Reference no: EM133408062

Question: DJ is a 38-YO married father of two with no history of any treatment for either substance abuse or mental illness. He presents cleanly shaved, dressed in jeans and a plop shirt, and appears physically fit. He speaks with animation, seems nervous, and makes frequent clearing sounds in his throat. He is seeking treatment for his daily marijuana use. He states, "I've been smoking pot since I was a teenager, and I have to stop."

When asked "Why now?"

He replies, "I work as a welder, and they've started to drug test us, I gave two dirty urines. They told me if I want to keep my job I have to get into a treatment program, stop smoking pot, and give clean urines. I can't lose my ob. My wife stays home with the boys, and to be honest, I'm spending too much money on pot and it's time to give it up. I also don't want my sons to grow up thinking it's okay or that their dad is a pothead."

In the course of the interview, he also admits to the use of alcohol, but adds, "It's not a problem...I don't blackout or anything." When he was in his early twenties, he did receive a DUI/DWI, for which he had to attend two months of court-mandated driving classes. Since being told he had to stop smoking marijuana, his alcohol consumption has increased from a couple of times a week to at least a few beers after work" nightly. He adds, "I know I'm just replacing one drug with another," but states, "I haven't had anything for the last four days." He ha no history of any form of alcohol withdrawal and has none at the time of this evaluation.

He denies other drug use, although he reports he tried synthetic cannabis (K-2/Spice) because he knew they wouldn't test for it. He says it makes him feel paranoid, and he'd never do it again. He doesn't smoke cigarettes.

When asked about his childhood and school history, he initially says, "It was fine." When pressed for details, the clearing noises in his throat become more pronounced and at times he stutters. His parents divorced when he was four and he had little contact with his father growing up. He explains that his father's absence is one of the reasons it's important for him to be a good father to his young children. He says he was always shy and easily embarrassed. In school, he was frequently teased about his stutter, which improved as he got older. He completed high school but had frequent absences and would often fake being sick to avoid going to school. Social settings make him profoundly nervous and he avoids them altogether unless he's had "a couple of beers or a joint." He describes situations where his anxiety spikes, accompanied by racing pulse, palpitations, drenching sweat, lightheadedness, and the feeling that something horrible is about what happen. In the past, he's felt like he was having a heart attack and has sought treatment twice in emergency rooms, and both times told e was having a panic attack. He admits that one of the reasons he likes both marijuana and alcohol is that they relieve his stress and his anxiety.

When asked to rate his current level of anxiety on a 10-point scale he states it's an 8, and that on any given day it ranges from no less than a 4 to a 9 or 10. Using the same scale e reports his feelings of depression are much lower, although the current threat to his job jas increased them from a 1 or 2, to a 4.

His family history is significant for his mother who's been treated for anxiety and has been taken diazepam for decades.

He has been married for 14 years. He describes his wife as being the one" who wears the pants in the house." She has made it clear that if he were to lose his job on account of his drug use, she would take their two children, ages 7 and9, and move in with her parents.

He has no active medical issues, is on no medication, and has no reported allergies.

Step One: Constructing the Problem/Needs List Significant data can be grouped into two large categories, one related to his substance use and the other covers his mental health issues. Identify the problems or needs of this client and list them into the two categories. Use this data to inform you discussion. Incorporate the information into your paper.

Also Include in your paper

Determine the level of care required using the model of four quadrants of care found in module 1. Based on the information provided make a determination as to what level of treatment is required for this client and why?

Identify probable diagnosis and make direct connection between information from vignette and the DSM-V criteria for that Diagnosis.

Assessment Identify at least one assessment tool to be used in each diagnosis.

Establishing the Initial Goals/Objectives for Treatment (As indicated in step two there are two active problems..) You must list at least two long-term goals one for each problem and at least 3 short term objectives for each goal.

As Always Address all Cultural Considerations, Risk Management Issues and Legal and Ethical Concerns.