Assessment and Treatment of Substance Use Disorder Introduction

This paper uses the case study of Ms. Knapp from the book Drinking: A Love Story by the same Ms. Knapp. It is an autobiography about the author and her substance use. She reflects on the destructive aspects of her drinking problem and how she went for years believing that so long as she kept her professional life in order, her drinking problem was not really an issue. In the end, she is compelled to face the facts after almost harming her friend’s daughters while under the influence. This paper discusses how I would assess Ms. Knapp and what approach I would use to treat her—the psychodynamic approach. It discusses the underlying theory of this approach, techniques of this approach, the expected outcome, gender-based issues that should be considered as well as the limitations of this approach.

Assessment of Ms. Knapp

Ms. Knapp would certainly benefit from self-assessment, and her autobiography of her alcohol abuse serves as a type of critical self-reflection and analysis. Self-assessment is beneficial in terms of allowing the patient to identify issues that are impacting the patient (Copeland & Martin, 2004). Self-assessment allows the individual to see where strengths occur, where weaknesses, what symptoms are predominant, and how behavior is connected to the disorder. However, though self-assessment can benefit the patient and compel him or her to seek treatment, for social workers, the need for a rapid assessment instrument is crucial (Feit, Fisher, Cummings & Peery, 2015) and can reduce the risk of misdiagnosing or mistreating a patient.

As a social worker, I would assess Ms. Knapp using a rapid assessment instrument such as the Michigan Alcohol Screening Test, which consists of 24 closed yes/no questions (Selzer, Vinokur & van Rooijen, 1975). If the respondent’s answers add to a score of 5 or more, an assessment of “alcoholic” would be appropriate to deliver. For Ms. Knapp, the Michigan Alcohol Screening Test would provide an assessment of “alcoholic” rather quickly. The pain it caused her in relationships, the harm she almost brought to her friend’s daughters as a result of drinking, and her lack of having a sense of actually having a problem (such as guilt over drinking) would indicate a problem with alcohol. Her attendance at AA would, right away, signify that she had a substance use problem. Thus, this type of rapid assessment instrument serves as an ideal way for social workers to identify an issue like alcohol abuse quickly and effectively.

Evidence-Based Treatment: Psychodynamic Approach

The evidence-based treatment approach that I would utilize to treat Ms. Knapp would by the psychodynamic approach. Because there are several underlying issues driving Ms. Knapp to drink and abuse alcohol, these issues need to be brought to the fore and addressed before the problem of drinking could really be treated. Indeed, from the psychodynamic approach perspective, in treating the underlying issues the problem of alcohol abuse would effectively be treated as well because the forces compelling her to abuse alcohol would be mitigated, aired-out—so to speak—disinfected by the sunlight of awareness so that they would no longer be the problems lurking in her unconsciousness that they currently are.

As Dodes and Dodes (2017) note, the psychodynamic approach creates a balance between a too microscopic approach to the patient and a too macroscopic approach: it places the patient at the center and looks at the experience of the patient, the environment, the underlying issues, and the motivational factors that are driving the patient’s thoughts, impulses, perspective formation, awareness, and behavior. The psychodynamic approach is rooted in the work of Freud, who launched the field of psychoanalysis, which developed in many different directions of the century that has passed since then. It would be an appropriate evidence-based treatment approach for Ms. Knapp, who is in need of having the underlying issues of her conscious behavior analyzed and explained.

Theory Undergirding the Psychodynamic Approach

Undergirding the psychodynamic approach is psychodynamic theory, which explains behavior and personality in terms of conscious and unconscious compulsions, desires, and forces (Khantzian, 2014). This particular theory holds that there is tension between the conscious mind and the unconscious mind; that the unconscious mind is where trauma typically lingers. The conscious mind is unable to process the trauma, the negative feelings, the overwhelming experiences, and the environment in which...

It is repressed and buried in the unconscious while the conscious mind strives to go about the daily duties and activities that the individual must engage in. However, because the trauma or the negative issues have not be adequately or effectively dealt with, they remain like an unwanted guest—an unwelcome specter that continues to haunt and drive the individual’s impulses. Coping mechanisms—like substance use—are typical symptoms of some trauma lingering within the unconscious that has to be explored, exposed and adequately addressed in order for the individual to at last come to some form of peace.
Freud (1915) developed psychodynamic theory throughout his career, evaluating the relationship between the Id, Ego and Superego, also known as the unconscious, the pre-conscious or subconscious and the conscious parts of the mind. Freud believed that the goal of human behavior was the achievement of pleasure and the avoidance of pain at all cost. The Ego was like the surface level motivator; the Id and the Superego contended with the will and the mind below the surface. The conscious mind rose up out of the surface and projected out into the world. For Freud (1915), the Conscious region consisted of that of which one is aware; the Preconscious region was that which one could be prompted to access if properly compelled; and the Unconscious region consisted of feelings, beliefs, impulses and instincts that are not accessible directly via the Consciousness. The aim of the approach is to help the patient to uncover the beliefs and ideas hidden deep in the Unconscious.

Techniques of the Approach

The technique of the psychodynamic approach involves assisting the patient in talking through prior experiences and allowing the unconscious mind to unfold so that the patient can better understand why he or she is having a particular set of problems. One of the goals of this approach is to help the patient to see patterns in their thoughts and emotions that can allow them to develop a better understanding of themselves, of who they are, and what is going on in their inner self. The technique involves beginning as far back as the patient’s childhood and looking at issues that developed during this particularly formative period of the person’s life.

Through asking the patient questions about his or her life, childhood, adolescence and adulthood, the patient begins to put the puzzle pieces of personality together. The counselor is rather minimally involved in explaining the personality of the patient to the patient; rather, the patient is the one who ultimately locates meaning and explains it to the counselor. The counselor’s aim is simply to prod and to get the patient to probe more deeply and fully into the unconscious to uncover what elements of experience and past thoughts, ideas or beliefs have been hiding there to cause the patient to see the self and the world the way he or she currently does.

There is no set schedule or routine with this approach. Instead the technique is based on the idea of free association (Khantzian, 2014). Sessions can be open-ended, rather intense at times, and begun by having the patient simply discuss whatever is on the mind. Thus, sessions begin with the consciousness and only through repetition of concepts does the patient, with the help of the therapist, begin to see patterns in thought emanating from the unconscious. Following these patterns down the rabbit hole, so to speak, is essentially the purpose of the psychodynamic approach. Revelation is the end-goal: the picture of the true self is the aim.

Formal techniques that have been applied include dream analysis, free association and the Rorschach test, in which the patient looks at inkblots and describes what he or she sees. This is supposed to offer a window into the unconscious ideas that sit below the surface. It is a method that can be used to introduce the conscious mind to the unconscious by way of the pre-conscious so that there a more unified person or whole person can emerge. The Freudian slip method is also an option, as it focuses on slips of the tongue that indicate that an underlying passion or feeling that is only revealed to the conscious mind by way of accident.

How Techniques Would be Utilized with Ms. Knapp

For Ms. Knapp, the technique would include posing a variety of open-ended questions and probing her background in a way that compels her to think about and talk about her past, her past relationships, her feelings surrounding her father, her family, her work, her relationships with men, and so on. As she talks, the goal would be to get…