Substance Abuse Treatment Analysis of David Ruffin

Substance Abuse Treatment Analysis of David Ruffin

Most people today probably recognize his signing voice from his hits such as "My Girl," but few may remember David Ruffin of The Temptations music group from the latter half of the 20th century. Like many of his contemporaries, Ruffin fell victim to the ravages of drug abuse during the height of his career, leaving his millions of fans with a musical void in their lives. To gain some further insights into his untimely death from an overdose of cocaine, this paper provides a review of the relevant peer-reviewed and scholarly literature to develop a background and an overview of Ruffin, his use of drugs, and an appropriate screening instrument that could be used to evaluate a similar client's stage of dependence, change or recovery. An application of this diagnostic tool to Ruffin's unique circumstances is followed by a discussion concerning possible placement options and treatment modalities for clients with Ruffin's diagnosis, and the rationale in support of their choice based upon a personal conceptualization and etiology of addiction. Finally, a summary of the research and important findings are presented in the conclusion.

Review and Discussion

Background and Overview of David Ruffin

The hit soul group, "The Temptations," consisted of members Mel Franklin, Otis Williams, Eddie Kendricks, Paul Williams, Dennis Edwards and David Ruffin who began their professional recording careers with Motown Corporation in Detroit in 1962 (Claghorn, 1993). Born in January 1941 in Whynot, Mississippi, one of his biographers reports that "David Ruffin was one of the most recognizable vocalists to have emerged from the Motown Records stable. He was the younger brother of Jimmy Ruffin and the cousin of Melvin Franklin of The Temptations" (Walker, 2012, para. 2). The son of a minister, Ruffin began his musical career singing with a gospel group, the "Dixie Nightingales"; in addition, he also performed with other groups before joining up with "The Temptations" as well as recording as a solo artist in 1960 (Walker, 2012). His connections with the group and his established track record of success thus far led to his joining "The Temptations" in January 1964 as the tenor vocalist (Walker, 2012) and later as lead singer (Friedlander, 1996).

As a result, like many of his contemporaries such as Little Richard, Dinah Washington, B.B. King, Sam Cooke, Johnnie Taylor, Lou Rawls, Wilson Pickett, Billy Preston, Cissy Houston, and Delia Reese, Ruffin's music was also strongly influenced by the gospel music he heard during his youth and which he performed during his early career (Pratt, 1990). In this regard, Werner, "The deepest connection between Motown and gospel, however, sounded in the voices of the singers, all of whom grew up in and around church. You can hear it in the way David Ruffin stretches the notes on the bridges and during the fadeouts of his songs" (p. 467).( This gospel-inspired style would characterize Ruffin's musical career, and it garnered him money, countless accolades and awards -- but it also earned him respect for the breadth and scope of his work. As Werner concludes, "The technical term is melisma, but for black listeners (and the small number of whites attuned to the style) it echoed the testifying that signified the presence of the Holy Spirit. Listen carefully to the vocals on 'My Girl' and it's clear that David Ruffin understood that the pretty melody wasn't the point" (p. 468). Sam Cooke, though, appears to have been an especially influential force in Ruffin's life, helping him make the successful transition from gospel into his own distinguishable music and lifestyle (Cusic, 1990).

As noted above, in January 1964, Ruffin had joined the "The Temptations" who became star recording Motown artists. In this regard, Kinnon (2003) reports that "The Temptations personified cool in the 1960s and were one of the leaders, along with the original Supremes, of that distinctive "Motown sound" that galvanized America in the 1960s" (p. 88). Cooke's influence on Ruffin and "The Temptations" became more pronounced by this time and the transition from gospel was complete. According to Kinnon, "With their tempting 'Temptation Walk' step, their top hats and tails, the original Temptations were the original American idols. Eddie Kendricks, Paul Williams, Melvin Franklin, Otis Williams and David Ruffin had a string of hits, including The Way You Do The Things You Do, My Girl, Since I Lost My Baby, Ain't Too Proud to Beg and I Wish It Would Rain" (2003, p. 88). During his lifetime, Ruffin experienced his fair share of relationships, and was married twice, had two daughters and a son by a girlfriend (Ribowsky, 2010). Despite his troubled personal life, Ruffin's legacy in popular American culture is assured. In fact, recently, the Center for Black Music Research of Columbia College, Chicago, began using a Grammy Foundation grant of $19,574 to catalog, preserve, and provide public access to 131 taped interviews with popular music artists from the 1970s era, including interviews with Ruffin (Ochs, 2005).

Ruffin's Drug Use

Unfortunately, Ruffin joined a long list of entertainment figures that have died as a result of their substance abuse. Although accounts of his death vary, one biographer cites the "peculiar madness that fame can install" and describes "The Temptations' David Ruffin stumbling into a hospital clutching a briefcase stuffed with $40,000 in cash and cheques" just prior to his death from a cocaine overdose (Ellen, 2006, p. 57). Another biographer simply states that, "A few weeks after his last performance, David Ruffin died in tragic circumstances following an overdose of crack cocaine" on June 1, 1991 at age 50 years (Walker, 2012, para. 3).

Clinical Evaluation of Ruffin

Choice of Screening Instrument. A wide range of clinical screening instruments are available with well established validity and reliability for use in evaluating clients for alcohol and other drug (AOD) abuse, including those described in Table 1 below.

Table 1

Clinical Screening Instruments for Substance Abuse and Addictions

Screening Instrument

Source/Author(s)

Addiction Severity Index

McLellan, A.T., Luborsky, L., Woody, G.E., and O'Brien, C.P. An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index. Journal of Nervous and Mental Disease 186:26-33, 1980.

AUDIT

Babor, T.F., De La Fuente, J.R., and Saunders, J. AUDIT: Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. Geneva: World Health Organization, 1989.

CAGE

Mayfield, D., McLeod, G., and Hall, P. The CAGE questionnaire: validation of a new alcoholism screening instrument. American Journal of Psychiatry 131:1121-1123, 1974.

DAST

Skinner, H.A. Drug Abuse Screening Test. Addictive Behavior 7:363-371, 1982.

DSM-III-R

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised. Washington, D.C.: American Psychiatric Association, 1987.

History of Trauma Scale

Skinner, H.A., Holt, S., Schuller, R., Roy, J., and Israel, Y. Identification of alcohol abuse using laboratory tests and a history of trauma. Annals of Internal Medicine 101:847-851, 1984.

MAST

Selzer, M.L. The Michigan Alcohol Screening test: the quest for a new diagnostic instrument. American Journal of Psychiatry 127:1653-1658, 1971.

POSIT

Rahdert, E.R. The Adolescent Assessment and Referral System Manual. DHHS pub. no. (ADM) 91-1735. Rockville, Md.: National Institute on Drug Abuse, 1991.

RHSS

Fleming, M.F., and Barry, K.L.: A three-sample test of a masked alcohol screening questionnaire. Alcohol 26:81-91, 1991.

Although all of the instruments described in Table 1 above can be useful in initiating the process of assessment by identifying clients' possible problems and determining whether they need a comprehensive assessment, some are better suited for certain situations than others, and some should only be employed by clinicians who are trained in their use. Therefore, the Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse from the Treatment Improvement Protocol (TIP) Series, No. 11 developed by the Center for Substance Abuse Treatment was selected for the evaluation of David Ruffin. The rationale for this choice was based on the guidance from the Center for Substance Abuse Treatment that states, "Ideally, a screening instrument for AOD abuse should have a high degree of sensitivity: it should be broad in its detection of individuals who have a potential AOD abuse problem, regardless of the specific drug or drugs being abused" (Chapter 2, 1994, p. 3). The AOD abuse screening instrument described below was designed to include a wide range of signs and symptoms that are indicative of substance use disorders, making it particularly useful for a broad range of applications..

The AOD abuse screening instrument identifies five primary content domains as set forth in Table 2 below.

Table 2

Five Primary Content Domains of the AOD Abuse Screening Instrument

Content Domain

Description

AOD Consumption

A person's consumption pattern - the frequency, length, and amount of use - of AODs is an important marker for evaluating whether he or she has an AOD abuse problem. Patterns of AOD consumption can vary widely among individuals or even for the same individual. Although substance use disorders often consist of frequent, long-term use of AOD, addiction problems may also be characterized by periodic binges over shorter periods.

Preoccupation and Loss of Control

The symptoms of preoccupation and loss of control are common in persons with substance use disorders. The symptom of preoccupation is marked by an individual's tendency to spend a considerable amount of time thinking about, consuming, and recovering from the effects of the substance(s) of abuse. In some cases, the individual's behavior may be noticeably altered by his or her preoccupation with these matters. Such an individual may, for example, lose interest in personal relationships or may become less productive at work as a result of constant preoccupation with obtaining more of the substance of abuse.

Adverse Consequences

Examples of adverse physical consequences resulting from AOD abuse include experiencing blackouts, injury and trauma, or withdrawal symptoms or contracting an infectious disease associated with high-risk sexual behaviors. One of the most serious health threats to AOD abusers, particularly those who inject drugs intravenously, is infection with human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS). Adverse psychological consequences arising from AOD abuse include depression, anxiety, mood changes, delusions, paranoia, and psychosis. Negative social consequences include involvement in arguments and fights; loss of employment, intimate relationships, and friends; and legal problems such as civil lawsuits or arrests for abuse, possession, or selling of illicit drugs.

Problem Recognition

Making a mental link between one's use of AOD and the problems that result from it - such as difficulties in personal relationships or at work - is an important step in recognizing one's AOD abuse problem. Some individuals who have experienced negative consequences resulting from their AOD abuse will report these problems during a screening assessment. Clients who show insight about the relationship between these negative consequences and their use of AODs, should be encouraged to seek help. Many, if not most, people who abuse AODs, however, do not consciously recognize that they have a problem. Other reasons why a person may not disclose an AOD abuse problem include denial, lack of insight, and mistrust of the interviewer. These individuals cannot be expected to respond affirmatively to "transparent" problem recognition items - those in the form of direct questions, such as "Do you have an AOD problem?" - during a screening interview. For these individuals, questions must be worded indirectly in order to ascertain whether negative experiences have ensued from the use of AODs.

Tolerance and Withdrawal

AOD abuse, particularly prolonged abuse, can cause a variety of physiological problems that are related to the development of tolerance and withdrawal. Tolerance is defined as the need to use increasing amounts of a substance in order to create the same effect. If tolerance has developed and the individual stops using the substance of abuse, it is common for withdrawal effects to emerge. Withdrawal from stimulants and related drugs often includes symptoms of depression, agitation, and lethargy; withdrawal from depressants (including alcohol) often includes symptoms of anxiety, agitation, insomnia, and panic attacks; and withdrawal from opiates produces agitation, anxiety, and physical symptoms such as abdominal pain, increased heart rate, and sweating.

Source: Adapted from Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases. Treatment Improvement Protocol (TIP) Series, No. 11. Center for Substance Abuse Treatment

As noted above, the selection of the AOD screening instrument is based on its known reliability and validity across the five domains as described further in Table 3 below.

Table 3

Sources for Items Included in the AOD Screening Instrument

Question No.

Source Instrument

Domains Measured by the Instrument

1

Revised Health Screening Survey (RHSS)

This question is designed to help delineate an individual's consumption pattern (the frequency, length, and amount of use) as an important marker for evaluating whether the client has an abuse problem.

2

Michigan Alcohol Screening Test (MAST)

This question is designed to identify symptoms of preoccupation and loss of control (preoccupation refers to an individual spending inordinate amounts of time concerned with matters pertaining to AOD use; loss of control is typified by loss of control over one's use of AODs or over one's behavior while using AODs).

3

CAGE

This question is designed to identify symptoms of preoccupation and loss of control as defined in question two and Table 1 above.

4

MAST, CAGE

This question consists of a series of problem recognition items that ask about past contacts with intervention and treatment services which can be a valid indicator of AOD abuse problems.

5

History of Trauma Scale, MAST, CAGE

This question is designed to elicit adverse consequences of AOD abuse including physical, psychological, and social domains; in addition, this question is aimed at determining whether an individual has experienced any of the signs of tolerance and withdrawal.

6

MAST, Drug Abuse Screening Test (DAST)

This question is designed to elicit adverse consequences of AOD abuse including physical, psychological, and social domains.

7

MAST, Problem-Oriented Screening Instrument for Teenagers (POSIT)

This question is designed to elicit adverse consequences of AOD abuse including physical, psychological, and social domains.

8

MAST, DAST

This question is designed to elicit adverse consequences of AOD abuse including physical, psychological, and social domains.

9

MAST, DSM-II-R

This question is designed to identify symptoms of preoccupation and loss of control as defined in question two above; in addition, this question is also designed to elicit adverse consequences of AOD abuse including physical, psychological, and social domains.

10

POSIT, DSM-III-R

This question was formulated in order to help delineate an individual's consumption pattern (the frequency, length, and amount of use) as an important marker for evaluating whether the client has an abuse problem; in addition, this question is aimed at determining whether an individual has experienced any of the signs of tolerance and withdrawal.

11

POSIT

This question was formulated in order to help delineate an individual's consumption pattern (the frequency, length, and amount of use) as an important marker for evaluating whether the client has an abuse problem.

12

POSIT

This question is designed to identify symptoms of preoccupation and loss of control as defined in question two above; in addition, this question is also designed to elicit adverse consequences of AOD abuse including physical, psychological, and social domains.

13

MAST, POSIT, CAGE, RHSS, Alcohol Use Disorders Identification Test (AUDIT), Addiction Severity Index (ASI)

This question is designed to elicit adverse consequences of AOD abuse including physical, psychological, and social domains.

14

MAST, POSIT, CAGE, RHSS, Alcohol Use Disorders Identification Test (AUDIT), Addiction Severity Index (ASI)

This question consists of a series of problem recognition items that ask about past contacts with intervention and treatment services which can be a valid indicator of AOD abuse problems.

15

MAST, POSIT, CAGE, RHSS, Alcohol Use Disorders Identification Test (AUDIT), Addiction Severity Index (ASI)

This question consists of a series of problem recognition items that ask about past contacts with intervention and treatment services which can be a valid indicator of AOD abuse problems.

16

MAST, POSIT, CAGE, RHSS, Alcohol Use Disorders Identification Test (AUDIT), Addiction Severity Index (ASI)

This question consists of a series of problem recognition items that ask about past contacts with intervention and treatment services which can be a valid indicator of AOD abuse problems.

Source: Adapted from Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases. Treatment Improvement Protocol (TIP) Series, No. 11. Center for Substance Abuse Treatment

Two versions of the AOD screening instrument are available for use depending on the specific needs of the clinicians or social workers using them, as well as the abilities and willingness of clients to participate. In any event, both of these screening instruments have been designed to be administered in the form of an interview (Appendix A) or a self-administered version (as depicted at Appendix B) to clients who are perceived to be at risk of having a substance abuse problem.

Appropriate Diagnosis. The evaluation of the client using the AOD screening instrument proceeds in a step-by-step fashion:

1. The screening instrument begins with a question about the individual's consumption of AODs (question 1). This question is intended to help the interviewer decide whether to continue with the interview - if the response to this first question is no, continued questioning may be unnecessary.

2. Questions 2-4 are problem recognition items intended to elicit an individual's assessment of whether too much AODs are being used, whether attempts have been made to stop or control AOD use, and whether previous treatment has been sought. Answers to these questions may help the service provider understand how the individual thinks and feels about his or her use of AODs. People who later report negative consequences as the result of their AOD use but who nevertheless answer "no" to these problem recognition questions may have poor insight about their AOD abuse or may be denying the severity of their AOD problem.

3. Questions 5-12 were designed to determine whether an individual has experienced any adverse consequences of AOD abuse. These include medical, psychological, social, and legal problems that often are caused by AOD abuse and addiction.

4. Some questions are intended to elicit symptoms of aggression (question 9), physical tolerance (question 10) preoccupation (question 11), and loss of control (question 12).

5. Question 13 is designed to tap feelings of guilt, which may indicate that the individual has some awareness or recognition of an AOD problem.

6. Questions 14 and 16 are intended to measure the respondent's awareness of a past or present problem.

7. Question 15 elicits the individual's family history of AOD problems.

In some cases, various words or phrases are used in connection with questions in order to provide the clinician with salient examples of the types of behaviors that are typical of substance abusers, such as with question one that prompts the interviewer to ask follow-up questions concerning the types of substance that are abused. Based on Ruffin's lifestyle and history, a hypothetical administration of the Simple Screening Instrument for AOD Abuse Self-Administered Form (see proforma copy at Appendix B) for David Ruffin is provided in Table 4 below.

Table 4

Hypothetical Responses by David Ruffin to the Simple Screening Instrument for AOD Abuse Self-Administered Form

Directions: The questions that follow are about your use of alcohol and other drugs. Your answers will be kept private. Mark the response that best fits for you. Answer the questions in terms of your experiences in the past 6 months.

During the last 6 months...

Have you used alcohol or other drugs? (Such as wine, beer, hard liquor, pot, coke, heroin or other opiates, uppers, downers, hallucinogens, or inhalants)

X

Yes

No

Have you felt that you use too much alcohol or other drugs?

X

Yes

No

Have you tried to cut down or quit drinking or using alcohol or other drugs?

X

Yes

No

Have you gone to anyone for help because of your drinking or drug use? (Such as Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, counselors, or a treatment program.)

Yes

X

No

Have you had any health problems? For example, have you:

X Had blackouts or other periods of memory loss?

X Injured your head after drinking or using drugs?

____Had convulsions, delirium tremens ("DTs")?

____Had hepatitis or other liver problems?

X Felt sick, shaky, or depressed when you stopped?

X Felt "coke bugs" or a crawling feeling under the skin after you stopped using drugs?

X Been injured after drinking or using?

X Used needles to shoot drugs?

Has drinking or other drug use caused problems between you and your family or friends?

X

Yes

No

Has your drinking or other drug use caused problems at school or at work?

X

Yes

No

Have you been arrested or had other legal problems? (Such as bouncing bad checks, driving while intoxicated, theft, or drug possession.)

X

Yes

No

Have you lost your temper or gotten into arguments or fights while drinking or using other drugs?

X

Yes

No

Are you needing to drink or use drugs more and more to get the effect you want?

X

Yes

No

Do you spend a lot of time thinking about or trying to get alcohol or other drugs?