Paper Example on Addiction and Co-occurring Disorders

Introduction

The aim of this paper to establish the case of Miguel how possesses a major depressive disorder and a mild alcohol consumption disorder. This paper will form an assessment tool that will be used in screening addiction in Miguel, assessment of some of the risks that are very harmful to him and the assessment of some of the recurring health issues that are prevalent in Miguel. In addition to this, this paper will determine some of the strengths and challenges that are bound to hamper his treatment plan and thus provide a recommended care approach.

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Evaluation of Assessment Tools

Addiction Assessment or Screening

The first assessment tool for screening alcohol dependence that will be looked at is the alcohol use disorder identification test (AUDIT). AUDIT is a 10-item screening questionnaire that was developed and evaluated for over 20 years, and it was found to provide accurate assessment without biased based on age, gender or culture. The assessment focuses on the recent alcohol use and dependence symptoms. Since this assessment is to be used in a primary care setting, this assessment has several advantages over other assessment tools. The first advantage is that it is the only screening tool that can be used across culturally and internationally. This is the biggest advantage that this assessment has. This assessment also identifies harmful alcohol use and dependency while being brief, rapid and flexible (Babor, Higgins-Biddle, Saunders and Monteiro, 2001)

The second assessment tool for screening alcohol dependency that will be looked at will be the short Michigan Alcoholism Screening Test-Geriatric Version. This assessment tool contains ten yes or no questions about drinking pattern that is used to determine if an alcohol problem presents based on the score of two yes answers to any of the ten questions. To reach more people, this assessment tool uses two languages so that the non-English Speaking Latinos can use this assessment. With a score of two or more, it is an indication that a more comprehensive assessment of drug and alcohol history need to be obtained. "The instrument serves as a screening tool only. A more comprehensive assessment for alcohol and drugs dependence requires that the clinicians inquire about the quality and frequency of use and the negative social and health consequences of every drug used including nicotine, prescriptions, over the counter, herbal remedies, recreational drugs and alcohol(Naegle, 2008).

Assessment of Co-occurring Mental Health Issue

Because there might be some underlying problems that can be causing or intensifying Miguel's drinking issues, there needs to be an assessment to determining whether there is a co-occurring mental health issue. This section will look at two assessment tools that can be used to determine if there is such a co-occurring mental health issue.

The first assessment tool that will be addressed will be the Kessler Psychological Distress Scale (K6). The K6 is a shorter version of K10 and is preferred for the screening of anxiety disorders. Because people drink to cover up or deal with anxiety, it is prudent to find out if such a situation exists in somebody who has alcohol dependency. The K6 has no bias on gender or education, but it's still unknown where bias exists based on age and race ((Kessler et al., 2002).

The second assessment tool that will be used is the Global Appraisal of Individual Needs-Short Screener (GAIN-SS). The GAIN-SS is a short screen for the general population that quickly and accurately show whether one or more behavioral health disorders are present and if there is a need for future assessment. This assessment is straightforward to use and can be used over a diverse population and can be used to track the change in the behavioral health over time (global appraisal N.D).

Assessment of Risk of Harm

The first assessment tool that will be looked at for risk of harm will be Self Injury Survey (SIS). "The Self-Injury Survey is a four-page, self-report measure with 31 self-harm items, a write-in listing of suicide attempts, and a check-off list of reason for self-injury, types of past intervention and damage effects. This measure explores suicidal ideation as well" (Sansone and Sansone, 2010). The SIS is good because it covers a large number f areas and not only deal with injury but ideation as well which some people do not report as they have not injured themselves yet but think about it from time to time. Some of the shortcomings that can be seen from this assessment tool are that it is not clear as to whether it can be used for a diverse population. The second assessment tool that will be looked at is the self-harm behavioral Survey. This survey is a "174 plus multi-page, self-report survey with a variety of response options. The survey explores demographic information, family history of mental illness, religious background, family relationship, self-harm behaviors ..... but not suicide attempts" (Sansone and Sansone,2010).this assessment is good because it is great for a diverse population whereas the SIS may not be. However, for this case, there is a drawback that it does not take into account the suicide attempts.

When it comes to all this assessment tools, the one that would be the best fit for Miguel would be the AUDIT assessment for screening for addiction. The GAIN-SS assessment for co-occurring mental health issues because it is in a way comprehensive and even takes into account diversity where the K6 only takes some things into accounts such as gender or education and not age or race. And for the assessment on the risk, the best assessment to use is SIS because it takes into account the thought of committing suicide and in our case with Miguel; there is an idea of suicide cropping.

Results of Assessment

Diagnosis based upon the DMS-5

305.00 (F10.10) M Alcohol Use Disorder

296.31 (F33.0) M Major Depressive Disorder

Relevant Medical Diagnosis: None

Note: other conditions that may be of focus of clinical attention

V60.0 (Z59.6) Low Income

The Measure of Symptoms Severity/Disability

Level 1 Cross-Cutting Symptoms Measure

When looking on how much Miguel has increased and continued to use alcohol which has began to affect his attendance at work and his ability to do his jobs more than once, a diagnosis of mild alcohol use disorder is relevant (APA, Substance-Related and Addictive Disorder, 2013). Along with his drinking conditions, he also presents with four major depressive disorder symptoms. His demeanor has changed, he has constant fatigue, he has a feeling of guilt and not being good enough, and he is having difficulty concentrating. Also because there is strain from the lack of finances, there is a reason to consider a V-code diagnosis for low income.

While these diagnoses will provide details to the counselor that can assist in treatment planning, further information from Miguel will be needed in order to formulate a more definite diagnosis.

Description of Client Strength

Something that can help Miguel is his inherent strength. These strengths are not just his strength but also his outside ones as well. For his strength is his willingness to get help. He is also taking responsibility for the negative effects that result from his drinking habits. His outside strength would be his support system which would include his supervisor who understands what is happening as he also has experienced the same. His idea of what Machismo is could be used as strength in counseling if it mean to Miguel that the growing alternative of machismo that is coming to popularity which includes that "men to be family oriented, hardworking, brave, proud and interested in the welfare and honor of their loved ones, including providing for, protecting and defending their families and less fortunate members of the society (Torres, Solberg, & Carlstrom. 2002). Because he cares for his family and wants to provide for them in the best way that can praise him for the steps that are needed for him to be the man they need him to be. Miguel would find additional motivation to maintain his sobriety.

Descriptions of Challenges to be Addressed

One of the biggest challenges that need be addressed in Miguel's case is the cultural aspect of gender roles. "Gender roles and the family structure are thought to influence health behavior differences among ethnic groups and can be affected by the acculturation process" (Lipsky & Caetano, 2009). In additional Latino families, the men provide for the family and are seen to be strong enough also to take care of themselves. This has been the case in the past for Miguel, but with seeking the help he may feel that is being a man is being called into question and could be hard for him to get past as he may feel as if he is regarded as weak. This overwhelming pressure and stress to be a provider should be monitored as it may increase the feeling of suicidal ideation.

Recommended Level of Care

According to Lewis (2014), with the condition that Miguel is presenting with the recommended level of care that he should receive is an Intensive Outpatient (IOP) program which will have him participate in weekly group sessions as well as family counseling sessions. Group therapy can be beneficial for Miguel be providing education and an outside support system for people who are going through similar situations and not involved in other aspects of his life which gives them any form of bias. Also, Miguel will be encouraged to attend a 12-step program, which will allow him to focus on his alcohol use and how to maintain sobriety.

Conclusion

This paper has looked at the case of Miguel who presents mild alcohol used disorder and major depressive disorder. Assessment tools for screening for addiction, assessment for co-occurring health issues and assessment of the risk of harm have also been looked into. It was determined that the best assessment tools for Miguel case were AUDIT, GAIN-SS, and SIS. The strength that Miguel has includes his willingness to seek help, his support system that includes his supervisors, and his idea of what it means to be a man. The limitations that will be faced with Miguel are cultural limitations on what the society deems to be acceptable and what is not acceptable. It is thus recommended that Miguel participate in an Intensive Outpatient (IOP) program.

References

American Psychiatric Association, & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5.

American Psychiatric Association, & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.

Higgins-Biddle, J. C., Saunders, J. B., Monteiro, M. G., & Babor, T. (2001). The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. World Health Organization.

Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. T., ... Zaslavsky, A. M. (2002). Kessler Psychological Distress Scale. PsycTESTS Dataset. doi:10.1037/t08324-000

Lipsky, S., & Caetano, R. (2009). Epidemiology of Substance Abuse Among Latinos. Journal of Ethnicity in Substance Abuse, 8(3), 242-260. doi:10.1080/15332640903110435

Naegle, M. A. (2008). Screening for Alcohol Use and Misuse in Older Adults: Using the Short Michigan Alcoholism Screening Test-Geriatric Version. AJN, American Journal of Nursing, 108(11), 50-58. doi:10.1097/00000446-200811000-00028