Chemical Use Assessment/History and Treatment Recommendations Upon careful review of Jay W’s case study, a client who is potentially suffering from a substance abuse disorder, it is deemed necessary to examine his history, compose a chemical use assessment, and devise a recommended treatment plan that will determine his clinical needs. Upon assessing the client, it is vital that he be examined holistically for better recovery results. Considering his spiritual, genetic, and psychosocial conditions will help to ensure a more accurate analysis of his current situation. Only then can it be determined if Jay W is in use, abuse, or an addictive cycle. Reason for Assessment
During the case study of Jay W. it is noted that he was referred to my office by his parents for a clinical assessment. Once a commendable student with excellent grades, his grades began to dwindle after reaching college. He eventually failed his first year of college as a result of his poor grades. Jay’s parents Don W. who is a neurosurgeon and his mother Beth W. who is a research scientist, is seeking help for their son because they are concerned that his heavy drinking is the cause of his flunking. They believe that if he does not get help, it could very well damage his future goals of becoming a chemical engineer. Sources of Information
During the verbal intake of Jay W.’s case, his father Don W. and his mother Beth W. were present along with Jay W., to provide all of the details of his need for assessment. Secondary sources that has been carefully reviewed and used in making a determination includes, Doweiko, H. E. (2012). Concepts of chemical dependency (8th ed.). Belmont, CA: Brooks/Cole. May, G. G. (1991). Addiction & grace: Love and spirituality in the healing of addictions. New York: HarperOne, Clinton, T., & Hawkins, R. (2009). The quick-reference guide to biblical counseling: Personal and emotional issues. Grand Rapids, MI: Baker Books. Hawkins, R. (2009). Theology and Addiction www.libertyuniversity.edu, Clinton, T. (2009). Addiction and Recovery www.libertyuniversity.edu.
Jay W. was born May 2, 1994, to Don and Beth W. The pregnancy was reportedly normal with no complications to the labor and delivery. Jay W. met all his developmental milestones early and was described as an advanced baby. Jay reportedly excelled in school with needing very little effort to maintain a straight-A report card, even in the gifted and talented program. The current school year, he flunked out of his first year in college. His parents are concerned about his drinking and how it appears to be interfering with his aspirations of being a chemical engineer. He states that he does not believe his drinking is the issue with his grades in college. Instead he assumes that boredom is the sole reason that his grades are failing. He also adds that his professors do not really know as much as they think they do. He even admits sometimes he just does not feel like going to class because it is “dumb.” As stated by his parents, Jay began drinking at the age of 12 years old.
He totaled his first vehicle two weeks after his sixteenth birthday. Jay lost his driver’s license at that time and was charged with a DUI. Shortly after, Jay and both of his parents began attending AA together, but Jay dropped out after 3 months. Jay states he stopped going because, “all they talk about is war stories.” Jay does admit to blackouts, drinking more than he intends to, and does seem to recognize that many of his friends have similar drinking patterns as he. He also reports a recent break up with his girlfriend of 2 years. He states he truly loves this girl, but she broke up with him because “she doesn’t like my friends.” He reports spending an average of $75 a week on beer, and his money does not always last until the end of the month. He attributes that to his parents not giving him enough money. He states they only give him $1,000 a month. Jay states he is willing to come to counseling but does not think he has a drinking problem, but he would like to figure out how to “win” his girlfriend back. Current Status
Out of reluctance, Jay has decided to proceed with obtaining clinical treatment. He realizes that if he doesn’t, his parents will no longer fund his college tuition. He also admits to currently drinking at least a 12 pack of beer on the weekends. He qualifies his actions by mentioning that his friends assists him with drinking the beer. He also does admit that his weekends sometimes start on Thursdays and don’t end until Mondays. He states that he does not believe his drinking is the issue with his grades in college. He states he just gets bored in classes and his professors do not really know as much as they think they do. He states sometimes he just does not feel like going to class because it is “dumb.” Jay does admit to blackouts, drinking more than he intends to, and does seem to recognize that many of his friends have similar drinking patterns as he. Indicators of Use/Abuse/Dependency
Addiction can manifest in the form of obsessive or compulsive behaviors. Overtime, over indulgence can cause a dependency to obtain more of the physical or chemical substance. Behaviors that can produce fear and/or excitement are factors that can lead to addictive behaviors (Doweiko, 2012). When there is an addiction, usually a manifestation of withdrawal symptoms will be evidenced when the source of addiction is absent. Abuse is usually evidenced when a substance is taken in disregard for directions or one’s well-being (Doweiko, 2012). Attitudes and Behavior
After careful review of Jay W.’s objective data found in his case study, it is apparent that Mr. W is in denial about his drinking problem. He appears reluctant to obtain treatment and is nonchalant in his attitude and behavior. He admittingly says he stopped attending AA because, “all they talk about is war stories.” Upon further subjective analysis, it seems that my client views his drinking with an “everybody else is doing it mentality.” This is evidenced by his reference to drinking as a “typical teenage behavior” as well as his assertion that his parents overreacted to his suspended license because he has several friends who has lost theirs also as if it’s a “normal” thing to do. He also seems to be irresponsible for his actions and constantly shifts blame on others for his current problems. He blames his parents for not giving him enough money instead of focusing on the fact that he is spending at least 75$ a week on beer. He also shifts the blame of his failing school on the inability of his professors to engage him cognitively and even claims that the classes are “dumb.” Jay W. appears saddened by the breakup with his girlfriend of 2 years and sincerely wants to “win” her back. As Dr. Clinton states in Addictions and Recovery “the tragedy of addiction is that is destroys, individuals, families, and friendships” (2009). Social Functioning
Drinking appears to be a social activity for Jay W. he states that his friends assist him with drinking the 12 pack case of beer that he usually buys on the weekend. He also has mentioned that several of his friends have lost their licenses, implying that it is also a result of obtaining DUI’s. Jay goes even further by acknowledging the fact that many of his friends have similar drinking patterns as he does. Apparently his ex-girlfriend of two years had many complaints about the “bad” company that he was keeping. Jay doesn’t take heed and loses her through a breakup instead. According to Doweiko, the consumption of alcohol can interfere with one’s social relationships by making preexisting one’s worse (2012). This is due to an adverse effect on judgment which causes a lack of control of one’s behavior. Irritability, black outs, and lying are only a few of the manifestations of alcohol addiction. The Psychosocial Models of Substance Use Disorders is another type of model of addiction. It is believed to be closely linked to the medical model (Doweko, 2012). It is proposed that addictions are “learned behavior, poor psychosocial functioning, or the result of maladaptive thinking” (Doiewko, 2012, p. 345), all in which are manifestations of a biological dysfunction. Occupational Functioning
Jay W., although obviously an intelligent guy (evidenced by his excellent grades in the gifted and talented program), has just flunked out of his first year of college. His future career goals are dwindling because of the negative choices that he is making. Booze and negative social relationships have become distractions that steered him off the path of success that he once embarked upon. A repetitive cycle of partying Thursday till Monday and trying to maintain normalcy (crashing is also an option) Tuesday and Wednesday is ongoing. It is possible that he is traveling down the road of addiction. Those who are bound by abuse can live unfocused and disoriented lives. Over time, this can lead to divorce, job loss, and even the loss of child custody. Although drug abuse may be a one-time event, if one is not careful, the behavior can lead one down the path of addiction as in Jay’s case. It appears that he have a natural proclivity towards abuse and addiction because his father Don also had a drinking problem. Dr. Clinton tells us in the video presentation that some of the effects of addiction includes: “control problems, compulsiveness, narrowing focus, denial, tolerance and withdrawal” (Clinton, 2009). We see many of these components in Jay’s occupational functioning. Financial Aspects
When examining Jay W’s financial condition, it is obvious that he is mismanaging his money. His parents was giving him a 1,000 monthly stipend, and he blew at least $75 per week of it on beer. His excessive spending habits have created a deficit towards necessary items. Instead of accepting responsibility for misappropriating funds, he blames his parents for not giving him enough money. Alcohol abuse often tends to cause make financial problems worse or either create new ones. Sadly, not only the abuser can suffer financially, but oftentimes his or her immediate family suffers as well. This usually occurs when monetary restrictions are placed on the abuser/addict to control his or her spending. This can force the abuser to start borrowing elsewhere, stealing and/or selling others belongings to obtain money so that the addicted habit can be sustained (Doweko, 2012). Familial Relationships
The medical model of substance use disorders (SUD) have suggested that the dysfunction have occurred on either a cellular or molecular level and that one is biologically predisposed to alcoholism when he or she is exposed to certain environments (Doweko, 2012). Jay W. has been exposed to alcohol through his father Don who is a neurosurgeon. Jay perhaps saw how he was able to get drunk and yet go to work and carry on a seemingly normal life. Don was described by his wife Beth as a “functional alcoholic,” displaying heaving drinking patterns and binge drinking when he was not on call. Jay’s parents seems to be very supportive of him though. His father was willing to give up drinking and both he and his wife joined AA along with Jay. Even when he dropped out after 3 months, they continued going to both AA and Al-Anon. It also appears that Jay W. has a genetic predisposition of alcohol abuse/addiction. Both Beth and Don have fathers that were alcoholics. Various genes have been identified by researchers and believed to have an influence in predisposing individuals to substance use disorders. Jay W. familial relationship is starting to reveal the beginning stages of strain. He is claiming that they are overreacting and also accuses them of not giving them enough money. Often, family members of an alcohol abuser/addict report feelings of fear, shame, grief or other negative emotion when dealing with him or her (Doweiko, 2012). When the addict is confronted about their drinking behavior, conflict typically arises causing the familial relationship to be strained. Legal History
Jay W is starting to have run in’s with the law. According to his parents, he totaled his vehicle two weeks after his 16th birthday. This incident caused the police to get involved. Jay inevitably was charged with a DUI and his driver’s license was revoked. His buddies seem to have frequent encounters with law enforcement. Jay has started to defend his and his friends’ behaviors and suggest that it’s typical. Jay is “destined to misunderstand the story [he] finds himself in” (Clinton & Hawkins, 2009) he has become irrational in his behaviors by accusing his parents of overreacting to his license being revoked. Health History
Jay W. seems to have a pretty clean health history. Thus far, no incidents have been reported. When he was born on May 2, 1991 there were no complications to the labor and delivery. He was considered very advanced for his age due to the fact that he had met all his developmental milestones early. Alcoholism can cause both short-term and long-term problems. Some of the short-term manifestations includes diarrhea, poor coordination and judgment, insomnia, as well as stomach problems (Doweiko, 2012). Some of the long-term problems includes: liver problems, cirrhosis of the liver, mental disorders, malnutrition, impotence, among a host of others (Doweiko, 2012). Spiritual History
The spiritual model of addiction assumes that addiction is derived from a sickness of one’s spirit that has possibly manifested in a physical manner. It is mankind’s way of searching for something to feel a void and escape pain and or discontentment that can often come with daily living (Doweiko, 2012). It is Jay’s first year in college. It’s possible that he wants to fit in and gain the approval of his peers instead of being a loner. Acceptance and the need to feel “cool” and included seems to have taken precedent over anything else. It’s how he gains his identity. He gets involved with the wrong group and starts being influenced by their deviant ways. Now, he’s saddened by the fact that his girlfriend has broken up with him. He has also just flunked out of his first year of college. All of these “rock-bottom” experiences can easily trigger the addiction cycle. It is characterized by: pain, hitting bottom, seeking relief, use or do, feeling good, crashing, cycles back to pain, and then tolerance. It is obvious that Jay W. is starting to undergo this cycle of addiction. Alcohol’s deceptive illusion of giving Jay control and euphoria keeps him on the wheel.
From all that has been gleaned from Jay W’s case study, it is safe to say that he is “at risk” for developing a substance use disorder. He is clearly on his way of having a drinking problem. Although he is displaying early problem alcohol usage if he is not careful, he could very well develop an addictive disorder. While evaluating Jay W to get a better diagnostic impression, it is necessary that I use the Psychopathy Checklist Revised (PCL-R) test on the client (Hawkins, 2009). This test is composed of three categories of assessment: 1.) interpersonal or affective defects; 2.) social deviance; and 3.) additional items such as unstable relationships, etc (Hawkins, 2009). The PCL-R Test will provide a better analysis of root causes of the client’s delinquent acts as well as to help identify prevailing risk factors. By identifying these risk factors, intervention strategies can be developed to counteract these risk factors. The following are a list of dynamic risk factors that has been identified and needs addressing: problem solving/impulsivity
poor social/family relationships
alcohol & substance abuse
Based on the risk factors identified, the following recommendations have been made for Jay W.: Problem solving/impulsivity
Habitually, Jay W. will be expected to attend group therapy where he will learn to think through decisions before moving impulsively. He will be given various scenarios in which he will have to explain how he should handle those situations appropriately. Role-playing will be a part of his therapy. For example, instead of not going to class because they are “boring,” he can try to get in more advanced classes if they are available. It could be that he’s bored because he is not being challenged enough. He will be expected to work through all possible options and their consequences before making a decision. Poor social/family relationships
Since Jay W. ex-girlfriend seems to be a good influence on him, their relationship should be encouraged. A relationship coach will be provided to assist him with maintaining healthy relationships. Hopefully, if all goes well, he will do what it takes to “win” her back (hanging around more positive people). Antisocial associates/attitudes
Jay W. will have access to a mentor who will confront his antisocial behaviors and attitudes and challenging him to participate in healthy functions and associating with positive people. The mentor will do habitual check-ins with the client and provide one on one time when needed to help him work through his feelings. Alcohol Abuse
Frequent alcohol tests will be conducted on the client. If at any point alcohol is found in his system, he will be required to attend an alcohol rehabilitation program. According to Dr. Hawkins, recovery is an inside out issue requiring the Holy Spirit (Hawkins, 2009). In order for Jay W to function optimally, his “human will must act in concert with divine will.” (May, 1991, p.178). He needs to have a divine encounter with God so that he can know who he is through Christ. In Addiction and Grace it is stated that “the alignment of our will with God’s must happen at a heart level” (May,
1991, p.178). Jay must first admit that he has a problem and needs help.
Clinton, T. (2009). Addiction and Recovery www.libertyuniversity.edu. Clinton, T., & Hawkins, R. (2009). The quick-reference guide to biblical counseling: Personal and emotional issues. Grand Rapids, MI: Baker Books. Doweiko, H. E. (2012). Concepts of chemical dependency (8th ed.). Belmont, CA: Brooks/Cole. Hawkins, R. (2009). Theology and Addiction www.libertyuniversity.edu May, G. G. (1991). Addiction & grace: Love and spirituality in the healing of addictions. New York: HarperOne,