Joanna’s Drinking and Drug Abuse Problems: Case Study

Introduction

Joanna Smith (the name of the client is changed) is a 27-year-old White female who suffers from substance abuse and has a drinking problem. Joanna complains of the impossibility to start her day without several low-alcohol drinks or cocktails and without smoking marijuana. The client lives alone in a large city, she rents apartments in the remote district of the city. The purpose of this case study analysis is to present the case related to Joanna’s drinking and drug abuse problems with a focus on a certain case presentation format, possible diversity issues, the ASI sections, a master problem list, interventions, ASAM criteria, and referrals.

Substance Abuse History

Joanna consumes one or two low-alcohol drinks or cocktails every morning after waking up or every day. The client also drinks three or four spirits (vodka, whisky, and tequila) about two or three times per week. Joanna started to drink alcohol following her current pattern one year ago when she moved to a large city and began to work as a dancer in a nightclub. During that period, Joanna also started to smoke cannabis on a regular basis: one or two cigarettes filled with cannabis every morning or day. The woman continues drinking alcohol and using cannabis on a regular basis, and she reports having frequent episodes of vertigo and headaches associated with alcohol consumption.

Three years ago, the client used methadone (non-prescribed oral administration, high doses) about seven or eight times per week for eight months. Joanna started to use non-prescribed methadone that was provided by her friend to achieve the effect of euphoria, to become more energetic, and to cope with panic attacks. It is possible to state that, currently, the client’s primary substance of abuse is alcohol. It is important to note that the effects of consuming alcohol and cannabis on a regular basis during a year include alcohol tolerance and an irregular heart rate (arrhythmia). According to the ASI (Addiction Severity Index), the severity rating for substance and alcohol abuse can be determined as 8.

Psychological Functioning

In the past, Joanna was diagnosed to have a panic disorder associated with frequent panic attacks and anxiety. Panic attacks caused significant problems for the client because they could last from several minutes to several hours, and the woman mostly experienced them outside that led to additional problems for her to become concentrate and rest. Currently, the client sometimes experiences panic attacks, but she cannot control them. Joanna is oriented, and she makes good eye contact. The client rejects having any hallucinations and delusions in the past and now, and she also rejects having any suicidal or homicidal ideations. Currently, Joanna is mildly anxious, her speech is spontaneous, she is not depressed, and she has some problems with concentrating. According to the ASI, the severity rating can be determined as 7.

Educational, Vocational, and Financial Status

Joanna has a high school education, and she did not attend college, but she has completed the training as an accountant sponsored by a community non-governmental organization for high school graduates. The client also attended a community dancing school that allowed her to develop skills in different dancing styles. After graduating from high school, Joanna worked as a waitress in local cafés and then as a bartender in a restaurant for five years, but she was fired when managers noticed that she consumed alcohol in the workplace. During that period, Joanna used methadone, but she was able to keep this fact hidden. After being terminated, the client borrowed some money from her parents and friends and moved to a large city where she currently lives.

After moving to another city a year ago, Joanna was able to find a position as a dancer in a nightclub with a good reputation. During an interview with an HR manager, the client concealed the fact that she could consume alcohol in the workplace and was treated because of her methadone dependence. Joanna works as a dancer in the same nightclub for a year, she reports stability in her financial status, and she does not plan to change her job in the nearest future. The client works in the club four times per week, and she receives a wage equivalent to three average salaries in her state. She makes savings to pay for additional training and seminars when required, but she does not know what occupation she wants to have in the future. The client’s ASI severity rating can be determined as 5.

Legal History

Referring to the ASI results, it is possible to determine the client’s legal status. Joanna was arrested once a year ago for driving under the influence of an extremely high dose of methadone. The client was arrested when she almost caused a car accident because of inaccurate lane use. Joanna drove at high speed, and she tried to change the lane ignoring rules and other cars on the road. After being arrested, it was found that Joanna was not under the influence of alcohol, but her behavior was affected by a high dose of methadone. The client reported the altered perception of distances, she had blurred vision, and she was extremely energetic.

For driving while being intoxicated or under the influence of methadone that caused the same effects, Joanna was convicted and paid a fine. The client decided to find appropriate treatment options for her after that situation. Currently, Joanna has no other legal problems or arrests. Still, it is important to note that she was at risk of being arrested for smoking cannabis in public places several times, but Joanna does not discuss these situations as requiring her attention. According to the ASI, the severity rating can be stated as 7.

Social History

Before moving to another city, Joanna lived with her parents and a younger sister. Joanna’s father is retired, and he worked as an engineer in a privately owned company for fifteen years. The father has a history of alcohol abuse, he regularly drank beer and spirits for ten years, and he was never treated. He consumed about two standard drinks of beer (500 ml each) or one standard drink of spirits (50 ml) every evening. The client’s mother was a housewife for thirty years, she had no alcohol or drug abuse problems. Joanna’s sister is 15 years old, and they were never close because of the age difference.

Joanna reported that the relationships in their family were not negative because there were no scandals or conflicts. The parents did not quarrel, but the client often noticed her mother crying. Psychosocial functioning in the family cannot be described as positive as the family members chose not to discuss their problems openly, and they had hidden conflicts and dissatisfaction. The family belonged to the lowest layer of the middle class in their city, and they could not afford a college education for their children.

After moving to another city, Joanna almost ceased communication with her family when she gave the borrowed money back. Currently, Joanna has no her own family, and she has no regular partner. She reported having problems with developing relationships with men because of her occupation. Joanna stated that she met all her boyfriends in the workplace, and they usually were the clients of the restaurant or the nightclub where she worked or currently works. Her relationships were not prolonged, and the longest relationships lasted three months, but Joanna suffered from sexual and emotional abuse in those relationships. They were ceased when the woman reported the problem to her manager who prohibited her boyfriend to visit the nightclub as a regular client. According to the ASI, the severity rating can be discussed as 7.

Physical History

Joanna noticed having frequent signs of vertigo and headaches associated with her alcohol consumption that do not cease for days. As a result of this physical condition, she experiences problems during her work (dancing), and she is afraid of falling because she cannot appropriately control her movements. Joanna usually smokes cannabis after waking up to cope with her headaches, but her vertigo seems to worsen after smoking. To feel better before going to work, the client drinks one or two cocktails, and this act seems to relieve her symptoms. Joanna reported alcohol tolerance and arrhythmia, and she also noticed abdominal pain in the upper left quadrant that seemed not to stop during the past four months. The client reported the loss of appetite during this period because eating seemed to be associated with more pain after meals, but sometimes eating helped relieve intense pain.

Discussing Joanna’s major medical problems, it is important to note that the client was diagnosed with a kidney stone disease five years ago and a high blood sugar level that required monitoring because of the risks of developing type II diabetes. Joanna was prescribed to follow a diet and consume some medications to address her problems, but she did not complete treatment courses. Joanna has no other diseases affecting the quality of her life or requiring specific treatment. The client was not pregnant in the past, and she has no disabilities, and according to the ASI, the severity rating is 7.

Treatment History

Three years ago, Joanna suffered from methadone dependence, and she was treated with the help of counseling after consuming this non-prescribed drug for eight months. She was never hospitalized because of these problems, and she did not complete the course of sessions offered by a counselor to address her drug-related problem. Joanna visited seven counseling sessions out of nine that were initially prescribed by her counselor. The client refused to visit her counselor after she had noticed the first improvements in her physical and psychological state. After those counseling sessions, Joanna never tried to use methadone or other similar drugs again.

The client did not receive any treatment associated with her alcohol problems in the past because she began to consume alcohol regularly only about a year ago. Before moving to the city where Joanna lives now, she primarily drank low-alcohol drinks one or two times per week, and she did not view that behavioral pattern as risky for her. Therefore, Joanna did not ask for help to resolve her alcohol-related problems in the past, and she understood the necessity of receiving treatment only two months ago when she noticed vertigo after drinking alcohol that did not cease after sleep.

Three years ago, Joanna was also treated for a panic disorder associated with frequent panic attacks that the client tried to address with the help of consuming methadone, as it was found during counseling sessions. The client stated that her panic disorder was not successfully treated with the help of sessions, and she experienced several panic attacks during the recent three years. Still, Joanna noted that she learned how to recognize attacks with the help of received counseling, and their duration decreased. Currently, she does not receive any treatment related to this psychological problem.

Assessment

Strengths

Joanna’s strengths include her desire to cope with her alcohol and drug consumption problems. The client understands the necessity of being treated, and she seems to be highly motivated to receive a counselor’s assistance. The client is motivated to be treated because of her fear to lose her job due to experienced physical problems (episodes of vertigo and headaches). Joanna demonstrates minimal resistance to any proposed treatment options, and she asks about details associated with different treatment plans.

Weaknesses

In the past, Joanna did not complete her treatment plans related to her drug abuse and psychological problems. In addition, the client has no appropriate social support system in order to continue treatment when she does not have enough motivation. There are risks that Joanna will not attend all counseling sessions or will not follow all prescribed procedures in order to cope with the identified problems.

Needs

To cope with her alcohol- and drug-related problems, Joanna needs to become more focused on following treatment plans strictly. She needs the assistance of a counselor to remain motivated during a long period of time and attend all required counseling sessions. In addition, the client needs to restore her relationships with her family and close relatives to receive the required social support. Joanna also needs a psychiatrist’s consultation to overcome panic attacks.

A Master Problem List

1. The client’s drinking behavior is risky or hazardous.
2. The client has a drug abuse problem related to her smoking cannabis (a moderate level).
3. The client suffers from panic attacks.
4. The client suffers from frequent episodes of vertigo and headaches.
5. The client suffers from alcohol tolerance and arrhythmia.
6. The client has the symptoms of possible pancreatitis, gastritis, or ulcer disease, and further examination is needed.
7. The client is at risk of worsening her symptoms of kidney stone disease and high blood sugar because of the lack of monitoring.
8. The client suffered from sexual and emotional abuse in her relationships in the past.
9. The client lacks a support system.

Treatment Plan

Among the identified master problems, it is important to focus on providing solutions to health and psychological issues related to alcohol consumption, drug abuse, and panic attacks. These three problems should be identified as needing immediate resolution with the focus on the results of the ASI assessment and the ASAM level for choosing effective interventions. According to the ASAM patient placement criteria, it is possible to assign Joanna to Level 2.1 (Intensive Outpatient Services) because she needs more than nine hours of service per week to receive intensive support and care. Long-term and short-term goals and objectives should be determined for the treatment process along with appropriate interventions and procedures. There are no diversity issues related to the case that can influence the proposed treatment.

Problem 1: The client’s drinking behavior is risky or hazardous

Goal: To cease Joanna’s alcohol consumption with the help of provided guidance and counseling.

Objectives:

1. By the end of two weeks of counseling, the client will verbalize her understanding of dependence and determine personal goals to stop drinking.
2. By the end of eight weeks of counseling, the client will significantly reduce the frequency of alcohol consumption in relation to low-alcohol drinks and spirits.
3. By the end of eighteen weeks, the client will completely stop alcohol consumption in relation to low-alcohol drinks and spirits.

Interventions:

1. Individual therapy with a counselor will be used during the first eight weeks of the treatment in the context of intensive outpatient services.
2. Motivational interviewing.
3. Cognitive-behavioral therapy will be applied during the first eight weeks of the treatment.
4. Group therapy will be applied during weeks 9-18 in the context of intensive outpatient services and after the completion of the treatment.

Problem 2: The client has a drug abuse problem related to her smoking cannabis (a moderate level)

Goal: To cease smoking cannabis as a result of provided guidance and counseling.

Objectives:

1. By the end of two weeks of counseling, the client will determine personal goals for ceasing marijuana consumption and develop a plan.
2. By the end of four weeks of counseling, the client will eliminate potential triggers for smoking cannabis in the morning and during the day.
3. By the end of eight weeks of counseling, the client will report decreasing the frequency of smoking cannabis.
4. By the end of twelve weeks of counseling and therapy, the client will cease smoking cannabis.

Interventions:

1. Individual therapy with a counselor.
2. Motivational interviewing.
3. Group therapy during weeks 8-12.

Problem 3: The client suffers from panic attacks

Goal: To decrease the frequency of panic attacks with the help of provided guidance and counseling.

Objectives:

1. By the end of two weeks of therapy, the client will determine possible triggers associated with anxiety and panic attacks.
2. By the end of four weeks of therapy, the client will report improvements in her psychological state.
3. By the end of twelve weeks of therapy, the client will report decreases in the number and duration of panic attacks if any.

Referral: Joanna will receive assistance in the context of the therapy provided by a psychiatrist specializing in treating anxiety and panic disorders.

Interventions:

1. Individual therapy with a psychiatrist.
2. Cognitive-behavioral therapy.
3. Relaxation training.

Course of Treatment

To address Joanna’s alcohol- and drug-related problems, it is effective to apply interventions in the context of the ASAM Level 2.1 (Intensive Outpatient Services). Depending on the client’s history of treatment, it is necessary to control treatment and guarantee the monitoring of her recovery with the help of intensive services (Ries, Fiellin, Miller, & Saitz, 2014). Individual therapy with a counselor will be used for treating both alcohol- and drug-related problems because of the necessity to increase the client’s motivation. For this purpose, motivational interviewing will also be applied as one of the counselor’s approaches (Maisto, Galizio, & Connors, 2018; Perkinson, 2017). Cognitive-behavioral therapy will be effective for changing behavioral patterns associated with Joanna’s drinking (Muskin, 2015). Group therapy will be used for treating alcohol consumption and drug abuse problems to help the client control her behavior and organize self-monitoring (Smith, 2017). This approach to therapy is effective at the final stages of treatment. Psychological issues associated with Joanna’s panic disorder will be treated under a psychiatrist’s control and guidance.

Discharge Summary

Joanna is motivated to receive treatment and assistance because of her fears associated with her physical state and episodes of vertigo and headaches provoked by her alcohol and substance use. She is able to monitor her drinking behavior, and she can easily cease smoking cannabis after discussing the physical effects of this habit, as well as alcohol consumption, on her health, memory, motor behavior, and reactions. By the end of the treatment, there are minimal risks of continuing alcohol consumption according to the current pattern, but there are still high risks of starting smoking cannabis again.

Conclusion

The current report has presented the case study analysis related to Joanna Smith and her problems with alcohol consumption and drug abuse. The key focus has been on the analysis of her drug and alcohol use status, along with mental, family, legal, and social status, according to the ASI assessment. As a result of conducting this assessment, a master problem list has been formulated. Interventions and an appropriate treatment plan have been proposed to address the determined problems.

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.