Marielis_Manzueta_Final_Comprehensive_Substance_Use_Assessment

pdf

School

Simmons College *

*We aren’t endorsed by this school

Course

422

Subject

Medicine

Date

Apr 3, 2024

Type

pdf

Pages

Uploaded by CorporalTreeStarling32

1 Comprehensive Substance Use Assessment Marielis Manzueta December 15, 2023

2 Comprehensive Substance Use Assessment Identifying Information Shaun Yates is an African American 34-year-old, married, heterosexual male, college student. After several years of underemployment, his wife convinced him to return to school for more job flexibility in the future. Mr. Yates lives with his wife and two younger children. However, in the decade that he returned from a 12-month military tour in Iraq, although he was not directly involved in the war, he lost many friends and is experiencing psychiatric symptoms he did not have before his enlistment. Presenting Problem Mr. Yates reported concerns over his chronic mood instability. He expressed that his mood has been down, and he feels he is not enjoying his time with his wife or two younger children. Mr. Yates also reported restlessness, concentration difficulties, uncalled-for vigilance in public, avoidance of driving, especially over bridges, and irregular sleep patterns. Mr. Yates reported that Cocaine initially helped and is his overall drug of choice. However, it has interfered with class, work, and his depressed mood over the prior year. He has lost at least three jobs because of cocaine-related absenteeism over the prior year. Mr. Yates has also begun using phencyclidine (PCP) to lower the cost of cocaine, along with alcohol, cannabis, and cigarettes. Current and Historical Information Medical History

3 Mr. Yates does not have a known medical history besides his passive suicidality. Mr. Yates has denied any history of psychiatric hospitalization or outpatient treatment, and there was no family psychiatric history aside from his father, who died from cirrhosis. Psychiatric History Mr. Yates has a history of passive suicidality, such as fleeting thoughts. He denied a history of psychiatric hospitalization or outpatient treatment. Mr. Yates had not received a psychiatric evaluation since returning from his enlistment, and he is presenting with psychiatric symptoms. Mr. Yates is not currently prescribed any psychiatric medications and is currently self-medicating. Social History • Childhood history: Mr. Yates was raised with his father, who had an alcohol use disorder. Mr. Yates engaged in drinking at age 14, smoking cigarettes at age 16, and was a social cannabis smoker in high school. • Educational history: Mr. Yates attended high school. It is assumed he started college either before or after his time in the military as his wife convinced him to go back to find more jobs with flexibility in the future. Socioeconomic history: Mr. Yates has no known socioeconomic status. He has had and lost various jobs since his enlistment in the military, working in transportation. Mr. Yates continues to have his wife and two children in one home. Religion/spirituality history: Mr. Yates has no known religion or spiritual history.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

4 • Immigration history: Mr. Yates has no known immigration history. • Cultural history: Mr. Yates has no known cultural history. • Military history: Mr. Yates deployed for a 12-month tour in Iraq. He worked in transportation and lost many of his comrades. • Legal history: Mr. Yates has no known prior arrest history. • Family history of substance use and mental health: Mr. Yates stated that his father had an alcohol use disorder and died from cirrhosis. Mr. Yates has no family psychiatric history. • Trauma history: Mr. Yates lost his father to cirrhosis and many of his comrades while deployed to the war in Iraq. Substance Use History Mr. Yates reported that he first consumed alcohol on the weekends when he was 14 and built a high tolerance. However, he began to limit his drinking to the weekends when his father died from cirrhosis at age 56. Since he started using cocaine, he reported using alcohol to “come down” from the cocaine high. Mr. Yates also reported that in high school, he used cannabis socially. However, during the prior year, it has helped with his insomnia, and he has been craving it every evening. Therefore, he continues to use marijuana despite arguments with his wife about it. Mr. Yates has consumed drugs such

5 as ecstasy, benzodiazepines, and perceived opioids when he found them easily available generally at parties. Since the age of 16 years old, Mr. Yates has smoked 3-5 cigarettes per day. His efforts to quit smoking have failed because of cravings and withdrawal symptoms. Formulation and Treatment Plan Formulation Using the biopsychosocial model of substance use, the client’s substance use seems to be rooted in many areas of his life, including his deployment, his loss of many comrades, dysregulated sleep, his wife and children, as well as depression from not talking to anyone about his psychiatric symptoms. • Protective factors at all levels: o Individual/personal: Mr. Yates took the initiative to get a psychiatric evaluation. Therefore, it shows he can seek help and be ready to receive help. o Social: Mr. Yates has a wife who supports and wants him to continue his education, she also encourages him to pursue sobriety and open up about his traumas. o Financial: Mr. Yates seems to have his wife’s support as he is in college and does not have a stable job. However, he has spent a large amount on drugs and has purchased drugs of lower cost when he is not able to afford his preferred drug, cocaine. o Risk factors at all levels: o Individual/personal: Mr. Yates has continued to use AOD even after it is affecting his moods and causing him to feel depressed after using. Mr. Yates has expressed

6 withdrawal and has continuous cravings for AOD. Mr. Yates has stated that he feels “down”. o Social: Mr. Yates has a conflictual relationship with his wife as she does not like when he uses AOD. Mr. Yates has tried various substances at parties when cocaine is not available. Mr. Yates's AOD use has caused conflict with class and work. o Financial: Mr. Yates is experiencing financial instability as he has pawned items in the past for AOD. Mr. Yates seems unable to hold down a job for an extended period. • Stage of change for each substance of concern: There are six stages of change, starting with pre-contemplation, contemplation, preparation, action, and maintenance. For both, the client’s primary substance use concerns cocaine and alcohol, as he is in the pre-contemplation stage. Raihan & Cogburn (2023), Pre-contemplation, the first stage, reveals unmotivated people who see no need to find a solution to a problem because they usually do not believe that one exists. Individuals in this stage are unaware of or have limited awareness of the problem or lack insight into the consequences of their negative/ addictive behavior. Mr. Yates is in denial of his AOD use and defends his actions regardless of adverse effects. Mr. Yates has not contemplated treatment options as he only presented for an evaluation for chronic mood instability and gives no clear timeline or commitment to begin treatment for each substance concern. DSM-5 diagnosis: Based on current knowledge of Mr. Yates's alcohol use, Mr. Yates presents as 303.90 (F10.20) with severe alcohol disorder (American Psychiatric Association, 2018). Mr. Yates meets

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

7 the criteria for severe alcohol use disorder as he presents six or more symptoms described in the DSM-5. Mr. Yates expressed that since the onset of frequent cocaine use, he began to use alcohol to “come down” from the cocaine high. Mr. Yates has been drinking alcohol since a young age and has continued to use it despite the substance causing problems to his physical and mental health. Based on current knowledge of Mr. Yates's cocaine use, Mr. Yates presents as 304.20 (F14.20) with severe stimulant use disorder (American Psychiatric Association, 2018). Mr. Yates meets the criteria for severe stimulant use disorder as he presents with six or more symptoms described in the DSM-5. Mr. Yates has expressed that cocaine usage has increased in larger amounts and for a longer duration of time than intended. Mr. Yates has reported loss of work due to persistent and recurrent cocaine use, as he has lost three jobs. Mr. Yates has reported an increased tolerance to cocaine use and has used cheaper drugs when he is unable to get cocaine. Ethical Dilemmas In Mr. Yates's case, I see two possible ethical dilemmas that could arise during our work together. First, as Mr. Yates served 12- months in Iraq, I feel there are many things I wouldn’t feel experienced enough to discuss with him and emotions I wouldn’t know how to begin to process with him. The National Association of Social Workers (NASW) Code of ethics principle of competence states that Social workers practice within their areas of competence and develop and enhance their professional expertise. Therefore, I would research the root of Mr. Yates's concerns/ problems to increase my knowledge and understanding of him and his practice regarding military trauma, etc. A second ethical dilemma that could arise is that Mr. Yates's wife is unaware of the severity of his psychiatric symptoms, and he won’t be receptive to opening up to her. As a social worker, I would want to inform the family members supporting him the most, but its important to also value the relationship we share with our client. According to the NASW code of ethical principles, social workers recognize the

8 central importance of human relationships. If Mr. Yates is not ready to open up to his wife, perhaps it is best that he still has emotional support, such as a social worker as someone he is willing to open up to in the meantime time while he works on communication with his wife. This might be his first step to recovery. Mental Status Exam Mr. Yates presented for an evaluation of chronic moods. When questioned, he denied active suicidal ideation and suicide attempts. His appetite was good, and he denied a history of panic attacks, mania, psychosis, or obsessive-compulsive symptoms. However, he reports that his mood was “down”. He reports concentration difficulties since returning from the service. Treatment Plan The American Society of Addiction Medicine (ASAM) criteria uses six dimensions to create a holistic, biopsychosocial assessment of an individual to be used for service planning and treatment across all services and levels of care (American Society of Addiction Medicine, 2021). Below, I will consider all six dimensions and recommend Mr. Yates's care level. Dimension 1- Acute Intoxication and/or Withdrawal Potential: Mr. Yates is at a severe risk for intoxication and withdrawal potential. He has severe signs and symptoms. Mr. Yates has demonstrated a poor ability to tolerate and cope with withdrawal discomfort. • Dimension 2- Biomedical Conditions and Complications: Mr. Yates demonstrates a high level of risk in tolerating and coping with physical discomfort or pain. • Dimension 3- Emotional, Behavioral, or Cognitive Conditions and Complications:

9 Mr. Yates demonstrates a high level of risk. His substance use directly impacts Mr. Yates's work and school work. Mr. Yates presents with a low level of skills to cope with emotional or behavioral problems outside of AOD, as he doesn’t enjoy time with his wife or children. He has reported uncalled-for vigilance in public and still has vivid, disturbing dreams from when he was in the service. • Dimension 4- Readiness to Change: Mr. Yates presents a severe risk. Mr. Yates has not received professional psychiatric help since leaving the military services and has been self-medicating since returning home. Mr. Yates has not stated any concerns regarding changing. However, he did seek help for unstable moods and has opened up about his usage. Dimension 5- Relapse, Continued Use or Continued Problem Potential: Mr. Yates presents a severe risk for continued use or continued problem potential as he has posed no immediate plans to abstain from AOD. Mr. Yates has reported cutting down on substances but never quitting completely. • Dimension 6- Recovering/Living Environment: Mr. Yates is at low risk for recovering. Mr. Yates has his wife's support as far as with him continuing his education. However, she is unaware of the severity of his drug use. Mr. Yates is also enrolled in college and has sought out help regarding getting a psychiatric evaluation. Therefore, he does have access to resources. Given the high to severe level of risk the client poses in all six ASAM criteria dimensions, my recommendation would be a group such as AA and individual outpatient therapy as he is still a college student with a wife and kids. Mr. Yates's symptoms seemed to onset while in the military as he never had psychiatric symptoms before returning home and witnessing many comrades

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

10 pass. According to Colvin and Ceide (2021), Grief disorders are relatively common, and the symptoms overlap with other disorders. Since the treatments differ, identifying grief disorders is important…therapy improves grief better than medications, but medications will help with any co-occurring disorders. Mr. Yates is indulging in drinking and stimulants because he is utilizing them as a coping skill to manage trauma he hasn’t processed. Therefore, processing it through therapy would put him on the right path of recovery. Since Mr. Yates was in the military, I would refer him to local AA meetings besides veteran groups to encourage him to begin his journey. According to the Recovery Research Institute, Alcoholics Anonymous (AA) is the world’s largest recovery support service and has helped countless tens of millions of individuals recover from addiction. Since Mr. Yates is not ready, he will feel less pressure and possibly relate more if someone else is experiencing the same thing.

11 References American Psychiatric Association. (2018). Desk reference to the diagnostic criteria from DSM-5® (5th ed.). American Psychiatric Pub. American Society of Addiction Medicine. (2021). About the ASAM criteria . Default. https:// www.asam.org/asam-criteria/about-the-asam-criteria Colvin, C., & Ceide, M. (2021). Review of Grief Therapies for Older Adults. Current geriatrics reports , 10 (3), 116–123. https://doi.org/10.1007/s13670-021-00362-w Recovery Research Institute. (2022, November 17). Evidence for Alcoholics Anonymous effectiveness and cost-effectiveness. https://www.recoveryanswers.org/research-post/update-evidence- alcoholics-anonymous-participation/ National Association of Social Workers (NASW). (2017). NASW - National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English Raihan N, Cogburn M. (2023). Stages of Change Theory. StatPearls Publishing. https:// www.ncbi.nlm.nih.gov/books/NBK556005/

Marielis_Manzueta_Final_Comprehensive_Substance_Use_Assessment

Related Documents