Week 10: Substance-Related and Addictive Disorders

Drugs—prescription and non-prescription—have become part of American life.

While the culture often shifts which drugs are at the forefront of public discourse, in treatment settings of all types, social workers frequently have to address the boundary between reasonable use and the development of pathological patterns of behavior. The DSM-5 addresses 10 classes of drugs: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics and anxiolytics, stimulants, and tobacco and other substances. The use of three of these drugs in particular—alcohol, opioids, and cannabis—is on the rise, especially for women, seniors, and youth.

This week you analyze evidence-based interventions for common substance use disorders and identify resources to assist individuals in recovery from various forms of addictions, as you apply learning to a case.

Learning Objectives

Students will:

• Analyze a case study focused on a substance use disorder utilizing steps of differential diagnosis
• Examine culturally aware engagement strategies and treatment options for treating a substance use disorder
• Recommend treatment and resources for a client diagnosed with a substance use disorder
• Demonstrate case collaboration skills when presenting a differential diagnosis
• Diagnose a mental disorder in a case study utilizing steps of differential diagnosis
• Create a culturally appropriate, evidence-based treatment plan utilizing client strengths

Learning Resources

Required Readings

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Chapter 15, “Diagnosing Substance Misuse and Other Addictions” (pp. 238–250)

American Psychiatric Association. (2013r). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm16

Gowin, J. L., Sloan, M. E., Stangl, B. L., Vatsalya, V., & Ramchandani, V. A. (2017). Vulnerability for alcohol use disorder and rate of alcohol consumption. American Journal of Psychiatry, 174(11), 1094–1101. doi:10.1176/appi.ajp.2017.16101180

Reus, V. I., Fochtmann, L. J., Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., … Hong, S.-H. (2018). The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. American Journal of Psychiatry, 175(1), 86–90. doi:10.1176/appi.ajp.2017.1750101

Stock, A.-K. (2017). Barking up the wrong tree: Why and how we may need to revise alcohol addiction therapy. Frontiers in Psychology, 8, 1–6. doi:10.3389/fpsyg.2017.00884

Optional Resources

Best, D., Beckwith, M., Haslam, C., Haslam, S. A., Jetten, J., Mawson, E., & Lubman, D. I. (2016). Overcoming alcohol and other drug addiction as a process of social identity transition: The social identity model of recovery (SIMOR). Addiction Research and Theory, 24(2), 111–123. doi:10.3109/16066359.2015.1075980

Hagman, B. T. (2017). Development and psychometric analysis of the Brief DSM-5 Alcohol Use Disorder Diagnostic Assessment: Towards effective diagnosis in college students. Psychology of Addictive Behaviors, 31(7), 797–806. doi:10.1037/adb0000320

Helm, P. (2016). Addictions as emotional illness: The testimonies of anonymous recovery groups. Alcoholism Treatment Quarterly, 34(1), 79–91. doi:10.1080/07347324.2016.1114314

Petrakis, I. L. (2017) The importance of identifying characteristics underlying the vulnerability to develop alcohol use disorder. American Journal of Psychiatry, 174(11), 1034–1035. doi:10.1176/appi.ajp.2017.17080915

Hom, M. A., Lim, I. C., Stanley, I. H., Chiurliza, B., Podlogar, M. C., Michaels, M. S., … Joiner, T. E., Jr. (2016). Insomnia brings soldiers into mental health treatment, predicts treatment engagement, and outperforms other suicide-related symptoms as a predictor of major depressive episodes. Journal of Psychiatric Research, 79, 108–115. doi:10.1016/j.jpsychires.2016.05.008

Document: Suggested Further Reading for SOCW 6090 (PDF)

Note: This is the same document introduced in Week 1.

Discussion: Treatment of Substance Use Disorders

Of the substance disorders, alcohol-related disorders are the most prevalent even though only a small percentage of individuals actually receive help. Recidivism in the substance treatment world is also very high. As research into treatment has developed, more and more evidence shows that genes for alcohol-metabolizing enzymes can vary by genetic inheritance. Women have been identified as particularly vulnerable to the impacts of alcohol. Native Americans, Asians, and some Hispanic and Celtic cultures also have increased vulnerability to alcohol misuse.

Even with these developments, treatment continues to spark debate. For many years, the substance use field itself has disagreed with mental health experts as to what treatments are the most effective for substance use disorders and how to improve outcomes. The debate is often over medication-assisted treatment (MAT) versus abstinence-based treatment (ABT). Recently the American Psychiatric Association has issued guidelines to help clinicians consider integrated solutions for those suffering with these disorders. In this Discussion, you consider your treatment plan for an individual with a substance use disorder.

To prepare: Read the case provided by your instructor for this week’s Discussion and the materials for the week. Then assume that you are meeting with the client as the social worker who recorded this case.

By Day 3

Post a 300- to 500-word response in which you address the following:

• Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
• Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
• Describe the assessment(s) you would use to validate the client’s diagnosis, clarify missing information, or track her progress.
• Summarize how you would explain the diagnosis to the client.
• Explain how you would engage the client in treatment, identifying potential cultural considerations related to substance use.
• Describe your initial recommendations for the client’s treatment and explain why you would recommend MAT or ABT.
• Identify specific resources to which you would refer the client. Explain why you would recommend these resources based on the client’s diagnosis and other identity characteristics (e.g., age, sex, gender, sexual orientation, class, ethnicity, religion, etc.).

Note: You do not need to include an APA reference to the DSM-5 in your response. However, your response should clearly be informed by the DSM-5, demonstrating an understanding of the risks and benefits of treatment to the client. You do need to include an APA reference for the assessment tool and any other resources you use to support your response.

By Day 6

Respond to at least two colleagues who selected a different diagnosis or treatment intervention for the client in the following ways:

• Explain why you agree or disagree with your colleague’s diagnosis and treatment approach.
• Identify potential barriers your colleague may experience when providing their explanation of the diagnosis to the client.
• Describe a strategy your colleague could use to engage the client in treatment.

Note: You are required to create a thread for your initial Discussion post before you will be able to view other colleagues’ postings in this forum. If you have not yet visited the weekly resources and assignments, you should visit that area now to access the complete set of directions and guidelines for this discussion.

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 10 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:
Week 10 Discussion

Assignment: Final Project

The sign of an effective clinician is the ability to identify the criteria that distinguish the diagnosis from any other possibility (otherwise known as a differential diagnosis). An ambiguous clinical diagnosis can lead to a faulty course of treatment and hurt the client more than it helps. In this Assignment, using the DSM-5 and all of the skills you have acquired to date, you assess a client.

This is a culmination of learning from all the weeks covered so far.

To prepare: Use a differential diagnosis process and analysis of the Mental Status Exam in the case provided by your instructor to determine if the case meets the criteria for a clinical diagnosis.

By Day 7

Submit a 4- to 5-page paper in which you:

• Provide the full DSM-5 diagnosis. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention).
• Explain the full diagnosis, matching the symptoms of the case to the criteria for any diagnoses used.
• Identify 2–3 of the close differentials that you considered for the case and have ruled out. Concisely explain why these conditions were considered but eliminated.
• Identify the assessments you recommend to validate treatment. Explain the rationale behind choosing the assessment instruments to support, clarify, or track treatment progress for the diagnosis.
• Explain your recommendations for initial resources and treatment. Use scholarly resources to support your evidence-based treatment recommendations.
• Explain how you took cultural factors and diversity into account when making the assessment and recommending interventions.
• Identify client strengths, and explain how you would utilize strengths throughout treatment.
• Identify specific knowledge or skills you would need to obtain to effectively treat this client, and provide a plan on how you will do so.

Submission and Grading Information