Reference no: EM133601935
What are the differences between coercive and voluntary treatment. Describe each in detail and compare and contrast them using the text for support.
Case 1: Sandy and Pam
Effective assessment and diagnosis in the case of Sandy and Pam would begin with the diagnostic interview. Using the Substance Use History Questionnaire (see Appendix), information would be gathered regarding each of their histories of substance use and abuse. Significant factors to consider about Sandy's substance use are as follows:
She has a history of alcohol use dating back to junior high.
By self-report, Sandy admitted to continuing to abuse alcohol into adulthood.
In assessing Sandy's substance use, it is apparent that her alcohol use has affected her family life and social relationships. She reports that she had married Joe, a violent alcoholic, and that during her drinking days, she left the children at home so she could go to bars and pick up numerous men. This behavior would clearly indicate that Sandy's alcohol use affected her judgment and ability to care for herself and her children.
With the information from the Substance Use History Questionnaire, it is possible to assess the phase of alcohol use that Sandy is experiencing. The crucial phase is characterized by obvious and pronounced behavioral changes. Sandy reported behavioral loss of control coupled with guilt and remorse about her actions while using alcohol.
In diagnosing Sandy's substance use, additional information is needed. The MAST and the CAGE Questionnaire would be useful in deciding whether Sandy meets the criteria for a substance-related disorder in the DSM-5. Sandy's childhood history is indicative of the potential for a personality or mood disorder. Her marriage to Joe may indicate that she has suffered some type of physical or emotional abuse. Posttraumatic stress disorder (PTSD) is also a diagnostic possibility. Differential or dual diagnoses must be considered when evaluating Sandy's substance use. After a period of sobriety, additional psychological testing would be indicated to assess whether Sandy needed treatment for other disorders.
Pam's history of substance use included cocaine and alcohol. In assessing Pam's substance use, the significant factors are her
employment history,
unstable relationships, and
report of anxiety symptoms.
In addition to the diagnostic interview using the Substance Use History Questionnaire, use of the Substance Abuse Subtle Screening Inventory-3 (SASSI-3) (https://www.sassi.com/products/) would be useful in identifying treatment issues and potential diagnoses. Clearly, Pam's substance use has also affected her judgment regarding relationships. The history with her live-in boyfriend seems to indicate intense conflict resulting in potential negative outcomes. Pam's history of unsuccessful employment indicates that she may be in the crucial phase of the progression of a severe substance use disorder. This pattern of substance use after a loss is a clear indicator of the overt consequences of the progression.
Other factors that need to be explored are the periodic abstinence or changes in Pam's pattern of substance use. The information from the SASSI-3 may be helpful in determining a SUD with a focus on polydrug use. Pam's childhood and recent conflicts with her boyfriend may indicate a possible personality disorder or mood disorder. Pam's statement regarding her boyfriend-that she "feels drawn to him" and wants to "make it work"-could indicate tendency to be dependent in a relationship. Pam's increasing anxiety could be indicative of either periodic withdrawal from the substances or an underlying anxiety disorder.
In summary, additional information gathered through an assessment would be needed in both cases in order to make accurate diagnoses and assist in planning treatment. Contacting other family members or significant others to gather information would be useful. Once each woman had established abstinence of at least two months, further assessment would help with answering questions about dual diagnoses.