Excessive use of marijuana and alcohol, especially within the last 2 years. Kurt began drinking and using marijuana at age 14 and by age 15 referred to the
usage as heavy. Despite recently being caught for the theft of his parents TYME card and $400, which resulted in him being forced to join an AODA group, he still
continues to use on a regular basis. He has also gone to work while intoxicated and attended a school dance under the influence of marijuana. As a result he was
fired from his job and had to undergo a urine screen in order to again be allowed back into his particular school. Regardless of these consequences, 17-year-old Kurt still uses.
Demographic: Male, age 17, white.
Early life: The youngest son in a two parent family, one older brother, one deceased brother, and a younger sister. The oldest son was killed in a freak accident about six years ago. Kurt expresses that since the accident (which he doesn’t remember) home life as been difficult. His mom has psychological and AODA issues and has been diagnosed with Munchausen syndrome. He had a good relationship with his father. Relationship with brother not very good.
Current home life: Lives at home with both parents and younger sister in a single family house. Remaining older brother moved out, recently. Average middle-class neighborhood. Social life: Many friends with three to four being close. He enjoys being around people most of the
Education: Currently attends a parochial school, is on schedule for graduation. He’s in the 11th grade and getting passing grades (C-average).
Employment: Currently working part-time after school and weekends. Previous job-he was fired for showing up intoxicated, however, has managed to keep a summertime job for the last two years.
Health: He rated current health as poor, stating bad lungs from previous bouts with pneumonia, and a bad back due to a 17% curvature of the spine causing muscle spasms in his lower back.
Mood: No history of depression or mania.
Sleep: Occasional nightmares (2 to 3 times monthly).
Appetite: No problems.
Sexual function: N/A
History of lost consciousness: Has passed out while drinking.
Hospitalization: Twice for pneumonia.
Alcohol/drug use: Heavy use of marijuana and frequent use
of alcohol. Has also experimented with narcotics which were stolen from his mother. Hallucinogens, including acid and shrooms. He is also a pack-a-day cigarette
Observations and Behaviors
Attitude: Good rapport during interview, very cooperative,
frank, and open.
Motor: Posture slumped, seemed nervous, a little agitated,
but held eye contact.
Speech: Adequate and average.
Language: Good vocabulary, normal.
Memory: Could not remember exact year his brother died. Otherwise, memory seemed fine, with accurate detail.
Mood: No depression or mania. Has had occasional thoughts of suicide, but never attempted. In the past has had anger- management problem, and saw a therapist (after complaints by teachers) from 1987 to 1990.
Affect: Appropriate and normal.
Insight: Consistent with abilities.
Thoughts: Appropriate to content, no phobias, obsessions, etc.
Attitude towards illness: Recognizes he has a problem, but doesn’t see it as serious, therefore is not very motivated to fix, or work on the problem.
Axis I: Substance abuse, particularly alcohol and cannabis, bordering on substance dependence.
Axis II: N/A
Axis III: Curvature of the spine.
Axis IV: Mother with significant psychological problems combined with AODA issues due to death of oldest son.
Axis V: 90
Support for diagnosis
Substance abuse-Despite being caught numerous times for drinking and drug use, and suffering the resulting consequences, Kurt refuses to abstain from participating in these illegal activities. I initially thought that oppositional defiant disorder may be a more appropriate diagnosis, but the negative, defiant, and hostile aspects are not really present. Kurt seems defiant only in order to obtain the alcohol or drugs he wants. This attitude doesn’t carry over into other aspects of his life.
I recommend continued AODA group therapy, but also think
individual talk therapy would benefit. I feel that the substance abuse is a symptom of an underlying problem,
probably the result of the stressors at home. He may also
be experiencing some mild depression and suffer from low self-esteem.