia but had never been treated for it. He was not prescribed any medications.

Ruel found the first couple of months in the program difficult due to his continuing paranoia that led to his lack of trust in the people around him. He was so suspicious that he even refused to take vitamin pills, claiming that these were designed for the program to read his mind. His old issue of sexual abuse also manifested as he showed an extreme sensitivity to touch, reacting aggressively whenever there was contact between him and another resident.

On his fourth month, Ruel was made to undergo another psychiatric assessment. This time he was prescribed anti-psychotic medication (Seroquel) and an anti-depressant (Lexapro) to address his condition. However, he refused to take the medications and his erratic behavior continued.

The Breakthrough

On the sixth month, with no improvement to speak of, the staff decided to go ahead and subject him to a case conference to get him to identify and face his real issues. Predictably he failed. However, this failure and the disappointment it caused pushed him to start opening up in subsequent counseling sessions.

As a result, just two weeks later, he underwent a second case conference. This time, he was able to open up and share all his issues and concerns and agreed to start taking medications. As a follow-up, the program allowed him to have a dialogue with his father during which he was able to share all the guilt he had about their relationship.

Upon taking the medications, Ruel displayed a marked improvement in his behavior. His behavior remained consistent in the succeeding months despite the pressures that went with his promotion to TC Coordinator.

On his 14th month he earned another dialogue with his father and they were able to resolve the issues discussed in their first dialogue. He also convinced his father to let him finish his rehabilitation program.

Over the months, Ruel was progressively weaned off his medications as his behavior improved. In November 2008 he was deemed ready and was sent-off to Reentry where his leadership and people skills were honed while working in the COD office.

In March 2009 he asserted his desire to work in the admin building kitchen. Together with this request, Ruel was also promoted to Aftercare. As of this writing he is now preparing for graduation.

Conclusion

Ruel’s case once again demonstrates the efficacy of combined clinical therapy with behavior management in the treatment of Substance Dependency with Drug-Induced Psychosis. In his case, the TC created the necessary conditions that pushed him to open up about his condition, share his feelings and face up to the challenges of changing his behavior. The disciplined environment likewise trained him to take his medication religiously. By doing so, he was able to respond to and reap the from the healing benefits of the TC processes.

 

EILEEN SIMBULAN
Managing Psychologist, SELF
May 2009