Psychological Case Report for Substance Abuse

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The report is based on the movie Requiem for a Dream and the character that the case study will focus on is known as Harry in the film. The films plot involves the story of four individuals whose lives are ruined by the misuse of drugs and the dangerous activities associated with drug abuse. The characters include the Sara, a glamor-crazed woman, who gets addicted to a weight-reduction drug after she finds out that she will take part in a television show. Saras son Harry, his friend Tyrone and his girlfriend Marion are all drug addicts. Harry and Tyrone are regular users of heroin and Marion is addicted to cocaine. The three plan to get into illegal trade of heroin to support their livelihood. The venture fails, and Marion has to use sexual favors to earn money for Harris and her. The two, later on, fallout and Harry moves out. On their way to Miami Harris and Tyrone are arrested for drug possession when they stop at a hospital to treat Harrys infected arm. They all end up in jail after which Harry is taken to hospital for treatment. The film concludes with the four characters depicted to be suffering due to their drug dependence. Marion is on a couch; Sara has lost sanity after clinical intervention fails, Tyrone is in prison while Harrys arm is to be amputated due to the infection.

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Client Demographics

Harry is a young adult aged 25 years old of a low socio-economic status. He puts up with his girlfriend, Marion, and his friend Tyrone in Brooklyn, Brighton. Harrys mother, Sara Goldfarb is mentally ill as a result of amphetamine-induced psychosis. Harry and his friends do not have a stable source of income as either of them have a long term employment.

Screening Information

Harry was brought in for routine psychiatric tests and has been a long-time user of heroin that has affected him physically and mentally over time. Harrys has a history of violence, a probable consequence of the drug use and gang altercations. Harrys mother is also suffering from substance addiction. His social environment could influence Harry's involvement in drug abuse. His ambitions to start a business and a friends suggestion led to his involvement in illegal drug trade and a worsened addiction to heroin. The sale of medicines was not successful, and Harry had to endure letting his girlfriend use sexual favors on her psychiatrist to provide for their daily living and the drugs. Harrys relationship with his girlfriend Marion started having problems after he allowed her to have sex with her psychiatrist for money and the relationship ended. Harrys addiction affected him physically especially due to the injections of heroin. Wounds of injections on his arms got infected, and he had to amputate his arm. The doctors treating Harrys arm suspected use of drugs and Harry was arrested for drug possession. Most of the unpleasant moments in Harrys life revolve around the access and use of Heroin.

Initial Assessment

Harry showed a healthy sign of former drug use with signs of heroin withdrawal during the first evaluation. However, there were no previous psychiatric reports of substance abuse; he receiving a psychiatric assessment for the first time.

Personal History

Harry was a product of a normal vaginal delivery and his early mental and language development was normal. His language proficiency and IQ tests depict and individual with basic education. Harry did not show any signs of genetically caused mental disorders and had average intellectual development. He, however, has a family history of depressions, anxiety, violence and drug use. His mothers obsession with glamor and stardom led her to addiction. She became an amphetamine addict after she abused her assigned dose of the drug. Her ambition for a glamorous life encouraged her to use more of the drug as well as the high feeling that the drug caused. Harrys mother suffered psychosis and eventually permanent mental disorder after clinical psychiatric diagnoses failed. However, Harrys friends and his habit of substance abuse aggravated his situation as her mothers addiction was after he moved out of his mothers house. Moreover, Harry got deep in his addiction that the heroin injections led to infections on his arm that led to an amputation. Harry also has a criminal record for the possession of illegal drugs. Harrys addiction was not influenced by his family history but by his immediate social environment and his personal ambition to start a business.

Emotional Assessment

Harry faces frustration and anger issues due to his life choices and his current status. However, he gets along with people he interacts with. Some of the anger and frustration issues encourage the continued use of heroin to cope with the frustrations he faces. Harry has problems relating to the legal system due to anti-social behavior fueled by his social environment and substance abuse. Harrys personality is characterized by anger, aggression, feelings of inferiority inadequacy and general social isolation. Harry also reports that hallucinations and mood swings are a common occurrence. Moreover, he suffers anxiety and depression also a consequent of uncontrolled use of opioids. The withdrawals and other effects of the drug on Harry include reduced attention span and frequent events of confusion. From the interviews, Harry shows a feeling of shame and self-pity for his situation. He also feels sorry for his addictive behavior despite that he needs the heroin. Harry also admitted to using heroine for the purpose of alleviating feelings of anger, boredom and frustration. The heroine could use also encouraged by the company that he kept before he got to prison.

Diagnostic Assessment

The assessment adopted was a multi-axial diagnosis:

Axis 1: 305.10

Opioid dependence (heroin/morphine).

Depression disorders (psychosis).

Post- traumatic stress disorder.

Axis 2: 300.00 Avoidance personality disorders.

Axis 3: None

Axis 4: Problems were collaborating with the existing justice system (possession charges), Lack of stable employment.

Axis 5: GAF= 50 (on admission).

Narrative Clinical Evaluation

Opioid Dependence.

The amount of heroin that the client has taken before the assessments shows a deep addiction to the substance. Multiple symptoms of withdrawal indicate that the customer was a new user of morphine/ heroin.

Depression and PTSD

The client is experiencing constant mood swings and feelings of anxiety, therefore; he may be suffering depression and post-traumatic stress. Hallucinations and is also a common symptom indicating depression.

Avoidance Personality Disorder.

The client believes that he is inferior to others and is avoids people least they know his problems. Anger outbursts and aggressiveness is directed to individuals who make remarks regarding ones life are symptoms of avoidance personality disorder (Kantor, 2010). He is also sometimes uncomfortable with negative evaluations indicating possible avoidance in his personality.

Psycho-social problems

The client has problems relating to the justice system due to use and sale of illegal drugs was arrested and faces illegal drug possession charges. Moreover, the client does not have employment, making him prone to relapse.

Problem List

- Drug misuse and vulnerability to relapse after addiction treatment.

- Unemployment and anti-social tendencies such as aggression and illegal activity.

- Withdrawal symptoms and depression disorders.

- Post- traumatic stress disorder symptoms.

- Social- isolation and other social problems resulting from the effects of avoidance personality disorder.

Long-term Goals

- To cure the client of addiction and treat the possible damage caused by misuse of drugs. Some of the problems to focus on include withdrawal symptoms, anxiety or depression that is induced by the drug.

- To treat the personality avoidance symptoms and improve the clients self-worth. The client should be able to interact comfortably with others and feelings of confidence and belonging should be enhanced by the end of the intervention.

- To use various strategies for preventing the client from relapsing. The focus should be on the social life of the client during and after treatment. Some of the objectives of improving the clients social situation are by ensuring a source of income for the customer to live comfortably after treatment.

Short-term Goals

- To treat the withdrawal symptoms through medication. Some of the withdrawal symptoms of heroin include insomnia, muscle and bone pains as well as vomiting and withdrawal.

- To help prevent the immediate causes of relapse during the first days of treatment resulting from the detoxification process.

- Therapy sessions to enhance treatment process after withdrawals.

- Therapy and counseling to treat personality avoidance services.

Objectives for all Goals

Long-term goals

- To use various medical and psychiatric strategies to treat the clients addiction.

- To treat the disorders that caused by heroin addiction. Hallucinations and feelings of anxiety resulting from long-term use of the drug can be treated through medication (Galanter, 2011)

- To use suitable interventions to change the clients behavior about self-esteem and avoidance issues.

- To enhance the customers confidence and reduce social isolation and self-pity through psychotherapy.

- To use available methods of social training and education to facilitate responsibly living in the client.

Short-term goals

- Administration of medicines that reduce the withdrawal effects. Heroin withdrawal effects are some of the causes of relapse as the customer knows that the drug will immediately alleviate the withdrawals (Washton & Zweben, 2011)

- Strategize on therapy programs that will assist in stabilizing the patients soberness after withdrawal treatments.

- Therapeutically treatment for avoidance personality disorder.

Interventions for All Goals

Heroin Addiction Treatment

Pharmacological treatment is the most preferred option when dealing with substance abuse, especially when handling heroin addiction (NIDA, 2016). Medical treatment is known to provide the best results for decreased drug use, retention of sober life after treatment and decreased infections and criminal involvement. Medications play a crucial role during the withdrawal period of quitting drug use. The withdrawal period is commonly characterized by an increased urge to use the drug alongside other symptoms such as diarrhea, vomiting, insomnia and restlessness (NIDA, 2016). Medications usually help to reduce cravings for the drug and also assist the patient in coping with the withdrawal symptoms. Some of the effective medications that are useful during withdrawals include agonists that activate brain opioid receptors. Partial opioids activate the receptors but produce a smaller effect. Another medication involves antagonists that block the opioid receptors and any rewarding sensations caused by the drug (Fareed, 2014).

Fareed, (2014), adds that medical treatment for detoxification, followed by therapy treatment is an effective intervention for substance abuse addiction. Attending classes and training is the next step after detoxification period. The client will also benefit from counseling and support meetings with other individuals facing a similar problem. Cognitive-behavioral therapy and educational lectures are methods of preventing relapse and treating personality disorders that might have resulted from continued drug use. Educational lectures and cognitive therapy is also beneficial in treating anger issues and depressions.

Interventions for Personality and Psychosocial Issues


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