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Substance abuse assessment case study

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Case Assignment:

Please read the following case study. Once completed, please utilize the information to discuss, in a 5-8 page paper, the following:

1) which substances are involved

2) how might you assess further

3) whether this appears to be characteristic of abuse or dependence and why

4) the likely course of the addiction if treatment or untreated

5) any concurrent psychiatric disorders to consider, if so, how might it be
assessed and addressed

6) your recommendations for treatment.


THE CASE:

Al Santini, a 39-year-old restaurant owner, is referred by a marriage counselor to a private outpatient substance abuse treatment program for evaluation and treatment of a possible “cocaine problem.” According to the counselor, attempts to deal with the couple’s marital problems have failed to produce any signs of progress over the past 6 or 7 months. The couple continues to have frequent, explosive arguments, some of which have led to physical violence. Fortunately, neither spouse has been seriously injured, but the continuing chaos in their relationship has led to a great deal of tension at home and appears to be contributing to the acting-out behavior and school problems of their two children, ages 9 and 13.


Several days ago, Al admitted to the counselor and to his wife that he had been using cocaine “occasionally” for at least the past year. The wife became angry and tearful, stating that if her husband failed to obtain treatment for his drug problem, she would separate from him and inform his parents of the problem. He reluctantly agreed to seek professional help, insisting that his cocaine use was “not a problem” and that he felt capable of stopping his drug use without entering a treatment program.


During the initial evaluation interview, Al reports that he is currently using cocaine, intranasal, 3–5 days a week, and that this pattern has been continuing for at least the past 2 years. On average, he consumes a total of 1–2 g of cocaineweekly, for which he pays $80 per gram. Most of his cocaine use occurs at work, in his private office or in the bathroom. He usually begins thinking about “coke” while driving to work in the morning. When he arrives at work, he finds it nearly impossible to avoid thinking of the cocaine vial in his desk drawer. Although he tries to distract himself and postpone using it as long as possible, he usually snorts his first “line” within an hour of arriving at work. On some days, he may snort another two or three lines over the course of the day. On other days, especially if he feels stressed or frustrated at work, he may snort a line or two every hour from morning through late afternoon. His cocaine use is sometimes fueled by offers of the drug from his business partner, whom the patient describes as a more controlled, infrequent user of the drug.


Al rarely uses cocaine at home, and never in the presence of his wife or children. Occasionally, he snorts a line or two on weekday evenings or weekends at home when everyone else is out of the house. Al denies current use of any other illicit drug but reports taking 10–20 mg of an antianxiety drug, Valium (diazepam) (prescribed by a physician friend), at bedtime on days when cocaine leaves him feeling restless, irritable, and unable to fall asleep. When Valium is unavailable, he drinks two or three beers instead.


He first tried cocaine 5 years ago at a friend’s party. He enjoyed the energetic, euphoric feeling and the absence of any unpleasant side effects, except for a slightly uncomfortable “racing” feeling in his chest. For nearly 3 years thereafter, he used cocaine only when it was offered by others and never purchased his own supplies or found himself thinking about the drug between episodes of use. He rarely snorted more than four or five lines on any single occasion of use. During the past 2 years his cocaine use escalated to its current level, coincident with a number of significant changes in his life. His restaurant business became financially successful, he bought a large home in the suburbs, he had access to lots of cash, and the pressures of a growing business made him feel entitled to the relief and pleasures offered by cocaine.


He denies any history of alcohol or drug abuse problems. The only other drug he has ever used is marijuana, which he smoked infrequently in college but never really liked. He also denies any history of other emotional problems and, except for marriage counseling, reports that he has never needed help from a mental health professional.
During the interview, Al remarks several times that although he thinks that his cocaine use “might be a problem,” he does not consider himself to be “addicted” to it and is still not sure that he really requires treatment.


In support of this view, he lists the following evidence:


1) his current level of cocaine use is not causing him any financial problems or affecting his standard of living

2) he is experiencing no significant drug-related health problems that he is aware of, with the possible exception of feeling lethargic the next day after a day of heavy use

3) on many occasions, he has been able to stop using cocaine on his own, for several days at a time

4) when he stops using the drug, he experiences no withdrawal syndrome and no continuous drug cravings.


On the other hand, he does admit the following:


1) he often uses much more cocaine than intended on certain days

2) the drug use is impairing his functioning at work because of negative
effects on his memory, attention span, and attitude toward employees and customers

3) even when he is not actively intoxicated with cocaine, the aftereffects of the drug cause him to be short-tempered, irritable, and argumentative with his wife and children, leading to numerous family problems, including a possible breakup of his marriage

4) although he seems able to stop using cocaine for a few days at a time, somehow he always goes back to it

5) as soon as he starts to use cocaine again, the craving and the preoccupation with the drug are immediately as intense as before he stopped using it.


At the end of the interview, Al agrees that although he came for the evaluation largely under pressure from his wife, he can see the potential benefits of trying to stop using cocaine on a more permanent basis. With a saddened expression, he explains how troubled and frightened he feels about the problems with his wife and children. He says that although marital problems existed before he started snorting cocaine, his continuing drug use has made them worse, and he now fears that his wife might leave him. He also feels extremely guilty about notbeing a “good father.” He spends very little time with his children and often is distracted and irritable with them because of his cocaine use.


Case retrieved from:


Spitzer, R.L., et.al, (2002). DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. American Psychiatric Publishing. Arlington, VA.

 

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July 1, 2023
    

 

81. Which of the following statements regarding the benefits of group psychotherapy is false? 
A. Group psychotherapy tends to raise each client's expectations for improvement.
B. The group experience makes clients more willing to share their feelings.
C. Participants in group therapy deal with their problems without the aid of therapists.
D. Group psychotherapy allows clients to try out new skills in a supportive environment.

82. The Robinson family has been experiencing family conflicts for the past two years. The parents attribute many of the conflicts to their son, Thom. Thom is fourteen and has been getting into trouble at school since the age of twelve. They seek help from a clinician renowned for her work in family therapy. Ultimately, the _____ become(s) the client and treatment will focus on _____. 
A. child; helping Thom adjust to the pressures of adolescence
B. parents; creating a more structured environment for Thom
C. family; family interaction patterns
D. parents; helping them understand Thom

83. Henry is fourteen years old and an alcoholic. His parents take him and his younger brother to a family therapist. Which of the following statements would that therapist most likely make to Henry's family? 
A. “Problems like this do not occur in a vacuum. I believe the parents are responsible for Henry's condition and are the ones with the true problem.”
B. “No single person has a problem here. The entire family has a problem. Here we are going to learn how to communicate with and support each other better.”
C. “Henry has a problem. In order to make this therapy work, Henry must first repay each family member for the grief he has caused.”
D. “Henry must stop drinking before any other family member will talk, eat, or in any way interact with him. The family must be strong in the commitment or the therapy will fail.”

84. Alex and Tricia have been married for two years. Recently they have felt as though they are growing apart. Alex and Tricia plan to attend couples therapy because they know that its main goal is to 
A. teach them to keep their emotions bottled up.
B. determine who is most responsible.
C. improve their communication.
D. eliminate “rules” in the relationship.

85. In couples therapy, Tom and Geraldine hope to salvage their difficult marriage. Tom and Geraldine should expect all of the following from couples therapy except 
A. learning to abide by rules of talking.
B. recovering from fights by expressing more positive statements.
C. discussing best practices with other couples in the group sessions.
D. identifying miscommunication or lack of communication.

86. Eysenck's controversial research findings highlight the difficulty in scientifically determining whether psychotherapy works. All of the following are mentioned as concerns with determining the effectiveness of psychotherapy except: 
A. Placebo and experimenter bias effects
B. Figuring out how to measure a client's improvement
C. The nature and quality of the therapist-client relationship
D. The client's motivation to change

87. Which of the following best summarizes the research on the effectiveness of psychotherapy? 
A. Behavior therapy is more effective than psychoanalysis in all cases.
B. There are no clinically significant differences between individuals who have undergone psychotherapy and those who have not.
C. Psychoanalysis is best for treating people with long-standing personality disorders.
D. There are no significant differences in the overall effectiveness of behavior therapy, humanistic therapy, and psychodynamic therapy.

88. Mary has a mental disorder and wants to see a therapist. She wants to make sure to choose the best type of therapy for the most effective treatment. What type of therapy should she choose? 
A. Behavioral
B. Rational-emotive behavior
C. Phenomenological
D. No single type of therapy has been proven to work better than all others for all types of disorders.

89. Which of the following is not a criticism of empirically supported therapies (ESTs)? 
A. The widespread use of ESTs might suppress the development of new treatment methods.
B. ESTs overemphasize the importance of developing a therapeutic relationship between client and therapist.
C. Research on ESTs may not be valid because clients and therapists are not paired up at random in the real world.
D. The studies supporting ESTs were limited by the fact that therapists were not allowed to adapt treatment methods to the needs of particular clients.

90. A friend asks your advice about what is most important in evaluating a therapist. You answer: 
A. “Don't even bother with therapy! Studies have shown that people in therapy recover more slowly than people not in therapy.”
B. “Check out a therapist's track record of clinically significant success in treating problems similar to yours.”
C. “Make sure that the therapist adheres to the techniques of her or his approach, as the therapist probably is not trained in the techniques of other approaches.”
D. “Make sure the therapist uses psychoanalysis, because it has been proven the most effective approach.”

 

default image
July 1, 2023
    

 

81. Which of the following statements regarding the benefits of group psychotherapy is false? 
A. Group psychotherapy tends to raise each client's expectations for improvement.
B. The group experience makes clients more willing to share their feelings.
C. Participants in group therapy deal with their problems without the aid of therapists.
D. Group psychotherapy allows clients to try out new skills in a supportive environment.

82. The Robinson family has been experiencing family conflicts for the past two years. The parents attribute many of the conflicts to their son, Thom. Thom is fourteen and has been getting into trouble at school since the age of twelve. They seek help from a clinician renowned for her work in family therapy. Ultimately, the _____ become(s) the client and treatment will focus on _____. 
A. child; helping Thom adjust to the pressures of adolescence
B. parents; creating a more structured environment for Thom
C. family; family interaction patterns
D. parents; helping them understand Thom

83. Henry is fourteen years old and an alcoholic. His parents take him and his younger brother to a family therapist. Which of the following statements would that therapist most likely make to Henry's family? 
A. “Problems like this do not occur in a vacuum. I believe the parents are responsible for Henry's condition and are the ones with the true problem.”
B. “No single person has a problem here. The entire family has a problem. Here we are going to learn how to communicate with and support each other better.”
C. “Henry has a problem. In order to make this therapy work, Henry must first repay each family member for the grief he has caused.”
D. “Henry must stop drinking before any other family member will talk, eat, or in any way interact with him. The family must be strong in the commitment or the therapy will fail.”

84. Alex and Tricia have been married for two years. Recently they have felt as though they are growing apart. Alex and Tricia plan to attend couples therapy because they know that its main goal is to 
A. teach them to keep their emotions bottled up.
B. determine who is most responsible.
C. improve their communication.
D. eliminate “rules” in the relationship.

85. In couples therapy, Tom and Geraldine hope to salvage their difficult marriage. Tom and Geraldine should expect all of the following from couples therapy except 
A. learning to abide by rules of talking.
B. recovering from fights by expressing more positive statements.
C. discussing best practices with other couples in the group sessions.
D. identifying miscommunication or lack of communication.

86. Eysenck's controversial research findings highlight the difficulty in scientifically determining whether psychotherapy works. All of the following are mentioned as concerns with determining the effectiveness of psychotherapy except: 
A. Placebo and experimenter bias effects
B. Figuring out how to measure a client's improvement
C. The nature and quality of the therapist-client relationship
D. The client's motivation to change

87. Which of the following best summarizes the research on the effectiveness of psychotherapy? 
A. Behavior therapy is more effective than psychoanalysis in all cases.
B. There are no clinically significant differences between individuals who have undergone psychotherapy and those who have not.
C. Psychoanalysis is best for treating people with long-standing personality disorders.
D. There are no significant differences in the overall effectiveness of behavior therapy, humanistic therapy, and psychodynamic therapy.

88. Mary has a mental disorder and wants to see a therapist. She wants to make sure to choose the best type of therapy for the most effective treatment. What type of therapy should she choose? 
A. Behavioral
B. Rational-emotive behavior
C. Phenomenological
D. No single type of therapy has been proven to work better than all others for all types of disorders.

89. Which of the following is not a criticism of empirically supported therapies (ESTs)? 
A. The widespread use of ESTs might suppress the development of new treatment methods.
B. ESTs overemphasize the importance of developing a therapeutic relationship between client and therapist.
C. Research on ESTs may not be valid because clients and therapists are not paired up at random in the real world.
D. The studies supporting ESTs were limited by the fact that therapists were not allowed to adapt treatment methods to the needs of particular clients.

90. A friend asks your advice about what is most important in evaluating a therapist. You answer: 
A. “Don't even bother with therapy! Studies have shown that people in therapy recover more slowly than people not in therapy.”
B. “Check out a therapist's track record of clinically significant success in treating problems similar to yours.”
C. “Make sure that the therapist adheres to the techniques of her or his approach, as the therapist probably is not trained in the techniques of other approaches.”
D. “Make sure the therapist uses psychoanalysis, because it has been proven the most effective approach.”

 

default image
July 1, 2023
    

 

81. Which of the following statements regarding the benefits of group psychotherapy is false? 
A. Group psychotherapy tends to raise each client's expectations for improvement.
B. The group experience makes clients more willing to share their feelings.
C. Participants in group therapy deal with their problems without the aid of therapists.
D. Group psychotherapy allows clients to try out new skills in a supportive environment.

82. The Robinson family has been experiencing family conflicts for the past two years. The parents attribute many of the conflicts to their son, Thom. Thom is fourteen and has been getting into trouble at school since the age of twelve. They seek help from a clinician renowned for her work in family therapy. Ultimately, the _____ become(s) the client and treatment will focus on _____. 
A. child; helping Thom adjust to the pressures of adolescence
B. parents; creating a more structured environment for Thom
C. family; family interaction patterns
D. parents; helping them understand Thom

83. Henry is fourteen years old and an alcoholic. His parents take him and his younger brother to a family therapist. Which of the following statements would that therapist most likely make to Henry's family? 
A. “Problems like this do not occur in a vacuum. I believe the parents are responsible for Henry's condition and are the ones with the true problem.”
B. “No single person has a problem here. The entire family has a problem. Here we are going to learn how to communicate with and support each other better.”
C. “Henry has a problem. In order to make this therapy work, Henry must first repay each family member for the grief he has caused.”
D. “Henry must stop drinking before any other family member will talk, eat, or in any way interact with him. The family must be strong in the commitment or the therapy will fail.”

84. Alex and Tricia have been married for two years. Recently they have felt as though they are growing apart. Alex and Tricia plan to attend couples therapy because they know that its main goal is to 
A. teach them to keep their emotions bottled up.
B. determine who is most responsible.
C. improve their communication.
D. eliminate “rules” in the relationship.

85. In couples therapy, Tom and Geraldine hope to salvage their difficult marriage. Tom and Geraldine should expect all of the following from couples therapy except 
A. learning to abide by rules of talking.
B. recovering from fights by expressing more positive statements.
C. discussing best practices with other couples in the group sessions.
D. identifying miscommunication or lack of communication.

86. Eysenck's controversial research findings highlight the difficulty in scientifically determining whether psychotherapy works. All of the following are mentioned as concerns with determining the effectiveness of psychotherapy except: 
A. Placebo and experimenter bias effects
B. Figuring out how to measure a client's improvement
C. The nature and quality of the therapist-client relationship
D. The client's motivation to change

87. Which of the following best summarizes the research on the effectiveness of psychotherapy? 
A. Behavior therapy is more effective than psychoanalysis in all cases.
B. There are no clinically significant differences between individuals who have undergone psychotherapy and those who have not.
C. Psychoanalysis is best for treating people with long-standing personality disorders.
D. There are no significant differences in the overall effectiveness of behavior therapy, humanistic therapy, and psychodynamic therapy.

88. Mary has a mental disorder and wants to see a therapist. She wants to make sure to choose the best type of therapy for the most effective treatment. What type of therapy should she choose? 
A. Behavioral
B. Rational-emotive behavior
C. Phenomenological
D. No single type of therapy has been proven to work better than all others for all types of disorders.

89. Which of the following is not a criticism of empirically supported therapies (ESTs)? 
A. The widespread use of ESTs might suppress the development of new treatment methods.
B. ESTs overemphasize the importance of developing a therapeutic relationship between client and therapist.
C. Research on ESTs may not be valid because clients and therapists are not paired up at random in the real world.
D. The studies supporting ESTs were limited by the fact that therapists were not allowed to adapt treatment methods to the needs of particular clients.

90. A friend asks your advice about what is most important in evaluating a therapist. You answer: 
A. “Don't even bother with therapy! Studies have shown that people in therapy recover more slowly than people not in therapy.”
B. “Check out a therapist's track record of clinically significant success in treating problems similar to yours.”
C. “Make sure that the therapist adheres to the techniques of her or his approach, as the therapist probably is not trained in the techniques of other approaches.”
D. “Make sure the therapist uses psychoanalysis, because it has been proven the most effective approach.”

 

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