Case Conceptualization for Marcus’ Alcohol Disorder

Running head: CASE CONCEPTUALIZATION FOR MARCUS’ ALCOHOL DISORDER 1

CASE CONCEPTUALIZATION FOR MARCUS’ ALCOHOL DISORDER 7

Case Conceptualization for Marcus

Charlotte Wilkins

Nova Southeastern University

June 16, 2019

Case Conceptualization for Marcus’ Alcohol Disorder

Client reported he cannot stop drinking or using marijuana (smokes for depression and anxiety) and cannot stop using Meth. Marcus is 25-year-old Caucasian American who has been struggling with alcoholism since he was 12. Client reported girlfriend is in treatment also. Marcus lost his job because missing work often and showing up to work drunk. This caused him to increase his daily alcohol intake, causing his condition to deteriorate further. As a result, Marcus was referred by his family to Palm Partners for counseling and treatment. Before seeking services at PHC clinic, the client has attempted numerous self – rehabilitation but he had not managed to recover from alcoholism fully or marijuana for depression and anxiety.

History

Marcus was healthy presented, and his hygiene was respectable. He is currently on felony probation. His is cooperating with staff and currently denies suicidal ideation. He has racing thoughts, anxiety, fatigue, mood swings, emotional, restlessness, stress and stress sensitivity, he is very agitated and irritable. Marcus mood is anxious, sad, mood swings, depressed, irritable, calm and happy. His pain level is low, but his cravings are high. His thought process is circumstantial, concentration impaired. Marcus developmental stressors have been identified at all stages of development.

Marcus reports that he first experimented with alcohol during his early childhood age 12, age 16 for meth and marihuana. Marcus was introduced to alcohol by his mother an active addict. Marcus reported mother absent a lot, emotionally disturbed, struggle with education until 11th grade when he quit. From then onwards, he would drink or smoke marijuana whenever available. However, growing up from pillar to post or homeless shelters he began drinking heavily. He was 20 years old and in a troubled relationship with a child. Although Marcus’ heavy drinking was somehow connected to his troubled love life, the condition could also be attributed to family history. For instance, his mother, was also an alcoholic/addict who escaped death twice in accidents caused by driving while drunk and high. He attempted suicide after his best friend who had sold him drugs overdosed and died. He mentioned that this event had a profound impact on is life. Marcus’ dad neglected him, his mother also neglected and rejected him, yet she was still in his life. He had been struggling with alcohol disorder for over a decade.

Other than the biological or family background, Marcus drinks heavily to forget his mother, his baby mama, and his troubled love relationship. He has not been able to sustain positive relationships. He has had over 10 girlfriends and two fiancées who have abandoned in unclear circumstances. At different times, he had moved in with his fiancées, but they could not stay together for long due to substance use. As he argues, he can only avoid mental frustrations caused by his failed relationships and termination from work by drinking heavily (American Psychiatric Association, 2013). Moreover, peer influence also compels him to indulge in alcohol. Over the time, he has made many friends in his drinking sprees. Some buy him shots regularly whilst he has also exhausted his savings on them.

Multi-Axial Diagnosis

As I assessed Marcus, I embarked on a multi-axial diagnostic criterion for his alcohol use disorder. To make a successful diagnosis for his condition, Marcus revealed that, in every drinking session, he takes more alcohol than he could anticipate, his love life has been affected by his alcoholism, he complains his mother is straining him financially as she uses every penny on drugs and alcohol, he/she is consuming almost a gallon of alcohol every day, he has difficulties decreasing his intake alcohol, he has a strong craving for vodka and other spirits, and has perpetually used alcohol even after being diagnosed with depression and anxiety which he smokes marijuana to focus and concentrate. Moreover, he confirmed that whenever he missed drinking, he experienced severe withdrawal symptoms. This included depression and anxiety where he is smokes marijuana to manage daily living. Other withdrawal symptoms included sweating profusely, shaking and mood disturbances, which are all synonymous with symptoms of someone with an alcohol disorder (Berman, 2015). Such mood swings, he says, exacerbates his cravings for alcohol, marijuana and meth. In Addition, from the intake/biopsychosocial assessment, it measures sustenance a diagnosis of (PTSD) posttraumatic stress disorder 309.81 (F43.10). Marcus, experiences dreams and nightmares of his best friend lying dead with needle in his arm. Marcus exhibited evidence of emotional breakdowns, depression and anxiety and fear of best friend family.

Treatment Goals and Objectives

Marcus’ treatment will focus on augmenting social support besides endeavoring to develop a sense of productiveness (APA, 2013). Thus, his treatment goals will include:

Goal 1: Consistent abstinence from alcohol for the entire duration of treatment and counseling;

Goal 2: Increasing his social support so that he can get along well with his family and potential girlfriends or fiancées;

Goal 3: Increase his sense of industriousness. Specifically, this will help him to explore his career interests with an aim to return to the labor market either as an employee or self-employed.

Goal 4: Verbalize the powerlessness and unmanageability that result from using addictive behavior to cope with depression.

Goal 5: Identify the pattern of using drugs or alcohol abuse as a means of escaping from depression and verbalize more constructive means of coping.

Goal 6: Maintain a program of recovery, free from addiction an excessive anxiety.

Goal 7: Assist the patient by educating and encouraging him of dysphoric mood due to grief, and come to the understanding (that selling the drug is not what killed his best friend, what he did was wrong by law, but it is not his fault for the overdose). Marcus will then begin to understand the trauma of bad dreams and nightmares.

Accordingly, these goals will be monitored even after the client has left PHC to ensure he does not go back to alcoholism or substance use. Therefore, in future, the treatment plan for Marcus will entail attending counseling sessions regularly of group therapy, psychotherapy and pharmacotherapy to ensure he is permanently cured of his disorder. With this combination Marcus will develop coping strategies for thoughts of death, flashbacks, and skills to self-control his self-defeating behaviors and feelings.

Theoretical Approaches

Cognitive Behavioral Therapy (CBT) is the theoretical approach that will be utilized to help the client to understand his condition. Marcus’ family background and exposure to an alcoholic/substance abuse mother and peer pressure have created cognitive emotions that make him to take refuge in alcoholism. This theoretical perspective (CBT) will help in addressing and changing his thinking patterns and habits associated with alcoholism. Martin (2019) explained that “Cognitive Behavioral Therapy (CBT) is a short-term, goal-oriented

psychotherapy treatment that takes a hands-on, practical approach to problem-solving”.

Cognitive Distortions

Marcus is experiencing some cognitive distortions due to his depression and anxiety issues. As distortions, his thought pattern is flawed, and it leads to making some wrong decisions. Some of the distortions that Marcus is experiencing are:

1. Control Fallacy

This situation is brought about in the situation where he feels that he must be in control of every situation around him. This has in the past led him to give money to his mother to fuel her alcohol and other drug problems, and this has left him financially drained. It has also affected his planning and formulation of positive ideas that can help in his life, since he feels that every situation that happens around him is tied to him and therefore, he must do something about it.

2. Catastrophizing

In this situation, Marcus’ ability to make long term or even short-term goals is affected. He is constantly battling feelings that tragedy is going to happen in his life. This can be majorly attributed to the kind of past that Marcus has had with his parents, also his work, his love life, and even his social life. At every turn, he seems to face a stumbling block, and this pushes him back a step. He cannot make long term of even short-term goals because he expects that something might go wrong in the end. In addition, Marcus still believes that it is his fault that his best friend died because he sold him the drugs.

In conclusion, some traumatic circumstances with post traumatic syndrome disorder, alcoholism, substance abuse will lead to depression and anxiety, but Marcus will develop a reality based positive cognitive message which will increase his self-confidence in coping with irrational fears by utilizing Individual Therapy, Core Group, Behavior Group, Emotions, Feelings and Coping Strategies Group to not only identify but handle situations, problems and circumstances with healthy defense mechanisms.

References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Publishing.

Berman. (2015). Developing case conceptualizations and treatment plans. Sage Publications, Inc.

Martin, B. (2019). In-Depth: Cognitive Behavioral Therapy. Psych Central. Retrieved on June 16,

2019, from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/