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Provisional Diagnosis and Intervention Plan

Introduction

Post-divorce loneliness and depression are common among people of different ages and both genders. According to Kendler et al. (2017), spousal loss either through a divorce or due to physiological causes is frequently associated with the consumption of alcohol or other substances like cannabis or sedatives. In this paper, a case of a divorced man who is involved in a 50-50 custody arrangement will be analyzed to offer an assessment and interventions based on properly identified concepts and diagnoses.

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Presenting Problems

Freddie is a 55-year-old divorced father of two children who presents with two main problems, excessive alcohol drinking, and cannabis smoking. The client feels depressed and lonely when he has to spend weeks far from his family. He uses alcohol and cannabis to fill in the emptiness and admits that he is becoming socially avoidant. Although the man believes that substances help him when he is also, there are situations when he drinks once the children are asleep.

Case Conceptualization

Freddie uses divorce and the inability to be with his children all the time as the main excuse for his alcohol and cannabis addiction. A moment of being alone is the main trigger that raises such automatic thoughts as the necessity to drink or smoke. The client does not have additional relaxation training sources to change the situation, and his children and job may be the only support and assistance in therapy. In this case, no attention is paid to the conditions under which the man can communicate with his ex-wife. However, Freddie values his role as a father for his two children, and the increasingly risky cue is finding out that they also consume alcohol at parties. Lasting changes due to alcohol and cannabis consumption are also observed in terms of his job. Being an operator of heavy machinery, a man must take certain psychological and physiological tests regularly. He has already been withdrawn from his job once because of elevated reading. He is concerned about a warning he has and becomes anxious due to the initial low sense of safety at work.

Provisional Diagnosis

In addition to evident alcohol use disorder, severe stage (303.90 – F10.20), the client may be challenged by such problems as cannabis use disorder, moderate stage (304.30 – F12.20), and major depression, mild stage (296.21 – F32.0). The severity of alcohol use disorder is explained by such facts as Freddie takes alcohol often in large amounts (750 ml bottle of scotch a day). He tries to control alcohol use, but all his attempts are unsuccessful at the moment because as soon as he is alone, he needs to drink. The client continues taking alcohol, even being aware of his harmful effects, reduced behaviors, and a negative impact on his social responsibilities. The pieces of evidence of cannabis use disorder include its continuous use after being aware of its harms (several cones every second night) and it’s worth as pain relief. Finally, major depressive disorder is explained by the presence of feelings of emptiness and hopelessness (reported by the client) and diminished abilities to concentrate (evidenced by the employer).

Assessment Plan

The main idea of assessment is to understand what methods are appropriate to gather information about a client, identify concerns, and formulate a diagnosis. First, it is necessary to take several questionnaires to identify the level of substance abuse and depression in Freddie. Second, if the client is not interested or able to write a diary, a personal activity like taking the Alcohol Timeline Followback is recommended. Third, communication with family members and colleagues is necessary to provide Freddie with evidence that his behavior is not normal and that therapeutic relationships are necessary to avoid problems.

Questionnaires

In Freddie’s case, the Alcohol Use Disorders Identification Test (AUDIT) questionnaire will help the client assess his alcohol dependence. The Cannabis Use Disorder Identification Test will show him the level of substance control. Freddie has to be encouraged to truly answer all the questions because alcohol and cannabis affect human health in different ways, and it is important to understand what outcomes may be expected. Both questionnaires are proved as valid and reliable in terms of criteria developed by the Diagnostic and Statistical Manual (DSM-5) and the International Classification of Diseases (ICD-11) (Bonn-Miller et al., 2016; Babor & Robaina, 2016). These methods are frequently applied by medical workers and psychologists around the globe.

Personal Activities

Diary methodologies are frequently applied to control the mental health and behaviors of people. However, sometimes, patients who have depression and anxiety are not able to create diaries because of the lack of motivation and interest. Therefore, in this case, it is reasonable to complete the Timeline Followback form (TLFB). This tool aims at assessing the individual’s drinking habits and substance use. It is expected to help Freddie to see his problems and report on them individually. The main idea is to assess the man’s habits during at least a month (28 days) period and reveal actual problems (Bradley et al., 2017). Besides, the client can observe if some changes happen to his life as soon as therapy begins (the number of drinks or cannabis intakes may be increased or decreased). Visual observations influence critical thinking and decision-making, and the task is not to stop making notes about the drinks and the use of other harmful substances.

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Communication

The effectiveness of diagnosis and treatment depends on the information obtained from key people in Freddie’s life. Regarding the fact of divorce, it could happen that the man would not agree to involve his ex-wife in assessment (a woman may know nothing about his problems and current behaviors or use subjective opinions). However, communication with his children and colleagues is a chance to assess the situation from a new point of view. Interviews will consist of ten questions about recent changes in Freddie’s behavior, the quality and duration of meetings, his attitudes toward his job or responsibilities, and chosen beliefs and interests. According to Vaeth et al. (2017), individuals who have jobs and families are more likely to be coerced into therapy and positively supported by family members and employers. Interviews with the chosen group of people will be useful for qualitative analysis in terms of its reliability and validity to identify the main triggers and reasons for Freddie’s behavior in case he fails to report on them in his questionnaires.

Ethical Issues

To make sure Freddie participates in the assessment and shares true information, certain ethical issues and regulations have to be followed. He is informed that all answers remain confidential and voluntary. There is no need to use some threats and identify risky cues because the situation shows that family and work issues must be elaborated. Freddie also needs the motivation to complete the TLFB form, and the fact that all results are for him to make observations and analyze cannot be ignored. Interviews with people who play a crucial role in Freddie’s life should also meet the ethical standards and protect the client, as well as participants. Voluntary participation in communication is promoted, and all interviewees demonstrate their desire to help Freddie and keep his personal information confidential. They sign special documents to prove their fair intentions and cooperation. It is preferable to organize face-to-face interviews (no longer than one hour), the TLFB form has to be filled in by the client’s hand (printed version), and alcohol/cannabis use disorders identification tests are taken online.

Intervention Plan

To help Freddie deal with three potentially dangerous disorders at the same time, a special treatment plan has to be developed. In addition to motivational interviewing as a part of counseling, it is important to combine several cognitive-behavioral therapy (CBT) practices, relapse prevention, and Acceptance and Commitment Therapy (ACT). All of them will be implemented within ten sessions:

  • Session 1: first contact. The goal is to gain an understanding of Freddie’s problems by analyzing his reports, tests, and answers to the questions. Riper et al. (2014) admit that motivational interviewing is effective for gathering information about patients who suffer from depression and alcohol abuse (even if not all DMS-5 criteria are met). It is planned to use reflective listening, avoid confrontation, and support self-efficacy.
  • Session 2: understanding of goals. In Freddie’s case, attention should be paid to the goals and his expectations. This session aims to prove the importance of abstinence and free choice and to remove drinking risks from the client’s life (van Amsterdam & van den Brink, 2013). The establishment of trustful relationships with a therapist helps cooperate and discuss beliefs, experiences, and changes.
  • Session 3: education. It is necessary to educate the client about substance abuse and its relapsing nature. Tait et al. (2012) say that men are more likely to use alcohol to solve their problems and deal with depression. If a man consumes more than 15 drinks per week, the risk of alcohol harm is evident (Friedmann, 2013). This session is used to provide Freddie with information about why alcohol or other substances are harmful to his health in the quantity he prefers.
  • Session 4: cognitive restructuring and lasting change. Freddie is a divorced man who wants to see his children not drink or smoke cannabis. Men’s drinking is rooted in multiple problems, and the task is to remove negative thinking patterns (Giusto & Puffer, 2018). Cognitive restructuring lies in the idea to identify the distortion of reality when the man is alone. The goal is to find out new interests and activities to replace the emptiness of the children’s absence.
  • Session 5: social support. It is not always enough to send a client to Alcoholics Anonymous and believe that this support is enough. Social support for patients with substance use disorders includes perceived control, coping behaviors, and stability (Brooks et al., 2017). The task is to prove that a social worker or a healthcare provider may be a good source of support for Freddie at the moment.
  • Session 6: relapse prevention. Alcohol is a habit that may be neglected for a long period and occur as soon as another problem bothers the client. The relapse prevention model helps to identify a high-risk situation (stay alone), demonstrate an effective coping response (find a hobby), increase self-efficacy (get prepared for another meeting), and decrease relapse probability (Hendershot et al., 2011).
  • Session 7: plans and achievements. At this moment, it is possible to discuss the opportunities Freddie gets unless he quits drinking. Seeking help may be identified as a weakness, and men’s stability is characterized by financial success, confidence, and independence (Smith et al., 2018). Freddie’s future is his path as a successful man, with strong beliefs and clear attitudes.
  • Session 8: relaxation training. Mindfulness training helps men when relapse occurs, and negative emotions overwhelm them. This practice shows how to control automatic impulses, increase awareness of high-risk situations, and support positive behavior (Priddy et al., 2018). Men’s willpower and abilities to resist temptation are underlined during this session.
  • Session 9: ACT worth. Alcohol use disorder provokes the development of new mental health problems, and such co-occurrence influences the quality of life. At this stage, the ACT is necessary to promote psychological flexibility and thought diffusion and deal with uncomfortable feelings (Helle et al., 2019). ACT for Freddie is used to emphasize his values and acceptance of life where he cannot be with his children all the time.
  • Session 10: role-playing as a part of CBT. Marital dissolution may be either an outcome of or a reason for divorce (Cranford, 2014). As soon as the relationships between a man and a woman are over, the role of parents cannot be ignored. However, it does not mean that the man should focus on his parental responsibilities only, and this session aims to discuss his potential role in society.

Conclusion

In general, the case of Freddie has several remarkable features that must be considered while developing an intervention plan. The client has several mental health disorders, and his alcohol dependence prevails. CBT, ACT, and relapse prevention are the main techniques with the help of which the work with Freddie can bring positive results and certain health improvements within a definite period of ten sessions.

References

Babor, T. F., & Robaina, K. (2016). The alcohol use disorders identification test (AUDIT): A review of graded severity algorithms and national adaptations. The International Journal of Alcohol and Drug Research, 5(2), 17-24.

Bonn-Miller, M. O., Heinz, A. J., Smith, E. V., Bruno, R., & Adamson, S. (2016). Preliminary development of a brief cannabis use disorder screening tool: The cannabis use disorder identification test short-form. Cannabis and Cannabinoid Research, 1(1), 252-261.

Bradley, K. A., Ludman, E. J., Chavez, L. J., Bobb, J. F., Ruedebusch, S. J., Achtmeyer, C. E., Merrill, J. O., Saxo, A. J., Caldeiro, R. M., Greenberg, D. M., Lee, A. K., Richards, J. E., Thomas, R. M., Matson, T. E., Williams, E. C., Hawkins, E., Lapham, G., & Kivlahan, D. R. (2017). Patient-centered primary care for adults at high risk for AUDs: The choosing healthier drinking options in primary care (CHOICE) trial. Addiction Science & Clinical Practice, 12(1).

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Brooks, A. T., Lòpez, M. M., Ranucci, A., Krumlauf, M., & Wallen, G. R. (2017). A qualitative exploration of social support during treatment for severe alcohol use disorder and recovery. Addictive Behaviors Reports, 6, 76-82. Web.

Cranford, J. A. (2014). DSM-IV alcohol dependence and marital dissolution: Evidence from the national epidemiologic survey on alcohol and related conditions. Journal of Studies on Alcohol and Drugs, 75(3), 520-529. Web.

Friedmann, P. D. (2013). Alcohol use in adults. The New England Journal of Medicine, 368, 365-373.

Giusto, A., & Puffer, E. (2018). A systematic review of interventions targeting men’s alcohol use and family relationships in low- and middle-income countries. Global Mental Health, 5.

Helle, A. C., Watts, A. L., Trull, T. J., & Sher, K. J. (2019). Alcohol use disorder and antisocial and borderline personality disorders. Alcohol Research: Current Reviews, 40(1).

Hendershot, C., Witkiewitz, K., George, W., & Marlatt, G. (2011). Relapse prevention for addictive behaviors. Substance Abuse: Treatment, Prevention, and Policy, 6(1).

Kendler, K. S., Lönn, S. L., Salvatore, J., Sundquist, J., & Sundquist, K. (2017). Divorce and the onset of alcohol use disorder: A Swedish population-based longitudinal cohort and co-relative study. American Journal of Psychiatry, 174(5), 451-458.

Priddy, S. E., Howard, M. O., Hanley, A. W., Riquino, M. R., Friberg-Felsted, K., & Garland, E. L. (2018). Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: Neurocognitive mechanisms and clinical implications. Substance Abuse and Rehabilitation, 9, 103-114.

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Smith, D. T., Mouzon, D. M., & Elliott, M. (2018). Reviewing the assumptions about men’s mental health: An exploration of the gender binary. American Journal of Men’s Health, 12(1), 78-89.

Tait, R. J., French, D. J., Burns, R., & Anstey, K. J. (2012). Alcohol use and depression from middle age to the oldest old: Gender is more important than age. International Psychogeriatrics, 24(8), 1275–1283.

Vaeth, P. A., Wang‐Schweig, M., & Caetano, R. (2017). Drinking, alcohol use disorder, and treatment access and utilization among US racial/ethnic groups. Alcoholism: Clinical and Experimental Research, 41(1), 6-19.

van Amsterdam, J., & van den Brink, W. (2013). Reduced-risk drinking as a viable treatment goal in problematic alcohol use and alcohol dependence. Journal of Psychopharmacology, 27(11), 987-997.

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