This paper applies functional assessment and functional analysis frameworks to substance abuse behavior, using a real case study involving a young man with chronic alcohol dependence and a history of family violence. Drawing on the World Health Organization's definition of substance abuse and established behavioral assessment procedures, the paper walks through the five core steps of functional analysis — interview, direct observation, experimental manipulation, summary, and behavioral lesson plan — across two related behaviors: the subject's assault on his father, and his broader pattern of alcohol abuse. The analysis reveals deep-rooted antecedents including childhood trauma, parental alcoholism, domestic violence, and a diagnosis of chronic schizophrenia, and concludes with recommendations for treatment and intervention.
The World Health Organization (2015) defines substance abuse as the harmful use of psychoactive substances such as drugs and alcohol, which can lead to dependence and a loss of control. Dependence can be physiological, cognitive, or behavioral, to the point of neglecting important responsibilities and relationships (WHO, 2015). In the United States, substance abuse costs more than $700 billion a year, accounting for crime, healthcare, and lost work productivity (NIH, 2015).
Functional assessment consists of procedures that aim to identify the cause or causes of maladaptive or socially unacceptable behavior in order to control or reduce it (Carbone & Zecchin, 2015; Hanley et al., 2003; CECP, 2001; EOHHS, 2015; Webster, 2015; Maclino, n.d.; Opioidrisk, 2015). Assessment seeks out causes in the person's immediate environment and learning history. The findings of an assessment form the basis of an analysis of how the person learned or developed the maladaptive behavior and how his current environment supports or maintains it. Unlike a medical diagnosis, functional assessment does not classify behavior according to symptoms, but by its function. It then selects the appropriate and precise treatment or intervention to reduce that behavior (Carbone & Zecchin, 2015; CECP, 2001; EOHHS, 2015; Webster, 2015; Maclino, n.d.; Opioidrisk, 2015).
Functional analysis identifies the controlling environmental functions of a person's behavior (Carbone & Zecchin, 2015; Hanley et al., 2003; EOHHS, 2015; Webster, 2015). These functions are then manipulated in order to change the maladaptive behavior. A functional analysis concludes with the least restrictive and most effective interventions for reducing or modifying the maladaptive behavior. The five general steps used in functional analysis of behavior are: a functional interview with knowledgeable or involved persons, direct observation of the behavior, experimental manipulations, a summary, and a behavioral lesson plan. Functional analyses of two behaviors are illustrated below using an anonymized case involving a substance user and his father.
Functional assessment interviews were conducted with the subject's father, the subject himself, and a third party — the two involved persons in the incident. As complainants, they alleged that the subject physically assaulted both of them. The assault on the father resulted in chest bruises and a left arm fracture. The third party attempted to intervene but the subject pushed him against the shop's front counter and used a broken bottle of alcohol to prevent further interference. CCTV footage substantiated both their accounts of the assaults.
The Court Liaison Service observed and assessed the subject's behavior at the watch house, in addition to reviewing his history of consultations with mental health services. An authorized mental health service was also secured for an independent assessment of his remand status.
The subject had to be arrested and physically restrained due to his aggressive and irrational behavior, then taken by force to the watch house by authorities. Given his mental state, he was subsequently subjected to an authorized mental health assessment and confined to a hospital for appropriate treatment.
The subject behaved extremely aggressively in assaulting his father and the shop employee. He was under the influence of alcohol at the time, with a blood alcohol level of 0.075. The precise trigger for the assault on the wine shop was not established. The assault caused chest bruising and a broken wrist to the father, while the employee was not seriously harmed. The subject was most likely driven to assault his father for reprimanding his drinking, though deeper underlying causes for the assault cannot be ruled out.
The most immediate steps are to separate the subject from his father and ensure the father receives treatment for his injuries. Treatment for the subject may include physical rehabilitation for substance abuse and psychotherapy in which the deeper causes of his alcoholism should be explored and addressed. His parents should also receive counseling, given their involvement in the underlying causes of his heavy drinking and aggressive behavior and their serious consequences.
"Deep causes of chronic alcohol dependence explored"
"Targeted interventions and treatment options proposed"
Behavior reduction attempts can include procedures that assess the home environment, which is the primary cause of the subject's overall aberrant and aggressive behavior, along with manipulation of antecedents and consequences, and direct teaching of replacement behaviors appropriate to his situation. Should a cure for schizophrenia eventually be developed, the subject may be able to respond to it and recover greater functioning. Chronic alcoholism itself requires substantial support to overcome, but the existence of others who have successfully done so provides reason for cautious hope.
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