Client Map for Ray Charles Based on the Film Ray In the movie Ray, Ray Charles is depicted as using multiple types of drugs, but only his use of heroin would meet the guidelines for a diagnosis under DSM-V. Furthermore, after recovers from his heroin addiction, the movie suggests that Ray became sober. In reality, Charles became a heavy drinker and used significant amounts of marijuana throughout his life. However, since that drug use is not portrayed in the film, those diagnoses are not included and will not be considered in this client map. Knowing that behavior would change the client map for him, but that knowledge and information comes from outside of the source material found in the movie.

Diagnosis

304.00, Substance Use Disorder, Heroin, Severe.

Under DSM-V, a scale of 1 to 11 symptoms is used to determine whether a substance use disorder is mild (2-3 symptoms); moderate (4-5 symptoms); or severe (6 or more symptoms). He took increasing amounts of the substance; he spent a great deal of time in drug-related activities; there was evidence of strong drug cravings; his drug use resulted in him failing to meet obligations at home; he continued to use heroin despite having legal problems; he used heroin despite it being physically hazardous (although this was not made explicit in the film, heroin use is inherently physically hazardous); he continued to use heroin despite it causing recurrent social and interpersonal problems; and he appeared to display tolerance.

Objectives

The short-term goal is to detox Charles from heroin. Of all substances, heroin is notorious for its physically hazardous withdrawal symptoms, which can mean that the detoxification process needs to be medically supervised. It can also mean that some addicts use opiate substitutes, such as methadone, to replace the heroin. For Ray, the goal would be total detoxification in a medically supervised facility. He would be expected to enter the facility immediately; he would not be expected to use within the facility; and detoxification would last approximately one week, though his initial treatment program would last longer than the physical detoxification. The mid-term goal would be for Ray to avoid scenarios that would tempt him to use heroin for six months after being released from the treatment facility. Because he is a musician and drugs are part of the music scene, it is unrealistic to expect him to avoid exposure to drug usage for an indefinite period of time, but avoiding triggering scenario initially may help him create new habits that reinforce sobriety. The long-term goal is for Ray not to use heroin for a one year period following his release from recovery.

Assessment

Ray's drug usage led to involvement with the criminal justice system, and this involvement would have played a role in his assessment, even if it was only through his arrest reports. Interviews with friends and family members could be conducted, but given Ray's celebrity status and the financial interdependency of many people in his life, it would be critical for an evaluator to consider whether those people could provide an objective assessment. Using the structure of the ASI would combine the benefits of a self-assessment with the structure of a more rigid tool.

Clinician

Ray's ideal clinician might not actually be a clinician at all. He began his drug usage intentionally because he believed it would promote creativity, so a clinician who was also an artist would be an ideal match. In fact, another artist who had successfully completed recovery and was continuing to thrive in an art community that had a drug-friendly environment could help Ray learn how to navigate sobriety. In this way, Ray's ideal clinician might actually be closer to a traditional sponsor in a 12-step program than to a clinician. However, given the difficulty in matching Ray's level of genius, an older, African-American woman with a holistic approach might be ideal for Ray's clinician because of his close relationship with his mother.

Location

Because his addiction is to heroin, which is notorious for creating very difficult withdrawal symptoms, his treatment should begin at an in-patient care facility. In-patient care should be continued not only until the threat of withdrawal symptoms has been removed, but long enough to give the patient sufficient time...

Rather than use methadone to step-down his addiction, a medically supervised withdrawal would be suggested because it would be a quicker process for him. The intervention should be future oriented and focused on avoiding substitute addictions. Significant time should be spent with Ray to develop appropriate coping skills because he cannot avoid trigger scenarios without stopping music, which is an unrealistic goal. Ray should find a sponsor, attend support groups, exercise, and see if meditation works for him. The treatment model to be used would be the Minnesota Model, which looks at addiction as a disease. Because drugs are so linked to music and artistry, it is important to highlight the notion that addiction is dysfunctional to the outside world without doing so in a way that that strips people of their dignity.
Emphasis

The Minnesota Model would be adapted specifically to Ray in a number of ways. The main difference between a celebrity and non-celebrity addict is that, for celebrities, drug usage may be considered pro-social and adaptive, rather than a non-adaptive response. There would need to be constant reinforcement of the idea that the substance abuse had deleterious impacts on his life outside of his music career. His motivation level is high, he wants to change, and he sought treatment in a somewhat voluntary manner, though the reason behind doing so was coercive.

Number of People

Once released from treatment, it seems likely that Ray will begin touring within a short time period, making compliance with follow-up treatment programs burdensome unless they are easy for him to accomplish. Therefore, his treatment plan would be a little different. Like many recovering addicts, he would be asked to attend a 12-step program or similar recovery support group on a regular basis, and it would be important that he attend some of these groups in person, which he could do in various different locations. However, it would also be important for him to get into a fixed group, so that setting him up in an online support group would be helpful. Individual counseling could help him identify other things that he could do to help him tap into his artistic side and an individual counselor might be able to help him avoid the development of comorbidities. Given that the film featured significant marital and family problems that were the result of his addictions, family and couples counseling might be mandated, though they may not be appropriate immediately because he may not be prepared to do the work necessary to complete those types of counseling until he has had a longer period of sobriety.

Timing

The in-person support groups would need to be twice a week, and the length of the sessions could vary as long as they were at least 30 minutes. Online support group participation is generally not time-based, but he would need to show participation in the group on a daily basis. Individual counseling, which could be conducted by phone when he was traveling, should occur 2x week, for one hour sessions. The individual counseling sessions would occur at 10am CST on Tuesdays and Thursdays, because those times are likely to accommodate any traveling schedule he would have and work with a therapist's schedule. Marriage and family counseling would not begin until the therapist could assess Ray's mindset towards the therapeutic process and their duration would depend on the extent of the problems discovered and the attitude of the various other parties towards Ray and his addiction.

Medication

A medication evaluation is not appropriate. Ray will be in an in-patient treatment facility for the detoxification period, so that if symptoms of withdrawal become sufficiently severe as to warrant a medical intervention, the intervention will be possible at that time. There are no co-morbid psychiatric concerns.

Adjunct Services

Ray is not in need of any adjunct services. The patient is blind, which would normally warrant an investigation into social services that might be needed to improve his living condition. In addition, he is facing legal problems because of his heroin addiction. However, even at the time portrayed in the movie, Ray had significant financial success as a result of his musical career. He would not qualify for any social service programs and was in a financial position to pay for any adjunct services. Furthermore, having spent years at a special school for the blind, his blindness was not a new disability to which he needed help adjusting.

Prognosis

Based on the movie, Ray's prognosis is good. He is not in denial about his addiction, but has been an addict for about half of his life. There do not seem to be any coexisting disorders, though he does use other substances, so monitoring them for abuse would be a good preventative measure. He is very determined to…