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Case Report No 2
(A Case of Drug Abuse)
Bio Data:

Name: L.A

S/O: M.H

Age: 25 years

Sex: Male

Address: Chack No 85 Junbi, Sargodha.

Education: Illiterate

Religion: Islam

Occupation: Rickshaw Driver

Monthly Income: Rs. 8000/-

Siblings: 6 (Brothers 3 Sisters 3)

Birth Order: 6th

Material Status: Married

Wife’s Age: 21 years

Wife’s Education: Illiterate

Wife’s Occupation: Housewife

Children: One

Father living / dead: Dead

Father’s education: illiterate

Father’s Occupation: Labourer

Mother living / dead: Alive

Mother’s Education: Illiterate

Mother’s occupation: Housewife

Socio - economic – status: Lower class

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Assessment Procedure:

The patient’s assessment was done through clinical interview, behavioral

observation and psychological tests (SDCT, SPM, RISB, HFD, BDI).

Reason & Source of Referral:

The patient was referred by one of my friend and was taken for learning

purposes.

Presenting complaints (verbatim):

Symptoms of illness:

Symptoms Duration

Loss of appetite 9 days

Insomnia 9 days

Restlessness 9 days

Body Pain 9 days

Vomiting 9 days

Headache 9 days

Addiction 4 years

Behavioral Observations:

The behavior of the patient was cooperative and he responds well. He talked

friendly. He showed his determination to get rid of drugs. Eye contact and motor

control also was appropriate.

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Pertinent Background Data

Family history:

The patient belongs to a lower class. He lived in Sargodha with his family

(mother, wife and children). His father died in 1986 at the age of 58 years. The patient

mother is illiterate and a house wife. He has three brothers and three sisters. The

patient’s birth order is 6th. The patient’s elder brother was died in 2008 due to heart

attack. His second elder brother is in Prison in case of a murder. There are good

relationships among all the siblings. All the siblings are married. The patient is

married and he has one child (Boy) and who is three years old.

Family history of illness:

The patient’s uncle was drug addict. His mother is suffering from Hepatitis C.

PERSONAL HISTORY:

His birth was normal, no neonatal problems were reported and he grew up

normally as other normal children in his family.

Early Childhood:

He achieved all developmental milestones at appropriate age. He was one year

old., when his father was died.

Adolescence:

He spent most of his time with his friends. He was very found of listening

music. He was very good in football. His relations with his siblings were normal.

Adulthoods:

He was 19 years old, when he became Rickshaws Driver. He was interested in

a girl, but she was already engaged with some one else. He was 21 years old, when

he got married with her cousin. Then he joined a company of addicts. Due to his

sitting with such friends he started to take drugs. The sudden death of his elder brother
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disturbed him. He had good marital relations but after he becomes a drug addict, his

relations with his wife and family affected. He did not commit any other crime in his

life except addiction.

Premorbid Personality:

Before his illness, he was socially useful personality. He was a Rickshaw

Driver. He had good relations with his friends, family and relatives. His attitude

towards moral and religious values was not much concerned.

History of present illness (reported by Patient):

The patient is a drug addict. He uses chars and Heroin. The patient started

these drugs in 2006.

Physical / Biological Problems:

The patient has no physical / biological problem except he reports vomiting

sometimes.

Psychosomatic Disturbances:

He reports headache, muscular pain, lack of energy and restlessness.

Psychological Assessment:

 Clinical interview

 Behavioral observation

 Mental status examination

 Slosson drawing coordination test (SDCT)

 Standard progressive matrices (SPM)

 Beck Depression Inventory (BDI)

 Human figure Drawing (HFD)

 Rotter Incomplete Sentence Blank (RISB)

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Clinical Interview:

The patient comes to hospital with the complaints of restlessness, body pain,

headache and insomnia. Clinical interview was conducted with patient and his mother.

The patient has not physical / biological problem except vomiting. Almost four years

ago, he joined the company of addicts, due to his sitting with such friends he started

the smoking. But with the passage of time he started to take chars and heroin. He

spent most of his time with his friends. According to his mother, he was loving and

caring person but after he becomes a drug addict, he became very aggressive and

often beat her wife. The patient belongs to lower class.

Mental status examination:

A young man, wearing dirty dress and was lying on bed. His personal hygiene

was not satisfactory and hairs were not well combed. He was talkative person. He

acknowledged that he had teased his mother. He had no interested in religious

activities and he had very little knowledge regarding religion. He participated in talk

with interest and in active mood. He had no specific hobby. Eye contact and motor

control was found normal. Orientation of time place and person was there.

INTERPRETATION OF RESULTS

Slosson Drawing Coordination Test (SDCT)

Quantitative analysis:

Age 25 years

Errors 25

Accuracy Score 33 %
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Qualitative Analysis:

According to the SDCT scores, the patient’s eye-hand coordination does not

seems to be intact.

Standard Progressive Matrices (SPM)

Quantitative Analysis:

Patient’s age 25 years

Total Score 23

Percentile 5%

Discrepancies 4, 1, 0, -2, -1

Time taken 45 minutes

Intellectual level Intellectual defective

Qualitative Analysis:

The score indicates that the patient seems to be intellectually defective.

Beck Depression Inventory (BDI):

Quantitative Analysis

Score 28

Range 20 – 28

Category Moderate

Qualitative Analysis:

The patient’s scores on the BDI, shows that he has moderate level of due

depression.

Rotter Incomplete Sentence Blanks (RISB)

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Quantitative Analysis

Types of No of Categories of No of Responses in Values Total

responses Responses Reponses categories

C 28 C3 7 6 42

C2 13 5 65

N 5 C1 8 4 32

P 6 N 5 3 15

P1 4 2 8

P2 2 1 2

P3 0 0 0

Total Total 164

Calculated Score: 164

Cut off Score : 135

Qualitative Analysis:

According to the RISB scores, the patient seems to have maladjustment.

Familiar attitude:

The patient showed conflicting attitude at home. For example, Item No. 4:

Beck home…… “I get sleep”. Item No. 26: Marriage….. “Should be done”. Item No.

35: My father…….. “Not remembered”. These responses indicate conflicts regarding

family. Any how, he has positive feelings about his mother as he respond on item No.

11: A mother…….. “Is a pious woman”.

Social and sexual attitude:

He showed conflicting attitude as he responded on item No. 3,5,19,21,and 40

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Item No. 3: I want to know……. “Nothing”.

He showed conflicts regarding addiction as at

Item No. 5: I regret…… “Why I take drugs”

Item No. 19: other people….. “Are Selfish”.

Item No. 21: I Failed ……. “In life”.

Item No. 40: Most women…….. “Are Good”.

All these items are indicating that patient has conflicts in social life.

General attitudes:

He showed conflicted attitudes again at item No. 6: At bed……… “May Allah give

me Rizkay Halal”. Item No. 12: I feel………. “I hurt my mother. Item No. 13: My

greatest fear……. “Death”. He showed inferiority complex at the response of item

No. 18: My nerves…….. “Are very weak”. A ambiguous and conflicting response was

at item No. 30: I hate……. “A Person”. He also showed inferiority complex again at

the response of item No. 33: The only trouble….. “ Earn money”.

Character trait related to the patient:

Above mentioned items 13,18,33 indicates that the patient has feelings of

inferiority and worthlessness. He showed a bit determination to optimistic as shown

on item No. 1: I like….. “I wish to up bring my children in a good way”. And item

No. 24: The future….. “The future will be good”. He also had a little bit positive

attitudes regarding social life as he wants to live as a cooperative society members, as

show on item no: 9 and 16, I dislikes…….. “Make a quarrel”. And sports …… In

sports every body should be happy.

Human Figure Drawing (HFD):

Qualitative Analysis:
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The picture on HFD revels that the patient seems to have immaturity,

instability, anxiety, poor coordination, impulsivity, Lack of balance and aggressive

behavior towards environment.

Discussion:

From clinical interview and behavioral observation and psychological tests, It

was identified that the patient came to hospital with the symptoms of restlessness,

body Pain, Insomnia, loss of appetite from 9 days. These complaints are short due to

withdrawal of drugs. Different psychological tests were administered like SPM,

SDCT, HFD, RISB, BDI. Then therapeutic plan is designed for the treatment of

problem.

Conclusion:

The patient history, behavioral observation, clinical interview and test

administered showed that he is a patient of Opioid abuse.

DIAGNOSIS:

Axis I: 305.50 Opioid Abuse

292.0 Opioid Withdrawal

Axis II: 71.09 No diagnosis

Axis III: None

Axis IV: Job dissatisfaction

Axis V : GAF = 42 (current)

Case Formulation:
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The diagnosis was done by clinical interview, behavioral observation and

psychological tests. The results of SDCT indicates that the patient’s eye-hand

coordination does not seems to be intact. According to the result of SPM the patient

seems to be intellectually defective. According to the score of BDI that the patient

seems to have moderate level of depression. The results of RISB indicates that the

patient seems to have maladjustment. According to the result of HFD the patient

seems to have immaturity instability, anxiety, poor coordination, impulsivity and

aggressive behavior. So it is concluded that the patient is suffering from these

problems due to drug abuse. These symptoms and duration meet the criteria of DSM

IVTR of Opioid abuse and Opioid withdrawal.

PROGNOSIS:

The prognosis for a psychological intervention is good. At the time of

admission, the patient was so much aggressive, restless. He had insomnia and loss of

appetite. So, with the help of medicines all the problems of the patient are some what

settled now, except addiction. So with the help of biological and psychological

treatment and with the co – operation of family the patient may become healthy.

RECOMMENDATION

Psychological Treatment:

 In behavioral modification techniques, aversive technique, assertive therapy

and Token economy can be successfully used.

 Deep breathing and other relaxation should be done for the management of

restlessness.

 Environmental conditions, which force him to take drugs, should be

eliminated.
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 Family members should pay attention to him because co – operation of the

family is very important for patient.

 Cognitive – behavioral treatment should be used to maintain and enhance the

better cognition.