Case study part 2
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CaseStudyandTreatment-WanDeRer1.docxRunning head: CASE STUDY 1 1
CASE STUDY 1 13
Case Study 1: Wan DeRer
Student
Course
Instructor
Date
Reason for Assessment
42-year-old Wan DeRer is a homeless man. The names of his parents, who have both passed away, are unknown, as are those of his unknown siblings. Information pertaining the number of siblings that Wan DeRer has, as well as their ages, is also unknown. The established facts, however, are that Wan DeRer and his siblings were physically neglected and punished as children, though no evidence or records exist about his siblings having any mental disorders or substance dependence. As for Wan DeRer, no records exist about any personal relationships that he might be involved in, or whether he has children of his own.
Wan DeRer is, however, known to be a gifted welder who earns a good income from this profession. Unfortunately, the man can only go a few weeks without drinking, and this means that he is often unable to keep whatever jobs he gets. Despite having attended numerous treatment programs, Wan DeRer is only able to remain sober for a short while before he relapses. But even when he does so, he often goes back for treatment time and time again, sometimes under the influence, and makes emotional pleas for help. So far, however, no success has been forthcoming with Wan DeRer and his commitment to the inpatient residential program or hospital detoxification program.
Indeed, the staff at these programs have set boundaries so that he is only allowed to attend group meetings when he is sober and able to participate. Wan DeRer still refuses to go to treatment and makes excuses for not showing up. He has even been found passed out in the alley right next to the treatment center, in an instance where he had to be admitted to hospital for his severe alcohol dependency. It is his continued lack of commitment to being sober, his attitude, and his unwillingness to be treated that continue to frustrate the clinical staff.
Sources of Information
The sources of information include the interviews that were conducted by the clinical staff at the treatment program, the report by the police and the emergency room report by the medical team that treated him once he was taken to the hospital after having been found passed out in an alley, as well as his medical records.
Biopsychosocial History
The link between the biological, psychological, and social aspects of Wan DeRer can help give a counselor an idea of what areas to focus on first, as well as the type of treatment that Wan DeRer may require. Revelations about Wan DeRer’s childhool could help illuminate how his relationships with family and friends have been affected, or what internal conflicts may be unconsciously motivating his actions and behaviors (Broderick, & Blewitt, 2015).
Biological. Understanding the biological factors at play can help the counselor understand Wan DeRer’s attachments in relationships. The possibility of there being a medical condition could influence the reason that Wan DeRer consumes excessive alcohol if he is self-medicating to alleviate any pain he could be feeling. The negative reinforcing effects of alcohol have been known to contribute to alcohol-drinking behavior in people with coexisting psychiatric disorders or medical conditions as they self-medicate to deal with their issues (Gilpin & Koop, 2008). Knowledge about the possible medication that Wan DeRer is taking, also, would better help the counselor understand whether there are any health issues or chronic pain from which Wan DeRer suffers.
It is indicated that Wan DeRer’s parents died a long time ago. There have been findings that associate childhood parental death with adverse health outcomes throughout an individual’s life course. For this reason, it is critical that information is obtained about what happened to the parents, and the feelings that accompanied this loss be explored (Berg, Rostila, & Hjern, 2016). The occupational background of the parents, as well as the relationship that Wan DeRer had with them are important elements that may help establish the extent to which he was abused physically and emotionally. Here, a history of possible traumas or physical injuries, whether to the head or otherwise, A history of mental illness in the family should also be obtained, as should that of any substance use and abuse, and any experimentation with drugs as these could possibly indicate neurobehavioral deficits (Broderick, & Blewitt, 2015).
Psychological. The psychiatric issues that Wan DeRer may be having could be of significance to determining just what ails him. symptoms of mental illness should be investigated, as should any type of physical or emotional stress that would be potent enough to bring about depression. How well an individual copes with stress can play a significant part in the development and persistence of an alcohol dependence (Iwanicka, Gerhant, & Olajossy, 2017). At this juncture, it would be important to establish whether Wan DeRer has any patients or siblings that have any psychiatric illnesses, and what it is that they are doing to treat these issues. Finding out what it is that motivates Wan DeRer to act as he does, too, is crucial.
Social. Here, Wan DeRer’s everyday life and how he functions as a member of the society would be good starting points. It is important to establish the kind of social support system that he has, as well as what his cultural background is. Since it is already established that Wan DeRer has been trained as a welder, it would be important to establish what schools he attended, and how well he faired in them, particularly in the social aspects. As for present knowledge about Wan DeRer, information on any friends he may have, the activities he engages in for fun or for development purposes, and the community he interacts with would all be significant. It is in this section that the counselor ought to find out whether Wan DeRer’s social circle consumes alcohol or uses drugs, whether it is controlled or to the extent that Wan DeRer does, and the kind of social events that he attends, as well as the segment of those events where he feels a need to consume alcohol.
Development. Critical questions that need answering in this section are those related to Wan DeRer’s childhood and developmental milestones. Establishing how Wan DeRer felt about certain years of his childhood would be in line with using Erickson’s psychosocial stages of development to establish whether he felt that the world was a safe and reliable place thanks to sensitive caregiving (Broderick, & Blewitt, 2015). Given that Wan DeRer and his siblings were physically and emotionally abused, however, it would be appropriate to get his perspective about his development as a child so as to understand how he has come to his current worldview. Any recollection that Wan DeRer has about his motor skills or any assigned responsibility for his siblings up to the age of six could help establish whether he reached positive outcomes in his development.
Broderick and Blewitt (2015) claim that if positive outcomes are not reached in the various stages of development, the possibility of self-doubt and guilt manifesting in the life of the subject skyrockets. Sorin and Iloster (2006), on their part, add that children who are moved from place to place may suffer academically, and also have adverse effects visited on their behavior and social interactions. For this reason, finding out whether, and how, Wan DeRer moved a lot as a child would help. His participation in school, group activities, and even in sports or clubs, as well as his relationships with fellow students and teachers could also be used as pointers to mark and establish various developmental milestones.
Family. Establishing a family history is critical as it informs the counselor their impact on the subject’s life. The drug use or abuse of both Wan DeRer’s parents and grandparents is important information as it can help clarify whether there are any genetic influences on his alcohol use and dependence. The significance of this information cannot be gainsaid as genetic influences on alcohol use and dependence have been shown to vary dramatically across development, with environmental influences being the ones that play a predominant role in early adolescence while genetic influences become increasingly important across adolescence and into young adulthood (Dick, 2011). At this juncture, familial relationships should be explored, as well as the extent to which abuse was inflicted on Wan DeRer as a child. Given that his parents dies at an early age, his reaction to their death, as well as information pertaining to who brought him up, would be crucial.
Current Status. Wan DeRer recently passed out in the alley next to the treatment center. He had to be taken in to the hospital by the police and an emergency team so that he could get some treatment for his alcohol abuse and dependence. But even though Wan DeRer has been referred to an inpatient program, he has proven unable to commit and keeps making excuses to avoid attending the program. Inaba and Cohen (2014) explain that the chronic use of alcohol can increase the chances of developing mental, emotional, or psychiatric symptoms, just as it can impact the problem-solving techniques that are necessary to cope with life. In examining Wan DeRer, we note that he has issues committing to a treatment program and yet he literally begs to be included in one when he is intoxicated. His refusal to commit to a program, however, makes him a difficult client, especially when he insists on coming around when drunk, and even refuses to talk about his life.
Indicators of Abuse and Dependency
Attitude and Behavior. Wan DeRer has a long history of alcohol abuse and dependence. He is a careless man who has been found dead drunk and passed out in an alley, and who makes a habit of coming to the treatment center while under the influence. When at the center, he will make emotional pleas for help, but yet he stubbornly refuses to be admitted for the inpatient treatment by giving all manner of excuses. In addition, the man consistently avoids talking about his past when he attends sessions. Wan DeRer has, however, been known to stay sober for a few weeks before he relapses. In accordance with Broderick and Blewitt, it is possible that the abuse and neglect suffered at an early age contribute to the sensitivity and responsiveness in his psychosocial development (2015). Wan DeRer’s development of hope and willpower is at question because he is consistently unable to maintain a job and he is consistently showing up drunk and late to his meetings.
An examination of Wan DeRer’s behaviors show that he meets the criteria for alcohol dependence as seen in the Diagnostic and Statistics Manual of Mental Disorders V. He has drunk more or longer than he intended; wanted to cut down on his alcohol intake; spent a lot of time drinking or being sick from drinking; wanted to drink so bad that he has wanted nothing else; found that his drinking interferes with his everyday life and jobs, but still continued to drink despite the trouble that it has gotten him into; and he has even drunk so much that it has gotten to the point that he could potentially get hurt – such as when he passed out in an alley (American Psychiatric Association, 2013).
Social Functioning. There is little doubt that Wan DeRer has issues being himself or connecting with other people without the use of alcohol. Inaba and Cohen (2014) explain that alcohol can affect people psychologically by lowering their inhibitions, increasing their self-confidence, and promoting their sociability. When he is drunk, Wan DeRer is able to express his desire to kick off his alcoholism, even though he can hardly surmount the courage to do so under normal circumstances. It is also possible that Wan DeRer has been socially conditioned to abuse alcohol as a result of witnessing his parents or those who raised him depend on alcohol for their daily functioning. Broderick and Blewitt (2015) explain that observational learning and modeling can take place when an individual observes another performing some acts and learns to do those same acts from the close observation.
Occupational Functioning. Wan DeRer is not an unskilled individual. He is an intelligent man who is exceptionally gifted as a welder. His skills allow him to get jobs, get promoted quickly, and get highly paid too. But he is unable to keep these jobs because he will eventually go off and drink. Since alcohol alters the neurochemistry in the higher centers of the cortex that control reasoning and judgement as well as the lower centers of the limbic system which oversee mood, emotion, and craving (Inaba, & Cohenm 2014), it is only a matter of time before Wan DeRer loses his resolve not to give in to the craving for alcohol and is unable to function.
Financial Aspect. Wan DeRer still gets occasional jobs through his Union hall because of his exceptional skills. It may be assumed that he does not have as many financial woes because he consistently claims that the reason he may not undergo the inpatient detoxification program is because he has to maintain his standing at the Union hall so that he can continue paying for his tools in storage. But if he had taken on the role of a caregiver from early on where his family is concerned, then he may have added stress on himself. Broderick and Blewitt (2015) explain that adult roles are stressful and that, for a child to take on them by perhaps paying bills and otherwise taking care of his siblings the way his parents were supposed to do, then he may have added an extra stressful burden on himself.
Familial Relationships. Given the abusive history we know of Wan DeRer that was also coupled with neglect, it is possible that he developed an insecure attachment to his mother. Neglectful caregivers will often demonstrate reduced eye-contact, be nonresponsive, hold their children infrequently, and otherwise have a less positive and more negative affect on them (Broderick, & Blewitt, 2015). Given these markers, it is possible that Wan DeRer was unable to build a strong relationship with his parents, especially because they were also physically and emotionally abusive. For these reasons, the relationships that he develops throughout his life are affected negatively thanks to the increased likelihood that he is impulsive, highly likely to internalize problems and get depressed, and also susceptible to externalizing problems by being aggressive and so on. Parental neglect may also have left him fearful of others, likely to self-doubt, and more guilty of his thoughts and actions (Broderick, & Blewitt, 2015).
Legal. While he has not experienced any legal problems that we know of yet, Wan DeRer is likely to get in trouble due to his alcohol dependence. He may be caught driving or operating machines while under the influence, or even breaking and entering so that he can steal so as to support his habits. These offences may cost him fines, attorney fees, and even jail time.
Health. Alcohol dependence, unfortunately, brings with it a host of health concerns. Wan DeRer may lose the ability to absorb the needed nutrients from his food thanks to the effect of alcohol on his digestive track. Additionally, it is only a matter of time before his liver is affected and he develops steatosis which could lead to hepatitis and liver cirrhosis (Doweiko, 2015). As a heavy drinker, his circulatory system may also be affected, putting him at risk of a possible stroke, hypertension, and even damage to muscle tissues. His central nervous system is also at risk of getting damaged, while alcohol-induced memory deficits are likely to affect him, as are blackouts and anterograde amnesia (Doweiko, 2015).
Spiritual. There is little indication that Wan DeRer has a spiritual life. As such, he might need to develop one so that he can get the social support system that he definitely needs if he is to combat the specter of alcohol dependency without backtracking every so often as he does. A lack of a spiritual support system may have contributed to Wan DeRer thinking that the only way he could escape from worry, satisfy his need for approval and acceptance, and reduce any guilty feelings that he may have developed and sustained throughout his life was though alcohol abuse. It is likely, too, that Wan DeRer desires to reduce or avoid pain in his life and, therefore, opts to self-medicate by using alcohol. But this drug use continues to draw him deeper into an addictive cycle. An introduction to God and spirituality may help him recognize that he does not need to shoulder these burdens alone – and that a strong spiritual support system is what has been lacking all along, hence his continued relapses as he seeks to bury his past in drink and bury all the pain that he has suffered.
Case Study 2
Begin Case Study 2 with the following section (be sure to change the title of your paper to correspond with the assignment). You may add it to Case Study 1 at this point in the document. The Diagnostic Impression heading will immediately begin after your last paragraph for the Spiritual Level 2 heading above. This will provide a complete assessment from beginning to end.
Diagnostic Impression
Using the information provided in the Case Study and in your assessment of the individual, give a diagnostic impression by ascertaining if this person is in the use, abuse, or an addictive cycle and if there are any co-occurring/additional issues. Utilize the information obtained in this assessment to formulate your diagnosis. The diagnosis must be justified with citations from textbook readings, presentations, etc.
Treatment Plan
Next, formulate a comprehensive referral(s) and treatment recommendations based on your determination of the individual’s current needs. This will require a thorough examination and evaluation of the client’s current status, treatment needs, and treatment goals. Explain your referrals and recommendations and support them with scholarly sources. You are expected to incorporate your readings and presentations. Use the learning materials to support your assessment, referral, and treatment recommendations. This assessment needs to be strongly supported by the literature.
Aftercare Recommendations
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Berg, L., Rostila, M., & Hjern, A. (2016). Parental death during childhood and depression in young adults - a national cohort study. Journal Of Child Psychology And Psychiatry, And Allied Disciplines, 57(9), 1092-1098. doi:10.1111/jcpp.12560
Broderick, P. C., & Blewitt, P. (2015). The Life Span: Human Development for Helping Professionals (4th ed.). Boston: Pearson.
Dick, D. M. (2011). Developmental Changes in Genetic Influences on Alcohol Use and Dependence. Child Development Perspective, 5(4), 223-230.
Doweiko, H. E. (2015). Concepts of chemical dependency. (9th ed.). Stamford, CT: Cengage Learning.
Gilpin, N. W., & Koob, G. F. (2008, Fall). Neurobiology of alcohol dependence: focus on
motivational mechanisms. Alcohol Research & Health, 31(3), 185+.
Iwanicka, K., Gerhant, A., & Olajossy, M. (2017). Psychopathological symptoms, defense mechanisms and time perspectives among subjects with alcohol dependence (AD) presenting different patterns of coping with stress. PeerJ, 5, e3576.
Inaba, D.S. & Cohen, W.E. (2014). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs. (8th Ed). Medford, OR: CNS Productions.
Sorin, R., & Iloster, R. (2006). Moving schools: Antecedents, impact on students and interventions. Australian Journal of Education, 50(3), 227-241.
