Addiction Treatment Plan

Running head: ASSESSMENT OF ADDICTION 0

Assessment of Addiction and Co-occurring Disorders

The assessement forcuses on an in-depth analysis of a case study of Tyrell, a 30-year-old African American who has shown signs of alcohol substance abuse and concurring disorder. Dual diagnosis or concurring disorder is a condition when an individual has a drug problem alongside mental disorder. Alcohol addiction and concurring alcohol disorders show different aspects that affect the way a person functions. Comorbidity is the presence of these two conditions in an individual, and the understanding is imperative in prevention and effective treatment efforts. Tyrell bursts to the waiter and a couple of friends after taking alcohol, and it is the intervention of the boyfriend which calms him down. Since the conditions often occur simultaneously or sequentially, it can lead to severe medical and psychiatric conditions. In the case scenario, James described Tyrell’s behavior as explosive. It is estimated that 1.1 percent of the US population is struggling with alcohol use disorder alongside concurring disorder which is known as dual dependence (Roerecke & Rehm, 2013). For people who actively use drugs or withdraw from drugs, they can simulate psychiatric disorder symptoms as well.

Addiction Assessment or Screening

Screening alcohol disorders are done through questionnaires which may be one simple question to a more extensive assessment. The one simple question tool is applicable if there is less time where all that matters is a positive response to questions asked. For instance, the question may seek to establish if in the past three months a person has taken more than five alcoholic drinks on one occasion. A positive response to this issue meets the criteria set by NIAAA in the document Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV), putting them at risk for drinking and alcohol dependency or abuse (Earle, 2014). The questionnaire can be administered by integrating into the pre-exam interview.

In the case study, the CAGE questionnaire can be administered due to its simplicity, briefness, short to master and the proven effectiveness in detecting some alcohol-related problems. The CAGE is a four-acronym screening tool for alcohol, which stands for concern/ cut-down, anger, guilt, and eye-opener. Its advantages include excellent sensitivity and specificity. Additionally, no complex training is required to administer the CAGE. However, concerns have to do with examining a slight range of diagnostic symptoms associated with alcohol dependence and abuse. Also, it fails to determine patterns accurately. There are also longer tests such as the Michigan Alcoholism Screening Test (MAST) which consists of 25 questions about drinking behavior and other alcohol related problems which are self-administered. It uses the yes/no format that inquires information from the patient.

Moreover, in the case scenario, it can be useful in helping determine if Tyrell is dependent on alcohol. Both sensitivity and specificity in identifying alcoholism are real. It also does not require any training to administer. Concerns of the tool have to do with recent studies which have found the screening instrument less useful ("Supplemental Appendix S12: Mental Health Screening and Assessment Tools for Primary Care", 2010). The tool has a higher sensitivity to specificity which has led to the mistaken identity of individuals who are non-substance abusers as potential substance abusers. Additionally, there is no timeframe for a response, and it is limited to alcohol-related problems.

Assessment of Co-occurring Mental Health Issue

Modified Mini Screen is designed to identify anxiety, mood and psychotic disorders using a 22-item scale to assess the person. The benefits of the MMS is that it can be administered in a short time and the score obtained within a timeline of 5 minutes. According to validation studies, it is very reliable, sensitive and accurate. Training is brief and works well for the African American and Caucasians. It can be considered in the case scenario. However, the available sample is in Spanish and small to infer the same performance for both African American and Caucasian groups.

The original design of the Mental Health Screening Form MHSF III was a rough screening device administered to persons who were seeking admissions to substance abuse treatment programs. It is 17 yes/no questions which can be utilized in the case scenario to identify symptoms of mental disorders. The advantage includes more content validity and test reliability. The screening is administered in 15 minutes, and positive response can be followed by questions about intensity, duration, and concurrences of the symptoms ("Supplemental Appendix S12: Mental Health Screening and Assessment Tools for Primary Care", 2010). However, one of its concern is the better performance in mental health related screening only.

Assessment of Risk of Harm

The best tool for determining the level of alcohol risk is the AUDIT. The World Health Organization developed the tool and first administered it to a population of 2000 as a test to determine alcohol use and disorders. It consists of two parts, the first a ten-item questionnaire measuring dependency symptoms, consumption problems and challenges caused by use. Then the second part abnormal physical exam findings and trauma history because it is a physical examination instrument. It is advantageous because the tool is easy to administer. In detecting substance abuse problems, the tool has high sensitivity, and its record in research has a proven track record (So & Sung, 2013). However, the concerns include a reasonable specificity and it cannot detect substance abuse problems before one year.

FAST (Fast Alcohol Screening Test) consists of four items taken from the AUDIT test. By using the first question, 50 percent of the patients are identified. To take the first question will determine whether the rest of the questions will be answered. The design it to make fast assessments and identify hazardous drinking. It is possible to measure hazardous drinking in the past 12 months by the tool.

Results of Assessment

Using the DSM-5 manual Tyrell has alcohol disorder or substance use disorder. It describes a problematic pattern of use of alcohol up to the point where the daily life is impaired or obvious distress. Tyrell is distressed and ends up in club brawl and confrontations with people. It is the case with most people who use alcohol that they continue to use the drug anyway. The criteria for DSM-5 in determining alcohol disorder consists of characteristics which must be cognizant in the person (Agrawal, Heath, & Lynskey, 2011). Like in the case scenario, the first criteria are based on the continued effect of the drug on others which include fight. After usage of the substance, there is also withdrawal symptoms which include tremor, vomiting, irritability and anxiety.

There are 11 symptoms which a patient must show so that they are diagnosed. The DSM-5 defines the criteria as showing tolerance to a drug or alcohol use. In this case, a significant amount of alcohol is involved so that the patient gets the desired effect. Sometimes these people just leave activities or give up on things just because they do not feel like attempting them. Despite having health problems, patients who continue to use drugs show signs of psychological problems, anxiety and sleep disorders (Earle, 2014). Tyrell’s case study reveals that he works for long hours and sleep deprivation is part of his life. He was first diagnosed while in high school, and the patient has continued to use the drugs. This has had a bad effect on his health.

Medical treatment options available for treatment of alcohol disorder mean that detoxification of the patient is necessary. Laboratory tests are mandatory primarily to determine the condition of the liver and nervous system. Using chlordiazepoxide is a mode of treatment but depends on testing positive for alcohol withdrawal signs. Heavy drinking by the patient during treatment period must be avoided at all costs. Tyrell needs enlightenment that addiction is a moral failure, and the families, spouse, and friends need information so that they offer support during the recovery process. Clinicians can conduct alcohol blood test which may be very useful in determining relapse and essentially, exercise is important.

Description of Client Strengths

The client is a thirty-year-old African American, educated and with a supportive partner. Additionally, the family knows about the condition and readily provides information about the state. Therefore, in the case scenario family and spouse is a major factor. James the gay partner to the client is very resourceful. The clinician can partner with the family and James to ensure that drinking is controlled and help in educating the patient about addictions. If properly trained, the family can be resourceful. Apparently, Tyrell can work at a prestigious law firm despite the condition and can change because most of the time he responds well to James’s reactions.

Description of Challenges to be Addressed

One of the greatest challenges that the patient is faced with is the risk of harm. It is not once or twice that Tyrell has got into a fight or confrontation with people. The patient in the case scenario may be exposed to danger when they engage in such impulsive behavior. Most of the time he fights even when the other person backs off. Additionally, the addiction might have made Tyrell use substances which may be risky to the health of the patient. Another challenge is the part of the family. Tyrell’s disorder first triggered in high school, and he had to see a doctor remain in school, and now they describe the new incident as purely something that blew out of proportion and attributable to the stress of joining law school. That may not be the case based on the criteria identified by the range of assessment tools. So to get the family into involvement is a difficult task and another issue has to do with Tyrell’s sexuality.

Recommended Level of Care

The recommended level of care is based on the six dimensions in ASAM criteria. It is aimed at addressing various patient needs, liabilities and obstacles. Individual unique relationship with relapse should be explored the same to continued use and problems (Stallvik, Gastfriend, & Nordahl, 2014). The level of care involves looking at the living condition or recovery and the people that surround the person all need exploration in level care.

According to the ASAM criteria, which is an effective outcome-oriented and results based care for dealing with addiction, Tyrell is recommended some levels of care. Tyrell diagnosis and treatment should be based on past experiences of substance use and withdrawal. For example, the incidences in which he fought and confronted other people. The current physical situation and health history are important in the treatment. For this reason, the family should be actively involved and provide the necessary documents. Additionally, the clinician must assess the level of mental stability, emotions, and thoughts of the individual (Stallvik et al., 2014). In the case scenarios, it is recommended to look at whether Tyrell is willing to change and continue with a normal lifestyle.

References

Agrawal, A., Heath, A., & Lynskey, M. (2011). DSM-IV to DSM-5: the impact of proposed revisions on diagnosis of alcohol use disorders. Addiction, 106(11), 1935-1943. http://dx.doi.org/10.1111/j.1360-0443.2011.03517.x

Earle, W. (2014). DSM-5. The Philosophical Forum, 45(2), 179-196. http://dx.doi.org/10.1111/phil.12034

Roerecke, M. & Rehm, J. (2013). Alcohol use disorders and mortality: a systematic review and meta-analysis. Addiction, 108(9), 1562-1578. http://dx.doi.org/10.1111/add.12231

So, K. & Sung, E. (2013). A Validation Study of the Brief Alcohol Use Disorder Identification Test (AUDIT): A Brief Screening Tool Derived from the AUDIT. Korean Journal Of Family Medicine, 34(1), 11. http://dx.doi.org/10.4082/kjfm.2013.34.1.11

Stallvik, M., Gastfriend, D., & Nordahl, H. (2014). Matching patients with substance use disorder to optimal level of care with the ASAM Criteria software. Journal Of Substance Use, 20(6), 389-398. http://dx.doi.org/10.3109/14659891.2014.934305

Supplemental Appendix S12: Mental Health Screening and Assessment Tools for Primary Care. (2010). PEDIATRICS, 125(Supplement), S173-S192. http://dx.doi.org/10.1542/peds.2010-0788r