Case Concept-Marci 1
Case Conceptualization-Marci
Belinda Richard
School of Community Care and Counseling- Traumatology, Liberty University
Case Conceptualization-Marci 2
Addictions Case Study: Diagnostic Impressions
Primary Diagnostic Impressions
Marci, a female college student of 22 years old, struggles with substance addiction. Marci is the
eldest of her three siblings. Her substance abuse has negatively impacted her mental health, family
relationships, spiritual life, and academic life. Marci has smoked cigarettes since she was 16 years old.
Additionally, she has used marijuana, cocaine, and LSD. Alcohol abuse continues to be an ongoing
concern. Alcohol Use Disorder, Severe F10.20 is Marci's primary diagnosis (American Psychiatric
Association, 2013). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
includes eleven diagnostic criteria for alcohol use disorder. (American Psychiatric Association, 2013) In
order to receive a diagnosis, a patient must satisfy two of the eleven criteria that have occurred in the
past year. The problems and history of the client (Marci) are consistent with criteria for alcohol use
disorder.
The client appears to meet eight out of eleven criteria for alcoholism. In addition to meeting the
criteria for severe, the client has more than six symptoms. Those who meet at least six of the criteria are
diagnosed with severe alcohol use disorder (AUD). Marci exhibits symptoms of depression despite there
being no mention of depression in the text. This could be due to her alcohol use disorder or genetics.
Listing of Criteria Met
1. Alcohol is often taken in larger amounts or over a longer period (American
Psychiatric Association, 2013, p. 490). At the age of 13, Marci had her first alcoholic beverage (wine). She
began consuming alcohol regularly around the age of 18. She has consumed a substantial quantity of
alcohol for an extended period of time. She drinks intoxicating beverages three to four times per week.
2. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or
Case Conceptualization-Marci 3
recover from its effects (American Psychiatric Association, 2013, p.491). Marci's attempts to abstain from
drinking alcohol have been fruitless. She did manage to cut back on her alcohol use a little bit, and she
has been sober for stretches of several weeks at a time, but she has not been able to quit drinking
entirely.
3. Persistent desire (American Psychiatric Association, 2013, p.490). On more than one occasion, Marci
has consumed a greater amount of alcohol than she had planned. It was typical behavior for Marci to
overindulge on the weekends. In addition to that, she has taken to drinking one or two glasses of wine
on school evenings. Marci has a few drinks between three and four times a week, and she was really
tipsy over the weekend. It is said that Marci began drinking on Friday evening and continued until about
two in the morning on Saturday, which is evidence of her intense desire to consume alcohol. During the
parties she attended on Saturday evenings, she drank the equivalent of six to seven cans, bottles, or cups
of beer. The fact that she has such a strong desire to drink alcohol is demonstrated by this.
4. Recurrent alcohol use that results in failing to fulfil key role obligations at work,
school, and home (American Psychiatric Association, 2013, p.491). Due to the aftereffects of drinking
alcohol, Marci would frequently sleep in and skip class on mornings when she was scheduled to have it.
She has been unable to maintain her position at the company. Because of her habit of drinking to excess,
her connection with her parents has become strained.
5. Continued alcohol use despite having persistent or recurrent social or interpersonal
problems caused by or exacerbated by alcohol effects (American Psychiatric
Association, 2013, p.491). Marci was taken into custody for driving while under the influence. Her driving
privileges were revoked. The relationship that she had with her parents became strained, and she has
not stopped drinking since then.
Case Conceptualization-Marci 4
6. Given up on and/or reduced important social, occupational, and recreational activities
because of alcohol use (American Psychiatric Association, 2013, p.491). Because she had been drinking
the night before, Marci skipped all of her classes the next day. She stopped going to church and ceased
serving in the church as well.
7. Recurrent alcohol use in situations where it is physically hazardous (American
Psychiatric Association, 2013, p.491). Marci has been involved in multiple car collisions, which has
increased the likelihood that she will get an injury.
8. Alcohol use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated
by alcohol (American Psychiatric Association, 2013, p. 491). Because of her heavy drinking, Marci has
struggled with issues related to her mental health, specifically with despair and anxiety.
Prevalence, Culture/Gender Issues, Functional Consequences, Comorbidity
According to the American Psychiatric Association (2013), the 12-month prevalence rate for
alcohol use in the United States is 4.6% among adolescents aged 12 to 17 and 8.5% among adults aged
18 and older. A study on the prevalence of alcohol use disorders among women and alcohol-related
problems among college students include an increased risk of contracting sexually transmitted infections
(STIs) from unprotected sex, misconduct, injury, and poor concentration or memory (Adegoye et al.,
2020). The majority of alcohol consumed by Americans is in the form of lager. (Hart et al., 2018) Less
than 27 gallons of beer per person per year equates to more than 1 gallon of alcohol per person.
Hingson and Zha [25] found that early drinking onset (e.g., 20 years old) is prospectively associated with
increased odds of alcohol dependence and participation in risky behaviors compared to later drinking
onset (> 20 years old). (Yang et al., 2019). Whites are more likely to drink than blacks, northerners more
than southerners, younger adults more than older, Catholics and Jews more than Protestants, non-
Case Conceptualization-Marci 5
religious more than religious, urban more than rural, large-city dwellers more than those with only a
high school or elementary education (Hart et al., 2018).
13-year-old Marci was introduced to alcohol by her parents during dinner when she was 13 years old.
When Marci began college, she had unfettered access to alcohol. Since she had already developed a
desire for alcohol, her cravings intensified, resulting in her developing an alcohol dependence. Her
weekend binge drinking with her companions became a habit that she found difficult to break. According
to DSM-5, 80% of 18-year-olds and elder Americans will consume alcohol at some point in their lives
(American Psychiatric Association, 2013).
At the age of 18, Marci's alcohol increased, which resulted in a DUI and car accidents. The DSM-5
also takes into account environmental, genetic, and physiological factors that can contribute to alcohol
use disorders. According to the American Psychiatric Association (2013), 40% to 60% of this disorder's
variance risk is attributed to genetics. Marci was exposed to alcoholic beverages at an early age. Even her
parents and maternal grandparents had a history of alcohol addiction. The great-grandfather of Marci
was a compulsive drinker.
In the United States, more men than women consume alcohol annually (68% males and 64%
females). Male consumers tend to consume nearly three times as much pure alcohol per year as female
drinkers (19.0 vs. 6.7 liters for males and females, respectively) (White et al., 2015). However, females
are more likely than males to have higher blood alcohol concentrations per drink. Also, women who
engage in excess drinking are more likely to suffer from physical consequences of alcohol use, such as
liver disease (American Psychiatric Association, 2013).
Marci does not confess to any physical problems. During allergy season, she experiences a
hacking wheeze. Other than the possibility that Marci will develop liver disease or cancer in the future,
there are no acute medical concerns. Current evidence that Marci's drinking is affecting her includes
Case Conceptualization-Marci 6
failing grades in school, car accidents, a suspended driver's license, and difficulties with depressive and
anxious emotions. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
states that a significant proportion of alcoholics also suffer from anxiety and melancholy (Anker, 2019).
Marci must be evaluated to determine if she uses alcohol to contend with the negative effects of her
depression and anxiety. Anker (2019) found in a prospective study that either clinically significant anxiety
or chronic alcohol abuse increases the likelihood of developing the other.
Alcohol intoxication may co-occur with other substance intoxication, particularly in those with
conduct disorder or antisocial personality disorder (America Psychiatric Association, 2013, p.499) Marci
does not satisfy the criteria for a personality disorder or a conduct disorder.
Possible Differential Diagnoses
Nonpathological alcohol consumption is a possible differential diagnosis for Marci. According to
the American Psychiatric Association (2013), a significant diagnostic criterion for this disorder is "the use
of heavy doses of alcohol with repeated and significant distress or impaired functioning" (p. 496). As
described in the case study, Marci consumes four or more alcoholic beverages three to four times per
week, followed by weekend binges. While Marci's excessive alcohol consumption has resulted in legal
consequences, loss of employment, and negative effects on her studies, she does not experience
consistent impairment or negative effects every time she drinks.
Secondary Diagnostic Impressions
Secondary Diagnosis 1
Marci began using marijuana at age 17. Her marijuana use increased after she entered college.
She used marijuana two or three times per week for approximately one year. Marci smokes cannabis
Case Conceptualization-Marci 7
alone and with companions. Due to her marijuana use, she was charged with possession of one gram of
marijuana and her relationship with her parents was negatively impacted. It also affected her academics
and, consequently, her aspirations to become an attorney in the future. Marci has insight into the
deterioration of her relationship with her parents, and she also disclosed that she feels negatively about
herself, particularly since her grades have declined and her general interests have shrunk. She also
acknowledges that marijuana has affected her motivation, academic performance, and spiritual life. Her
secondary diagnosis 1 is F12:20 Cannabis use disorder, Severe.
Listing of Criteria Met
A DSM-5 diagnostic criterion is "a problematic pattern of cannabis use resulting in clinically
significant impairment or distress, as manifested by at least two of eleven criteria occurring within a 12-
month period." Marci meets six of the eleven criteria. Since she satisfies three times the minimum
criteria, her condition is severe.
1. Cannabis is often taken in large amounts or over a longer period than intended (APA, 2013, p.509).
Marci spent an extensive amount of time smoking by herself and with friends.
2. There is persistent desire (American Psychiatric Association, 2013, p.509). Marci states that she would
smoke marijuana if she could find a means to do so despite her current status as a non-user due to legal
ramifications.
3. A great deal of time spent in activities necessary to obtain cannabis (American Psychiatric
Association, 2013, p. 509). Marci went out with friends and shared a few joints with them..
4. Craving or strong desire or urge to use cannabis (American Psychiatric Association, 2013,
p. 509). Since her arrest she has not smoked marijuana, although she still desires it.
Case Conceptualization-Marci 8
5. Recurrent cannabis use resulting in a failure to fulfill major role obligations at work,
school, or home (American Psychiatric Association, 2013, p. 509). Marci was terminated or quit her job
due to excessive absenteeism and property devastation. Her grades suffered, and she fell short of her
educational potential. Her connection with her parents deteriorated.
6. Continued cannabis use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of cannabis (American Psychiatric
Association, 2013, p. 509). Marci was accused with one gram of marijuana possession.
Her license had been revoked. She had two mishaps. She lost motivation to accomplish the educational
and professional objectives she had set.
Prevalence, Culture/Gender Issues, Functional Consequences, Comorbidity
Cannabis is commonly used as an illegal psychotropic substance in the United States. This
disorder has an approximate 12-month prevalence rate of 3.4% among 12 to 17-year-olds and 1.5%
among adults aged 18 and older. Cannabis use disorder is more prevalent among adult males than adult
females (0.8% versus 2.2%). The prevalence of this disorder is 3.8% among male adolescents aged 12 to
17, and 3% among females of the same age range. The risk of cannabis use disorder is lower among
those aged 65 and older (0.01%) compared to those aged 18 and older (4.4%), according to the
American Psychiatric Association (2013, p.512). According to the American Psychiatric Association
(2013), cannabis is likely the most widely used illicit substance in the globe. It is unknown whether this
disorder occurs in other countries, but the prevalence rates among developed nations are comparable.
Cannabis is frequently the first substance tried by people of all cultural backgrounds in the United States
(often adolescents) (p. 514)." In 2019, 22% of U.S. high school seniors were present cannabis users, and
14% had vaped cannabis in the previous month (Lee et al., 2021).
Case Conceptualization-Marci 9
The functional consequence of cannabis use disorder may result in a variety of physical and
mental health issues (American Psychiatric Association, 2013, p.514). Cannabis can diminish the user's
cognitive performance and ability to concentrate. Marci disclosed that her academic performance was
declining and that she had lost her job. Those with cannabis use disorder frequently experience
relationship issues (American Psychiatric Association, 2013, p.514). According to her, her relationship
with her parents has deteriorated. Cannabis use also impairs a person's ability to drive. Marci was
accused of having one gram of marijuana in her vehicle. Cannabis is commonly referred to as a "gateway
drug" due to its longer half-life than other harmful substances, such as opioids and cocaine. Cannabis is
linked to substance abuse disorders and mental health issues (American Psychiatric Association, 2013,
p.515). Cannabis use is highly co-occurring with alcohol and tobacco use disorders (American Psychiatric
Association, 2013, p.515). Marc used alcohol and tobacco in addition to marijuana. Cannabis use is
frequently considered a secondary diagnosis for individuals with a primary diagnosis of another
substance use disorder.
Cannabis is also linked to a variety of physical health issues, including shortness of breath,
cardiac disease, liver failure, and wheezing. Individuals with lifetime or past-year diagnoses of cannabis
use disorder also have elevated rates of other mental disorders (American Psychiatric Association, 2013,
p.515).
Possible Differential Diagnoses
A potential differential diagnosis for Marci may be other mental disorders. According to the
American Psychiatric Association (2013), chronic cannabis use is associated with a lack of motivation that
resembles a persistent depressive disorder (p. 515). It is crucial to distinguish between transient adverse
reactions to cannabis and symptoms of mental health disorders such as panic disorder, bipolar disorder,
major depressive disorder, delusional disorder, or paranoid type schizophrenia (American Psychiatric
Case Conceptualization-Marci 10
Association, 2013, p. 514). The evaluation of the case study concerning Marci revealed that she lacked
motivation and anxiety. Prior to accepting this diagnosis, Marci would require additional evaluation to
rule out psychiatric mental health disorders (American Psychiatric Association, 2013, p. 515).
Secondary Diagnosis 2
Marci began smoking cigarettes at the age of sixteen, according to the case study. She continues
smoking one pack per day. Marci meets two of the eleven occurrence criteria given her smoking
history.Z72.0 Tobacco use disorder, mild. Current severity 305.1 (Z72.0) Mild: presence of 2-3 symptoms.
Listing of Criteria Met
1. Tobacco is taken in larger amounts or over a longer period than was intended (American
Psychiatric Association, 2013). Marci is currently smoking one pack of cigarettes a per
day.
2. There is persistent desire or unsuccessful efforts to cut down or control tobacco use
(American Psychiatric Association, 2013). Marci quit smoking for 6 months, however, has started
smoking again. She has no current plans to quit or control her smoking cigarettes.
Prevalence, Culture/Gender Issues, Functional Consequences, Comorbidity
According to the DSM-5, cigarettes are one of the most commonly used tobacco products, with a
prevalence rate of over 90 percent for tobacco/nicotine use. 57% of adults in the United States are
nonsmokers, while 22% have previously smoked and 21% are currently smoking. There are
approximately 50 percent daily smokers in the United States. There is no significant difference between
the rates of adult male and female tobacco use (14% and 12%, respectively). The prevalence rate
decreases among individuals aged 65 and older. Throughout the '60s and '90s, the prevalence of tobacco
Case Conceptualization-Marci 11
use in the United States decreased. Native Americans have a higher prevalence of tobacco use than
other racial-ethnic groups in the United States. Males are affected at a higher rate than females in
developing nations (American Psychiatric Association, 2013, p.573).
In Marci's native culture, tobacco consumption was pervasive. Her mother stated she was
addicted to tobacco and had inhaled cigarettes for over 30 years prior to quitting 3 years ago. Out of the
22 years of Marci's existence, her mother smoked for nearly 19 years. New research on the association
between parental smoking and youth externalizing behaviors suggests that targeting parental smoking
and family functioning during childhood and adolescence may have additive effects in preventing or
reducing youth externalizing behaviors (Steeger et al., 2019).
Cardiovascular ailment, chronic obstructive pulmonary disease, and cancers are the most
common medical conditions caused by smoking. Alcohol/substance, depressive, bipolar, anxiety and
personality, and attention deficit/hyperactivity disorders are the most common psychiatric
comorbidities. The prevalence of alcohol use disorder, anxiety, depressive, bipolar, and personality
disorders in those with a current tobacco use disorder ranges from 22 to 32% (American Psychiatric
Association, 2013, p.574).
Possible Differential Diagnoses
The DSM-5 does not state a differential diagnosis. This might be due to a lack of research
on tobacco use disorder. However, it does mention other tobacco-induced disorders. Tobacco
induced sleep disorder in which symptoms characteristics are present but do not meet full criteria
for any specific tobacco related disorder (American Psychiatric Association, 2013).
Case Conceptualization-Marci 12
References
Adegoye, G., Reeder, N., Sunbul, M., & Tolar-Peterson, T. (2020). Disordered Alcohol Use
Among Female College Students at Mississippi State University. Journal of the Academy
of Nutrition and Dietetics, 120(9), A22. https://doi.org/10.1016/j.jand.2020.06.214
American Psychiatric Association. (2020). Desk Reference to the Diagnostic Criteria from DSM-5.
Independently published.
Anker, J. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging the Psychiatric,
Psychological, and Neurobiological Perspectives. Alcohol Research: Current Reviews,
40(1).
Bae, H., & Kerr, D. C. R. (2020). Marijuana use trends among college students in states with and
without legalization of recreational use: initial and longer term changes from 2008 to ‐
2018. Addiction, 115(6), 1115–1124.
Dumbili, E. W. (2020). Cannabis Normalization Among Young Adults in a Nigerian City.
Journal of Drug Issues, 50(3), 286–302. https://doi.org/10.1177/0022042620912805
Hart, C., & Ksir, C. (2018). Drugs, society, and human behavior (17th ed.. New York,
NY:McGraw-Hill.
Lee, M. H., Kim-Godwin, Y. S., & Hur, H. (2021). Race/ethnicity differences in risk and
protective factors for marijuana use among U.S. adolescents. BMC Public Health, 21(1).
Steeger, C. M., Bailey, J. A., Epstein, M., & Hill, K. G. (2019). The link between parental
smoking and youth externalizing behaviors: Effects of smoking, psychosocial factors, and
family characteristics. Psychology of Addictive Behaviors, 33(3), 243–253.
Yang, M. J., Borges, A., & Leyro, T. M. (2019). The Sequential Indirect Effect of Negative
Urgency on Drinking Consequences Through Distress Intolerance and Drinking Motives:
Initial Examination in College Students Reporting Past Month Alcohol Use.
International Journal of Mental Health and Addiction, 17(3), 479–492.
Case Conceptualization-Marci 13
Marci, a young woman who is enrolled in college and is 22 years old, struggles with
alcohol use, marijuana use, and nicotine dependence. After being pulled over for driving while
impaired with a blood alcohol level of 0.13, she was arrested five months ago. Her driving rights
were restricted, but she was allowed to drive in order to go to and from job and school while her
license was suspended. As a result of her substance abuse, she is having trouble concentrating in
class, which has led to a drop in her grades;5consequently, she is not living up to her full
academic potential. Marci is currently jobless and has been terminated or quit four previous jobs,
three of which were because of her chronic absenteeism5and one was because she destroyed
property.
She has never been to a facility, visited an in-patient or out-patient therapist, or had any
other type of treatment. While Marci is attending school full-time, she lives with her parents and
her two younger siblings. This arrangement causes tension because of Marci's dependence on
drugs5and her run-ins with the law. The most critical things to work on with Marci are getting her
over her despair and anxiety, kicking her substance abuse habit, and strengthening their family
relationship.
Past and Current Substances Used and Their Effects
Name of First Substance- Alcohol
According to the text, Marci presently5drinks5beer or wine on school nights, and on the
weekends, she will partake in binge drinking sessions. To gain a higher effect of the alcohol,
Marci combines her alcoholic beverages with energy drinks. Consumption of alcoholic
beverages has a substantial impact on the brain. It causes signs of intoxication, including
impaired judgment and speech, as well as slowed reactions, since it disrupts chemical impulses
that are sent between the cells in the brain. According to the findings of Hart and Ksir (2015),
Case Conceptualization-Marci 14
drinking alcohol over a long period of time can lead to a variety of health problems, including
harm to the brain, disorders of the liver, and heart disease.
When heavy drinking is continued for extended periods of time, it leads the brain to adapt
to the blockage of signals and responses from the body, and it also has an effect on the
neurotransmitters. After the alcohol leaves the body, the brain continues to struggle and
overreact to the neurotransmitters, which can cause severe withdrawal symptoms and possibly
damage to the brain's cells and tissues. As a result of the impact that alcohol has on the brain, a
variety of cognitive impairments can occur, such as a decrease in speaking and learning ability, a
slowed cognitive process, memory, and the ability to interpret spatial relationships. (Alcohol
Effects on the Brain, 2015).
Name of Second Substance-Tobacco
Marci is a current user who started smoking when she was 16 years old. She has stated
that she smokes one pack of cigarettes every day. According to Hart and Ksir (2015), nicotine is
a mild stimulant that can assist individuals be more alert and focused while still offering a calm
feeling. (p.236-237). Tobacco use can increase the risk of developing lung cancer or illness, in
addition to causing infants to have lower birth weights. In addition, those who smoke have a
higher risk of developing problems with their heart and blood arteries, which can lead to
cardiovascular disease. This is important to address because Marci is concerned about missing
her menstrual period and she may be pregnant.
Heart disease, which is the leading cause of death within the population of the United
States, is one of the additional complications that can occur. In addition, smoking has an
influence on the sperm of men, which leads to male infertility and an increased risk of birth
defects. Women who smoke have a lower bone density than women who don't smoke, according
Case Conceptualization-Marci 15
to reports from women who have smoked on the impact of smoking on bone density. Not only
can smoking affect the health of your bones, but it also affects the health of your teeth and gums.
Name of Third Substance-Marijuana
Since beginning her studies at the university, Marci has smoked marijuana on a more
consistent basis, and for the past year, she has done so three times each week. She even said that
throughout the preceding two months, while she was home alone on school nights, she had
smoked a half of a joint of marijuana. THC enters the bloodstream and has an instant impact on
the body due to this process. After half an hour, the majority of the THC is no longer present in
the brain. The most dramatic shifts in a person's mood and cardiovascular system will take place
between 5 and 10 minutes after smoking THC, depending on the individual. It usually takes
between two and three weeks for TCH to be eliminated entirely from the system of large doses.
THC causes a rise in one's pulse rate, as well as reddening of the eyes, dryness of the lips,
euphoria, stimulation, and appetite. Marijuana use is associated with impairments in cognitive
functioning as well as damage to the lungs. (Hart & Ksir, 2015, p.339-348).
Name of Fourth Substance-Cocaine
Marci claims that she does not use drugs at this time but that she has experimented with
them on multiple occasions and found that they did not fulfill her needs. According to Patterson
(2018), cocaine is a potent and addictive stimulant that falls under the schedule II classification
of prohibited substances. Cocaine can be ingested orally, administered intravenously, or inhaled.
Snorting the substance is the most common method of consumption among recreational users of
a controlled substance. When administered via inhalation or injection, the effects of this
medicine are amplified to a greater degree. When taken in large quantities, this chemical has the
potential to make a person more irritable and paranoid. Cocaine addicts who are considered to be
Case Conceptualization-Marci 16
"serving cases" have an increased risk of developing paranoid psychosis, a condition in which
the affected person loses touch with reality and experiences hallucinations. (Hart &Ksir,2015,
p.125). According to research published in 2017 by the National Institute on Drug Abuse,
negative effects of cocaine usage include an increase in both heart rate and blood pressure, as
well as a greater overall body temperature.
Name of Fifth Substance- Xanax
A fellow student in college gave Marci five Xanax prescription pills to help her deal with
her anxiety and sadness. Marci revealed that, for the past two months, she has been battling
emotions of despair and has been worrying excessively about the future. Although she has not
yet done so, she is considering taking them.
Risks/Dangers for Client
Consuming an excessive amount of alcohol can result in serious health issues and
complications, including cirrhosis of the liver, heart problems, and other conditions that could
potentially be fatal. The experimentation that comes with being in college can make substance
abuse look like less of a huge concern than it actually is. However, this can be a slippery slope
that leads to physical and psychological reliance on the substance in question. Addiction is a
debilitating and life-changing disease that can affect a person in all aspects of their life, including
their professional life, their personal lives, and their social lives. In the instance of Marci, her
addiction has a bizarre effect on both her professional and personal life, including problems with
the law and conflicts within her family. It would appear that Marci is currently operating in the
"Pre contemplation stage," which is the initial step of "change" in the model of addiction and
behavior.
Case Conceptualization-Marci 17
When people are in this stage of the process, they have a tendency to dismiss their
troublesome habits and see them as an issue that needs to be handled. It is because they do not or
have not encountered the negative aftermath of their acts, which might result in denial regarding
the severity of the repercussions that they have faced. Additionally, it is because they do not feel
the negative aftermath of their behaviors. Individuals who are in the pre-contemplation stage of
the addictive behavior cycle either do not recognize the existence of a problem or choose to
disobey recommendations to end their addictive behavior. These unfavorable repercussions have
the potential to propel the person towards the subsequent stage, which is referred to as the
"contemplation" stage5(Hartney, 2019).
AUDIT Scores and Explanation
The Alcohol Use Disorders Identification Test (AUDIT), which was established by the World
Health Organization, is a wonderful and straightforward method for determining excessive drinking and
aiding in the evaluation process. The AUDIT helps determine whether or not excessive drinking is a
problem that may be caused by an illness.
In addition, it offers guidance for the development of inventions that can assist riskier and more
problematic drinkers in cutting back on or quitting their usage of alcohol. The most significant function
that the AUDIT serves is to assist in the identification of alcohol dependence and the difficulties that are
linked with it. The first inquiry that was made was, "How frequently do you consume a beverage that
contains alcohol?"
The reason I gave the individual a score of 4 is because she consumes alcohol three to four times
per week. According to the case study, Marci stated that she had a drink three to four times each week.
The second inquiry was, "On an average day when you drink, how many units of alcohol do you
consume?"
Case Conceptualization-Marci 18
Because it was indicated in the case study that "During the past two months, she has sometimes
had one to two glasses of wine (she also used to smoke half a joint of marijuana with it) when alone on
school nights," I decided to give her a score of "0."The third inquiry asks, "In the past year, how
frequently have you had six or more units, if you are a female, or eight or more, if you are a male, on a
single occasion?" Because Marci drinks between three and four times a week, I decided to give her a
score of three out of a possible ten. Her overall score is seven, which the AUDIT classifies as risky
drinking.
The remaining question is, "How frequently during the course of the previous year did you find
that you were unable to stop drinking once you had begun?" I decided to give Marci a score of "4"
because she admitted that she drinks three to four times per week, which was the basis for my decision.
The following question is, "How frequently over the course of the past year have you failed to do what
was normally expected from you due to the fact that you were drinking?" For the purpose of this question,
I chose to respond with a score of "4" because I believed the following statement to be true: "On the
mornings after she used alcohol, Marci had a tendency to sleep in and skip class, but not every week."
Her social and recreational pursuits had become increasingly entangled with the use of alcohol and
marijuana, but ever since she was arrested, she has primarily been interested in alcohol. (although she still
desires to smoke cannabis). The following inquiry asks, "During the course of the past year, how
frequently have you consumed alcohol and subsequently experienced feelings of regret or guilt?" After
reading the case study, I realized that Marci has feelings of guilt while she is speaking with her parents; as
a result, I gave her a score of "1" for a period of less than a month.
The question “How many times in the past year have you gotten to the point where you couldn't
recall what happened the night before because you had been drinking?" received a score of 0 out of 100.
This is the score that was given since there was nothing in the case study that could be used to provide an
accurate answer. The following inquiry is, "Have you or anyone else been injured as a result of your
drinking?" A score of "4" was assigned to her since the case study demonstrated that although she has
Case Conceptualization-Marci 19
some bruises on her body and has bumped her head on occasion, she did not actually knock her head. The
final inquiry was, "Has a member of your family or close friend, as well as a medical professional or other
health care provider, expressed concern about your drinking or suggested that you drink less?" Given the
information presented in the case study, it is reasonable to answer this question with a "4" because
Marci's parents are concerned about her substance abuse and are trying to find a therapist who can help
her. After going through the Case Study, I believe that a score of "24" on the questionnaire that Marci
received is really accurate. According to the AUDIT, a score of 20 or higher indicates a possible risk for
developing alcohol dependence.
Referrals/Resources/Recommendations
Both our mental health and our moods are susceptible to being molded by the
environment around us. In some cases, like Marci's, past traumatic experiences can cause
emotional dysregulation, which subsequently in turn, can lead to a depressed mood, which can
lead to self-medication. Memories of traumatic events may arrive at our consciousness in pieces
that we do not always fully comprehend. When we get help for the traumatic experience and are
able to process it, our minds are then able to make sense of the memories associated with it,
which in turn enables us to comprehend the meaning of what happened.
It is possible to provide Marci with a number of suggestions that will assist her in
overcoming her addictions. I recommend the following interventions:
Inpatient Rehab. Marci needs to be away from everything and everyone that
influences her drinking, so I suggested that she enter inpatient treatment at a
rehabilitation center. She would have access to treatment specialists who are available
24 hours a day, seven days a week to give care such as psychotherapy, etc. She would
be able to obtain the appropriate treatment plan for her so that she might seek sobriety
Case Conceptualization-Marci 20
and gain an understanding of the significance of doing so. They might instruct her on
what to do in the event that she experienced a relapse.
Therapy/Counseling. Because cognitive behavioral therapy is such a
common kind of treatment for alcoholism, I strongly suggested that you try it. Marci
may be able to learn via cognitive behavioral therapy (CBT) to detect thoughts that
are negative and may lead to actions that are self-destructive, like as abusing alcohol.
She is able to acquire the knowledge necessary to identify possible triggers, establish
healthy coping skills, and learn how to handle stress.
NA (Narcotics Anonymous) or AA (Alcoholics Anonymous). I would
recommend NA/AA to her because it provides positive peer support, which is an
essential component of the recovery process. If she enters residential treatment,
attends NA/AA meetings, and receives therapy or counseling simultaneously, these
services may continue to be of assistance to her on the road to recovery and reduce
the likelihood that she will recidivate. She would find support and understanding
from other people in NA/AA who struggled with alcoholism and drug addictions in
the same way she does. Additionally, she can engage her spirituality by praying,
investigating her own flaws, and providing retributions5for those she has wronged as a
result of her alcoholism.
Questions
As professionals, we have a responsibility, in my opinion, to support our clients in any
way that is practicable, regardless of how that aid manifests itself. Our pledge is to do no harm,
and if having the appropriate Christian perspective and interpretation is beneficial to our clients,
we should support it.
Case Conceptualization-Marci 21
Positive psychotherapy, according to the text, can aid in post-ecstatic growth, but the
activity of the Holy Spirit must remain fundamental, central, and important from a biblical
standpoint. (Tan, 2019). According to the New International Version of the Bible, when
something goes wrong in our life, it makes perfect sense to turn to God. (Genesis 1:27). As
Christians, we acknowledge that the Bible is the only source of absolute truth, and that God is
the only source of truth. The Word was with God from the beginning, and the Word was God.
(John 1:1).
As Christian counselors, I believe we should help our clients reconstruct their cognitive
processes by following God's instructions in the Bible. Recognizing that we all experience
negative ideas on occasion, we must alter our style of thinking. Despite the fact that the Bible
says Jesus died for all of our sins (John 3:16, 1 John 2:1-2), many of us struggle with self-
forgiveness after accepting Jesus Christ as our Savior. We can only rely on the Holy Spirit to
change our minds and expose the truth through the Scriptures to replace all of the lies and
misconceptions we've developed as a result of previous traumatic occurrences. A few questions I
would like to have answered would be:
1. Were there any traumatic events that were experienced?
2. What does Marci believe to be the reason for her drinking and substance use?
3. What does she feel may help her abstain from future use of drugs and other harmful
substances?
Case Conceptualization-Marci 22
References
Hart, C., & Ksir, C. (2018). Drugs, society, and human behavior(17th ed.). New York,
NY:McGraw-Hill. ISBN: 9781259913860.
New International Version. [Colorado Springs]: Biblica, 2020. BibleGateway.com. Web. Mar.
2020.
Tan, Siang-Yang. (2019). Counseling and Psychotherapy (p. 353). Baker Publishing Group.
Kindle Edition.
