Management of Harmful Drinking and Alcohol Dependence - Case Study Example

Student name: Registration number: Module code: Module title: Tutor: University A). Background of the case The client is a female in her early 40s and has been diagnosed with Bipolar Disorder. She separated from her husband two years ago and had had a significant deal of conflict in her marriage. She has two children from the marriage; a teenage daughter who lives with her and her teenage son who stays with the father. The son has been seeking treatment for behavioral issues. Reason for referral The client has been seeking counseling but stopped. She is still having highs and lows and has resorted to taking alcohol to manage the feelings. The behavior, however, is of concern to her. History of the problem The client was first diagnosed with Bipolar Disorder at the age of 27 after experiencing several years of complicated social and work relationships. She described her mother as Manic, and her parents separated when she was ten years old. Her mother relinquished responsibility and disappeared from home. Her sister is now 37 years of age and apparently has mental issues also. The sister lives in Sydney, and her 32-year-old brother lives in Canberra. They, however, do not have a close relationship. At the delicate age of 14, the client starting drinking delinquently. At 17, her three closest friends died. She studied at Canberra and followed her dad to Sydney when she was 25 years old, a time she also joined the University to study education. She then met her husband and married soon after. She gave birth to her son in 2003, and her daughter came two years later. The client says that her first five years of parenting were right. She was a "good mother." When her daughter was 3or 4 years old, her husband started bullying and intimidating her. In the year 2010, she went back to the workplace and encountered relationship issues with her colleagues at work. Last May, she started heavy drinking and also experienced social relationships involving loss of friendships. Her son started abusing her and also attempted suicide last year. She says that around May/June is when she often feels she goes “off the rails.” More recently, she is experiencing lots of anguish in her dealing with her ex-husband and also feels she is over her head at work. She is still finding what she describes as her "baseline." She is under medication, taking anti-psychotics and anti-convulsant to manage moods, and valium when she needs it. She is highly concerned about going on a high and low again. B). Assessment of the case Medical and development history Apart from the Bipolar Disorder that the client was diagnosed with at the age of 27, there is no reported medical history from her infancy to her young adult age. The problem associated her childhood is the hardship of her parents’ marriage. She is under medication, taking anticonvulsants and antipsychotics and valium when need be. She usually experiences her mental issues in May/June. She has also been going for professional counseling which she cut short. Family and social history The client’s biological mother is described as Manic, and the parents separated when the client was young. The mother later disappeared from home and left them to their means, leaving them to survive on their own. She had to join her father. Her younger sister also has some mental issues. There is no close relationship between her and her siblings. During her adolescent years, the client experienced a barrage of social problems. From the distant relationship between her and the siblings, the absence of a mother in her life. She also started drinking at the age of 14. She reports having lost 3 of her closest friends at the age of 17, a development that affected her psychologically. Academic History Not much is said about the school history. She studied and joined the University at the age of 25. Relationship and marriage history She met her husband and married after a short period of dating, and within four years she had given birth to her two teenage children. Her first five years were fruitful for her as a mother. Things went off the hook when her husband started bullying and intimidating her. She has also been abused by her biological son. The son also attempted suicide last year. She is also separated from her husband and is in custody of only one of their children. She experiences a lot of problems dealing with her husband. Work/colleague relationship history She started drinking and has lost several friendships. The client’s social life is not at all stable. The relationship problems with the colleagues at work make her feel stressed up, and she thinks she might have the mental issues again. Substance abuse history The client is an alcohol user who started drinking at the tender age of 14. She reported having started drinking heavily last year, a season she associates with her highs and lows in the history of the disease. Mental status examination From the interview, the client came out as an honest person who gives an answer to all the questions posed. Her calmness was sometimes interrupted by a high tone, and the composed stature became suddenly restless. Though there were no incongruences in her communication patterns, she would seem thoughtful and nervous, characterized by a distant outlook. This, however, was not an impediment to the interview. A cognitive function examination was not authorized, but there as no indication of major impairment from the evaluation. She admitted to being moody and aggressive sometimes, getting angry a no particular reason. At no single point in time has she ever attempted suicide, though there are times she feels life is unworthy of her. She is concerned; however that she might lose her son to suicide if she takes no action in an attempt to counsel him. She also fears for her daughter, who she describes as quite a girl her age, with all the craze that comes with adolescence. Findings from the assessment The client is a young lady of productive age. From the cases in her family, she is at a high risk of experiencing these mental issues. At risk are also her children as is evident from the behavior of the son who has abused her and also attempted to take his life. Bipolar Disorder is a mental instability that is marked by seasonal periods of elation and depression. According to the history recorded at the interview, it is evident that her intelligence is not in doubt. Though there is no substantial evidence about her performance in school, the fact that she has gone to the University level is proof enough that she is capable and productive. An assessment of her parenting shows that she was a good mother to her children during the first five years. The fact that her children have been observing her behavioral patterns is enough to make her children stressed up themselves. Behavioral change patterns are evident from the son. From studies, it is also likely that her son is suffering from Manic Depressive disease (Bipolar Disorder) or Schizophrenia or Delusional Disorder drawing from the behavioral change and suicide attempt (American Psychiatric Association, APA, 2010). The daughter could also be at risk due to her social interactions with the mother and brother. Emotional functioning The client’s emotional instability is associated with the experiences she has had in her over forty years of life. From her parents’ unstable marriage and consequential separation, The client expresses a lot of emotional attachment to the separation. She states when asked how her relationship with her mother was, that they were very close and the disappearance affected her a great deal When asked to relate events in her life that have led to her current emotional orientation, she is quick to note that the death of her three closest friends cost her lots of joy and that her life has never been the same again. The weak relationship between her and her siblings is another cause of her anxieties and depression. While she notes that she indeed has a brother and a sister, she is quick to add that they are not in contact and she feels like a lone ranger. Asked about her father, she relents to answer that question. Her son’s attempts at his life is another event that factors in her traumatic depression. The mistreatment from her husband, their separation, and current relationship Interpersonal/social functioning The client’s response to interactions between her and her peers with contempt. At her workplace, she is normally a lone ranger mainly because she seems not to fit into the social groupings her colleagues. She has never been able to interact with her colleagues freely, and she asserts that more often than not, she picks quarrels with them. She is also short-tempered, and her self-esteem is low. She masks all her sorrows with heavy drinking, and this has never augured well with her seniors, her colleagues and also her ex-husband and children. C). Analysis of the findings and the diagnosis The client experiences a barrage of inter-personal and intra-psychic conflicts. She seems unsure of herself. To hide from the problems that daily encroach her life, she opts to mask her problems behind alcohol taking. It is not a surprise that she pretends to be okay with the smile she exhibits but deep within is an ailing woman. Several evidence-based approaches are employed in her case. These are: ALCOHOL-DEPENDENCE THERAPY The psychotherapist uses an interactive approach that is non-confrontational in nature. This is meant to help the client identify her problems and explore a treatment goal (National Institute for Clinical Health and Clinical Excellence, NICE, 2011). A full assessment of the drinking patterns and the amounts taken every day and the level of alcohol dependence using the Alcohol Dependence (AD) scale and the AUDIT (Alcohol Use Identification Test) (Thomas et al., 2001). In identifying the ma causes of the problem and involving the client in solving her issues, this might be a positive step towards her personal healing and recovery. Alcohol dependence leads to issues such as emotional function failure, break-ups in relationships and social/work problems. It may be unclear whether BD diagnosis is a resultant factor of the client's drinking, but it is probable cause. ACCEPTANCE AND COMMITMENT THERAPY-ACT ACT is a kind of intervention known to work in a wide array of psychological conditions, including depression and diabetes (Gregg, 2004). The fact that our client is taking anticonvulsants means that she has a seizures condition. The method is both an assessable and inexpensive manner and helps the client accept her condition, know that she is not waging war against her state but trying to contain it (Melin et al., 2006). Commitment to a cause of the desired direction arises from the realization that ACT, a psychological rather than pharmacological technique, improves the quality of life if the client first accepts their current situation as what they cannot change and then commits to a life of taking positive strides towards healing. INTERPERSONAL PSYCHOTHERAPY Our client’s psychiatric referral form shows that she was on professional counseling which she has since cut short. Though she does not admit to having suicidal thoughts, other than identifying them in her son, she agrees that she has had a barrage of issues relating with her husband and son who have abused her and her colleagues at work. She feels that she is over her head at work. She does not know what to do, and from the records, she is still trying to find her baseline. This approach is justifiable by the interpersonal conflicts that our client has had before coming for the therapeutic session (Frank et al., 2007). The therapist, in this case, employs this method that is effective against depression manifested by the described symptoms and the ambivalence she shows towards people, including her siblings (Ravitz et al., 2011). D). Plan and Implementation The goals of psychotherapeutic intervention in the case of the client above could be categorized into both short term and long term goals. However, because her issues have a long history dating from when she was a little girl, it is important to have long-term interventions to help her cope with the important people she has lost touch with in life. As such, the aims of this intervention are to reduce the symptoms of depression that they may not affect her relationships with people, more so her family members. The second goal would be to scale her emotional levels down to improve how she relates to people both at the workplace and at the family level. Thirdly, it is important that alcohol dependence is kept at bay in the attempt to solve the depression. Rehabilitative care, therefore, is needed to ensure that she recovers from the abuse. In the bid to solve interpersonal issues and problems, it is the acknowledgment of her failing marriage that is the driving force. The aim is, therefore, to restore her marriage. The treatment plan for the broad perspective would include: Meditative sessions by the client to help her visualize the incongruences between her current life and the life of her dreams. This will be overseen by the therapist to ensure that the client takes them seriously. Provision of psychosocial education on a routine to ensure efficacy of transition from the current state to a stabilized social connection network Medication management with the continuous use of the anticonvulsants and antipsychotics, to aid in coping with the culture shock from the drastic changes in lifestyle. Family therapy meant to encourage her kids and husband to take care of her to save her from impending dangers of self-harm from advanced stages of bipolar disorder. Individual intervention to help the client have an effective method of coping with colleagues and family as a means of reducing time spent alone. Restoration of professional counseling sessions meant to draw her to the realities of life and the fact that it is likely to lead a fruitful life after the phases she has passed through. Psychosocial-education and supportive education will be offered to the client in a bid to make her understand BD and fight the effects caused by its relapses. Interpersonal Social Rhythm Therapy (IPSRT) will be effected to allow regulation of the client's daily social patterns, especially about colleagues and husband. Enhanced care programs coupled with psychoeducation will be put in place. This is meant to institute long-term evaluation with a nurse attached to the client with the input of a doctor. This will enable her to cope with the depressive effects of BD. Cognitive Behavioral Therapy and Cognitive Therapy as a technique will be used on the client on a regular basis to allow the therapist to deal with the changes in moods as evidenced by her use of antipsychotics. Interpersonal therapy is a handy tool in controlling the inconsistencies in addressing people and containing her stress that is seemingly causing conflicts between her, her husband and colleagues at work. E). Evaluation and reflection The client is visibly and evidently experiencing psychosocial problems drawn from the experiences she has had in the past and the current life. The algorithm employed in her case is meant to have the best results. Given that the main aim is to solve her long-term problems, it is clear that the diagnosis and the laid down intervention measures are bound to deliver positive results if followed to the letter. As opposed to conventional drugs, the antipsychotics she has been using may lead to an altered state of consciousness. As such, the continuous, monitored medication is meant to help her overcome the effects and up her scale of cognitive function. The best interventions have been recommended for this case. It rests upon the patient and the therapist assigned to her to ensure that she follows the classical conditioning to have her get out of the injurious effects of depression. F). References American Psychiatric Association (2010). Practice Guideline For The Treatment of Patients With Bipolar Disorder, 2nd Edition. Frank, E., Kupfer, J., Buysse, J., Swartz, A., Pilkonis, A., Houck, R., Rucci, P., Novick, M., Grochocinski, J., & Stapf, M. (2007) Randomized trial of weekly, twice-monthly, and monthly interpersonal psychotherapy as maintenance treatment for women with recurrent depression. American Journal of Psychiatry. Gregg, J.,(2004). A randomized control effectiveness trial comparing patient education with and without Acceptance and Commitment Therapy. Ph.D. diss., University of Nevada, Reno. Lundgren, T., Dahl, J., Melin, L., Kies, B.,(2006). Evaluation of Acceptance and Commitment Therapy for refractory drug epilepsy: a randomized trial in South Africa: a pilot study. National Institute for Clinical Health and Clinical Excellence (2011). Diagnosis, assessment, and management of harmful drinking and alcohol dependence: National Clinical Practice Guideline 115. London, UK: British Psychiatric Association. Ravitz, P., McBride, C., & Maunder, R. (2011). Failures in interpersonal psychotherapy (IPT): Factors related to treatment resistances. Journal of Clinical Psychology, 67, 1129-1139. Thomas, F., Babor, J., Higgins-Biddle, C., John, B., Saunders, B., Maristela, G., Monteiro, J.(2001). Alcohol Use Disorders Identification Test. World Health Organization. Read More

The treatment plan for the broad perspective would include: Meditative sessions by the client to help her visualize the incongruences between her current life and the life of her dreams. This will be overseen by the therapist to ensure that the client takes them seriously. Provision of psychosocial education on a routine to ensure efficacy of transition from the current state to a stabilized social connection network Medication management with the continuous use of the anticonvulsants and antipsychotics, to aid in coping with the culture shock from the drastic changes in lifestyle.

Family therapy meant to encourage her kids and husband to take care of her to save her from impending dangers of self-harm from advanced stages of bipolar disorder. Individual intervention to help the client have an effective method of coping with colleagues and family as a means of reducing time spent alone. Restoration of professional counseling sessions meant to draw her to the realities of life and the fact that it is likely to lead a fruitful life after the phases she has passed through.

Psychosocial-education and supportive education will be offered to the client in a bid to make her understand BD and fight the effects caused by its relapses. Interpersonal Social Rhythm Therapy (IPSRT) will be effected to allow regulation of the client's daily social patterns, especially about colleagues and husband. Enhanced care programs coupled with psychoeducation will be put in place. This is meant to institute long-term evaluation with a nurse attached to the client with the input of a doctor.

This will enable her to cope with the depressive effects of BD. Cognitive Behavioral Therapy and Cognitive Therapy as a technique will be used on the client on a regular basis to allow the therapist to deal with the changes in moods as evidenced by her use of antipsychotics. Interpersonal therapy is a handy tool in controlling the inconsistencies in addressing people and containing her stress that is seemingly causing conflicts between her, her husband and colleagues at work. E). Evaluation and reflection The client is visibly and evidently experiencing psychosocial problems drawn from the experiences she has had in the past and the current life.

The algorithm employed in her case is meant to have the best results. Given that the main aim is to solve her long-term problems, it is clear that the diagnosis and the laid down intervention measures are bound to deliver positive results if followed to the letter. As opposed to conventional drugs, the antipsychotics she has been using may lead to an altered state of consciousness. As such, the continuous, monitored medication is meant to help her overcome the effects and up her scale of cognitive function.

The best interventions have been recommended for this case. It rests upon the patient and the therapist assigned to her to ensure that she follows the classical conditioning to have her get out of the injurious effects of depression. F). References American Psychiatric Association (2010). Practice Guideline For The Treatment of Patients With Bipolar Disorder, 2nd Edition. Frank, E., Kupfer, J., Buysse, J., Swartz, A., Pilkonis, A., Houck, R., Rucci, P., Novick, M., Grochocinski, J., & Stapf, M. (2007) Randomized trial of weekly, twice-monthly, and monthly interpersonal psychotherapy as maintenance treatment for women with recurrent depression.

American Journal of Psychiatry. Gregg, J.,(2004). A randomized control effectiveness trial comparing patient education with and without Acceptance and Commitment Therapy. Ph.D. diss., University of Nevada, Reno. Lundgren, T., Dahl, J., Melin, L., Kies, B.,(2006). Evaluation of Acceptance and Commitment Therapy for refractory drug epilepsy: a randomized trial in South Africa: a pilot study. National Institute for Clinical Health and Clinical Excellence (2011). Diagnosis, assessment, and management of harmful drinking and alcohol dependence: National Clinical Practice Guideline 115.

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