Respect Writer (final paper 305)

Dates of Interviews: 10-5-15 to 10-12-15

Evaluator: Luke Skywalker

Introduction

In order for an individual to obtain the direction and treatment he or she needs, they must be assessed accurately and effectively. Proper assessment requires practice and skill to ensure the correct information is being gathered. At the end of an assessment an examiner should know all about the client’s current use of addictive substances and treatment indications. Leia, a 28-year-old woman, should be questioned regarding her background, spiritual, genetic, and psychosocial information so that she may receive proper treatment and the help she requires for recovery.

Reason for Assessment

Leia requires an initial assessment upon admission at the center in order to properly examine her clinical needs. In order to receive appropriate and efficient care, the examiner must understand the quantity and frequency that she abuses alcohol and marijuana. In fact, it is the assessor’s duty to accurately assess Leia in order to obtain a holistic clinical picture of what brought her into the clinic (Doweiko, 2015). Without the spiritual, genetic, and psychosocial information obtained during the assessment, Leia will not receive the care she needs as the health care team will not be able to properly understand what lead her to her current psychological state. If the information is obtained meticously and correctly, it can serve as a source of direction for Leia’s treatment or as a guide to provide her with appropriate referrals.

Sources of Information

The source of information for this assessment is the client, Leia. In Leia’s interview she mentioned that her friends thought she should get help. Thereby, the opinions of her friends provide some information that Leia’s condition was prevalent to others.

Background Information

Evaluating Leia’s background can have a profound effect on how the examiner directs her course of treatment. She has been placed on parole, charged with disorderly conduct, and is awaiting trial for battery. She has been incarcerated twice during her adulthood for 10 months and then again for 10 ten days. Leia grew up in a family where there were various drug abuse and drinking problems. She was taken from her home due to physical abuse as a child and was raised by her grandmother, who she still currently lives with. She did not finish high school and has most recently worked as a parking attendant. Leia has been drinking since age 14 and using marijuana since she was 17. She was 17 when her first child was born and now has four children, ages 11, seven, four, and two. She is currently single and has no contact with her children’s fathers.

Current Status

According to May (2005), Leia’s current status is most likely emerging from the stage of a breakdown. Leia has recently been charged four times, put on probation, injured twice within the past six months, and is awaiting trial for battery. Even after these life circumstances started happening, she kept drinking and even used marijuana, a secondary addiction (May, 2005). Due to the compilation of these consequences from her addiction, she experienced guilt, remorse, and shame. She most likely felt that she could handle the consequences, but as they added up she lost respect for herself and felt despair. As Leia reached her breaking point she brought herself to the center for substance abuse treatment and services. She has chosen the only dedicated action that has the ability to truly counteract addiction, and that is to try and stop the addictive behavior (May, 2005).

Indicators of Use/Abuse/Dependency

Alcohol use disorder, as diagnosed in the DSM-5, incorporates tolerance, failed attempts to quit, “craving” for alcohol, preoccupation with alcohol use, and continual use in spite of physical or interpersonal risks (American Psychiatric Association, 2013). Using the criteria mentioned in this manual, it is evident that Leia uses, abuses, and is dependent on alcohol, yet denies that she is addicted. While she mentions that she only drinks once a week, she also reports that she often feels “down” and drinks to feel better. The discrepancy in her report in how often she drinks alcohol reveals that she most likely drinks more than she would like to admit, even to herself (Doweiko, 2015). Leia has various failed attempts at quitting, as she has not gone longer than 60 days without drinking alcohol or abusing another substance. She also continues to abuse alcohol despite physical or interpersonal risks. She has already injured herself twice within the past six months while intoxicated, and she has lost a relationship with her children due to her choices concerning substance abuse. Therefore, Leia is addicted to alcohol as she experiences occupational, social, and familial problems as a result of her drinking and has not refrained from abusive substances for longer than 60 days (Doweiko, 2015). In addition, though it is rare to become addicted to marijuana, Leia has most likely become addicted as she has not been able to go without it for longer than 60 days and has also allowed it to affect her social life and relationships (Doweiko, 2015).

Attitude and Behavior

Leia has a range of various attitudes and behaviors. Because she reports that she often feels “down” and then drinks to feel better, she most likely often practices rationalization and displacement. She justifies that alcohol is ok to use because it makes herself feel better. She makes these excuses in attempts to justify her addictive behavior (May, 2005). Leia describes her present health as “good”, however she has recently sustained injuries and says she often feels down. Thus, she may often have an attitude and thought process of denial as she does not recognize that her ailments are a result of her drinking (May, 2005). Despite her attitude resulting in rationalization, displacement, and denial, she also reports that she is concerned about her substance use and has decided that seeking treatment is important to her. Thereby, Leia also has an attitude of hope that has led her to a behavior and mindset of dedication in seeking treatment in order to cease her addiction to alcohol and marijuana (May, 2005).

Social Functioning

Leia has a moderate amount of social interactions as she goes out with her friends at least once a week. While it is healthy for Leia to be with people and not feel isolated, it is not beneficial for her to be with friends who drink socially (Doweiko, 2015). Since she has been cycling through addiction and recovery, being around others who drink socially is likely to cause her to drink. Although her friends do create an environment for temptation, they care enough to recommend that she receive help for her drinking problem. Marijuana is also a social compound used in certain social groups, although it is illegal in most states (Doweiko, 2015).

Occupational Functioning

Leia’s substance abuse has interfered with her vocational history and should continue to be explored by the examiner. She cannot hold a job as a result of her substance use disorder. She reports that her longest period of continuous employment was a little over one year and that she has worked irregularly throughout her adult life. Because of her lack of a high school diploma, her recent probation, charges, and trial for battery, it will be difficult for Leia to find another job. Her occupational history and current occupational functioning further reveal the extent of her alcohol use disorder. An individual with substance abuse is willing to experience vocational consequences associated with abuse as long as they are able to continue using the substance (Doweiko, 2015). Leia is not able to hold a job longer than a year due to her propensity to abuse alcohol and marijuana. All mind tricks, attitudes, and behavior have a single purpose: to continue the addictive behavior (May 2005). Leia is willing to give up jobs and sacrifice familial relationships in order to keep abusing substances.

Financial Aspects

Because Leia cannot hold a job longer than one year, she most likely does not have adequate finances. The reasons she has been placed on probation also reveal that she is not financially stable as she has reportedly been shoplifting and passing bad checks. She has most likely never been financially secure as her family also had drug and alcohol problems while she was growing up, and because she has been abusing substance since she was 14 (Doweiko, 2015). Her financial status is important to assess as it may reveal why Leia has delayed treatment for so long. If she has never been financially secure, she may have felt like she could never afford treatment, or that services would be denied to her if she did seek help (Doweiko, 2015).

Familial Relationships

Leia’s familial relationships have been a significant factor in establishing her pattern of abuse. Leia has a relationship with her grandmother who raised her due to her original family physically abusing her as a child. Because of these circumstances, Leia may have never developed properly through Erik Erikson’s developmental stages (Berger, 2014). This may have started as early as birth as she reports several family members having drinking and/or drug use problems. Because so many members of her family were addicted to substances, Leia may have a genetic predisposition towards addiction (Doweiko, 2015). With members of her family being addicted to substances, she may have never had the loving or trusting environment she needed to develop properly (Berger, 2014). With this background and environment, Leia was prone to search for acceptance and attention from other people, such as men, or things, such as alcohol or drugs (Berger, 2014). Through continual searching for acceptance from men she became the mother of four children, who are now either in foster care or living with another relative. Through continual searching for acceptance and forming an identify in drugs, she became addicted to alcohol and abusing marijuana.

Legal History

Leia’s legal history is indicative of the results and consequences of her decisions regarding alcohol and marijuana. Her legal history may reveal actions that are a result of being under the influence of substances, or they may reveal a deeper desire for attention being accomplished by acting out (May, 2005). Leia is currently on probation for crimes such as shoplifting, passing bad checks, vandalism, and parole/probation violations. She has also been charged with disorderly conduct and fishing without a license, as well as driving without a license. She also has a history of being incarcerated twice, one for ten months and one for ten days, during her adulthood. All of these actions reiterate the underlying mindset of an addict: to keep the addictive behavior going at all cost (May, 2005). Thereby, when an individual is in a state of abuse and addiction, no legal issues or probations will be enough to keep the addict away from their addictive substance (May, 2005).

Health History

While Leia does have certain health concerns that she is most likely unaware of, she does not have any diagnosed co-occuring issues. The examiner should be concerned with Leia’s mental health as physical abuse can determine an individual’s entire life trajectory if it is not treated properly (Berger, 2014). She may also feel lonely and isolated as she lives with her grandmother, and her four children are not with her. Because of this, Leia should undergo psychological testing and receive proper treatment that incorporates counseling to cover what she has been through throughout her life. She describes her overall present health as “good.” However, because she began drinking at such an early age and has not stopped for longer than six months, her body has most likely suffered despite her awareness (Doweiko, 2015). The most prominent organ that has experienced damage is most likely her liver. Doweiko (2015) claims that between 80 and 90% of drinkers will develop early manifestations of liver disease, also known as “fatty liver.” A fatty liver can develop just after a few days of heavy drinking, and can also develop quickly the longer one abuses alcohol. Thereby, due to her extended time of alcohol abuse and propensity towards liver damage, Leia’s physical assessment should include lab values, specifically evaluating serum liver enzyme levels (Doweiko, 2015).

Spiritual History

While Leia does not mention a spiritual history in her initial assessment, she does seem to recognize that her circumstances are bigger than herself and recognizes they are outside of her control. After years of continual substance abuse, she is concerned and seeks treatment due to her recognition that her problem require the help of others. Leia’s difficult family history may have also distorted her view of God, as she may have not able to view Him as a loving father when she was physically abused by her earthly father. While Leia’s past is not laid out in her case study or discussed openly, it has been hypothesized that every addiction, at its core, is a disease of the spirit (Doweiko, 2015). There is no way to avoid that when Leia put away her pride and realized she needed to let go of her addiction, she recognized there was a higher power from whom she needed help.

Diagnostic Impression

Leia meets various signs and criteria necessary of a substance abuse disorder. According to the DSM-5, some of the signs of a substance abuse disorder include preoccupation with continued substance use, intoxication at inappropriate times, reduction in social, occupational, or recreational activities, and continual use in spite of social, emotional, or vocational problems caused by the substance (American Psychiatric Association, 2013). Leia meets all of these criteria as she cannot hold a job, does not have a relationship with her children, and drinks alcohol excessively at inappropriate times. Thereby, according to the limited amount of information stated by Leia, she relays a diagnostic impression of substance use disorder.

Recommendations

Having established that Leia has a substance use disorder, she needs to receive an appropriate level of care and effective treatment. Leia’s ability and willingness to partipate in treatment, ability to carry out self-care activities, family and social environment, and need for structure all need to be evaluated in order to establish her best plan of care (Doweiko, 2015). The recommendation is for Leia to be admitted to a residential treatment facility where she can receive counseling and treatment. This will help stabilize her life and remove her from the environmental factors that may be contributing to her substance abuse. The goals of intervention and recommendation are to aide Leia in making the decision to stop using alcohol and marijuana (Doweiko, 2015). Because Leia does not think anything is wrong with her health, psycian-based brief intervention may be an effective first form of intervention for her. This may be the best treatment due to the fact that she does not think anything is wrong with her, when in fact, alcohol is actually already harming her body. If she is aware of this, it may be enough incentive to stop drinking alcohol. However, even with this treatment, Leia should still see a psychologists so that she may work out her past physical abuse, her current mental state, and possibly strengthen her relationship with her children and grandmother.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Press.

Berger, K. S. (2014). The developing person through the life span (9th ed.). New York, New York: Worth Publishers.

Doweiko, H. E. (2015). Concepts of chemical dependency. Stamford, CT: Cengage Learning.

May, G. G. (2005). Addiction and grace: Love and spirituality in the healing of addictions. San Francisco, CA: HarperOne.