Case Conceptualization of an African American Old Man A Counseling Case Study

COUNSELING

Counseling: Case Conceptualization

Substance use disorder is not a healthy life activity that should be continued at any stage of life. There are only risks associated with this condition since the individual and his family suffer from this addiction. It leads to physical harm such as chronic pains, heart diseases, mental disturbances, physical disabilities, loss of mobility, etc., and creates severe and adverse negative reactions on cognitive functioning. Not only this but, the social connections and income possibilities are also adversely affected. This paper aims to develop a hypothetical case study of a diverse client and explain how the ASAM dimensions model of addiction can address a client’s specific clinical needs.

A 62-year old African American has been addicted to alcohol and his hypertension and diabetes prevalence for the past ten years. He drinks alcohol daily and repeatedly, sometimes in larger amounts. Along with these conditions, his doctor has prescribed that he has to strictly abandon alcohol since it can lead him to suffer from heart diseases. He has been prescribed some psychotherapy sessions and felt abstinence for five to six months. He still mentioned that whenever he was under stress due to family stressors, such as his wife suffering from Alzheimer’s and only one son who lives away and never talks to them, he starts binge drinking again. He mentioned that the days when he stopped alcohol use were when his wife’s doctor told him that she might be showing signs of betterment. However, the alcohol drinking returned when he experienced stress coming from his wife’s one of the risky episodes of Alzheimer’s illness after a long time. Along with his medical conditions, the African American 62-year older man started drinking alcohol. He found that he could not keep himself away until his problems were solved, which seemed impossible.

ASAM Dimension 1: Acute Intoxication and Withdrawal

The risk associated with the patient’s current intoxication is the combination of his medical conditions of hypertension and diabetes and alcohol addiction. Research has shown that 65% of the adults who binge drink, which means that drinking five or more glasses at the same time for men, have an extremely high risk of health problems similar to the African American’s case here (National Institute of Drug Abuse, 2020). High blood pressure, heart failure, diabetes, liver problems, bone issues, memory difficulties, mood disorders, etc., are some of the common ones. These risks aggravate up to 107% in alcohol use disorder of the age is above 65 years since their metabolism reacts slowly and their sensitivity to drugs or intoxications like alcohol is higher than adolescents or middle-aged people. In such a case, as in the given African American’s alcohol substance disorder, there are greater chances of falls and difficulties occurring in memory, coordination, or sometimes reaction time when the intoxication of extensive drinking is severe (National Institute of Drug Abuse, 2020). Investigations about old age alcoholism have suggested that posture mechanisms could be problematic once elderly people suffering from alcohol substance use disorder fall (Rigler, 2000). If falls are severe, they might result in hip fracture or dislocation of bones due to age factors. Their bones have become weak with age, and their recovery could be slow. Alcohol impairs and imbalances are common risks associated risks with this disorder that cause dietary hardships and orthostasis. Some old and chronic alcoholics do have the strength to fight with their condition and likely develop myopathy. The sensory functioning start to decline f treatment is not diagnosed on time and can continue to result in peripheral neuropathy in addition to neural damage. Osteoporosis is not new to these circumstances since balance, posture, and gait are already affected by alcoholism.

The risk of severe withdrawal symptoms or seizures based on the patient’s history has been prevailing since it has been mentioned that the patient drinks when he is stressed due to the constant family stressors that are around him all day. When those stressors are diminished, such as his wife’s better condition, he stops by himself as he got busy with other daily routines and did not have to worry about his problems anymore, which leads him to drink to relieve him of stress. Since alcohol addiction is self-induced and abstinence is also voluntary, he was able to control withdrawal symptoms. During this period, there were no specific severe withdrawal symptoms such as delirium or acute confusional state, and sometimes confabulation (Rigler, 2000).

The current signs of withdrawal are not there as he had reverted to his previous drinking pattern and does not even adhere to his hypertension and diabetes medications sometimes because he forgets about the timings. His physician has strictly asked him to stop alcohol use, but he said he could not help it as he needs to find a way to end his problems first. Previous psychotherapy sessions were deemed to be helpful when he abstained from alcohol. Still, it was soon found out that the alleviation of his family stressors led the doctors to conclude that eliminating his stress could end his addiction to alcohol.

Ambulatory detoxification might not be a suitable option for this patient since his age, and other medical conditions do not allow for this outpatient option to be conducted safely. No one at home could support him if he opts for it. His signs of withdrawal could be mild to moderate, as mentioned above; he has the willpower to abstain from alcohol only if his stress is reduced, but it is still not happening any time soon, and again has reverted to his previous drinking pattern.

It is observed that if his alcohol abstinence were from medication prescribed by the doctors and forcefully induced without his willpower, then his struggle would have been different, and he might have shown signs of withdrawal. Yet, when his stress reduces, he naturally stops alcohol use. This natural transition to a normal routine does not induce withdrawal symptoms, leading to ambulatory detoxification that might not be fruitful.

ASAM Dimension 2: Biomedical Conditions and Complications

The patient’s current physical illnesses are hypertension and diabetes that need to be addressed and may complicate the treatment. The hardships in managing these diseases are already witnessed when he is under alcohol intoxication and forgets to take his prescribed medicines for these conditions on time. His physical health deteriorates at times, and he has to call his doctor for a visit repetitively.

The two ailments are chronic since they have been developing for the past ten years. The patient is taking treatment for both of them and psychotherapy to reduce his stress and alcohol dependency. Moreover, it has been studied that long-term or chronic stress can cause higher chances of increased hypertension, leading to heart failures or strokes becoming easier in old age (Spruill, 2010).

ASAM Dimension 3: Cognitive, Behavioral and Emotional Conditions

There are currently no psychiatric illnesses. The risk for cognitive problems persists due to alcohol use disorder as his memory does not help him. He finds himself incapable of taking good care of his wife and forgets to adhere to his medical treatment for hypertension and diabetes, which could be attributed to age factors.

The chronic conditions could be long-term stress and the continuing pervasiveness of both hypertension and diabetes that could affect the treatment outcomes.

The emotional, behavioral, and cognitive problems are part of the aging transition of the patient and the alcohol use disorder, where it is previously stated that his memory does not support him quite often. Therefore, his cognitive functioning could cause a hindrance due to the addictive disorder. It cannot be autonomous.

If connected to addiction and not treated timely, the severe impacts could be seen in this patient’s case as three health conditions should not be left untreated for a long time. It could lead the patient to seek specific mental health treatment. In association with the normal prevalence of racial discrimination of African, American treatment is taken into account. This patient’s current condition might worsen psychologically if proper treatment is not provided on time (Assari et al., 2019).

The patient finds difficulty managing daily living activities as he lives alone, suffers from his addiction, and has stress while coping with his wife’s illness. His neighbors sometimes do the daily cooking, home caretaking, and shopping upon his request. Otherwise, he tries to do it independently depending upon how much his condition allows him, which is seldom.

The patient tries hard to cope with his cognitive problems since he has to take care of his wife, but when he has been extreme intoxication effects, he gives in on some days.

ASAM Dimension 4: Readiness and Motivation

The patient’s emotional and cognitive awareness of the need to change is high as he willingly wants to take care of his wife and realizes that he is the only one there for her. There is no other family member he could rely on other than his neighbors, who sometimes come to help upon his call. He knows they have their life routines and could be available for nursing his wife. Thus, he understands his responsibility towards his wife and wants to change himself. Also, he insists that it is only due to his stress, and if stress is relieved, he would automatically be less dependent on alcohol.

His level of commitment and readiness for change is between medium to high. His degree of cooperation with treatment remains high for the first week; afterward, when his stress starts taking him over again, he becomes less adherent to the treatment and more dependent on alcohol to relieve his stress. He mentions in psychotherapy sessions that he wants to get rid of his chronic stress and wants to live a healthy life for his wife; he also mentioned that it has been possible in the past when his wife got better and his stress automatically left him, he was able to abstain from alcohol during those days. Still, his cooperation with treatment does not remain strong once stress occupies him again.

His awareness of the relationship between alcohol and negative consequences is high due to the same reason of caretaking of his wife.

ASAM Dimension 5: Relapse, Continued Use, Continued Problem

The patient does not seem to be in immediate danger as his willpower is strong, and he wants to change his current condition. He only blames his tress for the miserable condition he is in and wants to end it for becoming better as soon as possible. It is deduced that he would be in a stable mental health condition as long as his strong willpower does not discard him.

The patient understands his addictive behavior and knows the reasons, stress, which he wants to dispose of. He wants to prevent relapse. He did not exhibit any intention of suicidal behavior until now. His problems are severe since his age is the prominent factor that might contribute if successfully not engaged in treatment at this point. High alcohol usage and hypertension, and diabetes would easily lead him to heart failure at any moment. For reducing alcohol dependency, he is aware that he needs to be less stressed.

The patient is fully conscious of his relapse triggers. He experienced betterment in his stressors reduction once his wife’s condition improved for a short period and he was seen less relying on alcohol. His coping mechanism heavily relies on his stress, and his cravings increase once this condition worsens.

ASAM Dimension 6: Recovery Environment

The family members, significant others, or work situations do not threaten the patent’s safety or engagement in treatment; though, living situations, belonging to a racial minority, and access to healthcare could be a threat. This particular race has faced health disparities as differences by race, even for elderly people, have been predominant over the past several decades in the country (Mullins et al., 2005).

The patient has supportive friendships around his neighborhood. Still, he does not want to trouble them regularly because of his addiction and irresponsibility due to his intoxicated condition towards his wife. He believes that he should not direct his problems towards his friends, who are not even the source of his troubles. He should be able to become dutiful for himself and his family. Hence, he does not ask for their help regularly until he is helpless. In terms of his treatment, they could be a source of support for increasing the likelihood of success of his treatment; still, they cannot be relied upon.