Final Case Study (Case Study #2)

Comment by Tara Overzat: Pagination needed.

Case Study One: Maria

11/20/22

Assessments

Substance Abuse Subtle Screening Inventory-4

Maria's SASSI-4 assessment results are 13 for face-valid alcohol, 1 for face-valid other drugs, 8 for symptoms, 5 for obvious attributes, 2 for subtle attributes, 4 for defensiveness, 6 for supplemental addiction measures, 9 for family vs. controls, and 9 for correctional. A score of 13 for face valid alcohol means that Maria acknowledges significant past and current alcohol use. Importantly, it indicates that she is aware of some of the behavioral challenges exhibited by people who engage in alcohol use. The substance abuse subtle screening inventory-4 uses obvious, logically derived, subtle, or empirically derived questions (John et al., 2016). As such, a score of 13 is high but below 20. Based on the decision rule for substance abuse subtle screening inventory-4, a score of below 20 means that an individual may have been exposed to alcohol but has a low probability of having a substance use disorder. Maria’s score for face-valid other drugs is 1, which is very low, indicating that she may not have been exposed to drugs other than alcohol. Maria's Symptoms (SYM) score was 8, which is elevated and above 7; based on decision rule 1, any rule answered 'yes' means the individual has a high probability of having a substance use disorder. Comment by Tara Overzat: RAP needs to be discussed at the beginning. Comment by Tara Overzat: Text needs to be left-justified. Comment by Tara Overzat: Inappropriate source as it refers to the SASSI-3 not the SASSI-4. The SASSI clinical manual provides everything you need to discuss the instrument. Comment by Tara Overzat: Unsure where this is coming from in the material. It is also out of scope for the question. Comment by Tara Overzat: It is normal range.

Table 1

Maria’s Scores on Each Scale of the SASSI-4

Scale	SASSI Score	T- Score	Percentile	Description
FVA	13	68	88th Comment by Tara Overzat: Likely closer to ~96th or 97th.	Maria’s FVA score of 13 means she acknowledges exposure to alcohol use and related behavioral challenges that arise from such exposure. However, the score is below the rule 1 score of 20. That means whereas Maria may be exposed to alcohol, she has lower chances of developing substance use disorder. This is a good indicator of Maria's readiness for a lifestyle change. Part of the reasons why Maria might have been exposed to alcohol use is as a form of escapism from assignments or family issues, given that she is a single mother. Comment by Tara Overzat: Left-justified text only in APA style. Comment by Tara Overzat: Text in a table needs to be single-spaced. Comment by Tara Overzat: We do not judge the score's meaning based on this single rule. Please review the SASSI module and my video on SASSI.
FVOD	1	46	35th	Maria's score for FVOD is very low, indicating that she has never had an experience with substances other than alcohol. Furthermore, the low score means a minimal probability of developing substance use disorder. Comment by Tara Overzat: It is normal range.
SYM	8	68	92nd Comment by Tara Overzat: Likely ~96th or ~97th.	The score is more than 7, indicating a high chance of developing a substance use disorder. Notably, the results show that Maria could be a person who occasionally takes alcohol to either enjoy herself or run or relieve herself from family or pressure from assignments. Furthermore, based on the score, she perceived the use of alcohol as a regular use; it may not be different from her colleagues. Comment by Tara Overzat: She may perceive Comment by Tara Overzat: Good interpretation at the end here.
OAT	5	60	83rd	The score indicates that the client does not have obvious symptoms of substance dependence. It essentially means that whereas the client has experience with alcohol use, she does not show any signs that she is dependent on it or any other substance. This score correlates with the client’s FVOD score.
SAT	2	38	10th	The client’s score indicates that the client does not use any substance because it is below 7. The score is based on the indirect measure of substance use by using non-substance-related items. Based on the score, it is clear that the client does not use substances; as such, the probability of developing a substance use disorder is lowInc. Comment by Tara Overzat: Incorrect interpretation.
DEF	4	44	20th	The score is below the rule 6 score, which puts six as the benchmark for determining if the client has a high chance of developing substance use disorder. Based on the score, the client has low denial; she is not defensive and does not minimize telling the truth. Summarily, the score shows that the client is truthful and honest with what she says. Comment by Tara Overzat: It is normal range.
FAM	9	48	48th	The score is less than the benchmark; however, it is not part of the decision-making tools concerning substance abuse disorders. Based on the score, it can be determined that part of the reasons why the client is exposed to alcohol is family or work pressures. The pressure could be occasional, which is essentially occasional taking of alcohol. Comment by Tara Overzat: Incorrect interpretation.
COR	9	74 Comment by Tara Overzat: T-Scores look good.	100th Comment by Tara Overzat: ~99th as percentiles cannot reach 100.	The client’s COR score is not high, which means the client’s responses are not similar to the responses of individuals who have substance abuse disorder. Comment by Tara Overzat: It is very elevated. Comment by Tara Overzat: Incorrect interpretation.
Rx	1			The score is 1, which measures the client's misuse of prescription medications. Based on the score, the client has a low chance of misusing prescription drugs. The low scores in the SASSI-4 screening outcome and the low score in Rx mean the client is neither misusing prescription medications nor engaging in substance use.
				Comment by Tara Overzat: Extra space at end of table is not needed.

Strengths and Limitations

The assessment has significant strengths that include high criterion validity for the scale. Studies revealed that it accurately classified 100% of offenders with SUDs as having a high probability (Wooley et al., 2012). In this case, the scores for the various items are valid, and the conclusion is reliable as to whether the client has a high probability or low probability of developing substance use disorder. Comment by Tara Overzat: There are myriad reliability and validity statistics in the provided SASSI clinical manual. Outside sources are not needed. Comment by Tara Overzat: Insufficient answer to this question.

There are limitations to the SASSI-4; the internal consistency is high for the overall SASSI and is direct but not its subtle or indirect subscales, suggesting that the tool captures a single face-valid construct. That means the indirect scales used in assessing the client could not be used to determine if the client is using substances; however, they can still hl the clinician understand the possible reasons for the scores in the direct scalesI. Comment by Tara Overzat: Source? Comment by Tara Overzat: Typo. Comment by Tara Overzat: Insufficient discussion of limitations.

Beck Anxiety Inventory

Maria scored 36 on tBeck Anxiety Inventory. The score is between 30 and 63, which is perceived to be severe. The severe score indicates that the client has many anxiety symptoms. As such, the treatment plan focusing on addressing the anxiety symptoms is the most suitable for the client. According to Borwin, Sophie, and Dirk (2017), an individual with a high Beck Anxiety Inventory score should be treated immediately using therapies such as cognitive behavioral therapy, which is regarded as having the highest level of evidence on its efficacy and efficiency. Furthermore, the use of first-line drugs, such as selective serotonin reuptake inhibitors, is a good choice (Borwin, Sophie & Dirk, 2017T). Comment by Tara Overzat: Good. Comment by Tara Overzat: "the" needed here Comment by Tara Overzat: Incorrect. Comment by Tara Overzat: Treatment plan belongs in the treatment plan section. Comment by Tara Overzat: This paragraph should also address items of concern (e.g., items client endorsed with a 3).

Strengths and Limitations

Among the strengths of BAI is having reliability of .75 in a sample of adult patients with psychiatric problems (Beck et al., 1988). The reliability is based on test-retest; concerning the validity, BAI's construct validity is consistent with DSM-III-R criteria for anxiety disorders, emphasizing generalized anxiety disorder and panic disorder. Significantly, the items selected correlate with other scores, such as the State-Trait Anxiety Inventory and Hamilton Anxiety Rating Scale (Beck et al., 1988). The client's score of 36 indicates a severe condition related to other scores. Comment by Tara Overzat: Good. Comment by Tara Overzat: More discussion on reliability and validity needed. These statistics were provided in the BAI file.

There are limitations to the BAI, including the inability to differentiate between depression and anxiety. Furthermore, the inventory is criticized for predominantly focusing on phobias-related anxiety. There are situations where anxiety arises from other conditions that could be associated with depression. Comment by Tara Overzat: Source? Comment by Tara Overzat: Source?

Maria’s Background

Maria is a 25-year-old Latin female referred to the clinic due to potential substance abuse and other issues that the referring clinician deemed a "higher level of care" than he was able to provide at his outpatient private practice. Maria reports feeling nervous often and being generally unsure of herself in her day-to-day activities. Maria immigrated to Georgia from Honduras at five years old, and is currently working a retail job, a job she held during the Covid pandemic, and attending night classes at a local college to work on her Associate's Degree. She is single with one 5-year-old daughter and lives with her older sister's family. She is close to her parents, who live 15 minutes away. Maria agreed to take the SASSI – 4. Based on the SASSI – 4 scores, Maria has a low chance of developing a substance use disorder. However, she has been exposed to alcohol; she has not been exposed to non-alcoholic substances.

Furthermore, comparatively, she does not compare with individuals with substance use disorders. Consequently, part of the reasons why she is exposed to alcohol could be family pressures; being a single mother has challenges that make her occasionally drink as a way of running away from life pressures. However, if the problem is not addressed, she could be addicted and develop a substance use disorder. Furthermore, nervousness could be associated with fear of the worst happening, which is why she may be opting to drink alcohol. Comment by Tara Overzat: Indentation needed. Comment by Tara Overzat: I am unsure where this is derived from given th material. Comment by Tara Overzat: Please refer back to the bottom half of Maria's score sheet.

Treatment Plan

Based on American Psychiatric Association, the diagnostic and statistical manual of mental disorders, the treatment plan is based on the ICD10 and DSM5 classification (American Psychiatric Association, 2022). The treatment goals include reducing panic disorder, manifested by fear of dying, terrified, and nervousness. The goal could be addressed using different approaches that include pharmacotherapy. Studies reveal there is efficacy for medications for SAD, PDA, and GAD, including phobias (Borwin, Sophie & Dirk, 2017). Using licensed drugs in the country would help meet the treatment goal. Comment by Tara Overzat: What is your rationale for this diagnosis?

Furthermore, reducing anxiety would entail psychotherapy, which means using cognitive behavioral therapy, which has proved to have high efficacy and is better for the client (Borwin, Sophie & Dirk, 2017). Secondly, the goal is to reduce exposure to alcoholic drinks. This is better done using psychotherapy, specifically behavior therapy; this would entail encouraging Maria to deliberately confront her fears and life pressures rather than opting to drink alcohol. There should also be dietary adjustments because mineral deficiencies, such as a lack of magnesium, can contribute to anxiety. Comment by Tara Overzat: With her elevated FVA, detox, in-patient treatment or another significant intervention would likely need to be done first before anxiety or other issues could be addressed. Comment by Tara Overzat: This is out of scope of the counselor. This is best addressed by a dietician or medical doctor.

References Comment by Tara Overzat: Too much space at top.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders

(5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Beck, A.T., Epstein, N., Brown, G, and Steer, R.A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, pp. 893-897

Borwin, B., Sophie, M and Dirk, W (2017). Treatment of anxiety disorders. Dialogues Clin Neurosci., 19(2), pp. 93–107. Doi: 10.31887/DCNS.2017.19.2/bbandelow

John M. L., Robin, M. D., Allison, K. A., Sylvia, L-S., Christopher, P. R., Amy, W., Stephanie, C., Darren, W. L., Andrew, M. B., and Jim, S (2016). Assessing the accuracy of the substance abuse subtle screening inventory-3 using DSM-5 Criteria. The Professional Counsellor, 6(2), pp. 1-5 Comment by Tara Overzat: Minor reference page issues.