Case Study of Drug and Alcohol Abuse

This essay sheds light on the case study of Massimo, an Italian immigrant inflicted with illicit substance and alcohol abuse. It discusses extensively the various cultural and linguistic factors prior to provision of treatment, the effective assessment and screening tools, potential challenges, intervention strategies, the required substance counseling model and the ethical issues which must be considered prior to his treatment.

Running head: CASE STUDY OF DRUG AND ALCOHOL ABUSE
CASE STUDY OF DRUG AND ALCOHOL ABUSE
Name of the Student:
Name of the University:
Author note:

1CASE STUDY OF DRUG AND ALCOHOL ABUSE
Introduction
As stated by Burns, Coleman-Cowger and Breen (2016), uncontrolled alcohol and drug
usage has been reported to yield physiological and societal implications in the form of liver
damage, increased automobile accidents and mortality, domestic and public violence lead to
disruption of domestic as well as familial harmony.
The emerging rate of illicit drug and alcohol abuse amongst culturally and linguistically
diverse (CALD) populations continue to plague the Australian community, as stated by the
National Drug Strategy (Rowe et al., 2018). The following paragraphs of the essay shed light on
the case study of Massimo, an Italian immigrant inflicted with illicit substance and alcohol
abuse. The essay discusses extensively the various cultural and linguistic factors prior to
provision of treatment, the effective assessment and screening tools, potential challenges,
intervention strategies, the required substance counseling model and the ethical issues which
must be considered prior to his treatment.
Discussion
Cultural and Linguistic Factors
Massimo is an Italian immigrant and the counselor must consider providing a cultural
competent treatment. As stated by the National Drug Strategy of Australia, the prevalence of
substance and alcohol abuse along with illicit drug usage is alarmingly high amongst culturally
and linguistically diverse groups. The presence of more liberal practices of alcohol consumption
in Australia, often puts culturally diverse immigrants at a disadvantage due to the absence of
prevalent alcohol usage in their respective countries (Horyniak, Lim & Higgs, 2016). According

2CASE STUDY OF DRUG AND ALCOHOL ABUSE
to Roche et al., (2015), such groups continue to face continued discrimination from native
Australians, in terms of employment opportunities, resulting in financial constraints and
associated implications on mental health exhibited in the form of anxiety, depression and
distress. Such conditions often subject such groups to greater alcohol and substance abuse usage,
which may be prevalent in the case of Massimo. Massimo required an interpreter meaning that
he may be at a disadvantage during reception of treatment due to the prevalence of an English
speaking background in his surroundings (Gainsbury, 2017).
The counselor first consider Massimo’s cultural diversity along with his needs,
preferences and opinion which may be unique to his culture. The counselor must consider his
unique linguistic identity and hence, must provide a non-English speaking environment which
will facilitate communication (Posselt et al., 2014). Hence, the above cultural and linguistic
factors unique to Massimo’s culture, along with the possible presence of inequitable provision of
resources due to this immigrant identity, must be considered by his respective counselor for the
provision of culturally competent treatment.
Screening Tools
The key screening tools chosen for assessing Massimo’s condition prior to his treatment,
will aim to evaluate his alcohol as well as cannabis usage behaviors.
For the purpose of screening alcohol consumption, the AUDIT or Alcohol Use Disorders
Identification Test may be used. This screening tool is formulated by the World Health
Organization for the purpose of assessment of consumption of alcohol, conductance of behaviors
associated with drinking as well as evaluation of additional problems which may be associated
with alcohol ingestion. The AUDIT screening tool has been documented to be suitable across all

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sexes, and even across a variety of ethnic and culturally diverse groups, hence making it
appropriate for screening the condition of Massimo (Ludin et al., 2015).
The second screening tool is the Cannabis Use Disorder Identification Test- Revised
(CUDIT), which consists of 8 questions aiming to assess behaviors associated with cannabis
usage and attempts at quitting by the concerned patient. The counselor must aim to administer
these screening tools in the form of languages highlighting Massimo’s ethnicity, which will not
only be easy for Massimo to comprehend but will also form a successful step towards provision
of culturally competent treatment (López-Pelayo et al., 2015).
Assessment and Case Formulation
Case Formulation
Massimo, a 56 year old Italian social worker, was recently admitted to the local hospital
upon sustaining a head injury as a resultant of a fall. Despite the absence of any previous medical
complications, the patient engages in extensive marijuana usage.
Assessment
A pain screening in the form of a PQRST pain assessment tool was conducted which
included a comprehensive evaluation of palliation or provocation (P), quantity or quality (Q),
radiation or region (R), scale of severity and the timing of this head pain (Fink & Brant, 2018). A
comprehensive medical assessment was conducted concerning his medication usage,
musculoskeletal functioning and medical history (Traub et al., 2015). A psychosocial assessment
was also conducted considering his culturally unique identity, which aimed to assess his
opinions, belief and coping mechanisms (Singla et al., 2015). Lastly, considering his excessive
alcohol and marijuana usage, an Alcoholic Use Disorders Identification Test and Cannabis Use

4CASE STUDY OF DRUG AND ALCOHOL ABUSE
Identification Disorder Test was conducted which revealed alarmingly high levels of substance
and alcohol abuse (Harris, Louis-Jacques & Knight, 2014)
Potential Challenges
The client’s culturally and linguistically diverse background will serve as major
challenges due to the prevalent discrimination, inequitable share of resources, lack of
employment opportunities and the resultant financial constraints which minority migrant groups
are subjected to, from native citizens. The client is also lacks fluency in English which can be a
major determinant for initiating communication and understanding the individual needs of the
client, due to the majority prevalence of English speaking professionals (Patternote et al., 2015).
The client also denies his engagement in detrimental alcoholic and substance abuse behaviors,
which is a major challenge prior to the administration of treatment (Williams, Olfson & Galanter,
2015).
Potential Supports for Recovery
The key supports which can help the client in his treatment are multicultural and
culturally diverse self help and peers support groups, who engage in the provision of culturally
competent treatment practices. Peer groups and self help groups comprise of individuals who
suffer from common social issues and problems and hence engage in the dissemination of mutual
support for each other. Further, multicultural support groups consist of culturally diverse
members who share a common understanding of the issues faced by minority groups and hence,
yield beneficial outcomes through social interaction of shared experiences (Maura & Weisman
de Mamani, 2018).

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Interventions
As stated by Pereira, Figueiredo-Braga and Carvalho (2016), one of the key intervention
strategies which must be considered by the counselor is the usage of a patient-oriented support,
which comprises of involving the client in the decision-making procedure, to be performed
during the formulation of an appropriate treatment plan. Further, considering the diverse cultural
and linguistic background of Massimo, the counselor must consider additional three intervention
strategies during the first meeting. These will include: Awareness, Acceptance and Asking.
According to Hsieh and Bean (2014), one of the key intervention strategy outlines the
presence of awareness of the counselor considering one’s own beliefs as well as those of the
client belonging to a culturally diverse background. Possessing adequate self awareness
concerning one’s own cultural beliefs, will aid the counselor in the identification of potential
judgment and biases which must be removed. Possessing awareness of the unique cultural
identity of the client aids in the recognition of beliefs, preferences and opinions which are
intrinsic to the patient and must be considered for the purpose of successful culturally competent
treatment.
As stated by Guerrero et al., (2018), the second intervention strategy of acceptance will
require the counselor to accept that the culturally diverse client, in this case, Massimo’s Italian
origins, will possess unique beliefs and opinions, which must be empathetically attended to
during the first meeting and hence, will lead to client empowerment resulting in positive health
outcomes.
Lastly, as researched by Thom, Black and Pene (2018), appropriate enquiry or ‘asking’
must be used as an intervention strategy which will require the counselor to communicate and

6CASE STUDY OF DRUG AND ALCOHOL ABUSE
show interest concerning the culturally unique views, needs and preferences possessed by the
client. This will further help the counselor to gain awareness of the client’s diverse needs,
resulting in successful patient-centered intervention strategies.
Substance Abuse Counseling Model
The substance abuse counseling model will comprise of Gestalt Therapy, Cognitive
Behavioral Therapy and Didactic Therapy.
Fritz and Laura Perls were the formulators of Gestalt Therapy, which is a type of
psychotherapy concentrating on humanistic principles. This type of treatment focuses on
encouraging clients to express without inhibition, their reasons and justifications for engagement
in detrimental behaviors, resulting in an increased level of self-acceptance, accountability and
responsibility of the client. A popular gestalt therapy model which will be used in the treatment
of Massimo is the empty chair technique, where he will be required to sit and communicate
facing an empty chair, representative of a near and dear one Through role playing, Massimo will
be required to freely express his reasons of substance abuse and alcohol engagement further
allowing him to express issues which he may not have been able to communicate in reality. The
rationale behind this technique is Massimo’s constant denial of his engagement in detrimental
behaviors, and hence, this method will compel him to come to terms with his shortcomings
paving the way for effective treatment (Narkiss-Guez et al., 2015).
The psychotherapeutic principles of cognitive behavioral therapy, focus on the behavioral
paradigm underlying detrimental mental health and harmful activities in the client. Cognitive
behavioral therapy focuses on modification of harmful behaviors associated with specific stimuli.
Massimo’s drinking and cannabis usage can be a resultant of underlying social or emotional

7CASE STUDY OF DRUG AND ALCOHOL ABUSE
factors which may act as stimulus resulting in conductance of harmful behaviors – hence,
forming the rationale behind the usage of cognitive behavioral therapy. Hence, through the usage
of this technique, the counselor can identify the key stimulating factors which compel Massimo
to adhere to detrimental thoughts of denial and engagement in substance and alcohol abuse,
which can be further treated for modification (Carroll et al., 2014).
Massimo is part of a culturally diverse minority group and may find it difficult to
communicate his unique cultural needs and preferences to the native population. Hence, the
conductance of group therapy sessions consisting of multicultural team of individuals belonging
to various cultures form the rationale behind usage of didactic therapy, which is characterized by
providing psychological educational and demonstrative or experiment-oriented treatment in the
form of groups or teams (Zafar & Khalily, 2015).
Referral and Relapse Prevention
Referral Services
Additional referral services which can be used as referral for Massimo, would include
multicultural or culturally diverse self help groups or non-profit organizations. The availability
of diverse cultural and linguistic task force in such self help groups forms the rationale behind
referral selection since they will be sensitive to the unique cultural needs of Massimo. Examples
include: Australian Mosaic, Villaggio Italiano Limited: Extended Respite Care Service and the
Carers ACT: CALD Carers Program Support Groups prevalent in ten diverse linguistic
characteristics (Liamputtong et al., 2015).

8CASE STUDY OF DRUG AND ALCOHOL ABUSE
Relapse Prevention
Despite the usage of effective treatment programs, clients suffering from substance or
alcohol abuse can suffer from relapse. The key strategies for preventing relapse would involve
ensuring that Massimo engages in full completion of his treatment course along with usage of
effective medication treatments which can target mood alterations, reduce substance cravings
and regulate withdrawal symptoms (Witkiewitz et al., 2014). According to Linke and Ussher
(2015), additional relapse preventive strategies would involve adoption of multidisciplinary
holistic treatments, such as exercise and adequate nutrition. Supervised physical activity has been
documented to improve sleep and enhance transmission of impulses in substance abuse and
alcoholic patients. Extensive alcohol and drug usage also results in essential nutrient depletion,
which may still not be met despite avoidance of such substances. Hence, consumption of a
balanced diet through intervention by a nutritionist compensates for the nutrient loss and also
enhances physiological and psychological functioning in such patients.
Ethical Issues
For optimum ethical consideration of Massimo’s case study, the counselor must adhere to
the Psychology and Counseling Federation of Australia (PACFA) Code of Ethics. One of the key
ethical issues is the Massimo’s diverse cultural background which may be different that the
opinions of the counselor. As stated by the fourth ethical standard of PACFA, the counselor must
respect the diversity of Massimo, exhibit awareness concerning his culturally unique
background, engage in culturally sensitive communication and avoid any form of discrimination
in terms of his cultural diversity. In accordance to the PACFA Code of Ethics, the counselor
must put the client firsts and conduct a patient centered approach, engage in a trustworthy

9CASE STUDY OF DRUG AND ALCOHOL ABUSE
relationship, and most importantly, respective the privacy and confidentiality of the case details
of Massimo (Bolton, 2017).
Conclusion
For the provision of optimum treatment services to the client, the counselor must engage
in the conductance of culturally competent activities. Prior to Massimo’s treatment, the counselor
must consider his cultural background along with engagement in patient-centered approach and
usage of appropriate ‘asking’, ‘acceptance’ and ‘awareness’ intervention strategies. A substance
abuse model outlining psychotherapeutic principles of gestalt therapy, cognitive behavioral
therapy and didactic therapy have been utilized, concerning Massimo’s culturally diverse
background, prevalence of possible discrimination and constant denial. Referral services in the
form of multicultural self help groups have been recommended due to the presence of like-
minded, culturally diverse principles. Relapse prevention techniques such as medication,
adequate exercise and proper nutrition have been considered for the deliverance of holistic
treatment. Lastly, to conclude, adequate ethical standards have been considered in accordance to
code of ethics, for the provision of culturally competent treatment.

10CASE STUDY OF DRUG AND ALCOHOL ABUSE
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