Vignette I

Adam, a 25 yr. old Hispanic male, is admitted to a chemical dependency unit for detoxification. He is in active alcohol withdrawal. He has a 10 year history of alcohol abuse with suicidal ideation. His father, who he has not seen for 15 years, was also an alcoholic. Adam’s maternal grandmother was diagnosed as “mentally ill” and was institutionalized when Adam was a baby. His maternal aunt died of a successful suicide at 32 years old. Adam grew up in a ghetto in Los Angeles, where 2 of his siblings were killed in drug related crimes. He currently resides with his mother and 2 sisters.

1. Considering a differential diagnosis, what is your initial assessment and diagnostic impressions of Adam and why? How might sociocultural factors affect your assessment? Consider the depressive disorders and posttraumatic stress disorder concurrent with substance related disorders in your response. Please present other ideas that you have for Adam.

2. For Adam, consider the Six Dimensions Checklist

and the Mental Health Screening Form­ III and Simple Screening Instrument for Substance Abuse in Appendix H of“

Substance Abuse Treatment For Persons With Co-Occurring Disorders” of TIPS 42. Finally,

Using the vignette information, present a summary of the completed checklists and screening forms for Adam in consideration of your diagnostic impression. Integrate both treatment and pharmacological interventions. Remember to include culture in your treatment planning as well as legal/ethical issues that might be present.