Case Analysis
This paper is a case study review of a cocaine-using client (Donovan) who visited a clinic to seek help for his drug use. This paper reviews his case and provides a treatment plan. Before delving into the details surrounding this analysis, the following section of this paper outlines the best methods for screening and assessing the patient for further analysis.
Information Gathering
According to COP (2015), the success of psychological interventions depends on the successful adoption of different screening and assessment tests. Although not all existing screening and assessment tests are exclusive to the health and psychology fields, clinical and psychopathological training supports their continued use in the fields (Miller, Forcehimes, & Zweben, 2011). The purpose of a screening, or assessment test, is to find out the existence of an addiction, its extent, and the presence of preexisting conditions that could influence its effects. The National Institute on Drug Abuse (2014) says there are different screening and assessment methods for assessing drug users. They include interviews, behavioral monitoring, self-monitoring methods, tests, self-reports (scales, inventories, and questionnaires), psycho-physiological methods, role-playing, and surveys (National Institute on Drug Abuse, 2014). In Donovan’s case, I would use interviews to assess his drug use. Particularly, I would use the Addiction Severity Index (ASI) to do so because it has a good success record in screening and assessing patients who suffer from cocaine addiction (National Institute on Drug Abuse, 2014). The justification for using this treatment method is its holistic nature (it covers different aspects of a patient’s social and economic wellbeing) (National Institute on Drug Abuse, 2014). Working Partners and SAPAA (2012) clarifies this point by saying it covers different social and economic dynamics of a patient, including their “medical status, employment and support status, drug use, alcohol use, legal status, family and social relationships, and psychiatric status” (p. 8). This assessment tool should reveal different problems Donovan has faced from using cocaine in the short-term and in the long-term. This assessment tool will be instrumental in identifying urgent and chronic concerns surrounding his drug use (if any). I would summarize the responses in composite scores. These indices are useful in measuring changes that would occur over long periods (in particular how the clients respond to treatment) (Working Partners and SAPAA, 2012). Using this assessment method, a counselor could make an independent rating of different problem areas concerning substance abuse and addiction. The assessment would include an assessment of a client’s rating along a continuum of 0-9 where ‘0’refers to the non-existence of a problem and ‘9’refers to the existence of a big problem (Working Partners and SAPAA, 2012). A score of ‘9’would mean that treatment is necessary.
Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) helps clinicians to diagnose disorders. Although it has a strong rooting in the mental health field, its application has stretched beyond this discipline (Hasin & Schuckit, 2013). The DSM-5 tool outlines different criteria for substance abuse, which we will use to diagnose cocaine addiction in Donovan’s case. In total, DSM-5 outlines three sets of criteria for diagnosing disorders. The first criteria (for diagnosing substance abuse) include the presence of hazardous use, the existence of social/interpersonal problems related to abuse, neglect of major roles in a client’s life, and the existence of legal problems arising from substance use (Hasin & Schuckit, 2013). The second set of criteria involves a diagnosis to evaluate whether a client is dependent or not. The items of evaluation include the presence of withdrawal symptoms, reduced social tolerance, use of large amounts of prohibited substances for long periods, existence of repeated attempts to quit, excessive time spent using drugs, and the existence of psychological problems related to drug use (Hasin & Schuckit, 2013). The last set of criteria involves an analysis of whether a client has a substance abuse disorder or not. This analysis involves a review of the above-mentioned factors, including the presence of craving. Therefore, the distinction between the second and third criteria for evaluation is the presence of “craving” (Hasin & Schuckit, 2013).
Donovan’s case study shows that he meets two criteria for substance abuse. They are hazardous use of substances and social/interpersonal problems related to the same. The interpersonal problems relate to the problems he has experienced with his wife because she complains about his long working hours and the persistent neglect she has felt because of her husband’s long working hours. In fact, because of her concerns, she has threatened to divorce him. Clearly, these observations demonstrate that the client’s cocaine use meets the criterion for interpersonal problems. Donovan’s cocaine use also meets the criterion of hazardous use of cocaine because there are health concerns arising from his continued use of cocaine and his long working hours. These health concerns are high blood pressure and other health issues that may arise from increased stress levels. Collectively, these observations demonstrate that Donovan’s cocaine use meets the threshold for drug abuse because Hasin and Schuckit (2013) say a client only needs to meet two criteria to receive such a diagnosis.
Severity rating
There are three levels of severity noted in the DSM-5 criteria. They include mild, moderate and severe ratings. A client meets the mild severity level if he meets 2-3 criteria. Similarly, a moderate substance abuser would meet 4-5 criteria, while a severe substance abuser would meet six or more indicators of substance abuse (Hasin & Schuckit, 2013). Based on the two criteria met by Donovan, the severity of his substance abuse level is “mild.”
Treatment Plan
This treatment plan reviews different measures for addressing Donovan’s “mild” drug use.
The Problem List
In the treatment plan, I will highlight different problems associated with the Donovan’s cocaine use. Such problems may include poor interpersonal relationships, health problems and other socioeconomic issues in the client’s life (Sage Publication, 2015). The problem list will also highlight different issues about the patient, including the reasons for referral, patient’s current symptoms and behaviors, history of the problem, impairments in life functioning, psychological history, current risk and safety concerns, current and previous medication, current substance use, family background, personal history, and mental status. This list will be flexible because I would modify it after further consultations with the client.
Goals and Objectives
This section of the treatment plan outlines its overarching goal. This section outlines expectations of what the client should do to go back to his “normal” state. The goal of this treatment plan would be to end Donovan’s cocaine use.
Clinical Intervention
Clinical practice, psychology and related sciences have provided a wide body of knowledge for clinicians to create different types of interventions for drug users (National Institute on Drug Abuse, 2015). Some of the main types of methods include behavioral modification therapy, exposure methods, self-control methods, skill acquisition methods, cognitive-behavioral therapy methods, covert conditioning methods, and psychoanalytic methods (Hasin & Schuckit, 2013). The cognitive-behavioral therapy is the most appropriate method to use in Donovan’s case because at the center of his cocaine addiction is work-related behavioral issues and family (marital) issues. These two sets of factors, which fuel or justify his cocaine use, speak to the need to have an intervention that addresses his cognitive and behavioral issues. Several important features of the cognitive-behavioral approach make it appealing in this case. They include the short-term nature of the treatment method, which makes it applicable to many clinicians because they do not need many resources to make it work (The National Institute on Drug Abuse, 2015). The strong empirical basis for the formulation of the cognitive-behavioral approach also makes it a reliable instrument for treatment. Evidence also shows that the effects of the cognitive-behavioral approach are long lasting. Similarly, experts rarely contest its effects (The National Institute on Drug Abuse, 2015). This intervention method is also structured, goal-oriented and focused. Its compatibility with other interventions also makes it adaptable to different treatment settings, thereby making it more convenient to use in settings where counselors may require supplementing its use with another intervention (The National Institute on Drug Abuse, 2015). These features make the cognitive-behavioral approach appropriate to use in Donovan’s case. Overall, at the center of the use of the cognitive-behavioral therapy method is the understanding that maladaptive behavioral patterns could be solved by changing a client’s learning process (cognitive therapy).
Treatment Setting
Since cocaine use does not have serious withdrawal symptoms, there is no need of treating Donovan in an in-patient setting (Sage Publication, 2015). Instead, the treatment setting would take place in an outpatient format.
Treatment Plan Review
The purpose of a review is to monitor the progress made in the treatment plan (Working Partners and SAPAA, 2012). The treatment plan review will occur at different points in the decision-making process. The decision points refer to major milestones in the treatment plan, including admission, transfer, discharge, significant changes in the client’s condition, and the point of estimating the client’s length of treatment (Sage Publication, 2015). Depending on the progress made by the client, I would change the treatment plan accordingly.
Discussion of Continuing Care
According to Miller et al. (2011), before the formulation of a treatment plan, clinicians should have a plan for continuing care. Since this paper has already established that Donovan’s cocaine use is “mild,” the continuing care plan will have a 5-year plan review. A continuing care case manager will be responsible for its implementation. The plan will be a negotiated agreement with the patient and his family members. It will include an advisory for the patient to send a log of 12-step meetings on, or before, the 10th day of every month, regular meetings with the sponsor, and an agreement that the patient would regularly attend meetings that are set up by the primary counselor. To improve the odds of success, Donovan would also have to commit that he would allow random drug tests for the first six months of the treatment. Collectively, this plan will be Donovan’s treatment regimen.
References
COP. (2015). Procedures, Methods and Instruments Used By Clinical and Health Psychologists. Web.
Hasin, D., & Schuckit, M. (2013). DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. Am J Psychiatry, 170(1), 834–851.
Miller, W., Forcehimes, A., & Zweben, A. (2011). Treating Addiction: A Guide for Professionals. New York, NY: Guilford Press.
National Institute on Drug Abuse. (2014). Fact Sheet Treatment Planning M.A.T.R.S.: Utilizing The Addiction Severity Index (ASI) To Make Required Data Collection Useful. Web.
Sage Publication. (2015). The Treatment Plan. Web.
The National Institute on Drug Abuse. (2015). A Cognitive-Behavioral Approach: Treating Cocaine Addiction. Web.
Working Partners and SAPAA. (2012). Screening & Assessment. Web.