Using the case study you will identify key patient problems, stages of change for each identified problem, criteria that supports specific DSM 5 substance use diagnosis, and develop questions about items you would wish to understand in more depth.
Case Study –
Johanne, is 30-year-old woman and has been drinking alcohol for at least 9 years. At first her drinking modest (1-2 standard drinks) once or twice per week, and at social events with her partner and friends. She reports there were occasional periods of heavy drinking (4 or 5 drinks per event) about 2-3 times per year. When she divorced 4 years ago, she started drinking more frequently, almost every night and most often after her two school-age children and preschool age child had gone to bed Counseling Essay. About 3 years ago, she noticed that she was feeling more anxious and felt stress from efforts to get the children to daycare and school, doing day to daycare, not having enough money, hassling with her ex-husband over child support, and getting to work on time. She received a prescription for benzodiazepine Zanax from her family doctor and after about 6 to 7 more months noticed her frequency of use increased, along with her alcohol use. She began using up the medication 1-2 weeks before her next prescription was due and when she was out of medicine, she felt very anxious. When this occurred, she used alcohol to control her anxiety and feelings of stress. She also began to try to seek out other prescribers for this medication, when her health care provider declined to fill her prescription earlier than planned Counseling Essay.
Johanne grew up in a household she describes a “tense and chaotic”. She describes her mother as being verbally abusive and who has continued to struggle with excess alcohol use most of her life. Johanne recounts drinking alcohol two or three times during high school, yet not liking the taste or effects of alcohol. She then began to smoke cannabis around age 16 and enjoyed that more. Johanne went through a period of smoking cannabis regularly after ending her relationship with her first high school boyfriend. After she began another relationship, she reduced her cannabis use, decided she was becoming too reliant on marijuana stating, “I was afraid I was getting addicted to it”, and quit using entirely. She has been smoking cigarettes for at least 12 years and uses about 15-20 a day, but will smoke even more when “I am anxious”.
Johanne has been drinking regularly (she reports at least 1-2 times a week for about seven years) for at least ten years. After her divorce, her drinking increased to almost daily, and her use of benzodiazepines began three years ago. Johanne started “prescription shopping” like her need for the benzodiazepine increased. She reports feeling a sense of shame, feels regret about her divorce, reports low motivation, little belief in her own ability and low confidence. She reports little social interaction with others outside of teachers at her children’s school and her immediate family. She also reports that she feels like an ineffective parent but insists she has never neglected her children.
On admission, Johanne reports she has felt depressed: feeling sad about the loss of her husband through divorce, guilty about not taking good enough care of her children, anxious, lethargic, and unmotivated. Sometimes she sleeps for hours at a time, and when asked how long, she reports 10-12 hours or more. At other times, she wakes up in the middle of the night, then has trouble falling back to sleep and at other times cannot get to sleep. Her physical complaints include frequent headaches, a chronic cough, and an irregular menstrual cycle. She reports feeling “stressed out,” yet has trouble taking steps to reduce her sense of stress. Prior to entering the detox program, she had not had a physical exam in 4 years. While in the detoxification program, her restlessness, anxiety, and depressive symptoms seemed to increase. She reports feeling overwhelmed with issues of finances, childcare, and isolation.
Her doctor recognized her withdrawal risks and referred her to a psychiatrist trained in substance use disorder. The psychiatrist recommended inpatient treatment. After being monitored in a detoxification program for several days, and referred to an 8-week intensive outpatient treatment program, she is now ready to develop her treatment plan.
– Clearly identifies, defines, and explains key criteria, symptoms, issues, counseling strategies, risk reduction methods, etc.
– Demonstrated ability to effectively apply concepts, techniques, and related learning from case studies, and research.
– Paper must have a logical flow with complete ideas presented, clarity of argument and explanations, and the writing engages the reader.
Key patient problems
- Frequent drinking almost every night with the drinking intensity increasing since the divorce four years ago.
- Increasing anxiety and stress from taking care of children, financial issues, dealing with ex-husband, and work responsibilities.
- Heavy smoker (smoked for at least 12 years) using 15 to 20 cigarettes every day.
- Antisocial behavior by keeping away from social relationships with friends and family.
- Depression since the divorce.
- Increasing use of benzodiazepine (Zanax) prescribed for the anxiety and stress.
- Indications of prescription medication abuse and addiction with benzodiazepine not used as prescribed and alternative sources of medication sourced apart from prescribers.
- Has history of child abuse (verbal abuse by mother).
- Family history of alcohol abuse by mother.
- Has history of cannabis use as a teenager.
- Detoxification program was not helpful with her anxiety and depression increasing.
- Withdrawal risks identified (disturbed sleep, irritability, anxiety, and tension) and client referred to counseling.
Stages of change for overcoming the alcohol and prescription Zanax addiction
The stages of change are suitable for describing the case details. These stages help in understanding the range of behaviors that the client exhibits as she wants to reverse her addiction but has difficulty in doing so. Through understanding the stages of change that apply to the client, it is possible to present an effective recovery plan that applies person-centered and motivational approaches rather than pathological and confrontational approaches. The client began at the pre-contemplation stage when she ignored the negative effects of the addiction and only focuses on what she perceives as the positive effects. At this stage, she was not ready to change the addictive behavior. This is seen when she drank alcohol after her children had gone to bed, and used alcohol to supplement Zanax. At this stage, the client viewed the Zanax and alcohol addiction as a pleasant and positive experience. However, the negative effects were apparent although she ignored them (such as prescription shopping that could land her in jail and depression), choosing to use more alcohol and prescription Zanax (Hartney, 2019b).
The client moved into the second stage (contemplation) when she became aware of the negative consequences of the addiction and started thinking about changing through quitting, moderating and cutting down on the addictive behaviors. At this point, she was considering changing the addictive behavior, open to listening to information about the negative consequences of the addictive behavior, and learning strategies for addressing the addictive behavior. The contemplation stage concluded when she made the decision to seek treatment for the addictive behavior (Hartney, 2019b).
The client moved into the third stage (preparation) when she started planning and preparing for the treatment for addictive behavior, and carrying out the changes she contemplated. At this point, she planned about the change to be made: cutting down on the alcohol and Zanax, and reducing the harm. Also, she planned on how to make the change: seeking professional treatment to guide her through the treatment process. Besides that, she put support in place by booking a place in a detoxification program. In addition, she sought help from a social worker/counselor to help with the preparation. Once the preparation for treatment was complete, the client moved on to the next stage (Hartney, 2019b) Counseling Essay.
The client moved into the fourth stage (action) when she attempted to overcome the addictive behavior and actively sought to control the behavior. At this stage, she began the real change when she entered the detoxification program where trained professional personnel were on site to support her through the treatment and make informed decisions for therapy when necessary. However, this stage turned out to be more challenging than the client had anticipated, causing her to develop withdrawal symptoms that complicated the treatment effort. Her restlessness, anxiety and depressive symptoms increased, causing the medical personnel to be concerned (Hartney, 2019b).
The trained professional personnel at the detoxification program deemed the withdrawal symptoms dangerous and though it prudent to refer the patient to an intensive outpatient treatment program for additional monitoring. This caused the client to move back into the preparation stage where new treatment options were explored before moving back into the action stage with a new treatment plan being applied with a focus on minimizing the withdrawal symptoms, and addressing the issues that overwhelmed her (Hartney, 2019b) Counseling Essay.
Criteria that supports specific DSM 5 substance use diagnosis
DSM 5 identifies addictive behavior as substance use disorder, noting that the client qualifies for such a diagnosis since she uses alcohol and prescription Zanax in excessive amounts that cause her significant health and life issues to include having difficulties in meeting her home and work responsibilities. In fact, she is diagnosed with severe substance use disorder since she meets eight of the criteria for diagnosis within a 12-month period as presented in DSM 5. Firstly, she has used Zanax and alcohol in a hazardous manner when she was taking care of her children after the divorce thus placing them in a dangerous situation. Secondly, the alcohol and prescription medication use has caused her to experience social problems as she keeps away from social interactions and opts to be on her own. Third, the substance use has caused her to neglect major roles as she fails to meet home and work responsibilities owing to the substance use Counseling Essay. Fourthly, she experienced withdrawal symptoms when she stopped using alcohol and Zanax in the detoxification program. Fifthly, she had built up a tolerance causing her to require more of the substances to get the same effect. Sixthly, she uses larger amounts of the substance for longer periods of time. Seventhly, she spends a lot of her time using the two substances. Eighthly, she had developed psychological issues related to the use to include anxiety and depression (Hartney, 2019a; Sperry, 2016). As a result, the criteria presented in DSM 5 supports the client’s diagnosis as suffering from substance use disorder Counseling Essay.
In addition to the presented criteria, the client’s age of onset of substance use would also be considered since it has implications for the diagnosis. That is because it is significantly associated with psychological problems. To be more precise, the client began drinking alcohol at 21 years of age and Zanax at 24 years of age. This identifies her as a late onset substance user thereby reducing her risk for psychosocial problems in different life areas (when compared to early onset substance use) to include work adjustment, recreation/leisure, peer relationships, family system, psychiatric disorders, and behavior patterns (Poudel & Gautam, 2017).
Questions to ask for in-depth understanding before diagnosis conclusion
- What are the patterns of the substances use? Should include longest periods of abstinence from the substances, duration of sobriety, and date of last substance use.
- Have you had any legal consequences and/or complications from using the substances? Such as trafficking, selling, arrests and convictions.
- Have you had any cravings? As manifested in desires, thoughts and dreams.
- Do your parents, siblings, friends, ex-husband use the same substances? Probes for the types of substances use since this could be an important problem indicator Counseling Essay.
- Have you had any interruptions in social (home) and professional (work) history from substance use? Explanation required.
- What is your work/occupational history? Probes for source of finances linked to the substances use, such as stealing, skimming from family accounts, and participating in the commercial sex industry.
- Do you have a citation/arrest history caused by substance use? Such as probation, incarceration, and legal infraction.
One must accept that psychotherapy offers an opportunity for understanding and intervening in psychiatric issues. In addition, one must acknowledge that substance use disorder is a generalized diagnostic term that characterizes the excessive and uncontrollable use of chemical substances to include prescription medication and alcohol. Besides that, it is clear that persons with substance use disorder go through different stages of change that include pre-contemplation, contemplation, preparation and action stages. Still, there is a need for DSM 5 criteria to be applied to ensure that the correct diagnosis is presented. Also, age should be considered as it has implications for associated psychological problems and eventual diagnosis. Additionally, leading questions should be asked to understand patterns of use, relevant family history, and professional and social effects as they have implications for the implications. These issues have been discussed in the present case to show the complexities of diagnosis substance use disorder Counseling Essay.
Hartney, E. (2019a). The 11 official criteria for addiction/substance use disorder. Retrieved from https://www.verywellmind.com/what-are-the-official-criteria-for-addiction-22493 Counseling Essay
Hartney, E. (2019b). The stages of change model of overcoming addiction. Retrieved from https://www.verywellmind.com/the-stages-of-change-model-of-overcoming-addiction-21961
Poudel, A. & Gautam, S. (2017). Age of onset of substance use and psychosocial problems among individuals with substance use disorders. BMC Psychiatry, 17, 10. Retrieved from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1191-0
Sperry, L. (2016). Handbook of diagnosis and treatment of DSM-5 personality disorders: assessment, case conceptualization, and treatment (3rd ed.). New York, NY: Routledge Counseling Essay.