Miguel Schizophrenia Case Study

When evaluating differential diagnosis, Substance/Medication-Induced Depressive Disorder 291.89 (F10.24) is another possible primary provisional diagnosis (APA, 2013).. The DSM explains that the individual must present depression symptoms along with substance use. There is a possibility that Miguel’s depression existed prior to his substance use and would by any means continue, so this diagnosis does not appear to be justifiable. Another differential diagnosis could be Generalized Anxiety Disorder 300.02 (F41.1). Miguel meets at least three of the criteria; feeling edge, sleep difficulties and irritability (APA, 2013). Additional information would be required to make a justifiable diagnosis. The therapist would need to collect all the
result of the assessment tool along with any medical information and family history to make an educated access to provide the appropriate treatment for Miguel that would secure his safety and others. Description of Client Strengths Miguel represents commitment and dedication to his responsibilities as a financial provider and to his family.
He exhibits strength and perseverance. He appears to be receptive to change by agreeing to his employers demand for assistance with his alcohol problem. This demonstrates strength, courage and willingness to change. Additionally, Miguel demonstrates compassion for others, because he has been concerned about burdening his wife and mother with their financial situation. At this time it is uncertain if his wife or mother will be supportive with his treatment because from the information on the case study they have not been aware of his struggles. However, if his wife and mother are supportive it is a fantastic resource to have at ones disposal. Miguel also has support of his current employer which is an added bonus. Moral and physical support is extremely important. Additionally, more information is required to determine his health and the potential damage the substance abuse has caused. The Centers of Disease Control and Prevention recommends that older adults get screened for alcohol abuse to prevent abuse and possible death (Alpert,
2014). Description of Challenges to Be Addressed The first challenge for a client can be resistance to acceptance of their problem. Denial could be a reason individual’s reject treatment initially. The risk for Miguel could be the loss of his job since it was mandated to continue employment. Miguel has no choice if he wants to continue employment to follow through with the treatment program. The second, would be Miguel’s health. The damage alcohol does to an abuser can have a direct impact on those around them (Rehm, 2011). Furthermore, the damage alcohol can do to a person’s organs can be irreversible. The third, would be the safety of his family and their care. Miguel may believe that the only reason he is drinking is because of their financial situation and once that becomes manageable then he won’t have to drink as heavily. The more an addict thinks about the substance, the more they feel powerless over their abilities (Rehm, 2011). The cognitive and emotional internal messages are not able to cross over together to relay positive metacognitive messages. Recommended Level of Care Treatment would begin with ASAM Criteria 0.5, early intervention and level one outpatient treatment with Dimension 4, readiness to change.
Furthermore, ASAM Criteria 0.5, level 1 outpatient treatment with Dimension 6, recovery environment with the assumption that Miguel has the support of his family. Recommending the appropriate level of care can be complicated because of insurance. In Kosanke, Magura, Staines, Foote and Deluca (2002) article explains that patients entering treatment were asked to be place in a higher ASAM level so that their insurance would pay for it. This was especially true for medicaid patients. Depending on Miguel's financial situation and his stance it is suggested that Miguel attend regular weekly group meetings such as Alcohol Anonymous and weekly visit an addiction therapist to continue evaluate his emotional well-being through continued assessment to ensure he presents no life threatening threat to himself or others. Statistics have shown Hispanics are less willing to seek addiction programs than Caucasians (Reingle Gonzalez, Caetano, Mills & Vaeth, 2014). Furthermore, it has been expressed that there is a greater need for treatment within the Hispanic population (Reingle Gonzalez et al., 2014). The percentage of Hispanics entering into treatment programs have not increased over the last five
years. The use of any medication such as a benzodiazepine to assist with Miguel’s difficulty sleeping would not be considered at this time because of his alcohol use. The mixture of a benzodiazepine and alcohol can be dangerous, therefore not until his alcohol use is under control can a sleep aid, anxiety or depression medication can be prescribed. It is even more imperative that this is taken into consideration to ensure that Miguel takes the necessary steps to seek help.