RISK AND PROTECTIVE FACTORS

Any substance use disorder is a biopsychosocial phenomenon with risk and protective at these various levels interacting. At the biological level, Koren did not have a familial history of alcoholism. She also possessed a number of social influences that were protective. She came from a middle-to upper class two-parent household, and her parents were supportive. She was a good student in school and was involved in variety of extra-curricular activities, such as ballet camp, horseback riding, piano lessons, young writers, and diplomacy camp. Koren maintained a religious connection (Catholic) and attended Sunday School. On the risk side, her parents were fairly permissive about teenage experimentation and the use of alcohol. Psychologically, Koren struggled to fit in with her peers and drinking provided that venue.

These issues only intensified when she started college. Depression, anxiety and loneliness spurred the use of drinking to cope. The college environment was also conducive to alcohol as a way of socializing.

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

Risk and Resilience

Assessing a person from a risk and resilience framework helps see both the risk and the strengths and offers a more balanced appraisal. PROZAC DIARY does not emphasize strengths and resources; it is written in language symbolic of Lauren’s depression. Indeed, Lauren states that her creative writing is inspired by her depression; therefore, it is weighted to this account. Despite this slant, Lauren presents with many protective factors, as well as risk.

Risk and Resilience Assessment for the Onset of Depression

RISK

*Biological Factors
Female gender
Family history of mental illness

*Social Factors
Emotional abuse by Lauren’s mother (harsh and critical)
Parental divorce (not clear when this occurred relative to depression but assumed it was before depression started)

PROTECTIVE

*Psychological Factors
Leadership as a class president and leader of the school band (before age 12)

*Social Factors
Financial well-being
Participation in extra-curricular activities (music, dance, ice-skating, horseback riding)

Risk and Resilience Assessment for the Course (Adjustment or Recovery) of the Depression

RISK

*Biological Factors
Early onset

*Psychological Factors
Multiple episodes (and hospitalizations)
Residual symptoms
Co-morbid disorders (history of anorexia and cutting; current presence of obsessive-compulsive disorder)

*Social Factors
Lack of social support network
Poor employment history

PROTECTIVE

*Biological Factors
Intelligence

*Psychological Factors
Insight
Creativity (writing)

*Social Factors
Educated (bachelor’s degree from prestigious university
Financial support from family (this is assumed)