Introduction
The client under discussion is a 39-year-old White male patient who reports drinking beer and other alcoholic beverages four and more times per week. In order to develop an effective treatment plan for this client, it is necessary to analyze the results of such assessments as the Addiction Severity Index (ASI), DAST, AUDIT, and CAGE and determine the ASAM level for choosing appropriate interventions. The purpose of this paper is to provide the case study analysis with reference to the results of the above-mentioned tests, formulate therapeutic goals and objectives, and propose an effective treatment plan.
The Client’s Demographic Information
The client is a 39-year-old White male patient who is married and lives with his family, a wife, and three children, in his own house located in the suburban area. The man has a high school education and an incomplete college education. In the past, the client worked as an excavator operator, and currently, he works as an assistant to a warehouse manager in the same company. The client notes that he started to work as an assistant because his supervisor and manager became aware of his drinking problem. The man’s spouse complains about the client’s drinking behavior and substance abuse, but she is oriented toward supporting the man in coping with these problems.
The ASI Results
According to the assessment with the help of the ASI, the client’s medical status can be rated 7 while following the severity rating scale because the man has kidney disease and gastritis that significantly influence the quality of his life. The client’s employment and support status are also rated 7 because he is permanently employed, but he reported that he had not enough income to support his family (Smith, 2017). According to the drug and alcohol use questionnaire, the client’s severity rating is 8 because of his drinking behavior and the history of consuming marijuana twice per week. The client reports drinking beer and other alcoholic beverages (wine and spirits) four and more times per week.
When assessing the client’s legal status, it is found that he was not arrested or prosecuted in the past, and the severity rating is 4. According to the family and social relationships status, it is possible to state that the client has the required support and assistance; thus, the severity rating is 5. The psychiatric status is rated as 7 because the client reports the symptoms of anxiety, unrest, and problems with sleeping that can be connected with his alcohol consumption.
DAST, AUDIT, and CAGE Results
Referring to the Drug Abuse Screening Test (DAST), it has been found that the client’s score is 6. It means that there is the likelihood of a moderate level of drug abuse (consumption of marijuana) for the client depending on his answers to the proposed questions. Using the Alcohol Use Disorders Identification Test (AUDIT), it is determined that the client’s score is 9 that is associated with risky drinking with a moderate level of harm (Muskin, 2015; Smith, 2017). According to the CAGE questionnaire, the client’s score is 3 can indicate the presence of problems with alcohol consumption.
A Master Problem List
The following master problem list is formulated with reference to the assessment of the client’s state:
- The client’s drinking behavior is defined as risky or hazardous.
- The client has a drug abuse problem related to his marijuana consumption (a moderate level).
- The client has untreated kidney disease and gastritis.
- The client has the symptoms of anxiety, unrest, and problems with sleeping.
- The client has problems at work that are associated with his alcohol and drug abuse.
Behavioral Definitions
Problem 1: The client’s drinking behavior is defined as risky or hazardous
Behavioral definition: The client reports drinking beer and wine or spirits four and more times per week. Thus, he believes that his anxiety, unrest, and sleep problems are associated with alcohol consumption. The client cannot quit drinking in spite of his past attempts, he usually feels guilty about his drinking behavior, and his quality of work and concentration worsen.
Problem 2: The client has a drug abuse problem related to his marijuana consumption (a moderate level)
Behavioral definition: The client reports consuming marijuana twice per week, usually when drinking alcohol. After using marijuana, the client reports decreases in anxiety and unrest levels, but his ability to concentrate and memory seem to worsen. The client feels guilty about his drug abuse, and his spouse complains about his problem.
Long-Term and Short-Term Goals
Goals for Problem 1
The following long-term goal should be determined for the problem of alcohol consumption identified in the client:
- To cease alcohol consumption as a result of provided guidance and counseling.
This goal will be achieved with reference to completing the following short-term goals:
- To conduct additional assessments to classify the client’s drinking problem.
- To provide required guidance and counseling to reduce harm for the patient.
- To conduct a motivational interview and set goals.
- To involve the client inappropriate outpatient services and therapies.
Goals for Problem 2
A certain long-term goal should be identified in order to overcome the drug abuse problem in the patient:
- To cease marijuana consumption as a result of provided guidance, counseling, and therapies.
It is also important to identify short-term goals for this specific problem:
- To eliminate triggers that are associated with using marijuana when drinking alcohol.
- To conduct a motivational interview and set specific personal goals for the client.
- To determine group, family, and behavioral therapies for the condition depending on additional assessments.
Therapeutic Objectives
Each of the problems can be addressed after setting long-term and short-term goals, as well as associated therapeutic objectives to achieve. It is important to determine measurable and achievable objectives for two major goals related to the selected problems from the Master Problem list (Maisto, Galizio, & Connors, 2018). Therapeutic objectives usually determine what specific outcomes of the treatment should be observed after a certain period of implementing a selected intervention.
Objectives for Problem 1
- By the end of the first month of counseling, the client will reduce the frequency of alcohol consumption.
- By the end of the first month of counseling, the client will determine personal goals to stop drinking.
- By the end of the third month, the client will completely stop alcohol consumption.
Objectives for Problem 2
- By the end of the first month of therapy, the client will eliminate triggers that are associated with using marijuana when drinking.
- By the end of the second month of therapy, the client will report the reduction in the frequency of marijuana consumption.
- By the end of the third month of family, group, and behavioral therapy, the client will report ceasing marijuana consumption.
ASAM Levels
Referring to the frequency of the client’s alcohol consumption and his drug abuse problem, it is possible to assign the man to Level 1 (Outpatient Services). The reason is that the client requires assistance, support, and counseling in coping with his present drinking-related and drug-related problems (Ries, Fiellin, Miller, & Saitz, 2014). The client should receive a therapist’s assistance and counseling with a focus on about nine hours of services per week. It is important to note that these services should be oriented toward the provision of motivational enhancement and support for the client, as well as counseling and education.
Therapy According to the Treatment Plan
In order to help the client to cope with his alcohol-related and drug-related problems, it is appropriate to apply specific individual, group, and family therapies and interventions in the context of outpatient services that have been identified according to the ASAM level. The reason is that the client should receive motivational enhancement not only from a therapist but also needs to set personal goals during individual sessions (Muskin, 2015; Perkinson, 2017). In addition, the client is also expected to use the support of his family and peers in order to become oriented toward ceasing alcohol and drug consumption and overcoming his problems.
As a consequence, it is important to recommend individual, family, and group sessions, as well as cognitive behavioral therapy for the patient, to help him cope with alcohol- and drug-related problems, anxiety, unrest, and the associated sleeping disorder in 12 weeks. Individual sessions with a therapist will be appropriate for setting goals, conducting motivational interviews, and receiving advice from a counselor. Family sessions are important for the client in order to improve his motivation to change his drinking and substance use behaviors (Muskin, 2015; Perkinson, 2017). In addition, group therapy will provide the client with extra stimuli to self-monitor his drinking and drug abuse that is important to guarantee positive results of treatment. Cognitive-behavioral therapy is also effective while working with persons who are addicted to substances and consuming alcohol (Muskin, 2015; Perkinson, 2017). It is possible to state that, as a result of individual sessions of cognitive-behavioral therapy, the client will be able to change and improve his thinking and behavioral patterns. Moreover, educational guidance and support are required to assist the client in overcoming his alcohol and substance consumption problems.
Conclusion
This report has provided the analysis of the case study related to the 39-year-old White male patient who has a drinking problem and a substance consumption problem. In spite of the fact that the ASI assessment has allowed for determining a range of problems to address in relation to the client’s health and well-being, much attention should be paid to coping with alcohol- and drug-related problems. In addition, it is necessary to address the client’s anxiety and the unrest associated with his drinking and drug abuse behaviors. Individual guidance and cognitive behavioral therapy are recommended according to the set goals and objectives along with family and group therapies. The client should receive outpatient services for 12 weeks in order to achieve his goals and demonstrate positive changes by the end of the third month of interventions.
References
Maisto, S. A., Galizio, M., & Connors, G. J. (2018). Drug use and abuse (8th ed.). New York, NY: Cengage Learning.
Muskin, P. R. (2015). Study guide to substance abuse treatment: A companion to the American Psychiatric Publishing textbook of substance abuse treatment (5th ed.). New York, NY: American Psychiatric Pub.
Perkinson, R. R. (2017). Chemical dependency counseling: A practical guide (5th ed.). Thousand Oaks, CA: SAGE Publications.
Ries, R. K., Fiellin, D. A., Miller, S. C., & Saitz, R. (2014). The ASAM principles of addiction medicine (5th ed.). New York, NY: Wolters Kluwer Health.
Smith, D. C. (2017). Emerging adults and substance use disorder treatment: Developmental considerations and innovative approaches. New York, NY: Oxford University Press.