ABSTRACT
If you are like most mental health or substance abuse clinicians, your first thought may be to try to figure out whether you can refer Paul to someone who is better equipped than you to handle his problems. You then feel helpless that there seems to be no one out there who can help Paul overcome his vicious cycle of mental anguish and substance abuse. He has been to several hospitals, clinics,
and drug rehabilitation centers, some of which have helped for a while, but none for very long. Those who have treated Paul have diagnosed him variably as having schizophrenia, organic hallucinosis, alcohol dependence, cocaine dependence, psychotic depression, borderline personality, and antisocial personality. They have given him antipsychotics, antidepressants, lithium, and Antabuse. He has tried treatment free of all substances in a drug rehabilitation program. It seems nearly impossible to know what illnesses Paul has, why he has them, and what he needs to cope with them.
