Clinical Vignette

While acknowledging that each client is unique, the following case reflects an amalgam of male alcohol-dependent individuals and illustrates some of the commonly occurring features.

John Jones, a 46 year old, white middle- class client, sought treatment at an on outpatient substance abuse clinic for help with his excessive drinking after being arrested for drunk driving for the third time.

Mr. Jones had already called his insurance carrier to obtain authorization for the intake session. A traditional biopsychosocial history was conducted, and a multidimensional range of information was generated about the client's clinical status. Mr. Jones was in no acute distress and presented no signs of withdrawal. He appeared to be bright and capable of insight.

The assessment revealed that Mr. Jones had begun his drinking career when he was 16 years old. At that time he consumed a six-pack of beer on weekends. By the age of 20 he was drinking at least three nights per week at the rate of 8 beers per night. By 30 years of age he was consuming up to 10 beers each day. This level of consumption continued until his current arrest for driving under the influence of alcohol.

Although he had attended AA in the past in compliance with court orders after his first two arrests, Mr. Jones felt that he had "nothing in common with these people" and that he was "drinking because of job stress and marriage problems. " His score on the MAST and his SASSI-3 profile indicated a high probability of an SUD. He had made no significant effort to discontinue his alcohol consumption in the past, and his current participation in treatment is the result of legal and family influences. Mr. Jones seemed depressed and defensive in his emotional functioning; he denied any suicidal ideation. He started that he was currently on medication for elevated blood pressure, but denied any history of illicit drug or medication abuse.

Mr. Jones described his father and two uncles as "heavy drinkers." He described his childhood as non- nurturing. He was the middle child of five, raised in a rigid family in which he felt "unloved and unimportant." His school performance was poor despite his intellectual abilities, and he dropped out at the beginning of the 12th grade.

Mr. Jones has been married to his wife Mary for the past 16 years, and they have two sons. He had been experiencing financial stress due to legal fees, court costs, and missing work as a result of "hangovers." He claimed that Mary was also "a heavy drinker," although, when interviewed later, she claimed that she "only drank to help tolerate his drinking."

Mr. Jones was given a physical examination: The findings included enlargement of the liver and substantially elevated liver enzymes; his blood pressure was slightly elevated despite the use of medication. Mr. Jones was prescribed Antabuse (disulfiram), which he was to begin taking once his liver enzymes normalized. He was also prescribed Vivitrol (naltrexone) to curb his crave for alcohol.

His diagnosis (using DSM-5; American Psychiatric Association, 2013) is Sever Alcohol Use Disorder, 303.90, and the initial treatment plan indicated the following:

• Problem: A pattern of excessive alcohol use.
• Goals: Total abstinence from alcohol
• Objective:

(1) Participate in a motivational enhancement group;
(2) Understand the disease concept of dependence on alcohol
(3) Learn the medical consequences of excessive alcohol use
(4) Understand the process of recovery.
(5) Correct cognitive distortions about addiction
(6) Identify personal relapse triggers
(7) Develop two relapse prevention strategies for each trigger
(8) Learn the philosophy and 12 steps of AA
(9) Attend five AA meeting each week
(10) Actively participate in group and individual therapy
(11) Participate with spouse in family education and join session at later time
(12) Select a technology-based application that supports clean recovery.

o Level of care. It is recommended that Mr. Jones pursue these and other objective in an intensive outpatient treatment program, compromising 4 hours of treatment each day for 3 weeks. Mr. Jones will be further evaluated for alcohol problems and a separate plan developed. Once a stable recovery process is in place, the related issues of job stress and marriage problem will be addressed. After 1 month of complete abstinence, his mood will be reevaluated and the issue of the "non-nurturing" childhood explored. Following intensive outpatient care, it is expected that regular outpatient counseling will continue and be approved by the managed care company. Concurrently, a more thorough assessment of his wife drinking behavior should also be made.

It is important to note that as the treatment process unfolds, new information may emerge that requires changes to his treatment plan. Therefore, it is essential that the treatment staff remain flexible and willing to make changes in a timely manner.

John Alcohol Assessment

Given what you read about John's alcohol abuse

• Write 3 pages assessment on John Alcohol abuse.
• Assess the severity of John substance use.
• Give him a mental health diagnosis
• Decide on a plan of action which include treatment and after care planning.