Assessing Clients With Addictive Disorders 1
Assessing Clients with Addictive Disorders
Name
Walden University
NURS-6640
Instructor:
2022
Assessing Clients With Addictive Disorders 2
Introduction
According to the American Psychiatric Association’s (APA, 2013) Diagnostic and
Statistical Manual of mental disorders 5th edition (DSM-5), addictive disorders encompass 10
separate classes of drugs that include alcohol, caffeine, cannabis, hallucinogens, opioids, and
others such as anxiolytics and tobacco. These substances when taken in excess have direct
activation of the brain reward system. Drug abuse causes the intense activation of the reward
system called a “high” which can then develop into an addictive behavior of seeking and abusing
the drug (APA, 2013, p. 481). According to the Substance Abuse and Mental Health Services
Administration (SAMHSA, 2012), veterans sometimes abuse drugs such as alcohol as a way to
numb or erase the memories related to their war experiences. The purpose of this paper is to
assess the client in this week’s scenario who presents with addictive disorders and posttraumatic
stress disorder (PTSD), analyze the therapeutic approaches for treating such clients who also
present with addictive disorders, and also evaluate outcomes for clients with addictive disorders.
Episode 1
Mr. levy’s perception of his problem seems to be denial of the severity of his problems.
He’s minimizing his problem to just being “sick”. Mrs. Levy’s perception seems to be that her
husband is “depressed” because he is drinking a lot every day and that he has “anger issues”.
Some of the implications of Mr. Levy’s problems on the family as a whole could include loss of
his job due to missing work and possibly poor performance at work. This could lead to financial
hardship that may even lead to homelessness. Other problems emanating from his reckless/self-
destructive behavior could be injuries from accidents that may happen while he’s drunk. (APA,
2013, SAMHSA, 2012).
Assessing Clients With Addictive Disorders 3
Episode 2
After watching episode 2, I thought Mr. levy’s social worker’s ideas about Mr Levy’s
treatment options were inappropriate because she had not yet met the client. My thoughts about
social worker’s Supervisor are that he was right. It would be inappropriate for the social worker
to determine what therapies the client needs or what the treatment plan was before first meeting
the client. As the supervisor mentioned, it would also be a good idea to use therapies that are
evidence-based instead of what the social worker has “been dying to try”.
Episode 3
I think the therapy session as a whole went well. The therapist connected well with Mr.
Levy. Mr. Levy processed the events of his traumatic memories from Iraq freely. The therapist
did well especially for managing to intervene and teach the client some of the components of
exposure therapy such as controlled breathing in efforts to reduce his anxiety level as he was
verbalizing events of the traumatic event in Iraq. According to Russo, Santarelli & O’Rouke
(2017), the effects of changing the breathing mechanics by purposely slowing down breathing
and making expiration longer, slow, steady and gentle improves ventilation efficiency via
alveolar recruitment and distension which reduces alveolar dead space and thereby improves
arterial oxygen saturation. The slowed breathing rate and improved arterial oxygen saturation
also increases vagal activity (vagal tone) which shifts towards parasympathetic dominance,
which makes an individual relax faster (Polak et al., n.d., Russo, Santarelli & O’Rouke, 2017).
According to the American Psychiatric Association (APA, 2019) clinical practice
guidelines (CPG) for treatment of PTSD in adults, exposure therapy (ET) is among the strongly
recommended psychotherapy interventions that also includes the cognitive behavioral therapy
Assessing Clients With Addictive Disorders 4
(CBT), cognitive processing therapy (CPT), cognitive therapy (CT), and prolonged exposure
therapy (PET). According to Cahill et al (2006), ET is a general strategy that is a central
component of CBT and is used for reducing unrealistic anxiety through confronting anxiety-
provoking or avoided thoughts, situations, activities, and people that are not inherently harmful. I
therefore agree with the therapist’s choice of use of ET on Mr. Levy.
Episode 4, 5 & Conclusion
Mr. Levy’s very difficult story about Kurt, his platoon officer was very intense. Besides
showing empathy by verbalizing how sorry I was to hear about the traumatic incident, I would
also have intervened at an appropriate time to educate Mr. Levy on the breathing exercises which
are a component of ET. According to Field, Beeson & Jones (2015), the information shared by
Mr. Levy would be considered cognitive distortions that would need treatment focused on
confronting, disputing, and restructuring into a more adaptive thought pattern that would lead to
more adaptive emotional and behavioral response. Based on the ABCs of CBT as noted by Field,
Beeson & Jones (2015), it would be important to confront Mr. Levy’s story with fact checks such
as whether Kurt actually made a direct request to be shot – to quickly end his suffering, or it was
what Mr. Levy thought. If Kurt did or didn’t actually state that request, it can be disputed and
restructured into a more adaptive thought pattern of why it is still not ok to shoot someone to end
their suffering. I would therefore point out that it is ok and understandable that he didn’t “put a
bullet” in Mr. Kurt. As the supervisor to Mr. Levy’s therapist, I would process with her the
reasons why she was having issues with Mr. Levy’s story. If she felt not able to provide therapy
to this client, I would offer to take over. In conclusion, Mr. Levy needs treatment for his PTSD,
but also needs treatment for Alcohl abuse. It is important to point out these problems to Mr. Levy
so that he can understand need for treatment for both problems (Field, Beeson & Jones (2015).
Assessing Clients With Addictive Disorders 5
References
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Cahill, S. P., Foa, E. B., Hembree, E. A., Marshall, R. D., & Nacash, N. (2006). Dissemination of
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Assessing Clients With Addictive Disorders 6
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