Case Study – Substance Use and the Adolescent
From what can be seen in the case study, it is apparent that the client in question can be diagnosed with Mood Disorder due to Amphetamine Intoxication with Mixed Features. Basing the diagnosis in the DSM, it is worth noting that the symptoms of Mood Disorder, i.e., the feeling of worthlessness (the client characterizes himself as “stupid”), slowing down (the repetitive idea of zombie movies and blurred speech), loss of appetite, inability to concentrate, the fact that the client is depressed by report of his parent, anger, and the characteristic of manic episode, that is restlessness and constantly “doing things on the computer”, using telephone and texting. The latter action has been possibly performed by the client to get access to the substance he was using (Paris, 2015). Amphetamine Intoxication symptoms are also visible in the client, i.e.: blunting, unsociability and refusal to cooperate (the client does not show any inclination to communicating with his peers), aggressiveness and distress (i.e., music that sounds aggressive and, by the client’s report, “feels good”), fixated behaviors, and weight loss (American Psychiatric Association, 2013).
Since the client’s family does not have any substances in the house, the parent is sure that the client does not use any, and the client himself denies using substances, it is necessary to have the client checked for other bodily symptoms that correlate with amphetamine usage. The analyses of body liquids are necessary to ascertain the presence or the absence of the substance in the body. It would also be appropriate to subject the client to psychotherapy sessions to have dialog with him to check for anxiety or violent behavior; a more detailed demonstration of whether the client is coherent or impaired in his judgments is also required. In addition, the client ought to undergo a general examination. It is necessary to check the client’s vitals such as heartbeat rate with respect to tachycardia or bradycardia. In relation to the blood vascular system, it is necessary to see whether the blood pressure is above, level, or below normal; according to the DSM, any deviation from the normal is considered an Amphetamine Intoxication symptom. It is also needed that the reactions of the client’s pupils are checked: while using amphetamine, the pupils tend to be dilated.
As to the alimentary system, amphetamine affects the digestive apparatus in a way that causes nausea or vomiting, which the client should also be interrogated upon. To acknowledge the changes in the body mass index, the client’s previous medical records can be checked, or else, the family members can be interrogated whether the client has experienced a visible weight change. The cerebral and psychic activity may also be affected: in this case, psychomotor tests are to be conducted, and the family is to be interviewed whether the client has experienced agitation or retardation and slow-down. Amphetamine can damage the respiratory system as well; thus, the client ought to undergo pulmonary function tests, such as spirometry and others as necessary to find out the presence or the absence of hypoventilation, pains in the chest, and arrhythmias. The client can as well be in a confused mental state, experience convulsions, have motor disturbances and dystonia, or sink into a comatose state. Thus, as was stated above, the analyses are necessary to evidentiate at least two or more symptoms of Amphetamine Intoxication.
As to the other individuals that can be involved in the assessment, it appears appropriate that the first ones to question would be the client’s family. However, as it can be seen from the case study, the client’s mother is ignorant of the client’s current state and attributes the client’s changes in behavior to the music he listens to. Thus, the parents cannot present an impassive, evidence-based view that is required by the assessment. As a consequence, it is needed to refer to other sources of information. These would be the client’s friends, peers, and tutors. Due to the changes in the client’s social behavior, it is doubtful that the client’s classmates can present a relevant piece of evidence. However, the teachers have the client in view at least during the classes and there is an interaction between them, which means that the teachers can be a reliable source of information collected and delivered impassively. The client also communicates with other persons who, as the client’s mother states, are considerably older than him. It can be assumed that these people are the ones the client contacts by social networks, telephone, and text messages. There is a possibility that they provide the client with information about the substance the client is using and, probably, show him the means and ways of obtaining the substance. Thus, the family and the client’s friends are to be interviewed first. In treatment, it is best to use family therapy since, according to the longitudinal researches in the field, the abused tend to progress when undergoing family therapy (Rowe, 2012).
Cultural Awareness and the Diagnosis
The culture of the substance user can predict the sort, the way, and the consequences of the usage. It is stated, for example, that African American adolescents from poor backgrounds tend to use cannabinoids and alcohol, especially the ones that have not finished their compulsory education (Liu & Trimble, 2014). Another example concerns various youth subcultures that used many substances at once, such as beatniks and hippie counterculture demoralized by poverty and homelessness (Brake, 2013). The familial situations are also an important factor: there are cases when adolescents are dealt drugs without the parents noticing, with the parents being indifferent and even on the parents’ permit (Lyman, 2013). These examples show that culture does not solely mean ethnicity and race: the upbringing and socioeconomic status are significant as well. Substances are treated as either a trend or a norm, that is, a means of making a living. The information about such adolescents can be used when assigning a diagnosis. For instance, persons from a poor background or belonging to a youth grouping are at greater risk of substance abuse. The representatives of racial minorities tend to fall under stress when they change schools due to the threat of bullying – and, as in the case with African American students, either start using substances while studying or quit school whatsoever, thus increasing their chances to fall under drug abuse. It does not necessarily mean every person of color or from a poor family is an active drug user; nevertheless, these factors can be an additional clue in assigning the diagnosis since some of the social groups tend to be under greater risk than the others.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, Virginia: American Psychiatric Publishing.
Brake, M. (2013). The Sociology of Youth Culture and Youth Subcultures (Routledge Revivals): Sex and Drugs and Rock ‘n’ Roll? London, United Kingdom: Routledge.
Liu, W., & Trimble, J. (2014). Ethnic and Multicultural Drug Abuse: Perspectives on Current Research. London, United Kingdom: Routledge.
Lyman, M. D. (2013). Drugs in Society: Causes, Concepts, and Control. London, United Kingdom: Routledge.
Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, New York: Oxford University Press.
Rowe, C. L. (2012). Family Therapy for Drug Abuse: Review and Updates 2003–2010. Journal of Marital and Family Therapy, 38(1), 59-81.