SOCW 6090 Week 10 – Discussion: Treatment of Substance Use Disorders

Discussion: Treatment of Substance Use Disorders

Of the substance disorders, alcohol-related disorders are the most prevalent even though only a small percentage of individuals actually receive help. Recidivism in the substance treatment world is also very high. As research into treatment has developed, more and more evidence shows that genes for alcohol-metabolizing enzymes can vary by genetic inheritance. Women have been identified as particularly vulnerable to the impacts of alcohol. Native Americans, Asians, and some Hispanic and Celtic cultures also have increased vulnerability to alcohol misuse.

Even with these developments, treatment continues to spark debate. For many years, the substance use field itself has disagreed with mental health experts as to what treatments are the most effective for substance use disorders and how to improve outcomes. The debate is often over medication-assisted treatment (MAT) versus abstinence-based treatment (ABT). Recently the American Psychiatric Association has issued guidelines to help clinicians consider integrated solutions for those suffering with these disorders. In this Discussion, you consider your treatment plan for an individual with a substance use disorder.

To prepare: Read the case of Martin for this week’s Discussion and the materials for the week. Then assume that you are meeting with the client as the social worker who recorded this case.

Provide a detailed discussion Post a 500-word response in which you address the following:

· Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention). Keep in mind a diagnosis covers the most recent 12 months.

· Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

· Describe the assessment(s) you would use to validate the client’s diagnosis, clarify missing information, or track her progress.

· Summarize how you would explain the diagnosis to the client.

· Explain how you would engage the client in treatment, identifying potential cultural considerations related to substance use.

· Describe your initial recommendations for the client’s treatment and explain why you would recommend MAT or ABT.

· Identify specific resources to which you would refer the client. Explain why you would recommend these resources based on the client’s diagnosis and other identity characteristics (e.g., age, sex, gender, sexual orientation, class, ethnicity, religion, etc.).

Note: You do not need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5, demonstrating an understanding of the risks and benefits of treatment to the client. You do need to include an APA reference for the assessment tool and any other resources you use to support your response.

Must be original work.

Must contain at least 4 references and citations being sure to reference and cite:

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

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

American Psychiatric Association. (2013r). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm16

Capuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). New York, NY: Pearson Education, Inc.

Substance Abuse and Mental Health Service Administration (SMHSA). https://www.samhsa.gov/

Week 10: Substance-Related and Addictive Disorders

Drugs—prescription and non-prescription—have become part of American life.

While the culture often shifts which drugs are at the forefront of public discourse, in treatment settings of all types, social workers frequently have to address the boundary between reasonable use and the development of pathological patterns of behavior. The DSM-5 addresses 10 classes of drugs: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics and anxiolytics, stimulants, and tobacco and other substances. The use of three of these drugs in particular—alcohol, opioids, and cannabis—is on the rise, especially for women, seniors, and youth.

This week you analyze evidence-based interventions for common substance use disorders and identify resources to assist individuals in recovery from various forms of addictions, as you apply learning to a case.

Learning Objectives

Students will:

· Analyze a case study focused on a substance use disorder utilizing steps of differential diagnosis

· Examine culturally aware engagement strategies and treatment options for treating a substance use disorder

· Recommend treatment and resources for a client diagnosed with a substance use disorder

· Demonstrate case collaboration skills when presenting a differential diagnosis

· Diagnose a mental disorder in a case study utilizing steps of differential diagnosis

· Create a culturally appropriate, evidence-based treatment plan utilizing client strengths

Learning Resources

Required Readings

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

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

American Psychiatric Association. (2013r). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm16

Gowin, J. L., Sloan, M. E., Stangl, B. L., Vatsalya, V., & Ramchandani, V. A. (2017). Vulnerability for alcohol use disorder and rate of alcohol consumption. American Journal of Psychiatry, 174(11), 1094–1101. doi:10.1176/appi.ajp.2017.16101180

Reus, V. I., Fochtmann, L. J., Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., … Hong, S.-H. (2018). The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. American Journal of Psychiatry, 175(1), 86–90. doi:10.1176/appi.ajp.2017.1750101

Stock, A.-K. (2017). Barking up the wrong tree: Why and how we may need to revise alcohol addiction therapy. Frontiers in Psychology, 8, 1–6. doi:10.3389/fpsyg.2017.00884

Optional Resources

Best, D., Beckwith, M., Haslam, C., Haslam, S. A., Jetten, J., Mawson, E., & Lubman, D. I. (2016). Overcoming alcohol and other drug addiction as a process of social identity transition: The social identity model of recovery (SIMOR). Addiction Research and Theory, 24(2), 111–123. doi:10.3109/16066359.2015.1075980

Hagman, B. T. (2017). Development and psychometric analysis of the Brief DSM-5 Alcohol Use Disorder Diagnostic Assessment: Towards effective diagnosis in college students. Psychology of Addictive Behaviors, 31(7), 797–806. doi:10.1037/adb0000320

Helm, P. (2016). Addictions as emotional illness: The testimonies of anonymous recovery groups. Alcoholism Treatment Quarterly, 34(1), 79–91. doi:10.1080/07347324.2016.1114314

Petrakis, I. L. (2017) The importance of identifying characteristics underlying the vulnerability to develop alcohol use disorder. American Journal of Psychiatry, 174(11), 1034–1035. doi:10.1176/appi.ajp.2017.17080915

Hom, M. A., Lim, I. C., Stanley, I. H., Chiurliza, B., Podlogar, M. C., Michaels, M. S., … Joiner, T. E., Jr. (2016). Insomnia brings soldiers into mental health treatment, predicts treatment engagement, and outperforms other suicide-related symptoms as a predictor of major depressive episodes.

 

Journal of Psychiatric Research, 79, 108–115. doi:10.1016/j.jpsychires.2016.05.008

Document: Suggested Further Reading for SOCW 6090 (PDF)

 

Note: This is the same document introduced in Week 1.

Discussion: Treatment of Substance Use Disorders

Of the substance disorders, alcohol-related disorders are the most prevalent even though only a small percentage of individuals actually receive help. Recidivism in the substance treatment world is also very high. As research into treatment has developed, more and more evidence shows that genes for alcohol-metabolizing enzymes can vary by genetic inheritance. Women have been identified as particularly vulnerable to the impacts of alcohol. Native Americans, Asians, and some Hispanic and Celtic cultures also have increased vulnerability to alcohol misuse.

Even with these developments, treatment continues to spark debate. For many years, the substance use field itself has disagreed with mental health experts as to what treatments are the most effective for substance use disorders and how to improve outcomes. The debate is often over medication-assisted treatment (MAT) versus abstinence-based treatment (ABT). Recently the American Psychiatric Association has issued guidelines to help clinicians consider integrated solutions for those suffering with these disorders. In this Discussion, you consider your treatment plan for an individual with a substance use disorder.

To prepare: Read the case of Martin for this week’s Discussion and the materials for the week. Then assume that you are meeting with the client as the social worker who recorded this case.

Provide a detailed discussion Post a 500-word response in which you address the following:

· Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention). Keep in mind a diagnosis covers the most recent 12 months.

· Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

· Describe the assessment(s) you would use to validate the client’s diagnosis, clarify missing information, or track her progress.

· Summarize how you would explain the diagnosis to the client.

· Explain how you would engage the client in treatment, identifying potential cultural considerations related to substance use.

· Describe your initial recommendations for the client’s treatment and explain why you would recommend MAT or ABT.

· Identify specific resources to which you would refer the client. Explain why you would recommend these resources based on the client’s diagnosis and other identity characteristics (e.g., age, sex, gender, sexual orientation, class, ethnicity, religion, etc.).

Note:

 You 

do not

 need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5, demonstrating an understanding of the risks and benefits of treatment to the client. You 

do

 need to include an APA reference for the assessment tool and any other resources you use to support your response.

Must contain at least 4 references and citations being sure to reference and cite:

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
· Chapter 15, “Diagnosing Substance Misuse and Other Addictions” (pp. 238–250)
American Psychiatric Association. (2013r). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm16

Capuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). New York, NY: Pearson Education, Inc.

Substance Abuse and Mental Health Service Administration (SMHSA). https://www.samhsa.gov/

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CaseM

CASE OF MARTIN

INTAKE DATE: March 2020

DEMOGRAPHIC DATA: Martin is a 38-year-old, African American, married, employed male who lives with his wife and two children in Kansas City, Missouri. He works as a computer technician in a car dealership. This is his first psychiatric admission.

CHIEF COMPLAINT: “My wife says she wants to leave me because she is unhappy”.

HISTORY OF PRESENT ILLNESS: Martin states he has been feeling upset and sad. His wife told him she is unhappy, and she wants to leave. Client initially went to his primary care physician who gave him Xanax for his nerves in December 2019.

He recently began to mix Xanax and alcohol because his nerves are on edge. Martin went to a therapist in January 2020 because his wife urged him to. The therapist wanted to see them together because she said this was a marital issue.

Martin explains he had a heart attack December 31, 2018. He was very stressed that New Year’s Eve, trying to finish up his work and get home for their party. He had several friends over and was having a great time before his heart attack. When asked, Martin admitted to drinking a lot that night and using some drugs “recreationally”. When it was explored further Martin admitted to using marijuana and cocaine that evening.

Wife noted Martin has become more irritated over the past several months especially when she asked him to fulfill his roles around the house. She reports they have had several severe arguments about his behavior and drinking.

PAST PSYCHIATRIC/DRUG HISTORY: Martin reports that he went to a therapist as noted in History of Present Illness. He reports no other psychiatric contact prior to this time.

It should be noted that Martin had a history of substance use as follows. He first began smoking marijuana age 15. By the time he was 17 he was smoking daily. He decided to cut down and now he reports smoking marijuana on and off. At age 17½ he began to drink beer, however, since he got sick when he was 18, he no longer drinks beer. Since age 20, Martin reports he is a social drinker, drinking wine with dinner and on weekends. At the age of 26, he hurt his back. He was prescribed several different kinds of pain medication such as oxycontin, which he continues to use today occasionally. Patient reports using cocaine on weekends from 2012 until he had his heart attack. When questioned more specifically about his drinking, Martin became agitated, and stated he has several drinks to relax every day. Martin never discussed his drug use with his doctor because he reports being able to handle it and actually stops using drugs and alcohol every year for 6 weeks for religious reasons. Martin states it’s a way to give his body a rest.

FAMILY HISTORY: Patient is married for 18 years. He has a 16 and 17 year old son. Both parents are deceased. His mother died from cancer of the stomach and his father died the following year from cirrhosis of the liver. There is no psychiatric illness in the family.

MEDICAL HISTORY: Patient had a heart attack in December 2018. He is now on Blockadrin 5 mg, QD. He has hay fever. Patient smoked three packs of cigarettes per day since 17 years old. Patient also has hypercholesterolemia since January 2014. Patient reports his doctor spoke to him about his lifestyle and illnesses.

A little over two years ago Martin had a heart attack and was admitted to a local hospital on December 31, 2018 where he stayed for one week. The heart attack was considered to be stress related and Martin was urged to slow his life down.

PAST DEVELOPMENT AND SOCIAL HISTORY: Patient was born in Kansas City, Missouri and went to public schools. He graduated from high school in 2000 and tried college for several months. However, he dropped out.

He started working in the computer industry soon after he left college and has been working steadily up to this point. Patient has no legal complications.

MENTAL STATUS EXAMINATION: Upon intake the patient was casually dressed but neatly groomed male who appeared older than his stated age. He was anxious with mildly pressured speech, which was fluent, coherent and could be interrupted. There was no evidence of psychosis, paranoid ideation, delusions, or form of thought disorder. There was no looseness of association, flight of ideas, or ideas of reference. His affect was full range. He described decreased appetite and intermittent sleep problems, sometimes over sleeping.