PS377 Unit 5 Co-Occurring Disorders Paper Example

Sober, Sleeping Until Noon and Not Walking the Dog: A PS377 Unit 5 Co-Occurring Disorders Paper

[Student Name]

Purdue University Global

PS377: Models of Peer Recovery

Unit 5 Co-Occurring Disorders Paper

[Instructor Name]

[Date]

The writer, the center, the participant and every detail are composite and illustrative; the articles cited are real.

The Signs

Ray, forty-eight, had been sober for ten weeks when I noticed the changes. He had written in his recovery plan that walking his neighbor's dog was one of his best tools, and he stopped. He missed two Tuesday veterans' meetings. When I called, he answered at noon and said he had just gotten up. At the center that Friday, he said, "Everybody told me I'd feel better sober. I feel like I'm in a gray room." He also mentioned nightmares about his deployment, which he said had come back since he stopped drinking.

Some low mood in early recovery is common. But Ray's changes lasted more than two weeks, affected his daily routine and his recovery activities, and came with nightmares tied to his military service. Those are signs that a professional should assess for a mental health condition alongside his alcohol use disorder.

What Co-Occurring Disorders Are

A co-occurring disorder means that a person has a substance use disorder and a mental health disorder at the same time. The combination is common, and each condition can make the other worse. Alcohol can mask symptoms of depression or trauma, which may surface when drinking stops, and untreated mental health symptoms can increase the risk of relapse.

Noticing and Referring, Not Diagnosing

My role is to notice, share what I see and connect, not to diagnose. I told Ray what I had observed, in plain words: "You stopped walking Buster, you've missed two meetings and you told me you feel like you're in a gray room. And the nightmares came back. I think it's worth telling your counselor and the VA." I did not tell him he had depression or post-traumatic stress disorder; I do not know that, and labeling it would be outside my role.

He agreed. With his consent, I called his outpatient counselor, who scheduled an assessment for the following Monday, and I helped him make an appointment at the VA mental health clinic, which he had avoided for years. I went with him to the VA's front desk because, he said, "I'll turn around in the parking lot otherwise."

My job was to say what I saw in plain words, then get him to someone who could say what it meant.

Why Ray Had Avoided Help

Ray's reluctance about the VA was not stubbornness. He told me that after his discharge he had waited months for an appointment, felt rushed when he finally got one and left with a prescription he never filled. Like many veterans, he also worried that admitting to nightmares would make him look weak in front of other men from his unit. Knowing this changed how I supported the referral. I asked the VA's peer support specialist, a Marine veteran in recovery himself, to meet Ray in the lobby, and I let Ray decide what to say in his first appointment. A referral that ignores why someone has stayed away from care often leads to the same parking lot turnaround he described. Working with another peer, one who shared his military background, did what my own story could not.

When Sobriety Uncovers Symptoms

Ray's experience is common enough that our center now mentions it at every intake. People who used alcohol or drugs to blunt painful feelings or memories may find those feelings sharper in early recovery, and some take that as a sign that recovery is failing. Hearing in advance that symptoms may surface, and that they can be treated, gives participants a way to name what is happening instead of drinking to quiet it.

Evidence for Peer Support With Co-Occurring Disorders

O'Connell et al. (2020) studied adults with co-occurring psychiatric and substance use disorders who were randomly assigned to usual care, to a skills training intervention, or to skills training combined with peer recovery support. Adding peer support to skills training produced better outcomes on some measures than usual care, including reductions in alcohol use, suggesting that peers add value alongside structured clinical interventions for this population.

Davidson et al. (2012) brought together research and practice experience on peers working alongside people with serious mental illness. They found that peers can deliver services with outcomes similar to those of other staff, and that peer support may add particular benefits in hope, engagement and a sense of being understood. Eddie et al. (2019), reviewing peer recovery support for substance use disorders, found that connecting people to treatment and other services is among the roles peers fill most often.

Ray's Assessment and Plan

His counselor and the VA clinician assessed him over two weeks. They diagnosed a depressive disorder and post-traumatic stress disorder alongside his alcohol use disorder. His treatment now includes a trauma-focused therapy at the VA and a medication his VA psychiatrist prescribed, coordinated with his outpatient counselor. He gave me permission to know the diagnoses so that I could support his plan.

Adjusting Peer Support

My support changed in three ways. I learned more about how depression and trauma affect recovery, through training my supervisor arranged. I updated Ray's recovery plan with him, adding his new warning signs, such as sleeping past ten and avoiding the dog, and his VA appointments. And I connected him to a peer-led group for veterans with both substance use and trauma histories, where he could hear from others who had been through the same thing.

What I Would Do Differently

I noticed Ray's signs about two weeks after they began, mostly because he missed meetings. In hindsight, his recovery plan already listed walking the dog as a daily anchor; I could have asked about it in every check-in. I now ask participants about their daily anchors each time we talk.

Limits and Safety

If Ray had said anything about wanting to die or not being around, the response would have been different and immediate, following the crisis steps covered in a later unit. Peers must know the difference between signs that call for a referral this week and signs that call for help today.

Conclusion

Ray's gray room, nightmares and dropped routines were signs that called for professional assessment, which found depression and post-traumatic stress disorder alongside his alcohol use disorder. Naming observations in plain words and connecting him to care, rather than diagnosing, kept the peer role clear. O'Connell and colleagues, Davidson and colleagues and Eddie and colleagues support peer support alongside clinical care for co-occurring disorders.

References

Davidson, L., Bellamy, C., Guy, K., & Miller, R. (2012). Peer support among persons with severe mental illnesses: A review of evidence and experience. World Psychiatry, 11(2), 123-128. https://doi.org/10.1016/j.wpsyc.2012.05.009

Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., Weinstein, C., & Kelly, J. F. (2019). Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology, 10, Article 1052. https://doi.org/10.3389/fpsyg.2019.01052

O'Connell, M. J., Flanagan, E. H., Delphin-Rittmon, M. E., & Davidson, L. (2020). Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery support. Journal of Mental Health, 29(1), 6-11. https://doi.org/10.1080/09638237.2017.1294733