Case no 2 Drug Addict

Demographics

Name N.A

Age 24

Sex Male

Marital Status Single

Birth order Last born

No of siblings 3

Occupation Student

Source and reasons of referral:

The Client voluntarily sought admission to Rah e Aman Rehabilitation Center after recognizing

the detrimental impact of her addiction on her personal and professional life.

Presenting Complaints

According to client:

‫چکر آتے تھے‬

‫کمزور ی ہو جاتی ہے‬
‫چلنےمیں دشوار ی ہو جاتی ہے‬
25‫مجھے نیند کم آتی تھی‬
‫غصہ بہت جلدی آتا تھا‬
‫بے چینی بہت زیادہ ہوتی تھی‬
History of present illness
The client had a history of drug use since 5 years and was admitted to Rah e Aman

Rehabilitation Center 1 year ago. His drug addiction began at the age of 19, as a means of coping

with academic stress and social anxiety. Over time, her drug use escalated, and she became

dependent on various substances, including opioids and benzodiazepines. Despite being released

after a year, the experience left a lasting impact on his psychological well-being. This period

marked a decline in his mental health, manifesting in abnormal behaviors such as anxiety.

Seeking help, the client was admitted to Rah e Aman Rehabilitation Center, where he underwent

observation and treatment under the care of a psychologists and psychiatrists

Family history

The client's father worked as a Bank Accountant while his mother was a housewife. He

had 1 sisters and one brother, being the last-born in the family and had a childish attitude. Both

of his siblings were had an excellent education with the position Holder. The family followed a

nuclear family system. The home environment was generally warm and supportive, emphasizing

strong family values and open communication, emphasizing the importance of education and

personal development.

Personal history

The Client was an academically gifted and compassionate individual. he excelled in school and

developed a passion for Software Engineer. Despite her achievements, the client struggled with

low self-esteem and social anxiety due to the high competition, which contributed to her

vulnerability to drug addiction for 5 years. But his relationship with his family was good and had

a good time with them

Educational history

The Client excelled academically, earning a bachelor's degree. However, her addiction hampered

her career goals, resulting in periods of unemployment and instability and he loves to play video

games

Social history

The Client was initially outgoing and sociable, with a wide circle of friends and acquaintances.

However, her addiction isolated her from social activities and strained interpersonal

relationships. Sarah's social support network had dwindled over the years, leaving her feeling

lonely and disconnected.

Medical history

Aside from his addiction issues, the client reported no significant medical concerns.

However, prolonged substance abuse had taken a toll on her physical and mental health,

contributing to chronic fatigue, insomnia, and depression.

Premorbid personality

The client was friendly person and had an extroverted and gregarious attitude who

was active in community events and social gatherings. However, the cognitive changes he had

undergone over the previous 4-5 years had resulted in increased introversion.

Psychological Assessment

Assessment included formal evaluations:

 Formal Assessment
Formal Assessment:

Formal psychological is important on a different level as it also supports prognosis and

therapeutic techniques so following assessment were carried out.

 Mini mental state examination (MMSE)

 House-Tree-Person

 Rotter Incomplete Sentence Blank

 Beck Anxiety Inventory

 Drug Abuse Screaming Test

Mini mental state examination:

The Mini-Mental State Examination (MMSE) is a brief, standardized assessment tool used to

evaluate cognitive function in adults. It consists of a series of questions and tasks designed to

assess various cognitive domains, including orientation, memory, attention, language, and

visuospatial abilities.

Qualitative interpretation

To check cognitive impairment MMSE (Mini Mental State Examination) was conducted. Cut off

score of MMSE is 30 and the patient got 27 which shows that the client has no cognitive

impairment.

House tree person (HTP)

 The house-tree-person test (HTP) is a projective personality test, a type of exam

in which the test taker responds to or provides ambiguous, abstract, or unstructured

stimuli (often in the form of pictures or drawings).

House interpretation:

The small size of the house suggests a retreat from home life and a tendency to withdraw.

With its closed door, the client appears to seek warmth while also maintaining a defensive

stance. The closed window hints at limited social engagement, perhaps preferring seclusion. The

presence of strong lines reflects a struggle with anxiety and a heightened need for protection. The

minimal attention to the roof indicates an avoidance of overwhelming situations. Together, these

aspects of the drawn house offer insights into the client's emotional state, indicating a retreat

from home life, a desire for warmth with a defensive stance, limited social engagement, anxiety,

and a tendency to avoid overwhelming situations.

Tree interpretation:

The tree, created by the client, symbolizes the deepest and most unconscious

aspects of their perception. By omitting branches, it suggests limited contact with others.

The absence of roots indicates a sense of insecurity and instability in their personality.

However, the presence of the trunk represents inner strength and self-esteem. The

addition of fruits signifies a high need for nurturance.

Person interpretation:
 The drawing of a person facing left on the page suggests a self-oriented and

introverted disposition, accompanied by an overt display of behavioral tension, typical of

someone struggling with drug addiction. Notably, the inclusion of a circle eye without

pupil’s points towards egocentric tendencies, immaturity, and possible regression, all

common in individuals battling addiction. The omission of a mouth in the drawing

indicates communication difficulties and potential oral aggression, which can be

exacerbated by substance abuse. The presence of big ears suggests sensitivity to

criticism, often heightened in those dealing with addiction. The depiction of a long neck

signifies challenges in controlling anger, a common issue among individuals grappling

with substance abuse. The open arms in the drawing symbolize aggression, a trait that

can manifest during drug-induced states. Additionally, buttons on the shirt signify

dependency, immaturity, and a sense of inadequacy within the client, all of which are

frequently intertwined with addiction struggles. Collectively, the elements in the drawing

paint a portrait of a self-oriented, introverted individual grappling with behavioral

tension, communication difficulties, and a variety of emotional challenges.

Rotter Incomplete Sentences Blanks

The Rotter Incomplete Sentences Blanks (RISB) is a projective psychological test developed

by Julian B. Rotter. He published this test in 1950. It comes in three forms i.e. school form,

college form, adult form for different age groups and comprises of 40 incomplete sentences in 20

minutes, usually only 1-2 words long.

Qualitative Analysis

The client scored 153 on RISB which indicates that his personality was not socially

adjusted.
Beck Anxiety Inventory

Beck Anxiety Inventory (BAI); The BAI was administered to assess the severity of

client’s Anxiety.

Qualitative Analysis

BAI was used to check patients ‘anxiety level. The client scored 25, which shows a

moderate level of anxiety.

Drug Abuse Screening Test (DAST-10)

The drug Abuse Screening Test was developed by Harvey Skinner. It is a brief screening

tool that can be administered by a clinician or self-administered. This tool assesses drug use, not

including alcohol or tobacco use, in the past 12 months.

Quantitative Analysis

The client has a substantial level of problems related to drug abuse.

Prognosis

The course of treatment and family support will determine the prognosis. Because the

client's disease symptoms were less severe, his prognosis seemed to be significantly better. It is

possible for his prognosis to significantly improve if he takes his drugs as prescribed and

receives the necessary family support. His symptoms of anxiety, anger, and trust issues were

interfering with his everyday routine, therefore he wanted to get rid of them.

Diagnosis
 According to DSM V the most probable diagnosis is

Code Disorder

303.90 Substance Use Disorder

Case formulation

The client was 24 years old male He had a history of drug use since 5 years and was

admitted to Rah e Aman Rehabilitation Center one year ago. His drug addiction began at the age

of 19, addiction journey commenced during her college years, marked by experimentation with

recreational drugs to cope with academic stress and peer pressure. What started as occasional use

soon spiraled into dependence, as Sarah found herself increasingly relying on drugs to manage

her emotions and numb painful memories from her past. He was diagnosed with Substance Use

Disorder (303.90). Client was assessed by both formal and informal ways. Informal assessment

includes HTP, RISB, MMSE, BAI, DAST-10 and behavioral observation. In MMSE, he scored

27 which indicates that the cognitive functioning of client was impaired, and formal assessment

was Beck Anxiety Inventory scale was administered on the client. Client scored 25 in Beck

Anxiety Inventory which indicates that client was suffering moderate level of Anxiety. Client

was referred by his father to the psychologists of Rah e Aman in order to check the severity of

problem and for particular treatment plan. In RISB (Rotter Incomplete Sentence Blank) client

scored 155 which that the client has problem of adjustment. Client scored 6 on DAST-10 which

indicates that problems related to drug abuse.These assessments complemented formal

diagnostic evaluations, providing a comprehensive understanding of the client's mental health

status and contributing factors to his condition.

Recommendation

 Trauma-Informed Therapy

 Psychoeducation

 Cognitive-Behavioral Therapy (CBT)

 Social Support

 Holistic Approach

 Individualized Care
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