RESPONSE 1:

· Respond to at least two colleagues who chose a different area of focus in beginning treatment. How may have the inputs from the section Other Conditions That May Be a Focus of Clinical Attention influenced all of your decisions? Share any insights you gained from reading your colleagues' posts.

Colleague 1: Jonathan

I would diagnose Jake with Alcohol Use Disorder Severe 303.90 (F10.20). Jake meets more than six criteria of Alcohol Use Disorder, which is why I chose severe as the severity within this diagnosis.

Jake meets the following criteria under Alcohol Use Disorder: A persistent desire and unsuccessful efforts to control alcohol use(2), a large amount of time spent drinking (3), an urge to use alcohol (4), recurrent usage of alcohol resulting in a failure to fulfill major role obligations (5), continued alcohol use despite having recurrent interpersonal problems caused by continued use (6), and continued use of alcohol despite knowing that a psychological or physiological issue is either being caused by, or is making these problems worse (7) (American Psychiatric Association, 2013).

Jake is a veteran who also suffers from Post-Traumatic Stress Disorder due to what he witnessed and the things he did while deployed (Plummer, Makris, & Brocksen, 2014). Jake utilizes alcohol as a coping mechanism for this, as well as his deteriorating relationship with his wife.

According to Plummer, Makris, & Brocksen (2014), Jake knows that his relationship with his wife and his sons is not the same as it was before and continues to grow worse, and continues to drink despite this knowledge (Plummer, Makris, & Brocksen, 2014). Jake currently drinks daily, and spends most of his free time watching TV or playing video games while drinking. His persistence in drinking despite knowing that he is pushing his family away contributes toward his diagnosis of Severe Alcohol Use Disorder. This diagnosis of Severe Alcohol Use Disorder, paired with Post-Traumatic Stress Disorder, creates comorbidity when diagnosing Jake.

The first area of focus that I would take in treating Jake would be to refer Jake to a detox and residential program. Without detoxing from the alcohol and being of clear mind and body, there is no treatment that can truly assist Jake.

After he has detoxed from the alcohol, I would then refer Jake to inpatient treatment in order to learn about his addiction, and learn positive coping mechanisms while receiving therapy. Upon completion of an inpatient program (if he did complete), I would then recommend outpatient for both substance abuse and for therapy, in order to continue receiving help for the addiction while also beginning to gain insight into his PTSD and how that has affected his life, pre and post deployment.

References

Plummer, S.-B., Makris, S., Brocksen S. (Eds.). (2014). Sessions: Case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Colleague 2: Brian

Clinical Diagnosis of Jake

Posttraumatic Stress Disorder (F43.10).

Criterion A: Direct Exposure: Jake was in the military and was sent to Iraq.

Criterion B: Intrusive thoughts, emotional distress after exposure to traumatic reminders.

Criterion C: Jake experienced both trauma-related thoughts or feelings and trauma-related reminders.

Criterion D: Only two are needed to meet this requirement, Jake is experiencing five: Overly negative thoughts and assumptions about oneself or the world, negative affect, decreased interest in activities, feeling isolated, and difficulty experiencing positive effect.

Criterion E: Again, only two are needed to meet this requirement, Jake hits all but one of them: irritability or aggression, risky or destructive behavior (drinking), hypervigilance, difficulty concentrating, and difficulty sleeping.

Criterion F: Jake has been experiencing this well over a month.

Criterion G: The PTSD combined with the alcohol consumption are causing Jake to be impaired-socially, employment, and within the family; all of which is causing distress to him and family.

Criterion H: Symptoms are not due to substance abuse.

F10.99 Unspecified Alcohol-Related Disorder

It is clear that Jake is consuming a rather high level of alcohol as it appears he is missing work of late.

Z63.0 Relationship Distress with Spouse

With Jake's current untreated PTSD and alcohol abuse is causing distress with his wife.

Z65.8 Exposure to War

Jake was in the military and stationed in Iraq.

There are essentially three issues that are occurring simultaneously in the scenario with Jake. They are his PTSD which is derived from his exposure in Iraq as a soldier in the military, his high levels of alcohol consumption, and the current condition of the relationship with his spouse. In my opinion, all of these conditions and disorders, if you will intermingle with each other.

According to the Department of Veterans Affairs (VA), it is not uncommon for a PTSD and alcoholism to both be present (Ptsd.va.gov, 2017). What is worth noting, the VA also pointed out those who suffer from PTSD will likely develop alcoholism; which is what we are seeing in this case scenario. Additionally, alcohol can increase the symptoms of PTSD.

According to the VA, treatment for alcoholism must be incorporated into the PTSD intervention (Ptsd.va.gov, 2017). In other words, they must be both addressed at the same time. With this approach, I believe the relationship difficultly Jake and his wife are experiencing will diminish once Jake has been in the PTSD and alcohol intervention for a period of time.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Laureate Education. (Producer). (2014). Levy family (Episode 1 of 42) [Video file]. In Sessions.

Ptsd.va.gov. (2017). PTSD and Problems with Alcohol Use - PTSD: National Center for PTSD. [online]

RESPONSE 2:

· Respond to a colleague by offering your thoughts on how multiple factors contribute to the failure of people to implement specific policies. In your opinion, do you think frontline social workers are perceived as people who cause specific policies to not be implemented?

Colleague 1: AnnaVi

Social workers have the ethical duty to protect, serve, advocate and fight for unfair treatment for their clients and community. Social workers should abide by the implementation process unless it sabotages, harms, places his or her clients in danger.

According to Jansson (2018), a social worker should ask to be dismissed or resign from the following project if he or she cannot perform the duties in good conscious. There are ethical issues that can arise such as violating the law, conflict of interest, confidentiality, placing themselves or their clients in danger, etc.

In cases where social workers are elected to implement policies that are against his or her social work values, he or she should kindly resign or asked to be dismissed. The NASW Code of Ethics states that social workers have the ethical responsibility to protect and promote the client's self-determination and protect their privacy (2008). If for any reason, the implementation places the client in danger or is an awkward situation, the social worker must make changes.

During my foundation internship when the agency did not have an executive director, many people wanted to make changes that they felt were necessary. Unfortunately, the client's best interest was not considered or did not seem to be the main priority. The agency that I worked in provided monetary assistance for domestic or sexual abuse clients who wish to obtain their own apartment.

The approval was to be approved by the executive director before the money was given to the client. In one case, one of the case managers shared the news with the client that she would receive financial assistance, however failed to take the necessary steps to ensure that the grant was approved. Long story short, the grant was not approved and were left with a confused client. I was not asked to do this, but I imagine I would have difficulty making a huge decision without my supervisor's permission.

Jansson, B. S. (2018). Becoming an effective policy advocate: From policy practice to social justice (8th ed.). Pacific Grove, CA: Brooks/Cengage Learning Series.

NASW. (2008). Code of ethics.