Client Description
The client, henceforth referred to as IA, is a 17-year-old client with a substance abuse disorder. He started abusing drugs and alcohol when he was 11 years old and has sustained the behavior since then. He smokes marijuana 24/7 and takes anti-anxiety medication daily to cope with anxiety, depression, and post-traumatic stress disorder (PTSD). The anti-anxiety medication is not prescribed by a professional. Instead, IA uses it to get high. His PTSD is a result of domestic and community violence. The sustained drug use has led to various arrests associated with using and selling drugs such as marijuana and prescription pills.
Apart from being on the wrong side of the law by selling and using marijuana and prescription pills, substance abuse disorder has also affected his performance and dedication in school and other extra-curricular activities. His mother is a single mother, and his father has been out of the picture since he was young. IA's mother struggles with depression due to the lack of a stable income and low self-efficacy as a parent. The presence of depression in the family lineage indicates that IA faces a high risk of developing a major depressive disorder. Additionally, IA’s relationship with his mother is strained since his mother tends to lean on him for emotional support, which, IA feels, suffocates him.
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Client Diagnosis Using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Based on his admittance, IA uses marijuana and anti-anxiety medication to cope with his depression, anxiety, and PTSD. Based on this evaluation, the DSM-5 will be used to diagnose any psychological disorder.
Major Depressive Disorder
One of the chief symptoms of a major depressive disorder is experiencing a predominantly melancholic mood during the day, as reported by the client or the people around him. There is also a diminished interest in daily activities, loss of weight, insomnia, psychomotor agitation, lethargy, lack of self-worth, lack of concentration, and recurrent suicidal thoughts. The major depressive diagnosis is applicable when a client experiences five or more symptoms, which are persistent for two weeks. IA only experiences a diminished interest in daily activities such as school, which does not warrant the diagnosis. Therefore, he does not suffer from a major depressive disorder.
Generalized Anxiety Disorder
Six diagnostic criteria characterize generalized anxiety disorder (GAD). Excessive anxiety and worry, which persists for more than six months, is the primary diagnostic criteria. The client is also unable to control the worry. Worry is associated with the presence of three or more symptoms; difficulty concentrating, irritability, restlessness, fatigue, muscle tension, and sleep disturbance. The anxiety or worry also causes clinically significant distress, which affects critical functioning areas. The disturbance is not associated with a medical disorder or substance use (American Psychiatric Association, 2013). IA does not meet GAD's criteria since the information provided in the case study fails to indicate whether his anxiety persists for more than six months. He has limited symptom attacks. Additionally, generalized anxiety occur less frequently.
Post-Traumatic Stress Disorder (PTSD)
PTSD is preceded by exposure to actual or threatened death. IA has witnessed and experienced domestic and community violence. The second diagnostic criteria include the presence of one or more intrusion symptoms such as recurrent and involuntary recollections of the traumatic event and dissociative reactions such as flashbacks. Other diagnostic criteria include evading the stimuli related to the traumatic event, negative variations of mood, disturbance duration exceeds one month, and the disturbance is not associated with substance use (American Psychiatric Association, 2013). However, the duration of anxiety and additional information to warrant his PTSD diagnosis is missing. IA has some of the symptoms associated with PTSD but they do not meet the diagnosis criteria. Therefore, he can be diagnosed with unspecified trauma-and stressor-related anxiety (American Psychiatric Association, 2013).
Cannabis Use Disorder
Cannabis use disorder is manifested by two or more criteria occurring within one year. The criteria include taking cannabis in large amounts and over a prolonged period than intended, inability to lessen or regulate cannabis intake, prioritizing activities necessary to obtain cannabis, craving, recurrent cannabis use which causes failure to accomplish major roles in school or at work, and persistent use despite social issues associated with cannabis use. Additionally, users give up on various activities in favor of cannabis use, continue using it despite awareness of physical or psychological issues caused by cannabis use, and increased tolerance (American Psychiatric Association, 2013). Based on the diagnostic criteria described, IA meets six out of the eleven criteria, indicating that he suffers from a cannabis use disorder.
Psychotherapy and Medication Interventions
Some types of psychotherapy that can be used in IA’s case are cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), and contingency management (CM). CBT helps patients to identify the factors influencing user behavior, prevent relapse, and develop coping skills. Possible CBT techniques include self-monitoring and modeling. MET uses motivational interviewing principles. It motivates users to change by giving non-judgmental feedback, resolving inconsistency, and involves the client in goal setting. An empathic nonconfrontational tactic is used to encourage behavior change. CM is based on operant conditioning of desired behavior using frequent reinforcement opportunities (Sherman & McRae‐Clark, 2016).
Trigo et al. (2018) investigated the outcomes associated with the concurrent use of nabiximols, MET, and CBT. Nabiximols are pharmacological treatment medications consisting of tetrahydrocannabinol (THC) or cannabidiol (CBD) (Lintzeris et al., 2019). The study results indicated that nabiximols were well tolerated without any adverse reactions. Concurrent use of nabiximols, CBT, and MET, led to a reduction of cannabis use. Therefore, nabiximols, CBT, and MET can be useful in IA’s case.
Legal and Ethical Implications Related to Counseling
One of the legal issues in IA's case is the provision of informed consent. The counselor should balance assent from IA and his mother, who holds the legal rights of consent, protection, and decision making on his behalf since he is a minor. If the use of cannabis is illegal in the state, a conflict will arise between ethical responsibilities and laws. The Code of Ethics should be used to alleviate the conflict (Pope & Vasquez, 2016).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) . American Psychiatric Pub.
Lintzeris, N., Bhardwaj, A., Mills, L., Dunlop, A., Copeland, J., McGregor, I., ... & Chan, T. (2019). Nabiximols for the treatment of cannabis dependence: a randomized clinical trial. JAMA Internal Medicine , 179 (9), 1242-1253. 10.1001/jamainternmed.2019.1993
Pope, K. S., & Vasquez, M. J. (2016). Ethics in psychotherapy and counseling: A practical guide . John Wiley & Sons.
Sherman, B. J., & McRae‐Clark, A. L. (2016). Treatment of cannabis use disorder: current science and future outlook. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy , 36 (5), 511-535. 10.1002/phar.1747
Trigo, J. M., Soliman, A., Quilty, L. C., Fischer, B., Rehm, J., Selby, P., ... & Staios, G. (2018). Nabiximols combined with motivational enhancement/cognitive behavioral therapy for the treatment of cannabis dependence: a pilot randomized clinical trial. PloS one , 13 (1), e0190768. https://doi.org/10.1371/journal.pone.0190768
