Biopsychosocial and

Interventions
Integrative Seminar Class

Sara Kornoski
11/9/2014

Biopsychosocial and Interventions

Sara Kornoski

Greggory in his Early Years

The clients name is Greggory Brown. He is a forty two year old African
American male. He was born on October 14, 1972 in Detroit Michigan to his sixteen
year old mother Rhonda Asia Brown and his twenty year old father Daniel Scott Smith.
Greggorys father was not involved in his childhood. His mother dropped out of High
School and worked at McDonalds as a cashier making minimum wage, she struggled to
raise Greggory. Growing up Greggory and his mother Rhonda lived with his
grandmother because his mother did not have the financial means and resources to live
on their own.
When Greggory was two years old his mother met a twenty five year old African
American male by the name of Devon Friday who his mother had two daughters with,
which is his sister Ebony Deja Friday who is forty years old, She was born on August
5,1974. Greggorys youngest sister Asia Shanice Friday, she is thirty nine years old and
she was born on June 22, 1975.
Rhonda and Devon lived with each other in Pontiac Michigan for three years
before Devon had alcohol and drug addictions that put his in prison on his second
possession of a controlled substance charge, this led to Rhonda and her three children
moved back in with her mother. Due to Rhondas mother small house and complicated
relationship Rhonda and her children bounced around to apartment to apartment due to
not having money to stay in an apartment for any length of time. It was hard for
Greggorys mother to hold down a job with three children and no affordable child care
for her to send the children to when she was at work. After Greggorys two sisters were

Page | 1

Biopsychosocial and Interventions

Sara Kornoski

born they were not able to move in with his grandmother again because the lack of
room for everyone. Due to this it was hard for his mother to pay the bills and care for her
three children. Greggorys mother got on governmental programs like food stamps, and
Medicaid to help with the care of her children.
Greggory in his Pre-teen and Teenage Years
Greggory reported to staying at his home as a preteen as well as his teenage
years, by himself staying with his sisters. He would have to look after his two sisters
while his mother worked the midnight shift at their local grocery store as a stocker.
Greggory and his sisters would often run the streets with their friends who had gang
affiliation. He stated that these friends gave him a sense of family something he was
lacking without a solid foundation within his own family. Greggory stated that he first
tried drinking beer at the age of nine with his friends. Greggory reported to seeing drive
by shootings with rival gangs in the area.
Greggory and his friends would often go to his house and drink beers and hang
out at his apartment while his mother was working the night shifts. When Greggory was
thirteen he got involved with drugs, mainly marijuana and cocaine and when he was
fifteen years old he started to deal drugs and actively participating in drug use.
Greggory reports that when he was sixteen years old he dropped out of high school but
before that he said he hardly went and that he wouldnt have graduated on time so he
dropped out. He continued to be a drug dealer and got two possession charges. He
didnt go to court for these two charges which landed him in jail for one year.

Page | 2

Biopsychosocial and Interventions

Sara Kornoski

When Greggory Brown was in jail he was diagnosed with a mental illness which
is affective disorder, schizophrenia. When Greggory got out of jail he wanted to clean up
his act and change. So he got a full-time job as a car repair man. Greggory did not get
any help for his schizoaffective disorder, he thought he was misdiagnosed and didnt
have it. Shortly after getting out of jail and getting a job
A few months after Greggory got his job he meant a woman by the name of
Aliyah Jada King. Aliyah was younger than Greggory by five years. She worked as a
full-time receptionist at Ameritech in Southfield Michigan. Greggory and Aliyah got a
house in Detroit Michigan. The first couple of years life with Aliyah was good, but as
time went on there was cracks in their relationship, they started arguing more and more
and got physical with each other.
Greggory in his Twenties
In 1998 Greggorys mother Rhonda was diagnosed with stage four liver cancer and was
given six months to a year to live. This was really hard on Greggory because for all his
life his mother Rhonda was a big part of his life and always had a huge role in his life
even as he got older. Greggory still thinks about his mother each and every day.
Rhondas death was extremely hard on him and he didnt know how to cope with such a
hard situation for him. Greggory was in a bad space mentally. He started to use drugs
again and drink alcohol again and Aliyah began to do drink and use drugs with
Greggory. Due to this their physical altercations started to become more and more
frequent.

Page | 3

Biopsychosocial and Interventions

Sara Kornoski

Greggory Brown got another charge on him; He reported that an African

American male broke into his house through his bathroom window. He believes that the
man was aware of the fact that Aliyah and him were drinking and using drugs and broke
in to steal it, but when the man broke in Greggory met him in the bathroom and beat him
with a bat. Due to this incident that happened in 200, he was charged with assault,
battery with intent to cause great bodily injury. Due to this charge, he went to prison for
this for seven years (from 2002-2009).
Greggory in his forties
Greggory Brown is currently homeless and has been since March 22, 2013, he has
been homeless on and off for the past four years due to his lack of income which
causes him the inability to pay for housing costs. He is considered to be chronically
homeless. Chronically homeless is when an individual and/or family has had four (4)
episodes of homelessness in the last three (3) years. HUD defines homelessness as an
individual and/or family who is living or residing in a place not meant for human
habitation, a safe haven, or in an emergency shelter continuously for at least one year
or on at least four separate occasions in the last 3 years. (HUD.gov) He is currently
residing at South Oakland Shelter in Lathrup Village, Michigan.
Greggory Brown does not have a lot of natural supports other than his older
sister Ebony Brown, and reported to talk to her weekly but does not want to burden her
with his problems so he rarely calls her because he does not want to bother her with his
situation he is currently in, and worry her. His mother who was a big influential part of
Greggorys life while he was in prison became close and she visited weekly and who he

Page | 4

Biopsychosocial and Interventions

Sara Kornoski

called and talked with daily on the phone, passed away in 2002 due to heart disease.
Greggory Brown has reported to me that he has felt lost without his mothers love,
support, and guidance. He didnt take his mothers passing very well and began to
drinking alcohol mostly beer and later drank whatever he could afford and get his hands
on. Greggory is still an active drinking. He reports that due to his drinking his
schizophrenic symptoms have been heightened.
Greggory Brown is currently residing at Hope Shelter located in Pontiac,
Michigan because he is homeless. He is currently unemployed and currently not
seeking employment. He receives food stamps which he reports to receiving $189.00
on a monthly basis. He also receives Medicaid. He has been declined cash assistance
through the Department of Human Service. He was also denied Social Security benefits
because of the lack of a paper trail of his mental illness because he does not receive
mental health services for his mental illness after his diagnosis and still does not.
Integrated Programs
Individuals that have a co-occurring disorder like substance abuse and
schizophrenia are treated in integrated programs that combine and coordinate
psychotherapy, psychosocial treatments for mental illness and substance abuse
counseling, and the use of medications for mental illness, and addiction. The integrated
programs are implemented by multidisciplinary team of case managements, therapists,
and psychiatric prescribers involve inclusive services like pharmacotherapy
rehabilitation and social support interventions that match the clients level of motivation
that best suites each individual client that offer a long-term perspective. These

Page | 5

Biopsychosocial and Interventions

Sara Kornoski

individuals with co-occurring disorders profit from standard and approved psychosocial
services for schizophrenia as supported employment, and assertive community
services. These services and interventions have insufficient impact on substance
abuse. (Drake, ONeal, Wallach, 2007)
Medications
The use of medications can be effective. Medications like antipsychotic drugs
that were first introduced and used more than fifty years ago. They serve as the core
pharmacological intervention for the majority of clients who have schizophrenia.
Medications help to decrease symptoms of schizophrenia and improve the individuals
functioning. The medications vary depending on the individual as well as the medication
but they have been found to be very effective. (Drake, ONeal, Wallach, 2007)
Individual Counseling
Individual counseling is largely based on the technique of motivational
interviewing and cognitive behavioral which is a form of treatment that focal point is
analyzing the connection between thoughts, feelings, and behaviors. It is a type of
psychotherapy that is different from the original psychodynamic psychotherapy due to
therapists and the client will eagerly work together to assist the client recover from their
mental illness. It investigates patterns of thinking that leads to self-harming actions as
well as the beliefs that direct the thoughts. These individuals with mental illness can
alter their patterns of thinking to help improve coping. Therapists who use cognitive
behavioral therapy with their clients use problem-focused as well as goal-directed
approach to identify the challenging symptoms of mental illness. (Drake, ONeal,
Page | 6

Biopsychosocial and Interventions

Sara Kornoski

Wallach, 2007)
(http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/A
bout_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm) Studies show
that individual counseling has not been effective with individuals with schizophrenia and
substance abuse by itself. (Drake, ONeal, Wallach, 2007)
Group Counseling Interventions
Group counseling interventions can be useful. They are generally administered
once or two per week and last six months or longer. Most use cognitive behavioral
techniques. A few of them use several methods which may be coordinated with stage of
treatment. Group counseling interventions also includes education, peer support. The
focal point is on managing both mental and substance use disorder together. It has
become more definite, standardized, and productive. (Drake, ONeal, Wallach, 2007)
The Bellack, Bennett, Gearon, Brown, and Yang (2006) and studies like it have
found that group counseling interventions have positive results in various areas
culminated from a high particularization, multi-intervention approach that includes
cognitive behavioral, skills training, and contingency management which gives rewards
to positive behavior when its demonstrated to help the clients perform more positive
behavior (http://www.drugabuse.gov/publications/principles-drug-addiction-treatmentresearch-based-guide-third-edition/evidence-based-approaches-to-drug-addictiontreatment/behavioral-0) with their clients who have schizophrenia and substance abuse
disorders. (Drake, ONeal, Wallach, 2007)

Page | 7

Biopsychosocial and Interventions

Sara Kornoski

Family Interventions
Family interventions can be a useful tool. Its goal is to enhance the knowledge,
support, and coping skills of family members. Family psycho-education is a regularly
used intervention. It is usually combined with individual counseling. While the
counseling is happening the results are positive but when the counseling ends the
positive outcomes are not as present. (Drake, ONeal, Wallach, 2007)
Case Management
Case management is beneficial when working with clients who are diagnosed as
schizophrenia and have a substance abuse disorder. It is a comprehensive, teambased, multidisciplinary, outreach-oriented, clinically coordinated service that includes
the model assertive community treatment which is defined as an effective, evidencebased, outreach-oriented, service delivery model for people with severe and persistent
mental illnesses, (http://www.nami.org/Template.cfm?Section=ACT-TA_Center) and
intensive case management. The interventions all include some sort of integrated
treatment for interventions for clients with schizophrenia and substance abuse
disorders. (Drake, ONeal, Wallach, 2007)
In some of the studies, the empirical guidance was intensive case
management, and substance abuse outcomes had weak results. This could be
elucidated by the provisions of integrated treatment to clients with both a mental
disorder as well as a substance use disorder. The outcomes of the clients that had
mental illness symptoms were conflicting but did demonstrate positive outcomes in
Page | 8

Biopsychosocial and Interventions

Sara Kornoski

other areas as increasing engagement, decreasing hospital use, increasing community

occupy, and improving quality of life all of which are the usual outcomes correlated with
case management. Intensive, team-based case management is possibly a vessel for
integrated mental illness and substance abuse disorders treatments. The effect of
substance use seemingly depends on the distinguishing interventions within the case
management. (Drake, ONeal, Wallach, 2007)
Residential Treatment
Residential treatment which is also called rehab is a live-in health care facility
providing therapy for substance abuse, mental illness, or other behavioral problems.
The length of time individuals spend in the residential programs can be short term which
can be six months or less and long term can be a year or more. Studies show that
clients with dual diagnoses use integrated case management versus the clients with
dual diagnosis that use twelve step programs such as Alcoholics Anonymous, and
Narcotics Anonymous over twelve to eighteen months show that a decline in substance
use symptoms in thoroughly implements case management groups. There was also a
decline in psychiatric symptoms and had improvement in their psychological functioning
with improved family, social and global functioning. (Drake, ONeal, Wallach, 2007)
An experiment done by Myers (1993) show outcomes at a year after the
baseline with schizophrenia, schizoaffective disorder, bipolar disorder, or depression
and substance use disorder integrate treatment like case management, substance
abuse group therapy with treatment such as case management, substance abuse group
that typically involves day treatments. Day treatments versus treatment is usually for

Page | 9

Biopsychosocial and Interventions

Sara Kornoski

twelve months and showed no group difference in substance use outcomes and there
was no group differences in Mental Health outcomes as well as there was no difference
in satisfaction or in the number of hospitalization days. The studies of long-term
residential treatments of individuals with dual diagnoses show positive effects and
indicate to be helpful to nonresponsers. (Drake, ONeal, Wallach, 2007)
Intensive outpatient rehabilitation
Intensive outpatient rehabilitation is inclusive programs that administer services
for several hours for several days per week. Examples of intensive outpatient
rehabilitations are day rehabilitations, day treatments, as well as evening programs.
The Brooks and Penn (2003) distinguished two forms of integrated treatment and it had
assorted results. Burnam et al (1995) supplied a short, time-limited intervention that
showed high erosion and no effects. Intensive outpatient rehabilitation is understudied
to show more results regarding the outcomes. (Drake, ONeal, Wallach, 2007)
Contingency Management
Contingency management attributes to the methodical plan of incentives and/or
disincentives for definite behaviors for the aim of altering behaviors. Contingency
management studies are normally short-term interventions with a restricted focus on
reducing substance abuse. The interventions lasted for four to six months and they
examined the additional outcomes. The studies found notable improvements on
substance use outcomes. The on study that did not find notable improvements was a
study that the group attendance was reinforcements not their abstinence. These studies

Page | 10

Biopsychosocial and Interventions

Sara Kornoski

also showed that other functional behaviors improved in the studies that were assessed.
(Drake, ONeal, Wallach, 2007)

Legal Intervention
Legal interventions contain jail diversion, jail release, as well as other forms of
mandated treatment or monitoring. The studies only studied jail diversion. Other than
being a required form of treatment these programs varied significantly on the service
offerings. Legal interventions concluded with a growth in service implementation and
some effects on a wide range of other outcomes. The field of legal interventions for
forensically involved dual diagnosis clients is an understudied area. (Drake, ONeal,
Wallach, 2007)

Page | 11

Biopsychosocial and Interventions

Sara Kornoski

References
Burnam, M. A., Morton, S. C., McGlynn, E. A., Petersen, L. P., Stecher, B. M., Hayes,
C., et al. (1995). An experimental evaluation of residential and nonresidential treatment
for dually diagnosed homeless adults. Journal of Addictive Diseases, 14, 111 134.

Brooks, A. J., & Penn, P. E. (2003). Comparing treatments for dual Diagnosis: Twelvestep and self-management and recovery training. American Journal of Drug and Alcohol
Abuse, 29, 359383.

Bellack, A. S., Bennett, M. E., Gearon, J. S., Brown, C. H., & Yang, Y. (2006). A
randomized clinical trial of a new behavioral treatment for drug abuse in people with
severe and persistent mental illness. Archives of General Psychiatry, 63, 426 432.
Blankertz, L. E., & Cnaan, R. A. (1994). Assessing the impact

Drake, E. Robert, ONeal. L. Erica, Wallach, A.. Michael. A Systematic Review of

Psychosocial Research on Psychosocial Interventions for People with Co-Occuring
Severe Mental and Substance Use Disorders. Journal of Substance Abuse, January 1,
2007

http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/Ab
out_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm

http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-researchbased-guide-third-edition/evidence-based-approaches-to-drug-addictiontreatment/behavioral-0

http://www.nami.org/Template.cfm?Section=ACT-TA_Center

hud.gov

Page | 12