The Interplay of Early Attachment Difficulties and Long-Term Substance Use: A Clinical Case Study
DOI:
https://doi.org/10.55737/trt/v-i.202Keywords:
Substance Induced Psychotic Disorder, Social Withdrawal, Anger, Relapse Prevention, Psychoeducation, Cognitive Behavior TherapyAbstract
The current paper presents the case of a 33-year-old male, who was presented with the psychiatric day program because of constant anger, abusive behavior, social withdrawal, irritability, self-talk, self-laugh, auditory hallucinations, and lack of interest in daily activities. The clinical history showed that patient had substance use disorder, predominantly tobacco, with a current smoking of at least 10 cigarettes daily which had led to repeated and extended psychiatric hospitalization over a period of about 15 years. His clinical picture was in line with DSM-V TR criteria of Substance-Induced Psychotic Disorder with hallucinations being the result of Tobacco Use Disorder which was determined according to the temporal interrelation of substance use and remission of some of the symptoms during supervised abstinence. Mental Status Examination, Behavioral Observation, Clinical Interview and Subjective Symptom Ratings were assessed, along with such formal measures as Positive and Negative Symptom Scale (PANSS), Brief psychiatric Rating Scale (BPRS) and Rotter Incomplete Sentence Blank (RISB), as moderate positive symptoms, significant negative symptoms, and significant general psychopathology with depressive characteristics were observed. The client had auditory hallucinations that expressed early attachments disruption and family relationships. The intervention involved the use of Cognitive Behavioral Therapy (Cognitive Restructuring, Triple Column Technique, Thoughts Create Feelings, Graded Task, Mastery and Pleasure Techniques), Medication Adherence Interventions, Relaxation Techniques, and Psychoeducation of the client and his mother, including the overprotective and overbearing behaviors. After the intervention, the client improved significantly in general functioning, and psychotic symptoms, anger, and withdrawal had decreased.
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