Navigating the Mental Health Internet

Lesson 2.1 A Fisherman in Alaska with a Dual Diagnosis

The three cases in Lesson 2 cover a wide range of conditions, including depression, ptsd, substance abuse, medical illnesses, and sleep disorders. They are presented with links to illustrate the range of Internet resources available on clinical topics. This first case concerns rural mental health delivery. It is based on my experience teaching a workshop on the Internet to mental health workers on the Aleutian Islands of Alaska. Many were village-based counselors who had only 36 hours of training and no college education, and yet they provide multiple mental health services ranging from hospice care to detox. Many are now embracing the Internet to fill in their gaps in training and information on assessment and therapy.

Case

John is a 29 year old man living in the rural Alaskan town of King Cove. He works seasonally on the fishing boats, but when not fishing, he abuses alcohol. Recently he has begun using amphetamine as well. He is a dually diagnosed patient. For the past 2 years, he has been taking Zoloft for treatment of Major Depression. He has been referred to the mental health clinic because he has an enlarged liver presumed to be related to his abuse of alcohol. He states that he doesn't see the connection between his liver problem and drinking, and doubts that he's an alcoholic since he doesn't drink when he's working on the fishing boat. He is part Aleutian Indian and has expressed interest in learning more about his Native American background.

Treatment Issues

Denial

The first therapeutic objective is to convince John that he does have a serious problem related to alcohol and that his health is being affected by it. An online interactive test would demonstrate to John that he does meet criteria for alcohol dependence.

Internet Resources
EXERCISE: Take the Alcohol Screening Test as John, making up responses to fit someone who has an alcohol problem.

These are links to pictures from the University of Utah Medical School pathology mini-tutorial on the effects of alcohol on the liver that can be shown to John.
Normal Liver

Micronodular cirrhosis of liver, gross
This is a brochure on substance abuse from the National Clearinghouse for Alcohol and Drug Information that can be printed out and given to John.
Alcohol: What You Don't Know Can Harm You

Alcoholics Anonymous

John agrees to get involved with a 12-step program. However, there is no AA meeting currently being held in the small Alaskan village he lives in. However John lives one block from the clinic and is quite willing to come in to use the computer to read the Big Book of Alcoholics Anonymous and to join an online AA group when he is on shore.

Internet Resources
Big Book of Alcoholics Anonymous

Below are links to online AA groups
About.com-AA Online Meetings
LampLighters-A large e-mail AA Group with over 10,000 members.
Aleutian Roots

John's recovery could be aided by expanding his social support network for sobriety, including re-connecting with his indigenous roots. In addition to finding local resources, an Internet search on the Aleutian Indian Tribe turned up these sites.

Internet Resources
University of Connecticut Arctic Circle Web Site
This site contains information on the Aleutian Indians.

Four Worlds Institute for Human and Community Development
The Four Worlds Institute is an organization whose principles are based on the traditional teachings of North American tribal peoples.

Clinical Education

Internet Resources
Information on Zoloft is available on several sites, as you'll learn in lesson 4. Here is the information from the Internet Mental Health Site:
Zoloft (Sertraline)

Dual Diagnosis patients present unique treatment challenges. Visit Kathleen Sciacca's
Dual Diagnosis Website: Mental Illness, Drug Addiction and Alcoholism