Fictional Drug Abuse Case Case Study

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Chemical Dependency

Jesse Bruce Pinkman is one of the most important characters in the popular TV series, 'Breaking Bad'. He plays the deuteragonist (2nd most important character) in the series, partnering with Walter White in his methamphetamine drug ring. Pinkman acts as a dealer and manufacturer of methamphetamine, and is also a methamphetamine user. Jesse was also a former student in White's chemistry class.

According to the program script, Pinkman was born September 14, 1984, into a middle income family in Albuquerque, New Mexico. While still in high school, he began using and dealing methamphetamine. After being thrown out of the house for his continued drug use, he moved into his Aunt Ginny's place, and looked after her until she died of lung cancer. After her death the ownership of the house fell to his parents who allowed him to continue staying there. The rift between Pinkman and his family continues throughout most of the series; this is apparently because of his drug use and the accompanying lifestyle. Jesse's character is modified throughout the series, from a laid back funnyman who provides comic relief in the early episodes, to a disturbed and sad shadow of his former self (Pinkman, n.d).

Assessment

Substance abuse examination is an assessment of patients who satisfy two conditions. The first condition is that the individual's drug screening results are positive, and signal possible substance abuse. The second condition is that the individual's answers to a brief assessment test indicate a variety of additional factors. These include: impaired control, a craving to use drugs, lack of social support, evidence that they are afflicted by 'other' psychosocial conditions; and the likelihood that these factors will render a brief intervention unsuccessful. Data collected via the assessment will give pointers to the type of problem the individual faces; it will also assist in determination of a suitable treatment plan.

Assessment:

Studies problems linked to use and/or abuse of drugs, such as clinical, social, financial, and behavioral factors

Provides information for official diagnosis of a likely problem

Determines the extent of, or severity of the diagnosed problem - mild, intermediate, or severe

Enables identification of suitable care level.

Provides a guide to the treatment plan, such as type of referral(s) needed and/or necessity for specialized care

Establishes a baseline in terms of the patient's status for later evaluation and comparison

Assessment Guidelines

Important Factors in Screening and Assessment

Information accuracy

Data continuity

Sharing of information

Necessity to rescreen and reassess

Scheduling of screening and assessment

When is an official diagnosis necessary?

Drug testing

Issues to Address in the Above Exercise

History of substance use and abuse

The need for detoxification

Physical health status

The willingness to commence treatment

Possible dual diagnosis

Trauma history

Psychopathy and possible danger for recidivism and violence

From the information provided, it is possible to observe that Pinkman suffers simultaneously from different addiction disorders. These may include severe depression as well as an eating disorder (ED) linked to substance abuse. Anxiety and mood disorders occur at relatively increased rates among individuals who have substance abuse disorders (SUDs). Major depression has also been identified as the most common co-occurring Axis I psychiatric disorder. Co-morbid major depression is linked to chronic and extended substance abuse disorders (Worley et al., 2012).

Various aetiological factors that could have led to co-occurring substance abuse disorders in Jesse Pinkman's scenario can be best understood from a biopsychosocial viewpoint. The theories of aetiological co-morbidity include: behavioral and addiction models; biological factors such as genetic risk; personality factors such as chronic dysregulation; novelty seeking; increased impulsivity; and possible co-occurring psychopathology, in addition to environmental influences. Biological aetiological models point to disorders in neurotransmitter function. These include serotonin, gamma aminobutyric acid (GABA), dopamine, and the final endogenous opiate systems in both substance abuse disorders (SUDs) and eating disorders (EDs). The common physical symptoms among these disorders and the relation between the increased effects of substances that are biologically reinforced and food deprivation are some of the evidences of this biological model. In terms of genetic risk factors, research has shown that genetic heritabilities for eating disorders and substance abuse disorders are independent. Additionally, co-morbidity is likely to be influenced by both genetics and the environment. Some individuals are more susceptible to dependency because their genetic makeup raises their sensitivity to drugs. Several types of substance use and dependence appear to be genetically predisposed or influenced by the environment; in several cases, the substance abuse can be a mix of both. Various twin studies suggest that there is a huge genetic factor in alcohol abuse and dependency (Gregorowski, Seedat & Jordaan, 2013).

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The addiction aetiological co-morbidity model suggests chemical dependency in both substance abuse and eating disorders with personality, genetic, socio-cultural, and familial influences. Addictive disorders have similar underlying biopsychological processes that include personality and neurobiological factors. Evidence from addiction models show that personality susceptibility factors are considered likely causes for co-morbid substance abuse and eating disorders. These factors seem to differ based on the eating disorder subtype. There is a link between a family history in terms of alcoholism and dependence and the high prevalence of substance use among persons who have novelty seeking characters such as Jesse Pinkman.

Attention Deficit Hyperactivity Disorder (ADHD) is a possible mediating factor between his substance abuse and eating disorders. ADHD has several symptoms including lack of attentiveness, impulsivity, hyperactivity and others linked to personality factors and is usually present in persons suffering from eating disorders. Research has shown co-morbidity between attention deficit hyperactivity disorder and substance abuse and eating disorders. Environmental factors also play a part in the above co-morbid psychopathology. Cumulative early childhood trauma may cause various types of deregulation, often leading to psychopathology in adulthood (Gregorowski et al., 2013).

Substance abuse disorders are complicating factors in the screening, assessment and diagnosis and care of patients with eating disorders. Studies have proven that individuals who abuse substances and simultaneously suffer from eating disorders often have worse symptoms of their eating disorders, and lower functional outcomes than those with only eating disorders. As well, those patients with co-morbid eating and substance-abuse disorders have worse substance abuse. Co-morbidity results in medical complications, longer duration of recovery, lower functional outcomes, higher rates of attempted and successful suicide, and increased mortality rates. As soon as a co-morbid disorder has been diagnosed, a complete clinical and psychiatric evaluation should be conducted; it is possible that patients may have to be stabilized before commencement of treatment for the two disorders.

One of the main challenges to the diagnosis and treatment of co-morbid disorders is that patients suffering from substance abuse and eating disorders are often resistant to treatment and may possibly experience guilt. This guilt may result in reluctance to report symptoms. Substance abuse and alcoholism can also affect factors that are used to diagnose eating disorders, including appetite, weight, and diet. Therefore circumstantial information is important in the assessment of patients with eating disorders, while putting emphasis on a direct and open-minded approach (Gregorowski, Seedat & Jordaan, 2013).

Assessment tools

Standardized screening and assessment questionnaires

Assessment tools are important in evaluating the risk in primary care. The most successful technique for identifying co-morbid substance abuse disorders is the use of interviews. Obtaining comprehensive details of the substance abuse history, including details of current and previous drug use is recommended. Drug use history must also include information on the triggers, functions, and patterns of drug use. The questions in the interviews should concentrate on the abuse of substances. The role of alcohol and other psychoactive drugs in emotional control must also be explored (e.g. drinking of alcohol for the relief of depression, anxiety or shame). Some studies underscore the importance of behavioral assessment using questionnaires, role play, and self-monitoring so as to explore the link between substance abuse patterns and other behaviors (Gregorowski, Seedat & Jordaan, 2013).

Diagnosis According to DSM-5 Guidelines

Dual Diagnosis for Jesse Pinkman

The relationship between substance use and mental illnesses is a complex one. The two can be linked in various ways:

Heavy alcohol or drug use can cause mental illness by harming the brain.

Mental illness can also cause one to be susceptible to substance abuse to alleviate psychiatric stresses.

Several psychological impacts of substance use including anxiety, depression, mania, and mood swings often seem like mental illness.

The symptoms of several mental illnesses may also resemble side-effects of substance abuse.

An experienced therapist can evaluate the patient on different levels to determine the link between their substance use and their mental health. However, at times even the most skilled health care professionals may find it difficult to make a dual diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5, for the current edition) addresses substance abuse disorders. Substance abuse disorder in DSM-5 utilizes both DSM-IV levels of substance use and dependence as one disorder; it is measured based on different severity levels. Every particular substance except caffeine is categorized as a separate use disorder (e.g. stimulant use disorder); however, almost all substances are assessed based….....

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