Of the substance disorders, alcohol-related disorders are the most prevalent even though only a small percentage of individuals actually receive help. Recidivism in the substance treatment world is also very high. As research into treatment has developed, more and more evidence shows that genes for alcohol-metabolizing enzymes can vary by genetic inheritance. Women have been identified as particularly vulnerable to the impacts of alcohol. Native Americans, Asians, and some Hispanic and Celtic cultures also have increased vulnerability to alcohol misuse.
Even with these developments, treatment continues to spark debate. For many years, the substance use field itself has disagreed with mental health experts as to what treatments are the most effective for substance use disorders and how to improve outcomes. The debate is often over medication-assisted treatment (MAT) versus abstinence-based treatment (ABT). Recently the American Psychiatric Association has issued guidelines to help clinicians consider integrated solutions for those suffering with these disorders. In this Discussion, you consider your treatment plan for an individual with a substance use disorder.
To prepare: Read “The Case of Kaylin” and the materials for the week. Then assume that you are meeting with Kaylin as the social worker who recorded this case.
By Day 3
Post a 300- to 500-word response in which you address the following:
- Provide the full DSM-5 diagnosis for Kaylin. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
- Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
- Describe the assessment(s) you would use to validate her diagnosis, clarify missing information, or track her progress.
- Summarize how you would explain the diagnosis to Kaylin.
- Explain how you would engage her in treatment, identifying potential cultural considerations related to substance use.
- Describe your initial recommendations for her treatment and explain why you would recommend MAT or ABT.
- Identify specific resources to which you would refer her. Explain why you would recommend these resources based on her diagnosis and other identity characteristics (e.g., age, sex, gender, sexual orientation, class, ethnicity, religion, etc.).
Note: You do not need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5, demonstrating an understanding of the risks and benefits of treatment to the client. You do need to include an APA reference for the assessment tool and any other resources you use to support your response.
The Case of Kaylin Ma
Kaylin is 22 years old and the oldest child of two working-class parents. Her father is a heating and air conditioning technician, and her mother is an administrative assistant at a local community college. Both parents immigrated from Korea as children. Kaylin has one younger brother, aged 9, who has been diagnosed with attention deficit hyperactivity disorder (ADHD). Kaylin appeared normally dressed and is 5’4” tall. Kaylin’s childhood was otherwise unremarkable. She reported that she has always worked hard at school and generally was an “A” student through high school. She ran track and was involved in many activities, socializing with boyfriends and her wide friendship circle. She reported no particular difficulties with her parents other than fighting with them over her decision to leave the state for college. After delaying admission for a year and working, Kaylin left her home in New Hampshire at 20 to attend college in Florida. As a freshman, she lived off campus with three other roommates. She has been waitressing in Tampa since freshman year at a bar/restaurant to supplement financial aid for tuition. She had very good grades (B+ to A) in her first 2 years of college. Kaylin is now a junior. She complained of chronic anxiety and problems with concentration and attention. She still works long hours, and she recently took a course in bartending so she can serve drinks and “make more.” She had managed to maintain a B+ grade point average while studying juvenile justice up until this year. Kaylin initially began drinking with friends at the restaurant after closing during her second semester of sophomore year. She now drinks regularly on weekends with her college and “bar” friends. She reported that since her 21st birthday party she has at times been “out all night partying and drinking.” She missed enough classes this year that her grades have begun to suffer. She had to drop at least one course (and will need to retake it next year) due to nonattendance. “This is because I don’t get enough sleep,” Kaylin said, and she stated that she was simply unable to wake up in time for that course. Kaylin attended this session with the social work counselor on campus because she hadn’t been interested much in food this past semester. Her roommates insisted that she get some help, as she had gone from “slight” to “reed thin.” Kaylin stated that they are worried that she has an eating disorder. Kaylin denied any eating disorder, but she admitted that she often has no time for meals and at times has “no appetite.” She often reported mild nausea. Current weight was reported at 104 pounds. Upon further assessment, Kaylin reported that she spent much of the last 2 months of weekends drinking at her workplace as well as at college parties. She used “hair of the dog” practices—e.g., a morning Bloody Mary—to feel better this past month, as she sometimes had mild hand tremors in the morning and was strongly nauseous. She admitted to being “foggy.” During these weekend experiences, she claimed to have full memory (she denies blackouts) but reported that the hangovers make her “sound sensitive” with headaches. She said she “feels” normal by the end of the day most Mondays, but she also stated that she has trouble sleeping several nights a week without an evening beer. Her mood varies over the week, and she admitted to chronic anxiety and some tendency to get into “arguments” with her roommates when sober. She set some limits for herself, such as three cocktails per weekend evening, but she has often “not bothered” to maintain those limits for “other reasons.” She admitted occasional alcohol use in high school, but her status as a varsity athlete motivated her to limit her use. At the time of the assessment she was not involved in sports, clubs, or other steady exercise, and she stated that she “has no time” for that or for boyfriends