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Assessment of Addiction and Co-Occurring Disorders: Miguel Case study


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This paper seeks to establish the case of Miguel who presents a major depressive and mild alcohol consumption disorder. The paper will develop an assessment tool that will be used in screening addiction in this patient, assessment for some of the risks that are harmful, and an assessment of the recurring health issues that are prevalent in this patient. On the other hand, the paper will determine some of the strengths and challenges that are bound to affect his treatment plan and establish a recommended care approach.

Case Presentation:

Miguel, a 60-year-old Mexican-American resident, married and a father to three adult children living on their own presents some complications to a medical facility. Miguel worked in one of the food processing plants for a period of 20 years, where he advanced as the supervisor of the plant until the relocation of the company years ago, an aspect that left him unemployed for close to six years (Capella University, 2015). According to the case, Miguel was in a position to save for his retirement and did not disclose this information to his wife, considering that the savings would soon be depleted.

Recently, the client found a job opportunity in one of the recycling plants that only paid a fraction of his former salary (Capella University, 2015). As a result of this, Miguel turned out to be frustrated and anguished, trying to establish how he would support his wife and mother who relocated to America and currently live with them. He usually pays bills after his mother and his wife go to bed, an aspect that has seen him face a considerable amount of stress on how to manage the payments, this resulting in a drinking problem and a challenges to sleep. In addition to this, he has lost concentration, aspects that determine his financial stress levels. His situation is slowly turning to be hopeless, with his wife’s insurance policy the only bill he tries to pay.

Evaluation of Assessment Tools

The Michigan Alcoholism Screening Test (MAST) remains a 25-item that provides a yes/no questionnaire used in screening alcohol-related problems in individuals. This assessment tool was developed by Melvin L. Seltzer, with its use focusing strictly on alcohol users. One of the benefits of this tool remains in the fact that it takes close to 10 minutes in completing the test and can either be administered orally or by self and can alternatively be applied to several populations (Corey, 2013). However, the disadvantage of this assessment tool remains in the fact that the client has the capacity to fake the responses and may fail in determining the measure and levels of alcohol use in an individual.

Alternatively, the Alcohol Use Disorder Identification Test (AUDIT) is another 10-iten screening and assessment questionnaire that enables a counselor to collect some of the important information towards a specified treatment option for individual experiencing alcohol problems. Similar to the MAST, the AUDIT assessment tool can also be orally or self-administered within a time span of two minutes and can be used in several populations (Corey, 2013). It is, however, essential to detail that MAST may not be valid across particular groups of people such as women since they are likely to score lower as compared to men, with the older respondents also culpable of scoring low than the young. In this case, it is important to note that the AUDIT holds consequent challenges as MAST in providing falsified and misleading reports about a client. However, as a result of its reliability as well as its capacity to decipher a patient’s level of harmful drinking, this tool could be considered as an effective choice in the application of Miguel’s case.

Assessment of Co-occurring Mental Health Issue

Through the use of the Addiction Severity Index (ASI) it is easier to assess Miguel’s life issues through a structured approach o f interview. In this case, questions are developed and posed in regards to his substance use, relationship, legal issues, and psychiatric challenges, thus providing an avenue in establishing a dual diagnosis for the patient (Corey, 2013). These developed questions are in a position to provide in-depth information in regard to the client’s issues that contribute and trigger the possible behaviors of addiction.

On the other hand, another important assessment option would be the use of the DSM-5 Level 1 Symptoms Measure. This tool consists of 23 questions that have the capacity to assess 13 psychiatric problems that include anger, depression, anxiety, mania, suicidal ideation, sleep problems, somatic symptoms, and memory loss (Corey, 2013). Through this, a counselor is in a position to establish the symptoms and its frequencies and track the progress of a client at different levels during the therapeutic process. It is, however, essential to note that these assessment tools may present limitations that may need to be considered during the process. For instance, the ASI is time-consuming and may be conducted severally, an aspect that would constrain the process.

Assessment of Risk of Harm

In consideration o f the case of Miguel, his interest in only paying his wife’s medical insurance seems to be his final option, an aspect that establishes the need to carry out a risk of harm assessment approach to ensure the client is safe. This would establish the need to use the Beck Scale for Suicide Ideation (BSS), which is a 21 item self-conducted report that is administered to a client within a period of 5-10 minutes (Corey, The use of this tool is in a position to determine the client’s suicidal ideation with the aim of gauging the intensity and seriousness of his thoughts.

Provisional Diagnosis

According to the results of a provisional diagnosis, Miguel is considered to meet the DSM-5 criteria for alcohol use disorders. The client is considered to consume alcohol in large quantities and has been in this for a long period of time. As a result of his drinking, Miguel has failed in meeting his obligations both at home and work. He, however, continues with his drinking pattern, an aspect that has negatively affected his relationship with his family (Corey, On the other hand, the client also meets the four DSM-5 approaches that establish a major depressive disorder in his life. This is attributed to the level of distress in this patient, with the loss of energy and sleep, fatigue, and feelings of guilt depicted as some of the repercussions of this behavior.

Differential Diagnosis in Light of Cultural Considerations

In this case, it is important to establish the need for more information from the client in order to establish the possibility of a preferential diagnosis. This can be established in the need for a specific approach to determine his anxious distress that will be required to understand his feelings during the day (Corey, The length of the period of sadness during periods of withdrawal from the use of alcohol will be essential in informing the counselor of his co-morbidity in his disorders, an aspect that would require a review of the cultural considerations in the patients drinking habits.

Description of Miguel’s Strengths

In viewing the case of Miguel, it is important to establish that there are several strengths that may be depicted in the client that include:

  1. Taking a step to accept responsibility for the negative attributes of his behavior by accepting to attend counseling.
  2. Miguel has an understanding supervision who has committed to ensuring Miguel gets professional help instead of firing him from work, thus providing a strong support system for the client in addressing his issues.
  3. Motivation from his counselors in achieving his goals since he has been a responsible man and would achieve being sober.

Description of Challenges

In establishing the challenges of this client, it is important to consider the roles of different Latino genders (Olney, Gender roles and the structures of families within this race are likely to influence and impact health behaviors among individuals from these ethnic groups, an aspect that can be depicted in the acculturation process. Miguel’s challenges in this case include:

  1. His current position that has resulted into guilt resulting from his inability to meet the needs of his family and manage his family’s financial position.
  2. Chances of this client of turning out as a binge drinker as a result of excessive consumption of alcohol blended with depression and anxiety are possible aspects that may challenge the client.
  3. Feelings of inadequacy and vulnerability

The Treatment Plan

In establishing a treatment plan for Miguel, it is important to determine that the inclusion of a Solution Focused Therapy (SFT) remains appropriate in meeting the treatment needs and goals of the patient. The SFT approach is primarily structured in a manner that takes consideration of the belief that clients have the capacity to establish their own solutions to their problems since they are competent and healthy (Gehart, 2014). Unlike the use of the deficit based approach, SFT enables a client to take cognizance of his own strengths in adopting a proactive action aimed at changing his life. In this case, the client focuses on what works well for him, an approach that provides the patient with a positive outlook, thus creating an environment of optimism and hope upon the client. The therapist in the case of Miguel will act as a guide in helping him recognize some of the expectations and goals that he needs to achieve when handling his situation.

Application of the SFT in Miguel’s Case

The inclusion of the SFT remains essential in encouraging this patient to adhere to the counseling program. At the beginning of the program, the counselor encourages the client to discuss his future plans with the aim of establishing a positive view of the process. In this case, the client will be required to develop goals and detailing some of the compliments, exceptions, and strengths in achieving them, thus giving hope to the client (Proctor & Hoffmann, 2012). The best approach of this treatment method clearly depends on raining Miguel’s expectations in a positive way in order to establish the solution to his problem. The inclusion of the SFT approach consequently allows the client to develop his own treatment approach, an approach that provides the client with the opportunity to customize the plan in accordance to his needs with the guidance of a counselor. The client and the counselor act as a team in meeting the treatment goals one step at a time.


As detailed in this paper, the treatment process for an individual undergoing the same situation as that of Miguel requires a careful inclusion of assessment methods that would be used in established an effective treatment plan.

References: Assessment of Addiction and Co-Occurring Disorders: Miguel Case study

Capella University. (2015). COUN 5108 Case Scenarios

Corey, G. (2013). Theory and Practice of Counseling and Psychotherapy (9th ed.). Belmont,

CA: Brooks/Cole Cengage Learning.

Corey, M. S., Corey, G., & Corey, C. (2014). Groups: Process and Practice (9th ed.).

Belmont, CA: Brooks/Cole, Cengage Learning.

Gehart, D. (2014). Mastering Competencies in Family Therapy: A Practical Approach to

Theories and Clinical Case Documentation (2nd ed.). Northridge, CA: Brooks/Cole

Cengage Learning.

Olney, M. F., Gagne, L., White, M., Bennet, M., & Evans, C. (2009). Effective counseling methods for rehabilitation counselors: Motivational Interviewing and Solution-Focused Therapy. Rehabilitation Education, 23(3/4), 233-243.

Proctor, S. L., & Hoffmann, N. G. (2012). Identifying patterns of co-occurring substance use Disorders and mental illness in a jail population. Addiction Research & Theory , 20(6), 492-503.

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