Treatment of Substance Use Di

Respond to at least two colleagues who selected a different diagnosis or treatment intervention for the client in the following ways:

  • Explain why you agree or disagree with your colleague’s diagnosis and treatment approach.
  • Identify potential barriers your colleague may experience when providing their explanation of the diagnosis to the client.
  • Describe a strategy your colleague could use to engage the client in treatment.

Colleague 1: Ashley

Diagnosis:

303.90 Alcohol Use Disorder Severe

F32.1 Major Depressive Disorder

Z55.9 Academic Problems

Z272.9 Problem Related to Lifestyle

Sook qualifies for 303.90 due to her use of alcohol. She takes larger amounts than are intended reported most weekends. She has tried to create limitations for herself, and those have not been continued (Criteria 2). Additionally, she states that spending most weekends drinking and some evenings going out and drinking with her friends, and recovery time lasts well through the next day. Leading to making it difficult to continue her classwork and caring for herself. She continues to utilize alcohol even though it causes anxiety, lack of sleep as well as nausea. He schooling has been reduced due to her “lack of interest”; however that is a typical symptom of withdrawing and a “foggy mind,” as she states. Sook continues this usage pattern even though she knows she gets the shakes, is losing weight, and is now unable to sleep without alcohol. Lastly, she begins her day with a “morning eye-opener,” which allows her to combat the withdrawal symptoms she would feel otherwise.

She is not in remission, still performing in the same way but hoping to stick to the schedule of “cutting back” more. As well as not being in a controlled environment due to her access to alcohol and going to bars at any time. Sook is coded with Severe due to her presents of 6 or more symptoms, as classified by the DSM. She seems to have fair insight, understanding these symptoms are happening to her, however not correlating them or being fully honest about her alcohol problem.

F32.1 MDD Moderate was given due to her reported depressed mood most of the day, diminished interest and pleasure, significant weight loss, insomnia, loss of energy, the diminished ability for concentration, with impairment of social and educational facets in life. Some of these symptoms DO cross-match with withdrawal symptoms, especially the weight loss due to nausea, the loss of energy due to fatigue, and anxiety. Each of these considerations needs to be accounted for, which is why the diagnosis is moderate and not severe in the state; if no alcohol withdrawal considerations were in place, Sook would specify with severe.

The Z codes were based on her lacking interest and dropping a class at school; while she is still maintaining “good” grades, she is below her normal baseline, which clinicians consider. Academic difficulty is a large part of this case since she is a full-time student and losing interest with a lack of focus on schooling. Additionally, lifestyle problems were considered due to the amount she goes out and the activities she partakes in a while, knowing this is internally hurting her and trying to place limitations that she is not willing to stick to due to her social choices.

I would explain the diagnosis to the client, first on educating them about the symptoms of withdrawing, “Sook, you spoke to me about drinking; while this may not seem like a problem in your life, I want to express what withdraw looks like so you can decide whether we want to add it in your treatment plan.” This still allows her to have a choice and not an educated choice. After the education is completed, she could decide to say, “That is fine, but I do not want to stop drinking how I do.” and while that is hard as a clinician, we have to respect her life choices and decisions.

At this point, I would recommend MAT, she has already not been eating for some time, and her body has numerous effects from withdrawing. In order to ensure her safety and the overall dignity and best wishes of the patient, medicated assistance would be recommended. I would specifically refer her to a close detox facility and allow her to remain confidential and focus on social needs, the school needs, and, more importantly, what is best for her and what facilities she would want to explore if any.

Colleague 2: Kimberly

The client is a 22-year-old woman of Korean descendant. Client is the oldest child of two married parents and reports little brother having ADHD. The client is attending college in Florida and is bartending to supplement financial aid.

Alcohol Use Disorder 303.90 (F10.20) severe, Alcohol Withdrawal 291.81 (F10.239) without perceptual disturbances

The client reports drinking alcohol and trying to limit themselves. They reported drinking alcohol in the mornings to feel better. Client drinks vodka and cranberry juice or other mixed drinks because beer causes “bloating”. The client drinks after work or on the weekends along with college friends and “bar” friends. Client reports mild hand tremors and trouble sleeping. Client lack interest in involvement with activities such as clubs, sports, and having boyfriends. Client reports arguments occurring when sober.

Attention Deficit Disorder 314.00 (F90.0) predominantly inattentive presentation

The client has no motivation and also has a history of not attending classes. The client’s grade slipped from an A – B+ range to a low B range. The client reports finding it difficult to concentrate and feelings of restlessness.

Restrictive Food Intake Disorder 307.59 (F50.82)

The client reports having no appetite. The client denies having an eating disorder. Friends have noticed and pointed out the weight loss to the client stating “slight” to “reed thin”.

Assessment for validation of alcohol use disorder/withdrawal: The AUDIT has 10 questionnaires and measures the severity of alcohol use (AUDIT, n.d.). According to AUDIT (n.d.), a score of 8 or more is considered harmful or hazardous alcohol use.

Before getting into depth, I would first check about the level of understanding Sook has about the diagnosis. When discussing the diagnosis, I will refrain from using words or phrases that are too complex to follow along. I would also make sure I explain the diagnosis as simple as possible and is easy to comprehend.

I would engage the client by showing empathy and understanding. I would also be mindful of the negative stereotyping and other assumptions about the population the client identifies with. It is known, an individual belonging in an Asian community have the pressure of not sharing any issues concerning mental health and to meet high expectations (Paniagua, 2004).

I would recommend MAT for this client. Sook has been experiencing withdrawals and uses alcohol to “feel better” and has been showing sign of hand tremoring. Medication-assisted treatment (MAT), is combined with psychosocial therapy and medication to curb craving and withdrawals (Cordant, 2017). According to Cordant (2017), MAT has been shown to double the likelihood of a client to stay in recovery and avoid relapsing.

I would refer Sook to a program designed for women struggling with alcoholism and withdrawals. It is evident the client socializes with others with similar leisure activity (for example, drinking with peers and “bar” friends). Women-oriented alcoholism treatment provides an environment where women are in a setting that is compatible with their interaction styles (Beckman, 1994). According to Beckman (1994), the women-oriented alcoholism treatment takes into account the role women play in society and other aspects such as how women are portrayed in family structure. I think this would be a great way to personalize the treatment for Sook, considering coming from a minority background and identifies as a woman.

References

AUDIT. (n.d.). Alcohol use disorders identification test (AUDIT). Retrieved from

https://www.drugabuse.gov/sites/default/files/audi…

Beckman L. J. (1994). Treatment needs for women with alcohol problems. Alcohol health and

research world, 18(3), 206–211.

Cordant. (2017). The changing role of abstinence in addiction treatment. Retrieved from

https://cordantsolutions.com/changing-role-abstine…

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.

Chapter 15, “Diagnosing Substance Misuse and Other Addictions” (pp. 238–250)

Paniagua. (2004). Guidelines for the assessment and treatment of Asian clients. Retrieved from

https://www.sagepub.com/sites/default/files/upm-

binaries/4968_Paniagua_I_Proof_3_Chapter_5.pdf


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