Substance abuse/PTSD assessment
As Chapter 6 begins, you are
introduced to the case study of Pedro, which concludes at the end of the
chapter. Evaluate the counselor’s assessment, diagnosis, and treatment
recommendations for Pedro as presented in your Reading, and then answer the
following questions:
•Do you agree with this
counselor’s conclusions?
•What are the strengths and
weaknesses of this counselor’s assessment of Pedro?
•What assessment and diagnosis
techniques might you have considered other than those used?
•Can you support the assessment
instruments used in this case study? Why or why not?
•Finally, expand upon the
treatment recommendations presented in the case study and offer support for
your considerations and recommendations.
oldest son of his first generation American migrant farming parents. Pedro has
three younger brothers who all looked up to him while growing up. The family
was proud of Pedro the day he enlisted in the United States Army. He engaged in
combat several times while in Iraq but was spared injury until the day the
Humvee he was riding in ran over a roadside Improvised Explosive Device. The
vehicle’s extra armor plating protected Pedro from the flying shrapnel;
however, the explosion’s shock waves caused him to suffer from symptoms
consistent with a closed head injury. Also, the force of the explosion ruptured
his eardrums, permanently impairing his hearing. Pedro was honorably discharged
following a medical examination and returned to Northwest Ohio. He felt
disconnected from the person he was before he left for the military duty. He
had difficulty falling asleep almost every night and found himself frequently
thinking about what he had seen and experienced while in combat. He felt alone
and isolated from his family, who had returned to Texas for the winter. To
support himself, he accepted an offer to work as a manager at a local grocery
store. He quickly found it difficult to motivate himself to go to work each
day. His employer, a Vietnam-era veteran, felt obliged to continue Pedro’s
employment out of loyalty to a fellow soldier, but made no effort to hide the
fact that Pedro’s work was inadequate. He liked to complain to his subordinates
about catching Pedro staring off into space and how he often came late and left
early. As time went on, Pedro found himself spending more time at the VFW post
in the next town over. He spent more time drinking beer. On more than one
occasion he has found himself drinking until closing. Last week, he crashed his
car into a parked car and landed in a ditch on the drive home from the VFW at
2:00 in the morning. He was found passed out at the wheel by the deputy sheriff
and transported him to the local hospital. He escaped the crash uninjured even
though his car was totaled. He was cited
for DUI and destruction of property. Pedro retained an attorney that advised
him it would look good if he submitted himself to a drug and alcohol assessment
at the VA hospital. Pedro doubted that he had an alcohol problem but upon his
attorney advice he complied. He has been following through with his
appointments. Pedro counselor met for approximately 2 hours, during which time
he completed the MAST, SASSI-3, and the counselor administered ASI. Pedro’s
responses to the MAST produced a score of 12. The SASSI-3 classified Pedro as
likely substance dependent based on his elevated FVA scale score. The results
of the ASI were consistent with the MAST and SASSI-3 but further suggested that
Pedro receive a referral for a dual diagnosis assessment to rule out additional
psychological sequelae-post traumatic stress disorder in particular. Pedro’s
counselor concluded that his presenting features supported the following
DSM-IV-TR diagnosis:
Axis I: 309.9 Alcohol Dependence Rule out 309.81
Posttraumatic Stress Disorder
Axis II: 799.9 Deferred
Axis III: None, by patient report
Axis IV: Occupational Problems, Legal Problems
Axis V: Current GAF: 55 Past year GAF: 70.
Pedro was advised of the counselor’s diagnosis and treatment
recommendations. He decided to accept the recommendations to schedule an intake
interview with the PTSD department and to place himself on the waiting list for
inpatient alcohol dependence treatment. However, he felt it would be too
embarrassing for him to attend Alcoholics Anonymous meetings in his community.
