Your client Mark comes to your therapy office because his wife says he has a drinking problem and said she would divorce him if he did not get treatment.
-How would you know whether Mark has a “drinking problem”? (We haven’t learned the specific DSM criteria for substance use disorders yet, but you can address this based on your general knowledge of the DSM and what constitutes a clinical disorder.)
-What questions would you ask Mark during the intake interview? If you were a therapist, would your preference be to conduct a structured or unstructured/non-directive (or semi-structured) interview? What are the pros and cons of structured vs. unstructured interviews?
-What assessment tools might you want to use with Mark?
PLEASE REPLY TO THE BELOW COMMENT
Based on the scenario stated above, I would expect reluctance on Mark’s part toward treatment, since he’s forced to seek treatment in order to to save his marriage. First, I would determine if he has a “drinking problem” as he states, or if there is a serious alcohol abuse issue. To begin, I would start with an informal, unstructured interview: why are you seeking treatment, do you and your wife agree on what constitutes “heavy drinking,” does your wife drink or is drinking not a part of her culture, etc. This intake interview would determine if Mark needed further testing, or if his drinking was the result of a marital disagreement between volume of consumption. For example, if his wife only drinks a glass of wine at Thanksgiving and weddings, while Mark has a few drinks once a month with his buddies, I very highly doubt he has a drinking problem. If it is more persistent, I would continue the testing further.
According to the DSM-5, a patient must display 2 of 11 symptoms within 12-months, including “continuing the use of a substance despite its having negative effects in relationships with others (for example, using even though it leads to fights or despite people’s objecting to it) (Medina, 2015). Other symptoms include building up a tolerance, repeated use in dangerous situations, reduction in other life events due to alcohol use, using more than originally planned, and other symptoms (Medina, 2015). To determine whether Mark fits these symptoms, I would gather information from various sources, including the patient, people surrounding the patient (such as spouse or friend), medical history, lab tests and a thorough physical examination (Shivani, Goldsmith & Anthenelli, 2002). Along with semi-structured interviews with the spouse, I would conduct both an MMPI-2 (for comorbidity) a SCID-1 (for alcohol use) on Mark (Babor & First, 2015; Oltmans & Emery, 2015).
After gathering this information, I would determine whether the heavy drinking is a symptom of some recent life event or if it is the result of alcohol-induced psychiatric syndrome (Shivani et al., 2002). If the drinking is a symptom of life stressors, such as a recent death or loss of job, or personality disorders as defined in Axis II and III, then abstinence, support groups and treatments should suffice; however, if the symptoms point to a syndrome or if substance abuse is present, then symptom treatment plus aftercare and relapse prevention must occur (Shivani et al., 2002). The third possibility would be comorbidity; both the substance abuse and other disorder (ex: schizophrenia) must be treated concurrently (Shivani et al., 2002). Depending on the frequency, structured interview questions, lab work and physical, I would feel confident making a diagnosis regarding Mark.