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28 days Film Character Assessment...

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Running head: CHARACTER ASSESSMENT

Gwen Cummings in 28 Days: A Case Study

Assessment of a Film Charater SOWK 5368 – Clinical Practice in Addiction Treatment and Prevention

CHARACTER ASSESSMENT

2

Client's Name: Gwen Cummings DOB: 08/10/1996 Gender: Female Presenting Problem from the Client's Perspective

In her late twenties, the client came in today, seeking help after ruining her sister's wedding. She drove while intoxicated and crashed a limousine; she was ordered to mandatory rehab treatment or face jail time by a judge. Presenting Problem from Social Worker's Perspective

The client presents today with a history of substance abuse, specifically alcohol. In addition to this, she has flashbacks of her mother been an alcoholic from her childhood. She is seeking treatment for her alcohol and painkillers (Vicodin), with alcohol being her "gateway" drug.

Psychosocial History Reason for Seeking Services and Why this particular time She is seeking help at this particular time because, She is then court-ordered to a rehabilitation center for 28 days to be treated for Substance Use Disorder (SUD), specifically for Alcohol Use Disorder (AUD). She is reluctant to participate in any treatment programs and refuses to admit that she is an alcoholic. She is seeking help to identify she has a disease and get help for her condition. Health History Gwen's family does not have any history of chronic diseases. Although her mother has a history of alcoholism, she has no medical problem.

She does not have any sexually transmitted infections (STIs), but she practices unprotected sex at a high-risk factor. Mental Health History The client has no known history of mental health conditions and any family history of any mental health conditions. She is not currently receiving any mental health-related disorders. However, a co-occurring disruption exacerbates the substance abuse symptoms, lowering her quality of life, and complicate treatment. The severity of the mental health condition would directly impact the moment. Substance Use History The client indicated she has never received any formal treatment or attended any substance use disorder programs. Her PCP conducted various assessments, including SBIRT, to assess her substance use disorder(s) and the consequences of substance use. These questions refer to the past 12 months:

Circle Your Response 1. Have you used drugs other than those required for medical reasons? Yes No 2. Have you abused prescription drugs? Yes No 3. Do you abuse more than one drug at a time? Yes No 4. Can you get through the week without using drugs? Yes No 5. Are you always able to stop using drugs when you want to? Yes No 6. Have you had "blackouts" or "flashbacks" as a result of drug use? Yes

No

7. Do you ever feel bad or guilty about your drug use? Yes No 8. Does your spouse (or parents) ever complain about your involvement with drugs? Yes No 9. Has drug abuse created problems between you and your spouse or your parents? Yes No 10. Have you lost friends because of your use of drugs? Yes No 11. Have you neglected your family because of your use of drugs? Yes

No

12. Have you been in trouble at work (or school) because of drug abuse? Yes

No

13. Have you lost your job because of drug abuse? Yes

No

14. Have you gotten into fights when under the influence of drugs? Yes

No

15. Have you engaged in illegal activities in order to obtain drugs? Yes

No

16. Have you been arrested for possession of illegal drugs? Yes

No

17. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? Yes No 18. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)? Yes No 19. Have you gone to anyone for help with drug problems? Yes No 20. Have you been involved in a treatment program specifically related to drug use? Yes No

These include the Drug Abuse Screening Test (DAST-20).

Alcohol

Vicodin

Age

Type(s)

Route of

First Use 15

Beer

Administration Oral Daily,

15

Painkiller

Oral

Frequency

Quantity

Last Use

"every

Yesterday

multiple

once in a

times daily Daily

while" Four

Today

Two

Yesterday

N/A

N/A

A couple of Inhalants 13

Cigarettes

Oral

times Daily A couple of

Opiates

N/A

N/A

N/A

times N/A

The client reports sipping her mother drinks as a teenager, and her mother was addicted to alcohol and potentially other drugs as polysubstance use is expected. She also reports some of the drugs' effects included memory problems, inability to stand up straight or walk in a straight line, euphoria, relationship problems with her sister, and potential incarceration. In addition to this, she reports that her addiction was because her mother was a substance abuser, presumably with alcohol and other drugs. She reports having childhood's frequent flashbacks with her substance-abusing mother indicate some psychological stress. She stated she has been using alcohol and Vicodin to block out the pain and suffering that she was experiencing. When asked if she tried to stop, she said that s h ec o n t i n u a l l yde s i r e st ou s ea l c o h ol .S hee n j o y sg o i n go u tt o d r i n kwi t hhe rb o y f r i e n da n df r i e n dsi sar e g u l a rs o c i a la c t i v i t yt h a ts hewa n t s . Sh en e v e rt h o ug h t o fs t o p pi n g ,e v e nt h o u ghe x c e s s i v ed r i nk i n gh a sl e dt oh e ri n a bi l i t yt of u l fil l h e rwo r ko b l i g a t i on s . Sh ec o n t i n u e st od r i n ke v e nt h o u g hi t i n t e r f e r e swi t hhe ri n t e r p e r s o n a lr e l a t i o n s h i p s , s p e c i fic a l l y wi t hh e rs i s t e r Developmental History She had a regular developmental history with no history of delays, physically or emotionally. Family History She grew with her parents and sister, but much was not said about her father. When she and her older sister, Lily, were around, her mother frequently drank, and she was often found to be drunk on the floor of their house. It didn't show her father, so his role is unknown. Several things made her susceptible to substances. The drug behaviors, feelings of depression, and sociocultural variables (i.e., age and school of her mother) make it easy for her to fall victim to alcohol and the cyclical consequences.

Social History She had a close with her friends and boyfriend. She gets together with them and socializing almost overnight, drinking together. She regularly received positive reinforcement for drinkings, such as pleasant feelings, friendships, and her boyfriend's relationship. He stands the only support system she has and making it challenging for her to seek help voluntarily or admits that she is an alcoholic. Educational History Her education level was not stated at the moment, but she appeared to have a college degree. She is a journalist in New York. Her job line requires some level of education to remain relevant or to be employed by any organization. Employment History She is a journalist, and it appears that she is paying her rent and bills. She also does mention if she was still gainfully employed or not during the session. Relationship History She has significant relationships with Jasper, who is her lover and her enabler. He sneaks her out of rehab and encourages her to drink at will. Her relationship with him leads to her legal problems that necessitated her admittance, poor judgment like driving while intoxicated, evidence of intoxication before her admittance, and while at the center.

Military History She was never in the military and did not consider joining any of the branches. Legal History She was never arrested before driving the limousine and crashing into a building and been ordered to mandatory rehab treatment or face jail time by a judge. Housing She stays in a rented apartment in New York before going to rehab. The specific area she was staying in New York was not stated. There was also no indication that she was sharing the apartment with her friend Jasper at the moment.

Cultural The location of her house across the street from a bar and the general availability of drugs were the primary cultural factors that often affected her drug use. From recovery, she was able to call Jasper and make him bring her a bottle of Vicodin. The fact that in a short period, he had access to these drugs suggests that the supply in her everyday environment was strong

Spiritual She grew up to believe that by never practicing, they were Christian. Her mom was never religious, and at the recovery facility, the only type of spirituality she had was. While initially, she did not seem to be interested in the AA prayers, she came around later by saying the prayers to AA and believing that there is a higher force. Clinical Assessment Summary/Justification The client is a single, Caucasian female in her late twenties or early thirties, a New York journalist. Her drugs of choice were alcohol and painkillers (Vicodin), with Moderate substance use disorder. She was also addicted to the nicotine in cigarettes. Some of the drugs' effects included memory problems, inability to stand up straight or walk in a straight line, euphoria, relationship problems with her sister, and potential incarceration. Her mother was addicted to alcohol and potentially other drugs as polysubstance use are common. After ruining her sister's wedding, she drove while intoxicated and crashed a limousine; thus, she was ordered to mandatory inpatient treatment or face jail time by a court. DSM-5 Diagnoses According to the information she has presented with, Gwen would qualify for 303.90( F10.20) Moderate substance use disorder under the DSM-5. She meets 5 out of 11 Criteria( In a controlled environment),; Drank, overslept, one night before Lilly's wedding, and started drinking and using Vicodin during the day; (a lot of time spent obtaining, using, or recovering from use). She encountered a compulsion to use so intensely that she put herself in a risky position to get to

the Vicodin (craving/strong desire/urge to use). Tells Lilly, "you make it impossible to love you" after showing up drunk at her wedding (continued usage amid recurrent interpersonal issues caused or exacerbated (continued use despite recurrent interpersonal problems caused or exacerbated by substance effects). She started her day with an eye-opener; she would possibly drink more than she has in the past to feel the same impact. She has nausea, vomiting, repetitive thoughts/memories, cravings, and tremors. (withdrawal)

Recommended ASAM Level of Care Gwen's treatment plan would include several recommendations. A residential level of care for detoxification ASAM 3.3 level of care would be the first step with medical for proper supervision. After medical clearance was achieved, the other recommendations could be started. Treatment at the residential center would last a month and include individual therapy twice a week, group therapy five times a week, and weekly family sessions if her family could make it. She would also need help in learning and developing new coping mechanisms and motivational strategies. After a month of level three treatment, move to ASAM level 1 IOP treatment alongside the weekly 12-step Alcoholics Anonymous group.

Problems, Needs, Strengths, and Challenges I.

Problems: addiction, coping strategies, b e h a v i o r a lf o r mu l a t i on

II.

Needs: Intense inpatient SUD treatment, p o s i t i v er e i n f o r c e me nt

III.

Strengths: Education , employed, self-determination

IV.

Challenges: Bad influence, last of support from immediate family, flashbacks from childhood, self-denial Service Plan

Goal 01: Establish that there is a problem a. Objective 01: Establish that she needs help

i. Task 01: Attend all meetings while in the inpatient with proper mentoring ii. Task 02: Actively participate in all group and individual sessions iii. Task 03: Attend at least two meetings (AA, SMART, non-religious step meetings) b. Objective 02: Establish a b s t i ne n c ef r o ma l c o h o l , i. Task 01: Inpatient program for one month t oc h a n g ec o g n i t i o n sa b o u t a l c o h olu s e , de c r e a s ea n xi e t y , a n de mp o we rt h ec l i e ntt obu i l das up p o r t n e t wo r ka r o u n da b s t i n e n c e . ii. Task 02: Continue attending meetings and increased to 4-5 sessions a week with the plan of establishing a homegroup and finding a sponsor/support iii. Task 03: Develop a toolbox for the avoidance of triggers to reduce exposure to high-risk situations c. Objective 03: Implement methods for relapse prevention i. Task 01: learn cognitive-behavioral skills for dealing with urges and triggers ii. Task 02: Create a journal on triggering locations and activities and views on drinking iii. Task 03: Real material on Rational Emotive Behavior Therapy for Urge Coping in group sessions and talk about it. Goal 02: Begin the healing process from Childhood trauma a. Objective 01: Develop positive coping skills iv. Task 01: Attend group sessions related to family

v. Task 02: Concurrently meet on an individual weekly basis to discuss the impact of childhood trauma

b. Objective 02: Verbalize the ways the flashbacks has had an impact

vi. Task 01: Write a journal about her childhood and how impacted her growing up

vii. Task 02: Establish a relationship with her family, especially with her sister viii. Objective 03: Decrease statements of shame and increase statements reflecting personal empowerment.

Task 01: Process, within a group and in a unique environment, feelings of guilt and shame related to the events surrounding alcoholism.

Task 02: Feel empowered with the person therapist by working through the problems and letting go of her childhood.

II.

Goal 03: Learn the techniques of Relapse Prevention Therapy (RPT).

a. Objective 01: Develop a relapse prevention plan

i. Task 01: List three to do when having cravings

ii. Task 02: Identify two people that will support her when having drinking.

b. Objective 02: Implement a relapse prevention plan

i. Task 01: Identify triggers associated with her drinking problem.

c. Objective 03: Read materials about i n t e n t i o n a lo b j e c t i vi t y

d. Task 01: identify ways to decrease defensiveness, guilt, and shame while increasing the therapeutic bond. . i.

Task 02: Learns two ways t oc h a l l e n g eh e rp r e v i o u st h o u g h t sa nd b e h a v i o r s .

ii.

Task 03: Identity strengths and opportunities that can come from these strength...