These questions from Solution-Focused Therapy and Motivational Interviewing could be used to find out more about Augusten's strengths and resources and how these could be used to tackle his substance abuse.
1. How were you able to have such a successful career, despite dropping out of school so young and only having a GED? What qualities did you draw upon to reach your level of employment? How did you convince your employer that you were able to do this kind of work? How have you been able to be a success?
2. How were you able to survive the kind of childhood you had and rise above it?
3. The pain of this problem can affect many areas of your life. What aspects of your life are still intact despite the problem, such as relationships, hobbies, interests, employment, academics?
4. When have you been able to give up drinking or drugs, or cut down your use? How were you able to do that?
5. How have you been able to attract the friendships you have? What about you would they say you have going for you? How are you able to rely on them for support?
6. Motivational interviewing- What do you get out of drinking/What do you like about it? What are the not so good things?
7. What will your life look like when you are past this? What will you be doing/What will you be saying?/How will other people react to you?
1. How were you able to have such a successful career, despite dropping out of school so young and only having a GED? What qualities did you draw upon to reach your level of employment? How did you convince your employer that you were able to do this kind of work? How have you been able to be a success?
2. How were you able to survive the kind of childhood you had and rise above it?
3. The pain of this problem can affect many areas of your life. What aspects of your life are still intact despite the problem, such as relationships, hobbies, interests, employment, academics?
4. When have you been able to give up drinking or drugs, or cut down your use? How were you able to do that?
5. How have you been able to attract the friendships you have? What about you would they say you have going for you? How are you able to rely on them for support?
6. Motivational interviewing- What do you get out of drinking/What do you like about it? What are the not so good things?
7. What will your life look like when you are past this? What will you be doing/What will you be saying?/How will other people react to you?
Tuesday, November 23, 2010
Tuesday, November 9, 2010
BIOPSYCHOSOCIAL RISK AND RESILIENCE ASSESSMENT FOR DRY
Onset of the Disorder
Biological
RISK
• Family history of substance abuse (father)
• Family history of mental disorder (mother)
• Male
PROTECTIVE
Good Physical health
Psychological
PROTECTIVE
Lack of co-occurring disorder
Social
RISK
Physical abuse from father
Ongoing sexual abuse starting at 13
Maternal abandonment
Gay
PROTECTIVE
Was able to obtain his GED and have a high paying job
Course of the Disorder
Biological
PROTECTIVE
Good physical health
Social
RISK
Lack of family support
Gay
PROTECTIVE
Boss and co-worker are supportive of intervention
Has close relationships with friends
Continues to hold a well-paying job
Access to specialized treatment for people who are gay
Biological
RISK
• Family history of substance abuse (father)
• Family history of mental disorder (mother)
• Male
PROTECTIVE
Good Physical health
Psychological
PROTECTIVE
Lack of co-occurring disorder
Social
RISK
Physical abuse from father
Ongoing sexual abuse starting at 13
Maternal abandonment
Gay
PROTECTIVE
Was able to obtain his GED and have a high paying job
Course of the Disorder
Biological
PROTECTIVE
Good physical health
Social
RISK
Lack of family support
Gay
PROTECTIVE
Boss and co-worker are supportive of intervention
Has close relationships with friends
Continues to hold a well-paying job
Access to specialized treatment for people who are gay
Monday, November 8, 2010
Rationale for DSM Diagnosis for DRY
Axis 1: 303.90 Alcohol Dependence with physiological dependence
Augusten has displayed a maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by the following symptoms, occurring in the last year:
1. tolerance: a need for markedly increased amounts of the substance to achieve intoxication or desired effect (one liter a day of whiskey).
2. withdrawal (he is given Librium while detoxing to avoid physical shock)
3. the substance is often taken in larger amounts or over a longer period than was intended time (begins with intention to drink until midnight but keeps going until bottle is finished)
4. there is a persistent desire or unsuccessful efforts to cut down or control substance use (even when he has to attend to work responsibilities, Augusten is unable to stop his use)
5. a great deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects (drinks every night and is unable to meet work responsibilities due to lack of sleep and hangovers)
6. important social, occupational or recreational activities are given up or reduced because of substance use (occupational problems due to use, threatened with job loss)
7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (drinks even though he is allergic to alcohol and has to consume large amounts of Benadryl to prevent a reaction from alcohol)
• With physiological dependence is specified due to the evidence of tolerance and withdrawal
Axis II: V71.09 No Diagnosis
No evidence, at least in DRY, of a personality disorder, although this could be assessed further.
Axis III: Allergy to alcohol
Axis IV: Problems with Primary support: Poor relationship with parents who seemed to have abandoned him as a child; mother now suffers from a stroke
Problems with the social environment: enabling drinking friends, living alone, friend with terminal illness
Occupational problems: is threatened with job loss if he does not participate in treatment
Axis 5: 50
Augusten shows a serious impairment in social and occupational functioning, which indicates a GAF of 50. This would be lower if he did not continue to have a job that provides adequate income.
Augusten has displayed a maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by the following symptoms, occurring in the last year:
1. tolerance: a need for markedly increased amounts of the substance to achieve intoxication or desired effect (one liter a day of whiskey).
2. withdrawal (he is given Librium while detoxing to avoid physical shock)
3. the substance is often taken in larger amounts or over a longer period than was intended time (begins with intention to drink until midnight but keeps going until bottle is finished)
4. there is a persistent desire or unsuccessful efforts to cut down or control substance use (even when he has to attend to work responsibilities, Augusten is unable to stop his use)
5. a great deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects (drinks every night and is unable to meet work responsibilities due to lack of sleep and hangovers)
6. important social, occupational or recreational activities are given up or reduced because of substance use (occupational problems due to use, threatened with job loss)
7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (drinks even though he is allergic to alcohol and has to consume large amounts of Benadryl to prevent a reaction from alcohol)
• With physiological dependence is specified due to the evidence of tolerance and withdrawal
Axis II: V71.09 No Diagnosis
No evidence, at least in DRY, of a personality disorder, although this could be assessed further.
Axis III: Allergy to alcohol
Axis IV: Problems with Primary support: Poor relationship with parents who seemed to have abandoned him as a child; mother now suffers from a stroke
Problems with the social environment: enabling drinking friends, living alone, friend with terminal illness
Occupational problems: is threatened with job loss if he does not participate in treatment
Axis 5: 50
Augusten shows a serious impairment in social and occupational functioning, which indicates a GAF of 50. This would be lower if he did not continue to have a job that provides adequate income.
MULTI-AXIAL DIAGNOSIS FOR DRY
Axis 1: 303.90 Alcohol Dependence with physiological dependence
Axis II: V71.09 No Diagnosis
Axis III: Allergy to alcohol
Axis IV:
Problems with Primary support: Poor relationship with parents who seemed to have abandoned him as a child; mother now suffers from a stroke
Problems with the social environment: enabling drinking friends, living alone, friend with terminal illness
Occupational problems: is threatened with job loss if he does not participate in treatment
Axis 5: 50
Grateful acknowledgement to the contributions of Will Hayden, Erika Paz, and Dallas Williams.
Axis II: V71.09 No Diagnosis
Axis III: Allergy to alcohol
Axis IV:
Problems with Primary support: Poor relationship with parents who seemed to have abandoned him as a child; mother now suffers from a stroke
Problems with the social environment: enabling drinking friends, living alone, friend with terminal illness
Occupational problems: is threatened with job loss if he does not participate in treatment
Axis 5: 50
Grateful acknowledgement to the contributions of Will Hayden, Erika Paz, and Dallas Williams.
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