TREATMENT PLAN 2
Treatment Plan: Rafael Case Study
Introduction
In the case study, we were introduced to Rafael, who is a thirty-five-year-old male that
has been employed on and off in the construction business. He has four children and has been
divorced twice. Since divorcing his second ex-wife, he admits that he has had six different
girlfriends. Each of these women have expressed concerns of Rafael having a drinking problem.
Rafael even admits that he has received negative concern from all of the women about his
alcohol usage. Even when he has one-night stands, they also speak on the high volume of alcohol
intake he has.
As of right now, Rafael is not able to see his children. This is due to both of the ex-wives
restricting the amount of contact that he has with the children. They would like him to become
more stable and stop drinking prior to seeing and being around the children. Rafael has
experienced many ups and downs throughout his lifetime. A really downward point of his life
was when he was experiencing negative moods that caused him to have suicidal thoughts. Due to
this, Rafael has been receiving mental health treatment for some years although he has difficulty
taking his medication when is feeling down.
During the times that Rafael is feeling good and up in his spirits, he considers himself to
be in “crazy hypertime.” He believes that he has had this happen to him twice within the last ten
years. He states that it last approximately four weeks and that when it does occur, he experiences
thoughts going a mile a minute, he becomes very talkative, and that he engages in sexual
intercourse multiple times a day with either his partner at the time, a prostitute or even a stranger.
In our text, it mentioned how sexual addictions are a sickness when it involves any form of
uncontrollable sexual activity (Laaser, 2004). With all of this going on in Rafael’s mind and life
during his up times when he is going through “hypertimes” he stated that he also only gets about
two to four hours of sleep total each day and believes that he is capable of doing anything during
this time even though he may come up short.
Rafael has received treatment, counseling and psychiatric services from the local mental
health center where he was hospitalized. When Rafael is in treatment, he remains compliant up
until he wings himself out of the treatment protocol and goes back into his “hypertime.” Once
this happened, Rafael took some steps back and increased his amount of alcohol intake to numb
TREATMENT PLAN 3
the feelings of the low times he was facing. He did state that he wanted to stop using so much but
he was not able to have the willpower to do so. He also admitted that all he typically thinks about
is the next drink he is going to have and also who he will be the next person he has sexual
intercourse with. Rafael is aware of how detrimental drinking alcohol and his sexual behaviors
that he acts on has been on his life, family, children, health and career. With this being the case,
he has faced many emotional setbacks. This treatment plan will assist him in being able to focus
and find solutions to the battle of addictions he is facing in his life.
Key Factors
Utilizing the case study about Rafael, a clinician should be able to make assumptions to
be able to prioritize the key issues that are causing the mental and emotional damage to Rafael’s
life with addition to his addictions.
Rafael has developed a drinking addiction to alcohol that has caused his life to be
affected severely.
Rafael experienced suicidal thoughts.
Rafael has addictive sexual behaviors that have caused him to endure pain.
Rafael has displayed that he has various undiagnosed mental health behaviors that
develop into seasons of lows and highs.
Rafael has created a wedge between him and his children, ex-wives, and also ruined his
reputation as an employee at his place of employment.
Rafael has shown zero signs of him having any spiritual self-discipline and also shows
little to no remorse about anything.
These key factors are prioritized in the order that they are because of the amount of risk they
have in Rafael’s life. With the sexual addiction that Rafael is facing, one-night stands,
involvement in risky sexual behaviors and having multiple affairs, qualify for him to be assessed
and treated (Laaser, 2004). The hopeless feelings that Rafael is experiencing must be discussed
to tame his depression and suicidal thoughts. With him having negative thoughts and feelings
one moment then on top of the world happy the next, it displays a manic phase of bipolar
disorder. Even down to the voices in his head that he was hearing could be a result of
schizophrenia.
TREATMENT PLAN 4
Rafael has altered many relationships with his family. Support is necessary when one is
recovering, therefore, the distance he has created with his loved ones would need to be addressed
as well. Rafael also mentioned his unstable sleeping patterns. The poor sleeping habits can
trigger other underlying issues which also can make it harder to treat. After assessing all of these
factors and key issues, Rafael should be able to be correctly diagnosed according to the DSM-V
and placed on a plan that will be beneficial to him to assist him to gain back control over his life
in a positive manner.
Diagnostic Impressions
According to Rafael’s symptoms and actions along with the information that he provided; he
could be treated for the following diagnoses:
Alcohol Use Disorder –DSM – 5, F10.20
Rafael has severe dependence on alcohol due to daily usage. The Alcohol Use Disorders
Identification Test (AUDIT) should be completed to screen for the unhealthy amount of alcohol
use and that will determine if it is a dangerous amount of consumption (Higgins & Babor, 2018).
Bipolar Disorder I – DSM – 5, F31.13
Bipolar Disorder I is considered due to Rafael having multiple shifts in his mood from
manic to low and also with the alternations of wanting to socialize and then wanting to become
isolated.
Suicidal Ideations – DSM – 5, 45.851
Rafael openly admitted that he was having suicidal ideations thoughts. These thoughts
that he is experiencing are more than likely contributing to his “ups” and “downs” that he has.
Schizoid Personality Disorder – DSM – 5, F60.1
Rafael occasionally has auditory disturbances that are voices he hears in his head. With
this being the case, schizophrenia could be a developing case for his mental health.
Other specified problems related to psychosocial circumstances/ Religion and
Spirituality Problems – DSM – 5, Z65.8
TREATMENT PLAN 5
Throughout the case study Rafael made no reference to a higher power, his spirituality or
God. This can be the root cause of a lot of his issues that he is experiencing such as him
overindulging in alcohol and his lifestyle issues such as his sexual addiction and the lack of
support from his family.
Psychological and behavioral factors associated with disorders or diseases
classified elsewhere – DSM – 5, F54
Rafael suffers from mental, physical, spiritual and emotional health issues. He is being
faced with issues such as being addicted to sex and alcohol, along with mood swings and
negative thoughts.
Major Depressive Disorder – DSM -5, F33.1
Rafael has an inability to function properly without drinking alcohol and thinking about
his next drink while doing so. He uses sexual acts and alcohol to help him cope with his
depression and seasons of ups and downs.
Other sexual dysfunction, not caused by organic disorder or disease/ Excessive
Sexual Drive, male, DSM – 5, F52.8
Rafael admitted to practicing unsafe, risky behaviors sexually with others. often times it
was with random partners to satisfy his needs sexually (American Psychiatric Association,
2022).
All of these disorder diagnoses fit the criteria of Rafael’s lifestyle and accompanies the
symptoms he displays. Another test that could be completed would be the Sexual Dependency
Inventory (SDI) tool that is utilized for sexual addictions. It consists of six different sections that
will look for information about his sexual history and the development of his disorders (Carnes
& Adams, 2020). His chances of having a positive, successful recovery by addressing the
conditions listed above will provide him a high chance of overcoming his addictions and daily
life issues if he follows his treatment plan. Also, it is recommended that he attends support
groups with and without his family and others who support him.
Treatment Plan Recommendations
TREATMENT PLAN 6
It is important as Rafael’s therapist I be knowledgeable about alcohol and sexual
addictions. The assessments that were listed in the key factors would need to be completed with
him. Based on Rafael’s history of alcohol usage, I would initially admit him to a detoxification
center to begin his treatment plan. This center would heavily secure and monitor his actions
throughout the day to be sure that he does not indulge in drinking any alcohol. Once he has
completed detoxification, it is important to make sure his body is functioning properly and not
going through any complications due to withdrawal. Rafael then would need to attend a program
for substance use, such as a twelve-step program. A long-term program would probably be best
for him due to the severity of his usage of substances.
While in attendance weekly of the substance use program, Rafael is to attend a sexual
addiction group. This will allow him to be able to address the sinful cravings and lust that he has
for others and his sexual desires. Similar to twelve step groups, there are groups that focus on
sexual addiction and the recovery of the impurity issues he is facing (Laaser, 2004). With him
being faced with all these positive changes in his life overtime it should led him to grow closer to
God. God continues to love us regardless of if we sin or not, so it is important for Rafael to
realize this and seek him in his time of need to assist him through his issues.
All of the programs that Rafael will be in are completely confidential and will assist him
with his healing process mentally, physically, emotionally and spiritually. Alongside him
personally healing, this should also open the door for him to be able to have a cordial
relationship with his children’s mothers and also be able to see his kids again. Rafael will also
have another chance at gaining employment in a healthier state of mind. All of these things
should affect him positively and allow him to see the light shine on him and uplift his spirits
towards his fresh start.
Conclusion
In conclusion, Rafael is one that suffered from many issues in his life, including but not
limited to, substance use disorder, depression, bipolar disorder and a sexual addiction. Rafael
was experiencing multiple symptoms of these disorders that needed to be addressed by a
professional so that he could receive the proper help that he needed. His recovery will be a
lifelong journey that he will be on to improve himself. Rafael eventually gets well enough and is
TREATMENT PLAN 8
References
American Psychiatric Association. (2022).DDiagnostic and statistical manual of mental
disordersD(5th ed., text rev.).Dhttps://doi.org/10.1176/appi.books.9780890425787
Carnes, P. J., & Adams, K. M. (eds) (2020).DClinical Management of Sex Addiction (2nd ed.).
New York, NY: Brunner/Routledge.D
Higgins-Biddle, J. C., & Babor, T. F. (2018). A review of the Alcohol Use Disorders
Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United
States: Past issues and future directions. The American journal of drug and alcohol abuse.
Laaser, M. R. (2004).DHealing the Wounds of Sexual Addiction. Grand Rapids, MI: Zondervan
Pub. House. ISBN: 9780310256571.
Powered by TCPDF (www.tcpdf.org)
