Formulation Considerations for Individuals Experiencing Emotional Distress and Substance Use

The following chapter explores substance use and co-occurring emotional distress (often recognised as ‘dual diagnosis’ in psychiatric and mental health settings). The chapter outlines a fictitious case study example that portrays an individual who is struggling with their mental health, using cannabis and alcohol as coping mechanisms. An example will be provided of how formulation might be approached in a mental health nursing context—situating formulation within the nursing process. The use of substances and the thresholds that constitute a disorder is an area fraught with challenges relating to definitions, use of terminology, conceptualisations, and debates around substance use as a health issue versus it being an issue of personal choice and responsibility. All of this is situated within an arguably fractured policy context made up of distinct, overlapping and sometimes contradictory directions and guidance. When substance use co-occurs with various states of emotional or psychological distress, the complexities are further compounded. The current chapter briefly examines this complex context, as it contributes to shaping approaches to intervention, and help-seeking for individuals who are struggling with substance use and co-occurring emotional distress. For this chapter, the definition of substance use as ‘the recurrent use of alcohol [or] drugs that leads to clinically and functionally significant impairment’ by Earnshaw (2020) will be adopted. The chapter will also refer predominantly to the term ‘emotional distress’ which is a non-pathologising term to describe a state of emotional suffering or an individual’s struggle with their mental health. We acknowledge that in mainstream psychiatry (or diagnostic language) emotional distress would encompass what is understood as mental illness or diagnoses of mental health conditions such as depression, psychosis or bi-polar disorder.