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1, Read Chapter 13 Case 2 Larry and the intervention section of the chapter. 2. Review the Case Analysis Rubric  [DOCX]. 3. In a Word document, in 2-3 pages double-spaced, answer the following questions. Points will be removed for poor writing and spelling. a. Given Larry's presenting problems, what interventions do you think are most suitable for him and why? b. Be sure to cite information from the textbook or readings to support your opinion. 
4. Submit your assignment. To do this: a. Save your document as LastName_FirstName_A2.DOCX. b. Select the assignment link above. 

Case Analysis Rubric |
Content |
There are 4 case analysis this term, each is worth 10 points. While the content for each analysis is
different, all should respond to the posed questions, highlight important information for effective social
work practice, and note implications for practice. Each analysis should be approximately 2 - 3 pages in |
length.

7 points |
Grammar
Case analysis should be clearly written with no grammar or spelling errors.

3 points |

Total: 10 points

Larry is a 27-year-old white male who lost his driver's license 6 months ago after his third DUI offe
He is required to complete a substance use treatment program in order to have the license reinstate,
He kept drinking on the first two occasions he was placed in the program and refused to attend h.
required weekly AA meetings. This is the last opportunity the agency will give him to comply with
the program requirements before they close his case. Larry came to the interview at the treatment
facility well dressed and spoke articulately. He was somewhat fidgety, constantly Wringing his hands
and shifting in his seat. He also had some difficulty keeping his train of thought as he spoke about his
situation, stating that he felt “distracted.”

Larry started using marijuana when he was 14 and drinking when he was 16. He was arrested
for several drug- and alcohol-related offenses in his youth and spent time in a juvenile justice facility
as a result. He was diagnosed with ADHD when he was in elementary school and struggled with al
academic subjects, especially math. He was on Ritalin for several years but is no longer taking it. He
dropped out of school during his senior year because he was making so much money dealing drugs
that he did not see the need to continue struggling in school. He later completed his GED while sery-
ing a jail sentence for dealing. —— | |

Larry is now working as a realtor, but his business is suffering because he cannot drive, Although
he seems motivated to complete the program so that he can get his license back, he believes he has
learned to “control” his drinking and sees no problem with his regular marijuana use. When asked 

chaP vaeans BY controlling his drinking, he said that the three DUIs got his attention and he does

what he ro get into further legal trouble. He now drinks only “a couple of beers” on weekdays; on

not wan he consumes a six-pack each night. He no longer drinks at bars because he cannot drive

weeken a afford to buy drinks. He says he is not seeing much of his friends lately because of his

and can on problems. Another reason he views his alcohol use as not being a problem is that his

rransport4 dto drink more than he does. In contrast, he sees himself as only a social drinker.

friends te” Larry does not think he should be in a substance use treatment Program. He also thinks

" be given credit for the few weeks he attended the program in the past, so that his current
he en nents could be shortened. Larry is disgusted that he is required to attend AA, stating that he
eit those people” and asking, “How am | supposed to attend all these meetings and groups
f | can't drive?” . . .

Larry is the older of two boys. His parents divorced when he was 11, leaving his family to struggle
gnancially. He Is close to his mother. Larry considers his mother his strongest support and often turns
to her for help. He says she Is sympathetic to his driving prohibition, and she sometimes takes him
places he needs to go. She supports his need to seek treatment so that he can get his license back,
but according to Larry, "she doesn't think | have a problem either.” Larry has not kept in touch with his
father, and his relationship with his brother is somewhat strained. Larry claims that his brother is the
source of much of his stress and that he has a lot of resentment toward him. It seems that Larry and
his brother started a business together that is not working out, and Larry feels his brother is to blame.
Members of Larry's paternal family (an uncle and grandfather) have a history of alcohol use disorders.

Larry is currently living with his girlfriend of 18 months and their 3-month-old daughter in an
apartment. His relationship with his girlfriend has been a major source of stress for the last 6 months.
They were engaged to be married but have broken the engagement, because Larry wants to “move
on.’ Though they still live together, they are not getting along, and Larry is having a hard time dealing
with the tension. He says they argue about his inadequate earnings, his drinking and marijuana use,
and his children from a previous marriage. Larry admits he gets so frustrated with the situation that
he has been violent with his girlfriend, usually when drinking. She has called the police, and Larry
has been arrested twice for family violence. When questioned about these episodes, Larry says, “I’ve
never hit her." He does, however, admit to once pinning her against the wall and “getting in her face.”
He also shoved her out of the way when she blocked his way out of a room, which on at least one
occasion resulted in her being knocked to the floor.

Larry has three children from a previous marriage whom he cares for every other weekend. His
relationship with his ex-wife is acrimonious, according to his description. His oldest child, who is 6, was
diagnosed with leukemia 3 years ago. During that time, Larry was taking antidepressants to help him
deal with “that gut-wrenching situation.” The child’s cancer is now in remission, and Larry is no longer
taking the medication. When asked, he said that he did not notice if his distractibility and fidgeting
were any better on antidepressants as “| had other things on my mind.” He says that he does not feel
depressed currently but is “stressed out.”

Larry says he smokes marijuana to help him relax, and that it is the only thing that helps him in
this way. He has used it at least twice a week for several years in the evening. He finds using marijuana
preferable to being on medication. He does not report tolerance, saying that he has always smoked
One joint “to get high” and this amount has not changed in years.

Larry considers himself in excellent health and reports that “everything checked out fine” at a
Physical examination about a year ago. He suffers from asthma, but keeps it under control by using
an inhaler before he exercises. He is not currently taking any other medications. He tries to work out
every day and notices that he is having an easier time working out since he quit smoking last month.

Larry states that he has problems sleeping. It is not hard for him to fall asleep, but he wakes
frequently and has trouble getting back to sleep. He feels that he does not get enough “deep sleep”
to feel refreshed in the morning. Larry also complains that he feels anxious all the time and cannot
remember when he has not felt that way. He worries about his children, his relationship with his
girlfriend, his job, and his need to complete this program. He feels this anxiety in his stomach and

in his head and neck. 

Given his visible symptoms of distractibility and hyperactivity and the fact that Larry was diag-

nosed with ADHD as a child, the social work intern asked about other symptoms of inattention,

hyperactivity, and impulsivity. In regard to inattention, Larry admitted to avoiding tasks that take a lot

of mental energy and having difficulty keeping his attention on paperwork. He says that he would

probably make more money if he were better organized. He says that his girlfriend complains about

his forgetfulness and inattentiveness to her, even when she speaks to him directly. With regard to
hyperactivity, Larry fidgets, but he denies any of the other symptoms when asked about them. How-
ever, he admits to “feeling restless” if he does not drink or smoke marijuana in the evenings. Directions Part Il, Biopsychosocial Risk and Resilience Assessment Fo
ience assessment, both for the onset of the disorder and for the Course of heart’ a Fish
strengths that you see for this individual and the techniques you would Use te worder, clan rey
INTERVENTION
ing, permanent abstinence is the major goal. Whether adult clients can man 33 “eneraly
ing is a controversial topic, but studies have indicated that reduced drinking « COntrolleg tte
reduced health risks (Charlet & Heinz, 2017). Controlled drinking may also b. ‘an result in me
some people or may be appropriate in the early stages of alcohol use (Mirin et actin Boal a
About half of those with a substance use disorder will eventually make tr 22092) Or
(Wang et al., 2005), although past-year treatment seeking is low: 6% for vee cont,
use disorders, 16% for people with drug use disorders, and 22% for People with With aleoha
and drug use disorders (Stinson et al., 2005). Commonly available treatment setting alcohg)
order of usage) outpatient rehabilitation facilities, inpatient rehabilitation faciline Nclude lin
hospitals, and outpatient mental health centers (SAMHSA, 2006). Some programs ne MPatien,
designed for adolescents, pregnant or postpartum women, and women with youn ial
Many people receive intervention from locations that are not specialized for thee Children,
of these disorders, including self-help groups, private doctors’ offices, emergency a atmene
prisons or jails (SAMHSA, 2006). For further guidance on appropriate placement ie and
ers should be aware of the Patient Placement Criteria for the Treatment of Substance Work.
Disorders of the American Society of Addiction Medicine (Mee-Lee, Shulman, Fishn, ted
friend, & Griffith, 2001). an, Gagt.
Adolescents who access care for substance use concerns are often clients in other interyens
systems, such as child welfare, juvenile justice, and mental health. The needs of each youn ENtion
may consequently be managed by multiple agencies, and providing quality treatment often, Person
the social worker's navigation across these systems (Kraft et al., 2006). "Equires
1. Reduce or eliminate substance use. For Adolescents
2. Improve psychological and social functioning by 1 famil —
mending disrupted relationships, reducing impulsivity, | | /PYOYS ‘amy communication.
building social and vocational skills, and maintaining 2. Help parents to develop skills for providing proper
employment. guidance and limit setting for the youths,
3. Prevent relapse by discussing the client's ambiva- 3. Recognize and, if possible, treat addiction patterns in
lence about sobriety, identifying the emotional the parents.
and environmental triggers of craving, developing 4. Help adolescents and their families to develop
coping strategies to deal with internal or external alcohol- and drug-free lifestyles.
Stressors, exploring the chain of decisions leading tO SSuces Bukatein et al, 2005: Larimer, Palmer & Marlatt 1999
the resumption of substance use, and learning from '
brief relapse episodes (slips) about triggers leading to
relapse so as to develop effective techniques for early
intervention. Client characteristics at influence decision making about the MOSst appropriate treatment
‘ing include the ee chal ee of withdrawal, the severity of comorbid health and
set ral health concerns, C c evel o Previous treatment response, and the extent of environmental
me et for the client's sobriety (Mirin et al., 2002). These risks need to be addressed in treatment
suPP cher a high degree of community support or temporary removal from those circumstances
with h residential treatment. Regardless of the treatment site or modalities utilized, positive out-
phrous re associated with the frequency, intensity, and duration of treatment Participation (Mirin
comes 02: Prendergast, Podus, & Change, 2000),
et octal Intervention
psy » AA models of recovery have tended to dominate the substance use treatment field (Fuller
Alhoe Srurmhofel, 1999; Kelly, Myers, & Brown, 2002; Sheehan & Owen, 1999), social workers
g Hiller aware of alternatives for people who need help with substance use disorders. They
should be alternative self-help groups, motivational interviewing, Cognitive-behavioral treatment,
include A a erventiOns. In AA self-help groups, the Participant reaches and maintains abstinence
and fam ily ‘rough a series of 12 steps with the assistance of a support group and sponsor. AA and
by moving ics Anonymous) self-help groups have been shown to increase abstinence, self-efficacy,
NA (Narco® ctioning for those who attend, especially when they engage in outside activities with
and social fn eet at AA (Humphreys et al., 2004), Attendance at AA meetings may also stave off
peoP le mney n that often accompanies heavy drinking (Kelly, Stout, Magill, Tonigan, & Pagano,
the dee help groups should probably not act as a substitute for professional intervention,
2010): Still, se ‘howe who are mandated to attend treatment, because involuntary clients typically
especially tO enkin g when attending AA (Kownacki & Shadish, 1999).
do not stop ent models have also been developed as a treatment modality. In one large-scale
Aa Tt project MATCH, the AA model was as effective as other treatments, especially for those
study called owed severe dependence and for those whose social networks supported drinking
who nial Wirtz, Zweben, & Stout, 1998; Project MATCH Research Group, 1997). The reader
(Longabaue are that in addition to 12-step groups, there are alternative self-help groups available
should be hese wnaclude Secular Organization for Sobriety, SMART Recovery, Women for Sobriety,
OO tion Management (Humphreys et al., 2004).
and wae many people who present to treatment are not willing to change and maintain that
th ic vot have a problem. One treatment approach, known as motivational interviewing, has been
ssned for such involuntary clients (Miller & Rollnick, 2013) (see Table 13.2). Another individually
oriented approach that is typically used when the client is more motivated to change is cognitive-
behavioral therapy (CBT). These interventions focus on certain aspects of the substance use behav-
iorand can be utilized in a variety of comprehensive approaches (Kaminer & Waldron, 2006).
Other cognitive-behavioral treatments are part of family intervention. Families have tremen-
dous potential impact on either perpetuating or ameliorating the substance use problems of a
family member, including the abuser’s ability and willingness to comply with intervention (Mirin
ttal, 2002), For the partners of people with addictions, Al-Anon has been a widely used interven-
ton approach. Al-Anon is a 12-step model derived from AA and cultivates detachment from the
Pétson with the addiction and the well-being of the family member, A lesser-known group of
“eventions called by various names, such as CRAFT (Miller, Meyers, & Tonigan, 1999), essentially
tena hanbers in behavioral techniques to exert influence on the “drinker” so that he or
cach fora motivation to change. Behavioral couples therapy is another research-focused
tag, witha there is both a substance use problem (either alcohol or drug use) and a
- ton tha mainte the couple. The main objective of couples therapy is to alter patterns of inter-
Farrel & Fal ain chemical abuse and build a relationship that more effectively supports sobriety
S-Stewart, 2006),

Part 2. DSM-5 Categories :
isorders
| nce Use Disor
TABLE 13.2 Psychosocial Interventions for substé Indications and :
an |
Theoretical Orientation | Description Contraindicazo~
Individual dresolv- | C .
| 4 5essi0") exploring an : a be effective with che
Motivational interviewing | A brief model ( sople have about ¢ anging. | high levels of anger ( NS who q
ing the ambivalence p Project MATCH R ONBabaupt, SMO. |
g 5 7 esearch Groye et al 1, ale |
| voidance | The 1999, 748 :
as include caif- monitor: the a ae I hi peo should be motiy P. 1997) “7%
Cognitive-behavioral Techniques "° reinforcemen! patter r her behaviors MEd to
B a chang!né desist | behavi because Chan
of stimulus CO oung skills 10 manage ane’ 1s avioral therapy (CBT) ea cee:
and develope kills that can be incorpo” approach. ACtlon. One,
urges 10 sub tance refusal, communication, ed
rated include SY $ ertiveness: relaxation training,
blem-solving: ase ging COBNIIVE distor-
e managemen! modifying ©°8
anger
es and relapse preven won
Family onditions in the Although results are mixed f
. ber removes CO" . Or wh
Behavioral training for The family mem rtive of drinking, reinforces ment improves for the family m ether adjusy.
| vironment SUPPO™ 6: ee feedback | et al., 1999; Thom EMber (Mille,
family member (6. ae ropriate Denavir of the addict. gives © rch sh as & Corcoran, 209) ller
CRAFT) (Miller et al. appropri ropriate behavior while drinking, research shows that these approach ) the
1999) about InapP oP s if behavior exceeds resulted in the person with sub €S have
and provides consequenc® entering treatm Stance us
nits g ent at a significantly hj €
agreed-upon limits. rate and with reduced drinking th Y Nigher
comparison conditions. an in the
delivered A meta-analysis found that
to 15 sessions) CBT approach _ found that couples t
Behavior couples A brett indvidual or couples: group modalities was superior to individual treatment " ‘apy
therapy that entails building communication skills, plan- test on relationship satisfaction, but hotan
ning family activities, initiating caring behaviors, the follow-up period were substance use ™
and expressing feelings. outcomes superior to the control condit
(Powers, Vedel, and Emmelkamp, 2008) ions
of the research has been done with men Most
recently women with substance use disor but
ders have been a focus, and couples thera
especially has been found helpful for es
with other disorders. (Fals-Stewart, Birchler&
Kelley, 2006; McCrady, Epstein, Cook, Jensen
& Hildebrandt, 2009; Winters, Fals-Stewart n,
O'Farrell, Birchler, & Kelley, 2002). |
Family therapy approaches have received the most research attention for adolescent substan
use disorders (Bukstein et al., 2005), along with CBT (Waldron & Turner, 2008). Because of the mul
tidimensional nature of substance use problems in adolescence, most family therapy approach -
integrate several theoretical frameworks. For instance, brief strategic family therapy (Seapocenik &
Williams, 2000) incorporates both structural and strategic techniques. Functional family thera
sesses elements of structural and strategic family systems approaches, as well as behavi Py pos-
therapy, with a particular emphasis on the functions of sympto Al ehavioral family
Both multidimensional family therapy (Liddle, 1999) and iy ae ” (Alexander & Parsons, 1982).
Borduin, Rowland, & Cunningham, 1998) are presented i ate erapy (Henggeler, Schoenwald,
(Mirin et al., 2002), because they go beyond family thera ae ogically integrative approaches”
tioning affecting the youth’s behavior, including other ke py to modify multiple domains of func-
Because other mental health problems oft . y supports and systems in the youth’s life
lines have been devel en co-exist with substance use di a
use disord eveloped for the treatment of people with ; sorders, some guide-
orders (Petrakis, Gonzalez, Rosenheck, & Krystal co-occurring psychiatric and substance
, 2002). These are summarized in Box 13.4. Concrete needs, such as shelter and Physical hea}
must be a priority. ealth, * For clients with depression and anxiety, CBT can
. The mental disorder should first be Stabilized acres both the psychiatric and substance use
oe , i, concerns
. Motivational interviewing may he! eop!
with mental health treatment and subst OY The initial phase of substance use treatment may De
reatment. use crucial to successful engagement and retention, SO
. developing interventions that focus on improving
ion, aco
» Confrontat . MMON approach in many sub- early success in clients who are depressed may be
stance use treatment settings, may not be effective for beneficial.
clients who are psychotic or potentially suicidal, and = —————
ortive approach is su ' Sources: Conner et al., 2005; Martino, Carroll, Kostas, Perkins, &
a supp PP 8gested instead. Rounsaville, 2002: Petrakis et al. 2002 Rosenthal & Westreich, 1999.
Three types of rnae), de are Sently used in substance use treatment: (1) aversive medica-
tions (such as ta ose "7 aoe to deter client drinking; (2) anticraving medications (known as
the antidipsotropics); an (3) su stitution therapy. Details about these medications are provided
in Table 13.3. As aversive medications have lost popularity, anticraving medications have become
more widely used. Both acamprosate and oral naltrexone are associated with reduction in return
to drinking (Jonas et al., 2014).
When directly compared with one another, no significant differences were found between
acamprosate and naltrexone for controlling alcohol consumption. A prescription of Naltrexone
for those with drinking problems was found to substantially reduce health care costs compared to
cases in which there was none (Kranzler, Montejano, Stephenson, Wang, & Gastfriend, 2010). The
use of Naltrexone may thus be a cost-effective method of treatment.
Substitution medications, such as methadone and buprenorphine, are used for heroin depen-
dence specifically. The goals of such medications are the prevention of withdrawal, the elimination
of cravings, and the blockage of euphoric effects obtained by illegal opiate use (Bukstein & Cor-
nelius, 2006). The addition of psychosocial intervention to methadone or buprenorphine seems to
produce benefits in terms of compliance with treatment, reduced use of opiates, and abstinence
from drugs at follow-up over medication alone (Amato et al., 2009).
SSeS sh seasisvssssnasissepsns
Directions Part Ill, Goal Setting and Treatment Planning Given your risk and resilience assess-
ments of the individual, your knowledge of the disorder, and evidence-based practice guidelines,
formulate goals and a possible treatment plan for this individual.
eerste ins chesatannasssnetssarmensamranmemenes
CR
ITICAL PERSPECTIVE
disor der applying diagnostic criteria to substance use disorders is that so often comorbi
de Th. are present—about 50% of such persons will have a co-occurring mental health disor-
« S e ’
bsances ™ptoms of substance use, and the effects of certain substances and withdrawal from
a are often difficult to disentangle from symptoms of other mental disorders, such as
Presence oon and ADHD. Substance use can be a stand-alone disorder or it may mask the
€r disorders in which it is comorbid to those disorders. A conservative position is Pharmacological Treatment of Substance Use Disorders
Type [Description + tndeations and Contralndleation
Aversive ;
Antabuse Inhibits the activity of aldehyde dehydroge- Compliance with this medication \« dif
nase, the enzyme that metabolizes acetalde- physicians may be reluctant to bese Iicule and
hyde, the first metabolic breakdown product | common adverse reactions (Mctelig.® be Cau,
of alcohol In the presence of disulfiram, " 2008) of
alcohol use results in an accumulation of toxic
levels of acetaldehyde, which is accompanied
by a variety of unpleasant and potentially
dangerous (but rarely lethal) symptoms (Mirin
et al., 2002).
Anticraving
Naltrexone An opioid receptor antagonist, a substance Meta-analysis (Rosner, Leucht, Lehert
that blocks opioid receptors in the brain, so 2008): better at Preventing a“| apse’ f & Soyka
that the individual falls to experience positive | a relapse fom becom,
effects from opiates or alcohol COMBINE study (Anton et al. 2006); g
well as behavioral treatment on dinky ree 2
Meta-analysis: naltrexone for women B Outcome,
in modest reductions in the amount ny result
amount of relapse, but not on frequen drinks and
Acamprosate May block glutamine receptors while activat- | Meta-analysis (Rosner et al. 2008): 5 oy Of drinking
ing gamma-aminobutyric acid preventing a relapse Detter at
COMBINE study (Anton et al. 209¢).
evidence of efficacy + £006); Showed no
Substitution (for
opioid addiction)
Methadone Works on opioid receptors Substitution medication for Opioid (hero;
— OIN) addics
Buprenorphine Works on opioid receptors Can be prescribed on an outpatient ba ) Addiction
is
stimulants (for cocaine) po
Cannabis (for chronic
pain)
Sources: Ross & Peselow, 2009
to wait until after 6 weeks of sobriety to determine the presence of comorbid disorders al
this practice is typically not implemented in treatment settings. » although
Another critique, regarding treatment services, is that many facilities are still oriented
. ”» . aro
the “disease model of recovery.” Although this has been useful for many people, our vost und
. on
that substance use disorders, as well as other mental health problems, are a biopsychosocial nai
festation and that other research-based treatments should be readily available and disseminated in
addiction treatment settings. This is not so much a critique of the validity of the disorder as much
as the way in which addiction is perceived by the substance use treatment field, and even among
some social work professionals.
ace eee
Directions Part IV, Critical Perspective Formulate a critique of the diagnosis as it relates to this
case example. Questions to consider include the following: Does this diagnosis represent a valid
mental disorder from the social work perspective? Is this diagnosis significantly different from other
possible diagnoses? Your critique should be based on the values of the social work profession (which
are incongruent in some ways with the medical model) and the validity of the specific diagnostic
criteria applied to this case.