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Substance Abuser’s Mental Health Risks in 3D Model Case Study

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Updated: Nov 6th, 2020


Substance use and abuse may cause serious harm and disrupt an individual’s life. Therefore, it is paramount to be able to identify the risks related to substance abuse and the methods to lower or manage these risks. The current paper provides an analysis of the case of X, a 19-year-old man who engaged in regular drug consumption while studying in secondary school and suffered from numerous adverse consequences associated with his substance use and mental health issues.

Risks Identified

Risks That X Poses to Himself

On the whole, X is apparently suffering from paranoia, or “unfounded fears that others intend harm to the individual,” which may be induced or exacerbated by the cannabis use (Freeman et al., 2014, p. 391). In addition, the paranoia may be triggered by major life events (Freeman et al., 2014); it seems likely that the fact that X’s girlfriend ended their relationship could be perceived as such.

According to World Health Organization ([WHO], 2016), the constant use of cannabis is associated with such problems as an increased risk of mortality (nearly a fourfold risk when compared to the general population), possibly irreversible decline of cognitive performance, an increased chance of developing schizophrenia in the future (2.4 times more likely when compared to the general population, over the period of 15 years), an increased risk of suicide mortality (for males, odds ratio = 2.28, 95% CI: 1.54-3.37), and other issues (pp. 23-29).

According to WHO (2013), individuals who use injection drugs (such as heroin or other opioids) face a much greater risk of mortality when compared to those who do not use such substances. It is stated that the most common causes of death in this group include not an only drug overdose, but also the HIV infection gained when using non-sterile injections (WHO, 2013). Other serious diseases such as hepatitis C can also be transferred via non-sterile injections (MacArthur et al., 2014). It is also stressed that persons using injection narcotics often start taking multiple types of such drugs (WHO, 2013).

Therefore, X risks numerous adverse outcomes from the continuation of drug consumption alone. These outcomes include a decline of cognitive performance, potential schizophrenia, an increased risk of mortality (including mortality from suicide, narcotic overdose, or AIDS), and so on. Clearly, major adverse life events, such as the separation from his girlfriend, may also pose additional dangers and exacerbate the existing risks (Freeman et al., 2014). In addition, the fact that X has taken heroin makes him eligible for imprisonment for up to 7 years (Government of the United Kingdom, n.d.).

Risks That X Poses to Other People

According to WHO (2016), individuals who regularly take cannabis face certain risks that might adversely impact others. For instance, teenagers who regularly take cannabis (with an early onset, as was the case with X) may engage in juvenile offending and display behavioral difficulties (WHO, 2016, p. 25). When it comes to the use of opioids, there are also a number of dangers associated with it, such as engaging in delinquent or violent behaviors, which may be a risk for X, who already committed a forced entry into the house and an assault. In addition, if X becomes infected with HIV in the future due to the use of heroin, he will become capable of infecting others with HIV, especially his partners in drug use (WHO, 2013).

Protective Factors Identified

Generally speaking, there might be several protective factors that could reduce the risk that X continues to take narcotic substances and engages in violent or otherwise illegal behaviors. For instance, it is known that X maintains good relationships with his sisters and that the latter are concerned about his drug use, relationship breakdown, and the potential negative impact of these circumstances on his mental health. It is known that maintaining contact with the social circle that may provide support and discourages the use of substances may serve as a social protective factor against drug use and the resulting adverse outcomes (Traube, James, Zhang, & Landsverk, 2012).

Therefore, the relationships with his sisters might become protective factors against the continued substance abuse; they might also help X to continue participating in his methadone programme.

In addition, the strong desire of X to make things right with his ex-girlfriend, as well as his wish to maintain contact with her children, may also serve as a protective factor, at least in the case if the former girlfriend provides him with a chance to do it on the condition that he stops using substances and continues his participation in the methadone programme. This might supply X with a strong motive to cease the use of the drugs and further take part in the programme, therefore serving as a protective factor against the exacerbation of his drug addiction (Traube et al., 2012).

3 D’s Formulation

When considering the risks faced by an individual, it is possible to distinguish three types of processes through which the factors of risk may cause violence: drivers (that is, the beliefs or motives which may stimulate engaging in violence, such as the belief in the aggressive intentions of others, or the desire to gain money or power), disinhibitors (factors that cause a dearth of restraint, such as the impact of various substances), and destabilizers (factors that may cause one to lose control, for instance, adverse life events such as the loss of support in an individual’s social network, or certain vulnerabilities which may cause an individual to strongly affected by certain circumstances) (Logan & Johnstone, 2013, p. 19; Logan, 2014). The three Ds for X are considered below.


On the whole, in the case of X, the drivers which may stimulate him to engage in violence or other harmful or illegal behaviors include several positions. For instance, his obsessive beliefs that others wish to harm him (although the case does not mention whether or not X suffered from paranoia lately, this problem may still exist, or relapse might occur) are a potential driver for violence. Another driver is X’s perception that the father of his former girlfriend does not support the continuation of their relationships and takes steps aimed at preventing him from seeing the children of his ex-girlfriend.

In addition, there exist drivers which may stimulate X to continue his substance abuse. The main driver for this is probably the adverse feelings of X resulting from a broken relationship with his girlfriend and the deprivation of X of the chance to see her children. Another driver to continue taking drugs is his reunion with his previous associates in the hostel, who apparently played an important role in his resumption of illegal substance abuse.


When considering the disinhibitors which may lead to a decreased amount of self-restraint and control, one of the major factors, in this case, is the effect of the drugs which X resumed to use. Both cannabis and heroin might serve as disinhibitors (Logan & Johnstone, 2013), causing an individual to be unable to control oneself to a degree which is characteristic of one’s normal state. In addition, the possible mental conditions that X may suffer from might serve as destabilizers as well; apart from being drivers (paranoid fears that others have malicious intentions towards X), these mental conditions may negate the barriers which normally permit one to control oneself in a stressful situation or event (Logan & Johnstone, 2013).


When it comes to factors which might play the role of destabilizers in this situation, the disruption of the relationship between X and his former girlfriend might be considered one of the most important destabilizers in the given case. The lack of X’s contact with his own father may also serve as a destabilizer. In addition, the current situation which X finds himself in, that is, the need to live in a homeless hostel, may also destabilize X and lead to an increased risk of his committing illegal and harmful actions.

Intervention Points

There exist a number of aspects of X’s situation that increase his readiness to engage in illegal aggressive behaviors, and for some of these aspects, it is possible provide interventions aimed at mitigating the adverse effects of these aspects. Some of the points that may be addressed via interventions are discussed below.

  • Paranoia. It is clear that X suffered from paranoia, that is, unfounded fears that others desire to harm him and/or laugh at him (Freeman et al., 2014). Therefore, it might be possible to implement an intervention which would be aimed at getting rid of these unfounded fears. It is likely that a mental health specialist or a professional psychologist may be capable of helping X to address this issue.
  • Meeting the children of the former girlfriend. As has been noted in the case, X has a strong desire to meet the children of his ex-girlfriend; it might be assumed that he also wishes to take part in the process of bringing them up. At the described stage, it is possible to provide X with an opportunity to meet the children, probably under the supervision of a professional who would ensure the safety of these children and the mental comfort of his ex-girlfriend.
  • Decreasing the chance that X will take drugs; limiting his contact with his former associates. Another possible intervention might be aimed at lowering the chance that X takes drugs. It might be impossible to ensure that he does not do so; however, he might be persuaded to minimize the contacts with his former associates who provide him with substances. The continuation of the methadone programme should also be helpful.
  • Restoring X’s relationships with his father. It is possible to contact the father of X and persuade him to have a reunion with his son and to restore their relationships. The father might be able to have an influence on his son and to help him deal with his problems (Traube et al., 2012).
  • Strengthening X’s relationships with his sisters. It is stated that X’s sisters, who are older than he is, are concerned about his situation and are worried about the threat it poses to his mental state. Providing X with an opportunity to meet his sisters more often and to communicate with them might help him to increase his ability to resist the desire to consume substances and to convince him that he should fight his addiction. In addition, more communication with family members will mean that X will have less time to maintain contacts with his former associates and engage in drug consumption (Traube et al., 2012).
  • Finding an alternative place to live. If the relationships of X with his father or sisters are restored, someone of them might agree to take him in. This will reduce his ability to contact his former associates, as well as restrict his access to drugs. However, this should be done carefully so as to ensure that X does not experience paranoid feelings similar to those which caused him to run away from his home at the age of 16.
  • If X is not employed, it is also possible to help X to find employment (probably part-time at first), or to continue his education if he desires to. Finding a job might initially be more beneficial because that might keep him busier, whereas, in schools, he might feel oppressed by the teachers or the school administration, or find himself in an environment where illegal substances are useful. On the contrary, work might assist X in avoiding his old acquaintances, as well as provide him with a distraction from his problems and help convince his former girlfriend that he is willing to lead a normal life.
  • Finally, it is needed to provide assistance and/or take legal action towards X’s associates who persuaded him to use heroin again, as well as to take legal action against drug dealers who supply them with illicit substances (Government of the United Kingdom, n.d.).

Interventions to Reduce or Manage Risk

There are a number of interventions which may help reduce or manage the risks that X faces himself and that he poses to other people. For instance, Schaub et al. (2015) describe an Internet-based intervention combined with chat counseling that is aimed at decreasing the use of cannabis by individuals who are already taking it. It is stated that such interventions are effective at reducing the use of cannabis by such people (Schaub et al., 2015).

Another possibility is offered by Garety et al. (2014), whose study demonstrated the effectiveness of an intervention that targets reasoning biases which lead to delusional persistence. Utilizing a reasoning training intervention such as the one described by Garety et al. (2014) might allow for reducing the risk of paranoia exacerbation or relapse in X. Also, the Worry Intervention (Freeman, Dunn, Startup, & Kingdon, 2015) also might help address the groundless fears that X faces or may face.

In addition, it might be possible to provide X with an intervention aimed at informing individuals about the infections that may be transmitted via the use of injection drugs, such as HIV or hepatitis C (MacArthur et al., 2014). Such an intervention may help reduce the risk of X contacting HIV in the future, as well as the chance that he communicates it to someone else, should he continue using injection narcotics.


On the whole, it should be stressed that the risks faced by X are serious and that his situation is currently rather adverse. In fact, X may even face imprisonment. Therefore, it is paramount to provide him with assistance so as to help him deal with his substance use problem and aid him with regaining the trust of his former girlfriend so as to supply him with the opportunity to meet her children, and, possibly, with restoring the broken relationships. In addition, X’s ties with his family should also be strengthened.


Freeman, D., Dunn, G., Murray, R. M., Evans, N., Lister, R., Antley, A.,…Morrison, P. D. (2014). How cannabis causes paranoia: Using the intravenous administration of∆ 9-tetrahydrocannabinol (THC) to identify key cognitive mechanisms leading to paranoia. Schizophrenia Bulletin, 41(2), 391-399.

Freeman, D., Dunn, G., Startup, H., & Kingdon, D. (2015). ). Efficacy and Mechanism Evaluation, 2(1). Web.

Garety, P., Waller, H., Emsley, R., Jolley, S., Kuipers, E., Bebbington, P.,… & Freeman, D. (2014). Cognitive mechanisms of change in delusions: An experimental investigation targeting reasoning to effect change in paranoia. Schizophrenia Bulletin, 41(2), 400-410. Web.

Government of the United Kingdom. (n.d.). . Web.

Logan, C., & Johnstone, L. (Eds.). (2013). Managing clinical risk: A guide to effective practice. New York, NY: Routledge.

Logan, C. (2014). The HCR-20 Version 3: A case study in risk formulation. International Journal of Forensic Mental Health, 13(2), 172-180.

MacArthur, G. J., van Velzen, E., Palmateer, N., Kimber, J., Pharris, A., Hope, V.,…Hutchinson, S. J. (2014). Interventions to prevent HIV and hepatitis C in people who inject drugs: A review of reviews to assess evidence of effectiveness. International Journal of Drug Policy, 25(1), 34-52. Web.

Schaub, M. P., Wenger, A., Berg, O., Beck, T., Stark, L., Buehler, E., & Haug, S. (2015). A web-based self-help intervention with and without chat counseling to reduce cannabis use in problematic cannabis users: Three-arm randomized controlled trial. Journal of Medical Internet Research, 17(10), e232.

Traube, D. E., James, S., Zhang, J., & Landsverk, J. (2012). A national study of risk and protective factors for substance use among youth in the child welfare system. Addictive Behaviors, 37(5), 641-650.

World Health Organization. (2013). . Bulletin of the World Health Organization, 91, 102-123. Web.

World Health Organization. (2016). . Web.

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