Question

Case Study 1

Staria is a seventeen-year-old girl who has been brought to your outpatient treatment center by her mother. Staria has been suspended from high school on two occasions over the past six weeks for fighting and disorderly conduct. She has a history of recurrent detention and classroom dismissals for similar, though less severe, behavior at her previous high school. On the last occasion, she and another student were engaged in an altercation in the hallway. When security was called in, it was discovered that Staria had a pint of vodka and a small quantity of marijuana in her locker. At the time, it was noticed that Starina seemed intoxicated. She later tested positive for marijuana.

You meet Staria and her mother and learn that Staria stole alcohol and marijuana from her father's stash and that he was outraged by the discovery. Staria blames her parents for her school dismissal and feels she is being blamed and scapegoated by her parents. According to her, her parents are the ones who need counseling. She also reports that her grandfather recently passed away due to cirrhosis. Her mother states that Staria has a twin sister, who never uses drugs, cigarettes, or alcohol and that Staria should be more like her sister.

Case Study 2

George is a civil service employee who has been struggling with his drinking problem for years. He has tried to control his alcohol use and has made many attempts to refrain. Lately, he has been drinking more frequently to feel the same effect; he even drinks before he goes to work. His family has a history of alcoholism. Although George is aware of the genetic origins concept, he feels embarrassed and struggles to identify himself as an alcoholic. He compares himself with others who drink far more than he does, and in his perception, this rationalizes that he is not that bad.
George continues to drink despite the adverse consequences on his health and sociocultural relationships. In the past three years, he has experienced the following consequences:

One arrest for driving under the influence (DUI)

Loss of a job

Mood swings

Fights and arguments with family members over his drinking

Frequent inability to stop drinking

Blackouts

Need for increasing amounts of alcohol in order to get high

George's present employer asks him to attend Alcoholics Anonymous meetings. George responds, "I am not like those people. I am not that bad."

Using the DSM-V criterion, diagnose Staria and George. Explain the diagnosis by incorporating discussion over the concepts of addiction (i.e., withdrawal, tolerance, physical dependence, comorbidity, and psychological dependence). Be sure to explain the selected diagnosis.

The models for substance use can be categorized as physiological and psychological. Within each of these general categories, however, are different specialized foci. Review the Theories of Alcoholism document, as well as conduct research to determine which model(s) aid in understanding what is happening with Staria and George.

Answer 1

controlled According to According to DSM 5 Staria can be diagnosed as suffering from Conduct Disorder symptoms of which can be grouped into four categories-

1)Aggressive behaviour -fighting ,bullying

2)Destructive behaviour-arson and vandalism

3)Deceitful behaviour-lying , shoplifting(stealing in this case)

4)Violation of rules- which includes truancy or running away from home

These children( in our case Staria) also show symptoms of Drig and Alcohol Abuse as well as lowered self esteem.

CAUSES OF CoNDUCT DISORDER

Exact cause of conduct disoder is not known but ollowing factors act as triggers -

Biological - Injuries to certain areas of the brain which are responsible for behavioural regulation impulse and emotional control can lead to conduct problems.

Genetic- Children / people who have conduct problems often have a family history of mental illness , anxiety or personalty disorders which is clearly evident in Staria's case.

Environmenta- Inadequate or improper family life(evident in Staria's case) physical emotional abuse , traumatic experiences can precipitate conduct problems.

PsychologicL- Children of substance abusers have difficult temperaments and experience poor parenting both of which place them at a risk for failure in school and emotional disturbance which again is evident in Staria's case .

Another feature that is evident in Staria's case is the presence of 'negative affectivity'which means that children of alcohol abusers are also exposed to high levels of life stress and are temperamentally hyperactive to stress.

We can therefore infer that Staria has Adolescent onset of Conduct Disorder.

INTERVENTIONS

Staria needs to be investigated for Co- Occuring Disorder which would help in making a treatment plan and decide whether a referral to a Double Trouble groups is required.

Psychoeducation focussing on the current problem behaviours , there root in familial situation , the impact of family environment , poor parental role models role if genetics to be explained to both the parents.

Family Therapy

Cognitive Behavior Therapy for problem solving .aggression and impulse control for Staria

Skill enhancement hobby development

Medication

Case 2

George according to DSM 5 has Severe Alcohol Use Disorder(AUD) which can be substantiated by the presence of the following behaviours or symptoms in his history.-

1.George has in the last one year had situations where he has ended up drinking more or longer than intended.

2.George has tried to cut down / stop drinking but could not.(Psychological dependence)

3.Realises that drinking or being sick from drinking has interfered with taking care of home , family and work.

4.Wanted to drink so badly that could not think of anything else

5.Has continued drinking even though it was causing trouble with family

6.Has got into situations while or after drinking that increased the likelihood of getting hurt (driving)

7.Has continued to drink even though there are blackouts and health problems

8. Evidence of Tolerance I.e. Need to drink much more than he once did to get the effect he wanted or the usual number of drinks have much less effect

9. There are withdrawal symptoms increased heart rate restlessness memory loss shakiness etc.

There is an evidence of both psychological dependence and physical dependence . Physical dependence is evident by the presence of physiological symptoms and psychological dependence by his preoccupation to drink that he found it impossible to focus on anything else.

According to Jellinek George is in the Chrnic phase of alcohol addiction which includes daily drinking ,drinking is the main focus of life , presence of health problems, cravings, withdrawal symptoms , physical and mental long term alcohol abuse issues.

MANAGEMENT

Intervention would inlclude medication ( disulfiram)and psychological treatment involving psychoeducation , therapies based on classical and operant conditioning models.

Assertiveness Training

Relaxation

Controlled and managed drinking to be explained to him.

Group therapy