Alex is an infrequent attendee at your church. He is 28 years old, lives with his father, and is separated from his wife of 3 years. He has one child, age 2, whom he sees “occasionally.” Alex is seeking counseling at the insistence of his father. Alex is currently unemployed, but does odd construction jobs with a friend of his as he is needed. He complains of his father “always hounding me for drinking a beer, even though he drinks too.” He reports drinking “a few” beers per day, rarely getting drunk. He has drank since high school. His additional substance use history (per self-report) include marijuana use (daily when younger, “maybe once a month” currently), and polysubstance use during high school. He denies other use at the current time.
His wife left him 18 months ago, stating she felt him to be unreliable. He blames lack of employment as the issue, but also stated she complained about his drinking as well, though he does not feel there is a problem with his alcohol use. He has a history of a DUI from 3 years ago, reported getting in trouble several times when younger due to alcohol use, but denies experiencing related struggles from his perspective.
He has a hard time sleeping, has adequate appetite, and spends his day watching tv when not working with his friend. He drinks at home during the day, and goes out after working with his friend to a local bar when he has money to do so. He speaks of his relationship with God as distant, recalling his salvation story that occurred as a high school student. He attends church to meet others and to engage with the worship (he enjoys the band). He does not feel particularly close to anyone.
Please respond (short answer is fine) to all of the following questions:
In your diagnosis, please use DSM IV-TR diagnoses when appropriate (found in your powerpoint presentations)
What are the client’s most prominent ‘presenting issues’ (that is, what seems to take priority as being wrong)?
What else do you feel you need to know (or, what might be some areas you may ask about in order to determine what is going on and how severe the problem may be)?
What do you think may be your ‘initial diagnosis’ based on the information given in the case study? Why?
What, if any, psychospiritual factors might be present and maintaining the presenting issue?
What are possible methods of treatment or referral?
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