SOWK 431 Week 7 Mental Health Diagnosis and Assessment Paper Example

Mental Health Diagnosis and Assessment Paper: Assessing Alcohol Use Disorder After a DUI Arrest, From Screening to a Strengths-Based Treatment Plan

Introduction

Teresa, a composite 47-year-old real estate agent, was arrested after her car drifted across a lane line on a Friday night. Her blood alcohol concentration was well above the legal limit. As a condition of her case, the county court ordered a substance use assessment at a community behavioral health agency, where she met with a social worker. She arrived embarrassed and defensive, saying that she drinks to unwind like everyone else she knows. This paper describes how a social worker would assess Teresa, applies the DSM-5 criteria for alcohol use disorder, considers co-occurring conditions and proposes a strengths-based treatment plan grounded in recent research.

Assessment in Social Work Practice

Assessment in mental health social work is more than assigning a diagnosis. Corcoran and Walsh (2014) describe an approach that combines the DSM-5 with a biopsychosocial view of risk and protective factors and a deliberate search for strengths, so that the person's resources shape the plan as much as the problem does. For substance use, this means gathering information about drinking patterns and consequences, physical health, mood, family and work, spiritual life and the client's own goals. It also means using more than one source, since people often underestimate their drinking, especially when a court is involved. The social worker's stance matters as well: a respectful, nonjudgmental interview tends to produce more honest answers than a confrontational one.

The Scope of Alcohol Use Disorder

Alcohol use disorder is among the most common mental health conditions in the United States. About 29.5 million people aged 12 or older had alcohol use disorder in the past year, according to federal survey data collected in 2022 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023). Its consequences are severe. Esser et al. (2024) estimated that excessive alcohol use cost about 178,000 American lives each year in 2020 and 2021, an increase from earlier years, through causes ranging from liver disease to motor vehicle crashes. Yet few people receive help. In a systematic review of studies from many countries, Mekonen et al. (2021) found that only a small minority of people with alcohol use disorders, fewer than one in five, received any treatment. Assessments triggered by events such as a DUI arrest are therefore an important opportunity to connect people with care.

Case Background

Teresa has been divorced for six years and shares custody of her fifteen-year-old daughter. She began drinking wine nightly after her divorce, starting with one or two glasses and now finishing most of a bottle on weeknights and more on weekends. She has tried to limit herself to weekends twice in the past year and failed both times. She has missed two morning showings because she overslept, and her daughter recently asked her to stop drinking before driving her to practice. Teresa denies morning drinking or shakes. She describes feeling low and anxious most mornings and says she has felt "flat" for about a year. Her father had a drinking problem. She attends a Lutheran church occasionally and has a close friend from her real estate office.

Screening and Assessment Methods

The assessment begins with screening. The first instrument, the World Health Organization's ten-item Alcohol Use Disorders Identification Test, or AUDIT, covers drinking frequency and quantity, dependence symptoms and harm caused by drinking (Babor et al., 2001). Teresa scores 18, a range that suggests harmful drinking and warrants further diagnostic evaluation. The social worker then conducts a structured clinical interview organized around the eleven DSM-5 criteria, asking for specific examples rather than yes-or-no answers. With Teresa's written consent, the worker reviews the arrest report and speaks with her friend, whose account confirms nightly drinking and two recent episodes when Teresa could not recall the end of an evening. Finally, the worker refers Teresa to her primary care provider for a physical examination and liver function tests and asks about any history of withdrawal, since medical risk shapes the level of care. Throughout, the worker uses open questions and reflective listening, the core skills of motivational interviewing (Miller & Rollnick, 2013), which help Teresa move from defensiveness toward describing her own concerns.

DSM-5 Diagnosis

In the DSM-5, alcohol use disorder means a troubling pattern of drinking that causes significant distress or impairment, evident in at least two of eleven criteria over a single year; two or three criteria indicate a mild disorder, four or five a moderate one and six or more a severe one (American Psychiatric Association, 2013). Teresa meets five criteria: she regularly drinks more than planned, has twice failed to cut back, has let work responsibilities slip, continues drinking despite her daughter's concern and the conflict it causes and has used alcohol in a physically hazardous situation, driving. She reports needing more wine to feel relaxed than she once did, which may reflect tolerance, but the evidence is not yet clear enough to count it. The diagnosis is alcohol use disorder, moderate.

Differential Diagnosis and Co-Occurring Conditions

Teresa's low mood and anxiety require careful attention. The DSM-5 distinguishes an independent depressive disorder from an alcohol-induced depressive disorder partly by timing: symptoms that began before heavy drinking, or that continue for roughly a month or longer once drinking stops, point to an independent disorder (American Psychiatric Association, 2013). Teresa's flat mood began after her drinking escalated, which points toward an alcohol-induced condition, but the social worker should reassess her mood after a period of abstinence or reduced drinking rather than conclude now. She denies suicidal thoughts, and the worker should continue to ask at each session. Anxiety symptoms will be reassessed in the same way.

Risk and Protective Factors

Biological risk factors include Teresa's family history, since her father's drinking problem increases her vulnerability, and the physical effects of years of nightly use; psychological risks include her use of alcohol to manage loneliness and stress since the divorce; and social risks include a work culture of client dinners and drinks. Protective factors include her love for her daughter, stable employment, a supportive friend and a faith community she values, even if she attends irregularly.

Strengths

Corcoran and Walsh (2014) stress that every assessment should identify strengths. Teresa has built a successful business, which shows discipline and persistence. She has already tried to cut down, which shows that some part of her wants change. She is a devoted mother whose daughter's words affected her deeply. She is intelligent, articulate and capable of honest reflection once she feels respected. These strengths will anchor her plan.

Treatment Plan

Teresa's medical evaluation found no signs of significant withdrawal risk, so outpatient treatment is appropriate. The plan begins with motivational interviewing aimed at drawing out Teresa's personal reasons to change, followed by cognitive behavioral therapy focused on coping with stress and loneliness without alcohol and on planning for high-risk situations such as client events. The social worker will discuss medication with Teresa and her physician. McPheeters et al. (2023), in a systematic review and meta-analysis in JAMA, found the strongest evidence for acamprosate and oral naltrexone, both associated with less return to drinking when combined with psychosocial support, and noted that such medications remain underused. Mutual-help groups, including Alcoholics Anonymous or a church-based recovery ministry, can provide community and accountability. A family session with her daughter, if both agree, could address the hurt her drinking has caused. Goals will be set with Teresa, reviewed monthly and adjusted as her mood is reassessed.

Ethical and Cultural Considerations

A court-referred assessment raises questions of confidentiality and voluntariness. Teresa must understand exactly what information will be shared with the court and what will remain private, and the federal regulation known as 42 CFR Part 2 gives her treatment records added protection that the worker must respect. Stigma is another concern: many women hide drinking problems because of shame, especially mothers. A respectful, nonjudgmental stance and attention to her role as a parent can reduce that shame and make honest engagement possible.

Biblical Integration

Galatians 6:1-2 calls believers to restore a person caught in wrongdoing with a gentle spirit, watching their own hearts, and to carry one another's burdens (English Standard Version Bible, 2001/2016). That passage describes the posture a Christian social worker should bring to Teresa: neither excusing the danger of her drinking nor condemning her, but helping restore her with gentleness and shared effort. If Teresa wishes, her church community could become part of the support that carries her through recovery.

Conclusion

Teresa's DUI arrest led to an assessment that revealed moderate alcohol use disorder, possible alcohol-induced depression and significant strengths. A careful assessment using screening, structured interviewing, collateral information and medical evaluation made that picture possible. Recent research on prevalence, mortality, treatment gaps and medications shows both the seriousness of her condition and the value of the help available. With motivational interviewing, cognitive behavioral therapy, consideration of medication, mutual support and her own deep love for her daughter, Teresa has a realistic path toward recovery.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary care (2nd ed.). World Health Organization.

Corcoran, J., & Walsh, J. (2014). Mental health in social work: A casebook on diagnosis and strengths-based assessment (2nd ed.). Pearson.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Esser, M. B., Sherk, A., Liu, Y., & Naimi, T. S. (2024). Deaths from excessive alcohol use: United States, 2016-2021. Morbidity and Mortality Weekly Report, 73(8), 154-161. https://doi.org/10.15585/mmwr.mm7308a1

McPheeters, M., O'Connor, E. A., Riley, S., Kennedy, S. M., Voisin, C., Kuznacic, K., Coffey, C. P., Edlund, M. D., Bobashev, G., & Jonas, D. E. (2023). Pharmacotherapy for alcohol use disorder: A systematic review and meta-analysis. JAMA, 330(17), 1653-1665. https://doi.org/10.1001/jama.2023.19761

Mekonen, T., Chan, G. C. K., Connor, J., Hall, W., Hides, L., & Leung, J. (2021). Treatment rates for alcohol use disorders: A systematic review and meta-analysis. Addiction, 116(10), 2617-2634. https://doi.org/10.1111/add.15357

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Substance Abuse and Mental Health Services Administration. (2023). Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58). Center for Behavioral Health Statistics and Quality.