Addiction: Case Conceptualization Template

For your final project, you will prepare a case study of Marge, the client presented in the
interactive media throughout the course. Your case study will consist of two sections:
Part 1: Case Conceptualization and Treatment Plan, for which you fill in the sections of
the table below by responding to the prompts, and Part 2: Ethical Responsibility and
Professional Development, in which you reply to the applicable. In addition, copy and
paste your revised Week 7 Treatment Plan at the end of the document.
Your case study will include the client's admission into residential treatment (Counseling
Session 1), proceed through her course of treatment there (Counseling Sessions 2 and
3), and conclude with a discharge plan of her projected long-term treatment extending
through the next 12 months.
 Review the course media: The Case of Marge: Counseling Sessions 1, 2, and 3.
 Review your assignments/discussions in Weeks 1, 3, 4, and 6.
 Complete the Case Conceptualization Template, including the Reflection and
Professional Development Plan.
 Apply the feedback from your colleagues and Instructor and copy and paste your
revised Week 7 Treatment Plan at the end of the document.

Client Name: Marge

Presenting Concern: Why did the client come to treatment and counseling?
The client was brought to treatment from an intervention with her husband, family, friends, and children. They
believed she would harm herself or others. Marge struggles with alcoholism; she recently lost her job due to alcohol
and was in a car accident that left her with a DUI. Emotionally distressed, she believes she does not need to be her
and that she can handle things on her own.

Case Conceptualization
Addiction History

 Substance(s) used and any addictive behaviors identified: Alcohol


 Age of first use: The use started when she married and began having children.

 Family history of addiction (chemical and behavioral): Father and Uncle both drank until they died.

 Progression of use to current stage: started drinking when she got married and had children, just a glass of
wine several times a week with dinner and husband. It progressed every day, then mornings, then drinking
just to feel normal.

 Average frequency and amount over last six months: Every day, multiple times a day.

 Other signs and symptoms of addictive use (e.g., blackouts, increased tolerance over time, physical
withdrawals if use stopped): When she tries to stop, she gets so severely ill that she starts seeing things
and feeling things on her skin she begins to feel crazy (similar to her father and uncle)

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Client Name: Marge


 Negative consequences experienced due to use: Lost job as a teacher, received a DUI from a car accident,
her son Roger has been getting in trouble at school and home.

 Previous attempts to stop on own and treatment history: Mentioned going to A.A. and counseling before
at the Community Health Clinic.

 Level of denial of problem (e.g., none, mild, moderate, severe): Moderate; she knows she drinks too
much but believes she can handle it independently.

 Level of motivation to change on admission (i.e., low, moderate, high): Low


Co-Occurring Disorders and Diagnosis

 Any other current or past mental disorder or mental health problem: depression, anxiety, anger, stress,
self-confidence

 Signs, symptoms, course of disorder, and other pertinent information necessary to plan treatment:
does not possess the essential tools to cope with all life stressors and needs help.

 History of treatment or counseling: A.A. and counseling previously at the Community Health Center.


Medical History

 Pertinent current or past medical history related to or affected by addiction: history of depression.

 Current medications (e.g., psychotropic and/or prescribed addictive medications): Diabetic does not
mention medication.


Educational/Vocational History

 Education: does not mention education.


 Work/career history including problems related to addiction: She was a teacher but lost her job due to
her drinking; she would drink before going to school and would have her husband call out for her when she
was too sick to go.

 Current financial status: No employment

Legal History
 Current or past legal problems: Has a DUI for a recent car accident.

 Current status of any existing legal problems: Pending: has not gone to court or spoken to a lawyer.

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Client Name: Marge

Social/Cultural Status

 Socioeconomic status: Middle


 Any cultural/ethnic factors influencing addiction and recovery:

 Social/leisure activities: running


Family/Relationship Status

 Composition of immediate family: Husband Ken, three children: Roger (12), Carla (16), and Scotty (10).

 Description of roles identified for each family member: Ken: Enabler: has made excuses for her for
work, does not discuss Marge's addiction with the children,
 Roger: Scapegoat: Gets in trouble in school, acting out to get attention.
 Carla: Hero role: acting as the parent, good grades, sports, popular, acts as both parents to younger siblings.
 Scotty: Mascot: he clowns around to make everyone laugh when arguing.
 (Lander et al., 2013).

 An explanation of the potential impacts of these roles on family members: Higher risk of developing
SUDs due to genetic and environmental factors (Lander et al., 2013). Relationship with husband, poor
communication, impairment of emotional and physical intimacy, increased conflict. Home not physically or
emotionally safe, neglect of children, attachment disorders, emotional abuse, and not being able to have
healthy functioning relationships later in life.

 Include family in the treatment plan and a minimum of two resources that would be useful to them:
Family counseling, individual counseling, couples counseling, Al-anon for husband, and Al-lateen for
children.
(Walden University, 2012).

Assessment:
 Description of how initial screening was conducted to validate the existence of a problem and make
initial treatment recommendations. Include how information was gathered (e.g., verbal clinical
interview, paper-and-pencil assessment instrument) and sources of information (e.g., client, family
members): Verbal Clinical Interview with Marge and her husband Ken.

 Overview of ongoing assessment process to evaluate severity of the addiction, rule out the co-existence
of other relevant problems, assist in treatment planning, and monitor progress (e.g., continued more
detailed interviews with client and family members, observation, standardized assessment
instruments). : Continue to monitor the client: include interviews with the client and husband, IOP
(outpatient facility), TEA (Treatment effectiveness assessment), and family therapy.


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Client Name: Marge

Model of Addiction and Case Management (Refer to coursework submitted Weeks 1 and 4. Provide a summary)
 Model(s) of addiction used to plan treatment approach. Rationale for use and strengths and
weaknesses of chosen model(s):
 Biopsychosocial Model:

The Biopsychosocial Model of addiction posits that biological/genetic, psychological, and sociocultural

factors contribute to substance use, and all must be taken into consideration in prevention and treatment efforts

(Skewes & Gonzalez, 2013). Present in the right environment, biological and genetic predispositions may increase

the risk of substance use problems, according to Skewes & Gonzalez, 2013. Marge was exposed to consistent

drinking by her father and uncle at a young age; it has been reported that 30.8% of people with alcohol dependence

have at least one alcohol-dependent parent, according to Skewes & Gonzalez, 2013. Some studies have indicated

that children of alcohol-dependent parents are less sensitive to the negative consequences of alcohol, resulting in

increased alcohol consumption (Skewes & Gonzalez, 2013). Marge commented on the painful symptoms of

withdrawal and how crazy she started to act; she compared it to the behaviors of her father and uncle. Marge has

associated her reason for drinking with many areas of her life, especially when dealing with her illness of diabetes,

the pressures of raising a family, getting a DUI, losing her job, and her bouts of depression. Marge is using alcohol

to avoid or escape all her negative thoughts and avoid the responsibilities that overwhelm her. Research has found

that people are more likely to use substances in situations where they feel unable to cope with the demands of life

stressors. One of the model’s strengths is that it considers the effects of religious beliefs, relationships, past

incidents, and different dynamics of the individual's life. On the flip side, this model has been criticized for the

identical aspect: how can one model consider all these factors (Papadimitriou, 2017)? This model has also been

criticized that it does not constitute a scientific or philosophical model, it does not provide an answer to the crucial

question of how biological, psychological, and social variables interact in the disease's expression, and it allows for

a wide range of interventions without specific guidelines (Papadimitriou, 2017).

 Model(s) of treatment used. Rationale for use and strengths and weaknesses of the chosen model(s):
Include benefits of choosing evidence-based practice as a model of therapy:
 12-Step Facilitation/Pharmacological

The 12-Step Facilitation Model is based on the principle of Alcoholics Anonymous (A.A.) and has

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Client Name: Marge

emphasized spiritual and social components (Capuzzi & Stauffer, 2022). Marge is concerned about her ability to

handle daily life stressors and does not want to disappoint her family again; attending meetings can help her feel a

part of the community and meet with others to gain support. The benefits of working in a program are that it

provides emotional support, knowledge, and information that her family may not necessarily offer to her. The

limitation of this model is that if using pharmacotherapy, the program does not necessarily believe in anything other

than abstinence. Marge is looking for a sense of purpose and meaning in her life. The 12-step Program of

Alcoholics Anonymous (A.A.) can be beneficial for her. A.A. follows a structured approach that includes admitting

powerlessness over addiction, seeking support from a higher power, engaging in self-reflection, and completing the

12 steps with a sponsor. Marge stated in her sessions that she is ashamed and embarrassed over the things she has

done while drinking and is not sure how she can stop. Attending A.A. meetings provides a solid, strong, sober,

supportive network where they can share similar stories and challenges. There is a sense of belonging in the

meetings, which can be crucial for individuals seeking recovery. Marge can connect with others and receive tools to

help her stay committed to her recovery. These practices focus on assisting patients to set goals, identify triggers,

develop skills to stop or reduce using, manage emotions and stress, build relationships that will support treatment

goals, and create a network of support from family, friends, and those from the Program (U.S. Department of Health

and Human Services). 12-step facilitation therapy emphasizes the importance of accepting addiction as a disease. It

works on enhancing maturity and spiritual growth and minimizing self -self-centeredness while providing help to

others who are suffering from addiction (Donovan et al., 2013).

The FDA has approved four medications for alcohol dependence, including acamprosate, oral naltrexone,

long-acting injectable naltrexone, and disulfiram (Oliva et al., 2011). Naltrexone has shown mixed effects in

promoting abstinence but is particularly effective at reducing relapse to heavy drinking and may be more effective

among patients who are still drinking (Oliva et al., 2011). Marge, during her second session, expressed a few times

how she hopes that she will be able to stop but is not entirely sure if she can or will stay sober once she returns

home. The use of Pharmacotherapy can help with reducing her cravings; this medication acts by blocking

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Client Name: Marge

endogenous opioids, reducing the rewarding properties of alcohol, and counteracting the component of the

behavioral response to alcohol (Capuzzi & Stauffer, 2022). The limitations of this treatment include the medication

being covered by insurance companies and many physicians not being fully knowledgeable or having received

adequate training, according to Oliva, 2011.

 Model(s) of case management used. Rationale for use and strengths and weaknesses of chosen
model(s): Include benefits of choosing evidence-based practice as model of case management:
 Assertive Community Treatment:

Strengths-Based Perspective

The Strengths-Based Perspective provides help to individuals with persistent mental illness and makes the

transition from institutionalized care to independent living (SAMSHA, 2015). The two principles of this model

emphasize providing resources and support for clients to promote a successful recovery, examining clients' strengths

and assets, and focusing on the pathology and disease of addiction, according to SAMSHA, 2015. Marge expressed

that she has been depressed since she was a teenager and has used drinking to cope with the depression. This mental

illness was never addressed, and she did not receive guidance or support to help manage the symptoms. Using the

strengths-based model, we can address her lack of self-confidence and feelings of self-consciousness. She is

working together to identify her strengths and how to utilize them to gain the self-confidence to find meaning and

purpose in her life. After losing her job for alcohol-related reasons, helping her to see a meaningful means of

employment will be a start to regaining her self-worth. The limitations of this model can be a lack of structure due

to its recent work in the field and a lack of solid research study and framework (Mantra Care, 2023). Research

indicates that evidence-based practices improve treatment outcomes by relying on interventions with established

efficacy (Li et al., 2019).

The Role of Spirituality

 Describe how spirituality could be an essential factor in the client's recovery:
 Spirituality plays a significant and positive role in a client's recovery process. It addresses more physical and

mental aspects of their recovery. Spirituality can give an individual a sense of meaning and purpose the

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Client Name: Marge

client seeks. Marge could find a deeper motivation to continue their recovery journey if connecting with a

higher power. This spiritual connection can also connect her with community engagement, offering support

and a sense of belonging with others facing the same challenges. Connecting spiritually also introduces new

mindfulness practices, including meditation and yoga, and promotes the well-being of mind, body, and soul.

All of these can be used as ways to relieve stress and ways of coping with triggers.


 Ways in which spiritual needs might be addressed through case management referrals to community
12-step support groups or other spiritual resources.


 Spirituality plays a significant role in all 12-step programs. Surrendering to a higher power does not always

have to be aligned with a religious belief but emphasizes a force greater than oneself (Capuzzi & Stauffer,

2020). The emphasis on spirituality, surrender, and powerlessness contradicts contemporary dominant

Western cultural norms of self-reliance and widespread secularism (Capuzzi & Stauffer, 2020). Due to the

nature of religious connotations and the reference to God in the Christian-based foundation of A.A., it can be

exchangeable with "higher power," according to Capuzzi & Stauffer, 2020. In the 12-step programs, many

individuals describe their recovery journey as developing personal growth and transformation; spirituality in

A.A., an individual can create a sense of self-awareness and the pursuit of living a better, fulfilling life.

Research has suggested that spiritual well-being is associated with improved mental health outcomes

(Koenig, 2009). Spirituality is A.A. is also expressed through the sense of community and creating a

supportive environment where people can connect with others suffering from the same disease. A sense of

belonging and shared values can contribute to a positive recovery experience (Dermatis & Galanter, 2016).

Finding a sense of purpose and meaning beyond their addiction also involves spirituality in the 12-step

programs. Finding and engaging in activities that align with personal values and goals can contribute to the

well-being of oneself and others and can be a powerful motivator for change according to (Capuzzi &

Stauffer, 2020).

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Client Name: Marge

Course of Treatment
Current level of treatment (refer to ASAM Resource p. 13–14).
 Dimension 1: Acute Intoxication and/or withdrawal

 Dimension 2:

 Dimension 3:

 Dimension 4:

 Dimension 5:

Projected level(s) of treatment after discharge from residential treatment over the next 12 months and an
explanation of why this level(s) would be effective:
 Projected levels of treatment over the next 12 months:
 2.7: Medically Managed Intensive Outpatient (6 months)/2.5: High-Intensity Outpatient: Depending on the

client's review of medical history and the client receiving a physical. The client has expressed her resistance

to being able to stay sober when leaving the residential facility. She has admitted to not knowing how to

handle stressors and challenges in everyday life. Attending high-intensity outpatient will provide the client

with an outlet to work through issues and be given an alcohol test weekly.

 1.5 Outpatient Therapy/1.7 Medically Managed Outpatient: A step down from Intensive IOP will include

additional outpatient therapy, providing more flexibility for her. While still being surrounded by a

community of support.

 12-Step Program (A.A.): Provide a sense of community

 Weekly/Biweekly: Individualized counseling

 Employment Training: DUI charges, losing job over alcohol-related issues.


 Family Counseling: Creating more open communication between her husband and children and creating a

safe space to identify problems with the family dynamic without judgment.

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Client Name: Marge

 Prognosis for response to treatment over next 12 months:

 Clients who remain in treatment longer have higher success rates and who continue to be a part of a recovery

community and lifestyle are likely to achieve sobriety for longer periods of time (Mohammed et al., 2017).

Discharge Plan
 Summary of treatment recommendations over next 12 months (as reflected in treatment plan):
 Marge will join a 12-step treatment program (A.A.) and try to obtain a sponsor.
 Looking for employment and attend career counseling/services.
 Enroll and participate in couples/family therapy. Discuss key issues and concerns within the family unit
concerning her substance abuse and the roles the family plays.
 Find a counselor and actively participate in discussing life stressors and triggers associated with substance
abuse and mental health.

Relapse Prevention and Continuum of Care:

 Describe relapse prevention needs and challenges for the client. Discuss the continuum of care plan
and recommendations for the client:
 Needs: support network, identify triggers and ways to cope, focus on treatment plans and goals, and adjust
as needed.
 Challenges: co-occurring disorder (depression) and addressing the role it plays in using alcohol to cope,
environmental factors including high-stress challenges and life stressors.

 Continuum of Care Plan: Discuss and provide the client with relapse prevention tools and coping skills.
Importance of 12-step support groups utilizing community resources, education of health positive living. Put
into place a prevention plan and adjust as needed—subject Marge to regular alcohol tests to track her
progress. Focus on starting to regain control of her life, looking for employment, taking care of diabetes
(health), and talking to legal services about DUI charges.

Ethical Considerations: Note any moral considerations or challenges associated with this case.
 A.2.a: Informed Consent
 A.2.b: Competence
 A.1.b: Confidentiality and Privacy
 B.3.b: Interdisciplinary Teams
 B.5.c: Release of Confidential Information


Reflection and Professional Development Plan

 Reflect on what you learned from this case and how you will apply your knowledge to future practice:

 I have gained a deeper understanding of the models of addiction, treatment methods, and case management
services, and through research and implementing evidence-based practices providing the best level of care
for my future clients. I have learned there is no right way to treat a client recovering; all plans are

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Client Name: Marge

individualized and should be adjusted as needed.

 What are your ethical responsibilities in working with addictions and cultural responsiveness?
Support your points with specific ethical standards and a plan for ongoing ethical and cultural
responsiveness:

 Informed Consent (A.2.a): Clients can choose whether to enter or remain in counseling.
 Respect for Confidentiality (B.1.c): Protect the confidential information of prospective and current clients.
 Multicultural/Diversity (B.1.a): Maintain awareness and sensitivity regarding cultural meanings of
confidentiality and privacy.
 Advocacy (A.7.a): advocate to address potential barriers and obstacles that inhibit clients' access and/or
growth and development.
 Client Welfare (F.1.a): Monitor client welfare, supervisee performance, and professional development.

 How will you keep up with trends related to best practices, integrating telehealth counseling, and any
changes to laws or ethical standards? Support your points with the course learning resources and a
specific plan to address these factors.

 Continued education: workshops, professional conferences, memberships to counseling resources to

network and gain exposure to other counselors in my area of study, continued education, online webinars,
and reviewing past and current course materials related to region or work.
 Keeping up with current new practices by subscribing to newsletters and journals. Keeping up with legal
and ethical standards, state and national laws.
 Regularly meet with my supervisor and colleagues to discuss best practices and ethical dilemmas that may
have presented themselves.

 Finally, discuss your personal and professional strengths that will support your practices and a plan
for ongoing self-care.
 Effectively communicate with supervisors to seek guidance and support and ensure professional growth

when dealing with challenging cases and when it comes to self-care.

 Set clear boundaries between work/life balance. This will prevent burnout and improve overall well-being.

 Listen to what my mental/ physical needs are to be beneficial to my clients.

 Practice mindfulness: physical activities to alleviate stress. Find hobbies and activities outside of work to

provide a sense of purpose and fulfillment.

 Take a break when needed and do not ask for help or support when needed.

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Client Name: Marge

Support your points with specific references to the Learning Resources and any additional sources you identify,
using in-text citations and references. It is strongly recommended that you include proper APA format and citations

Treatment Plan

Treatment Plan for Marge

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 Reference List:

Case management models: 4 unique evidence-based approaches. (n.d.).

https://www.bonterratech.com/blog/case-management-models

Capuzzi, D. T., Stauffer, M. D. (2020). Foundations of addictions counseling (4th ed). Pearson.

Comprehensive Case Management for Substance Abuse Treatment [Internet]. Rockville (M.D.):

Substance Abuse and Mental Health Services Administration (U.S.); 2000. (Treatment

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An Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK571736/

Dermatis, H., & Galanter, M. (2016). The Role of Twelve-Step-Related Spirituality in Addiction

Recovery. Journal of religion and health, 55(2), 510–521. https://doi.org/10.1007/s10943-

015-0019-4

Donovan, D. M., Ingalsbe, M. H., Benbow, J., & Daley, D. C. (2013). 12-step interventions and

mutual support programs for substance use disorders: an overview. Social work in public

health, 28(3-4), 313–332. https://doi.org/10.1080/19371918.2013.774663

Koenig H. G. (2009). Research on religion, spirituality, and mental health: a review. Canadian

journal of psychiatry. Revue canadienne de psychiatry, 54(5), 283–291.

https://doi.org/10.1177/070674370905400502

Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on

families and children: from theory to practice. Social work in public health, 28(3-4), 194–

205. https://doi.org/10.1080/19371918.2013.759005

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Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes,

implementation, facilitators, and barriers among community nurses-systematic

review. Medicine, 98(39), e17209. https://doi.org/10.1097/MD.0000000000017209

Mantra Care. (2023, April 15). Strength-based therapy: Techniques, benefits, and limitations.

Therapy Mantra - Online Therapy Counseling.

https://therapymantra.co/therapy-types/strength-based-therapy/

Mohammad, A., Irizarry, K.J., Shub, R.N. and Sarkar, A. (2017) Addiction Treatment Aftercare

Outcome Study. Open Journal of Psychiatry, 7, 51-60.

http://dx.doi.org/10.4236/ojpsych.2017.71005

Oliva, E. M., Maisel, N. C., Gordon, A. J., & Harris, A. H. (2011). Barriers to use of pharmacotherapy

for addiction disorders and how to overcome them. Current Psychiatry Reports, 13(5), 374–381.

https://doi.org/10.1007/s11920-011-0222-2

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psychiatry. Psychiatriki, 28(2), 107–110. https://doi.org/10.22365/jpsych.2017.282.107

Skewes, M. C., & Gonzalez, V. M. (2013). The Biopsychosocial Model of Addiction.

Principles of Addiction, pp. 61–70. https://doi.org/10.1016/b978-0-12-398336-7.00006-1

U.S. Department of Health and Human Services. (n.d.). Recommend evidence-based treatment:

Know the options. National Institute on Alcohol Abuse and Alcoholism.

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recommend-evidence-based-treatment-know-options

Walden University, LLC. (Executive Producer). (2012). Counseling session 1,2,3. Baltimore,

MD. https://waldenu.instructure.com

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