Analyzing Multiaxial Diagnosis - Essay Example

Addiction Counselling Q The DSM-IV requires a multiaxial diagnosis, ly an assessment of the client’s functioning in five different areas or axes. Using the DSM-IV, how would you code Michael’s condition on 5 axes? Provide the numerical code for your diagnosis and describe the symptoms. Axis I – V Numeric Code Diagnosis Symptoms Axis I – Clinical disorders or conditions that are the primary focus of clinical attention 296.34 Major depressive disorder, recurrent. Severe with psychotic features Regular depressive symptoms like fatigue, sense of hopelessness, loss of appetite, insomnia, and fleeting suicidal thoughts. Streak of violence directed at family members especially on Clyde. Suspects Mary to have extra marital affair with a colleague with no evidence. 305.00 303.90 Alcohol abuse Alcohol dependence Uncontrollable drinking habit; drinking alone; decrease work productivity; increase involvement in traffic accidents Strong cravings for alcohol consumption; increasing consumption of alcohol. (Help Guide, 2008) 305.20 304.30 Cannabis abuse Cannabis dependence Increase in frequency of using larger amount of cannabis combined with the patient’s inability to control or cut down the use of the drug. (Caron Treatment Centers, 2006) Strong cravings for Cannabis; increasing dosage of Cannabis inhalation. 305.50 304.00 Opioid abuse Opioid dependence (Subutex) Overdose on Subutex can be fatal when used with a tranquilizer and cause him to experience sleepiness and/or become dizzy especially when taken with alcohol, cannabis, and/or dormicum (Drug Abuse Help, 2008) Strong cravings for Subutex intake; increasing dosage of Subutex intake. 305.40 304.10 Dormicum abuse Dormicum dependence Can be life-threatening when combined with the use of alcohol and other anti-depressant drugs; drowsiness, mental confusion, lethargy, ataxia, hyotonio, hypotension, respiratory depression, and possible coma. (Pharmaenergy, 2008) Strong cravings for Dormicum intake; increasing dosage of Dormicum intake. Axis II – Personality disorders or mental retardation V71.09 No Diagnosis of Axis II n/a Axis III – General medication conditions and physical disorder 291.00 Alcohol withdrawal Sleeplessness, lack of appetite, tremors, convulsions, hallucination, continuous sweating, and/or death caused by liver cirrhosis or heart diseases. (Drug Abuse Help, 2008; Addiction Research Foundation, 2003) Cannabis withdrawal Sleep disturbances, emotional and physical irritation, the sudden loss of appetite, nervousness, excessive sweating, anxiety, including some occasion of upset stomach, tremors, and chills (Drug Info, 2008) 292.0 Unbearable opioid withdrawal symptoms Respiratory depression which can lead to Michael’s untimely death and acute hepatic injury or failure in case he does not gradually withdraw from the intake of Subutex (Schering-Plough, 2008) 292.81 Dormicum withdrawal delirium Increased level of anxiety, headache, extreme anxiety, tension, sleepiness, weak and poor muscle coordination, confusion, irritability, becoming dizzy, and having an impaired judgement among others (Novus - Medical Detox Centers, 2007). Immediate withdrawal from the use of Dormicum leads to unexplainable seizures in case the patient has a history of epilepsy. (Pills for All, 2008) Axis IV – Psychosocial and environmental problems or concerns 301.83 Borderline personality disorder Disturbance in patient’s personality which resulted to unstable interpersonal relationship with family members and his boss. Axis V – A global functioning assessment for children below 18 y/o n/a n/a n/a Q.2 Michael gives a history of continual use during the past year of Subutex, Dormicum, Cannabis, and alcohol. He insists that he can “get off them all” by himself. You need to explain to him the special danger of withdrawal from one of the four drugs he is abusing. Identify the drug and give reasons why withdrawal from this drug can be dangerous? Subutex® is a buprenorphine hydrochloride product that is commonly used in treating heroin which is also known as opioid or opiate drug addiction. (Center for Drug Evaluation and Research, 2008; Patient UK, 2008) The over use of Subutex will not cause serious organ damage but it can increase the patient’s risk to develop liver-related diseases (CSAT Buprenorphine Information Center, 2008). The problem with Michael’s case is that he is abusing the intake of Subutex with the use of heroin, alcohol intake and other drugs. As a precautionary measure, Michael should be informed that the overdose of using Subutex can be fatal especially when used with a tranquilizer and cause him to experience sleepiness and/or become dizzy especially when taken with alcohol, cannabis, and/or dormicum (Drug Abuse Help, 2008). Since Michael is very much dependent with the use of Subutex, he is likely to experience disturbing withdrawal symptoms like hypoventilation – also known as respiratory depression and acute hepatic injury or failure in case he does not gradually withdraw from the intake of Subutex (Schering-Plough, 2008). Respiratory depression occurs when the patient experience inadequate ventilation or breathing which could cause the patient to have a significant increase of carbon dioxide concentration in the human body aside from having a possible respiratory acidosis. (White, 2008; Eilers & Schumacher, 2004) Subutex is not the only drug that can cause Michael to experience respiratory depression. His regular intake of alcohol, Dormicum also increases his risk to experience the negative health consequences of hypoventilation. (Pills for All, 2008; White, 2008) Without proper medical help or assistance, hypoventilation can lead to Michael’s untimely death. Q.3 Mary’s supportive role is viewed as critical to Michael’s chances of recovering from substance abuse. One of the purposes of family counselling is to educate family members about addiction and the family dynamics associated with both addiction and recovery. What are some topics you would include in a drug education programme for family members? Among the useful topics that I will include in a drug education programme for family members includes the following: (1) Types of drug abuse, the external and internal factors that triggers addiction, and the differences between drug abuse and drug dependency (Kolmac Clinic, 2008); (2) Social, economic, and health disadvantages of drugs and alcohol addiction; (3) Overview with regards to the importance of family program; (4) Importance of emotional and social support during the patient’s recovery period; (5) The process of treatment options like drugs and alcohol detoxification and the impact drug withdrawal over the patient’s emotion, physical, and psychological condition; (6) Discussing the psychological, medical, and spiritual influences of drug and alcohol addiction on the part of the patient and his family as a whole (Support Systems Homes, 2008); (7) Real-life success story with guest speaker who was a former drug and alcohol addict; and (8) Introducing the family to social network within the community. Discussing the different types of drug and alcohol abuse, the factors that triggers addiction, and the differences between drug abuse and drug dependency aside from the importance of emotional and social support during the patient’s recovery period will enable the family members to have a better understanding on possible reasons that made Michael become addicted not only to drugs but also in drinking alcohol. Allowing the family members to understand the process of treatment options like drugs and alcohol detoxification as well as the impact drug withdrawal over the Michael’s emotion, physical, and psychological condition will enable his wife Mary to become more understanding with her husband’s case. With a strong emotional support coming from Mary, it would be so much easier on the part of Michael to be more determined with his decision to seek medical help for his drug addiction. The fact that Michael has tried to control his heroin addiction made him become addicted to other drugs that can help him cut off his urge to use heroin again is a good sign that Michael is decided to quit the use of illegal drugs. In line with this matter, tackling the social, economic, and health disadvantages of drugs and alcohol addiction can be useful in terms of convincing Michael to make a firm decision to cope with the physical and psychological stress associated with his effort to withdraw from the use of excessive drugs and alcohol intake. Giving the family members a quick overview with regards to the purpose and importance of family program will enable them to have a better idea with regards to the counsellors’ role in assisting the family as the patient undergoes the process of drug and alcohol rehabilitation. Allowing someone who is a former drug and alcohol addict to share with the family the speaker’s real-life success story will encourage Michael and the family members to actively participate in the rehabilitation program. Lastly, introducing the family members to the available social networks on drugs and alcohol addiction within the community will enable them to talk with other people with the same problems they are going through. Q.4 You are asked by Michael whom you have been working with for two months on an outpatient basis to get his family in for marital counselling sessions. Even though you have worked as an addiction counsellor for the past one year, you have never had any formal experience with family counselling. Being ethical counsellor, how would you respond to the client’s request? Being an ethical counsellor, I will remind Michael that my profession is an addiction counsellor. Since Michael is a client and has requested me to convince his wife Mary to participate in a marital counselling program, I will inform Michael that I will do my best to communicate with his wife. First, I will contact Mary and tell her my profession as an addiction counsellor and that Michael has been seeing me for two months on an outpatient basis. Right after introducing myself to Mary, I will tell her that her husband requested me to talk with you about going with Michael on a marital counselling program. Since my profession and expertise is on addiction and not a marital counsellor, I will have to tell Michael that I can refer him to a marital counsellor. Given that marital counselling is outside my qualification, profession and expertise, it is but ethical on my part not to pretend or claim someone I am not. Basically, it is good to help clients who are asking for help but there will always be a limit with everything especially when trying to act on serious matter such as marital counselling. Q.5 Mary has disclosed to you that Michael tends to punish their 8 year old son, Clyde excessively on few occasions, with the most recent incident happening a week ago when Clyde with punched in the eye for disobedience. What responsibility or duty, if any, do you have to the child? Even though Michael is my client as addiction counsellor, it is another thing to learn from Mary that Michael has been physically abusing his own child. As a community member and a concern citizen, it is part of my responsibility and duty to protect the innocent child from being emotionally, verbally, and/or physically abuse by any person regardless of whether the abuser is a family member or not. Since Mary as the mother of Clyde is very much concern with the physical and emotional development of her child, the least that I can do is to remind Mary about the public campaign of National Society for the Prevention of Cruelty to Children (NSPCC) on issues related to child abuse throughout the geographical boundary of London, Midlands and West, North, Northern Ireland, Scotland, South and East, and Wales (NSPCC, 2008a & 2008b). In general, the main purpose of NSPCC campaigners for children is to give courage to children, young adults, and family members who either have been a victim or knows anyone who is a victim of domestic abuse to speak up against the person who abuses the child physically, verbally and/or emotionally. By calling ChildLine at contact number 08001111 and NSPCC HelpLine at 0808-800-5000 including NSPCC’s online and text message services (NSPCC, 2008c & 2008d), Mary can seek guidance and/or advice on what to do with her family problem. Right after Mary has reported the case of Clyde and his abusive father to NSPCC volunteer counsellor, NSPCC advocates can extend their support to Mary by giving her advices on issues related to family-related problems including emotional or physical abuse on children (NSPCC, 2008e). Eventually, NSPCC’s volunteer counsellors will help Mary solve her problem depending on what they would agree upon. *** End *** References: Addiction Research Foundation. (2003). Retrieved October 1, 2008, from Facts about Alcohol: http://www.erowid.org/chemicals/alcohol/alcohol_info2.shtml Caron Treatment Centers. (2006). Retrieved October 1, 2008, from Cannabis-Marijuana: Addiction, Treatment and Recovery: http://www.colorado.edu/alcohol/downloads/marijuana_report.pdf Center for Drug Evaluation and Research. (2008). Retrieved October 1, 2008, from Subutex and Suboxone: http://www.fda.gov/cder/drug/infopage/subutex_suboxone/subutex-qa.htm CSAT Buprenorphine Information Center. (2008). 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Retrieved October 1, 2008, from The Results: http://www.nspcc.org.uk/whatwedo/childvoiceappeal/WhatWeCanAchieve/what_we_can_achieve_cva60188.html NSPCC. (2008e). Retrieved October 1, 2008, from Online Volunteer: Whatever you do, you could do this too: http://www.nspcc.org.uk/getinvolved/volunteer/childline/OnlineVolunteer/OnlineVolunteer_wda57930.html Patient UK. (2008). Retrieved October 1, 2008, from Buprenorphine Replacement for Heroin: http://www.patient.co.uk/showdoc/27000288 Pharmaenergy. (2008). Retrieved October 1, 2008, from Dormicum: http://www.pharmaenergy.com/Dormicum-75mg-x20-pr-1127-c-491.html Pills for All. (2008). Retrieved October 1, 2008, from Dormicum: http://www.pillsforall.com/index.php?st=products&sbst=details&rid=45 Schering-Plough. (2008, March 31). Retrieved October 1, 2008, from Subtex: http://emc.medicines.org.uk/emc/assets/c/html/displayDocPrinterFriendly.asp?documentid=2581 Support Systems Homes. (2008). Retrieved October 1, 2008, from Family Education and Drug Counseling Program: http://www.recoverythroughsupport.com/specialprograms/family-drug-program.html White, M. (2008). U.S. Pharmacist. Retrieved October 1, 2008, from Drug-Induced Respiratory Depression: http://www.uspharmacist.com/oldformat.asp?url=newlook/files/feat/acf2ece.cfm&pub_id=8&article_id=17 Read More