Case Study: Client Brenda Brenda Was Born In New Jersey

Case Study Client Brendabrenda Was Born In New Jersey She Is The Mi

Assess the client's substance use disorder using the ASAM six dimensions, including severity ratings, reasons for these ratings, and reflecting on how this assessment informs treatment planning.

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Introduction

Substance use disorders (SUD) are complex conditions influenced by numerous biological, psychological, social, and environmental factors. An effective treatment approach necessitates a comprehensive understanding of the individual's specific circumstances and needs. The American Society of Addiction Medicine (ASAM) provides a multidimensional assessment framework that evaluates six key areas—the six dimensions—to inform treatment strategies tailored to each client's situation. This paper applies the ASAM six-dimensional model to Brenda's case, assessing the severity of her substance use disorder and considering how this assessment guides intervention planning.

Dimension One: Acute Intoxication and/or Withdrawal Potential

Given Brenda’s history of increasing opioid use—progressing from prescribed Vicodin to OxyContin and hydrocodone—she exhibits a high potential for withdrawal symptoms if her supply diminishes suddenly. Her escalation from controlled use to 10-15 pills daily, coupled with her physical dependence (evidenced by her inability to stop or control intake and withdrawal symptoms), suggests a Severe (4) rating in this dimension. Her withdrawal potential is substantial due to her physiological dependence, which could precipitate severe withdrawal symptoms if unmanaged.

Dimension Two: Biomedical Conditions and Complications

Brenda’s knee injury was initially physical but has now developed into a broader health concern owing to her opioid misuse. Long-term opioid use can cause various biomedical problems, including hormonal imbalances, liver toxicity, respiratory depression, and increased risk of overdose. Her increased dosage over time raises concerns about potential hepatic strain and respiratory depression risks. Additionally, her withdrawal from other physical health might involve nutritional deficiencies owing to her reported poor eating habits. Given her complex health trajectory, this dimension merits a Moderate (2) or possibly a Severe (4) rating; however, considering the absence of explicit biomedical complications beyond her opioid dependence, Moderate (2) is appropriate.

Dimension Three: Emotional, Behavioral, and Cognitive Conditions and Complications

Brenda’s increasing opioid use correlates with her deteriorating mental health—she reports sleeping late, missing classes, withdrawing from family, experiencing apathy towards her aspirations, and exhibiting behaviors associated with substance dependence. These behaviors suggest significant emotional and cognitive dysfunctions, including mood disturbances, possible depression, loss of motivation, and impaired decision-making. The escalation of use has likely exacerbated her emotional and behavioral issues, warranting a Substantial (3) rating, but unless diagnosable mental health disorders are confirmed, a Moderate (2) rating might be appropriate. Considering her symptoms—withdrawal from her passions and social isolation—a Substantial (3) rating reflects the severity effectively.

Dimension Four: Readiness to Change

Brenda initially demonstrated high motivation, having been accepted into Juilliard and actively pursuing her artistic dreams. However, her opioid misuse and consequent life deterioration indicate a diminished readiness to change. Despite her mother's concern and her own recognition of her problematic use, her behaviors reveal ambivalence and denial of the severity of her addiction. This suggests a Moderate (2) to Severe (4) rating; however, given her expressed concern and the fact that she is seeking help after her health and academic decline, a Moderate (2) rating captures her transitional readiness for change, acknowledging some motivation but needing further intervention to enhance commitment.

Dimension Five: Relapse, Continued Use, or Continued Problem Potential

Her pattern of escalating use, running out of prescriptions early, and seeking additional providers demonstrates a high risk of continued use and relapse. Her increasing dosage, feelings of shame, withdrawal from social and academic activities, and unsuccessful attempts to obtain prescribed opioids underscore her vulnerability to relapse without proper treatment. This dimension merits a Severe (4) rating, emphasizing the high potential for ongoing substance use if untreated or inadequately managed

Dimension Six: Recovery/Living Environment

Brenda’s living environment includes her family, whose concern has prompted her to seek help; however, her social environment appears compromised by her substance use. Her access to multiple providers indicates some level of healthcare support, yet her behaviors—such as running out of medications early and seeking illegal sources—reflect instability and potentially unsupportive surroundings. Her environment may be considered Moderate (2) or Substantial (3), but given her ongoing use, withdrawal risks, and social withdrawal, a Substantial (3) rating is appropriate. A supportive environment with family involvement might aid her recovery, highlighting the importance of environmental assessment in planning treatment.

Reflection

This multidimensional assessment using the ASAM framework offers a holistic view of Brenda's substance use disorder. Recognizing the severity levels across the six dimensions enables clinicians to develop targeted, individualized treatment plans. For Brenda, high withdrawal potential and relapse risk indicate a need for medically supervised detoxification combined with ongoing pharmacotherapy—perhaps medication-assisted treatment (MAT) with methadone or buprenorphine—to manage dependency safely. The emotional and behavioral factors suggest the need for integrated mental health services, including counseling or psychotherapy, to address underlying psychological issues and improve motivation readiness.

The assessment also highlights the importance of considering her social environment and recovery support systems. Engagement in peer-support groups, family therapy, and community resources can enhance her recovery environment. Ultimately, applying the ASAM model in Brenda's case ensures a comprehensive approach that addresses her biological, psychological, and social needs, increasing her chances of sustained recovery and reintegration into her passions and daily life.

References

  • American Society of Addiction Medicine. (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd Edition. ASAM.
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  • Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change. 3rd Edition. Guilford Press.
  • NIDA. (2020). Medications for Opioid Use Disorder. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/medications-for-opioid-use-disorder
  • Samet, J. H., & Dreicer, R. (2018). The integrated approach to substance use and mental health care. New England Journal of Medicine, 378(8), 734-741.
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  • Substance Abuse and Mental Health Services Administration. (2019). TIP 63: Medications for Opioid Use Disorder. U.S. Department of Health and Human Services.

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