The practitioner's action demonstrates a lack of understanding of integrated treatment for co-occurring disorders. A core principle of integrated treatment is to engage individuals and provide services regardless of their substance use status. Withholding prescribed psychiatric medication as a punitive consequence for drinking alcohol is contrary to the evidence-based model, which emphasizes harm reduction, non-confrontational approaches, and simultaneous treatment of both mental health and substance use conditions. This action can destabilize the individual's mental health, erode the therapeutic relationship, and is counterproductive to long-term recovery.

A. a failure to employ shared decision making.

While the decision was unilateral, the fundamental error is the clinical and philosophical basis for the decision, which stems from a misunderstanding of integrated care.

B. helping the person understand there are consequences to his actions.

This reflects an outdated, punitive model. Withholding essential medical treatment is a harmful action, not a therapeutic "consequence," and it undermines recovery.

D. appropriate caution due to interaction of medication and substances.

While medication interactions are a valid concern, the appropriate response is risk assessment, education, and consultation with the prescriber, not outright denial of necessary medication.

1. Drake, R. E., Mueser, K. T., Brunette, M. F., & McHugo, G. J. (2004). A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatric Rehabilitation Journal, 27(4), 360–374.

Page 362: The article outlines the principles of Integrated Dual Disorder Treatment (IDDT), stating, "Assertive outreach, motivational interventions, and a staged, long-term approach are used to engage and retain clients in treatment... The emphasis is on gradual, individualized, and sustained change rather than on dramatic cures or confrontations." Withholding medication is a confrontational act that disengages the client.

2. Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Treatment Improvement Protocol (TIP) Series, No. 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders. HHS Publication No. (SMA) 13-3992.

Chapter 5, "Principles of Co-Occurring Disorder Treatment": This chapter emphasizes that in an integrated treatment model, "neither condition is considered 'primary' or 'secondary'." The practitioner's action of prioritizing the substance use (by denying service) over the mental health need (medication) is a hallmark of a non-integrated, sequential model. The protocol advocates for a "no-rejection" policy.

3. Pratt, C. W., Gill, K. J., Barrett, N. M., & Roberts, M. M. (2014). Psychiatric Rehabilitation (3rd ed.). Academic Press.

Chapter 15, "Psychiatric Rehabilitation for Individuals with Co-occurring Substance Use Disorders": This chapter discusses the importance of an integrated approach. It notes that traditional substance abuse programs often discharge individuals for relapse, while integrated programs "use relapse as a learning opportunity" and continue engagement. The practitioner's action is analogous to a punitive discharge rather than an integrated, learning-focused response.