Module 6 Case Study
Preston Allen was referred to the Montgomery County rehabilitation center because of chronic problems with heroin use. Although Preston was only 17 years old, he had a long-standing history of psychosocial stress, disruptive behavior, and substance use problems. Preston’s mother, Gina Herriot, worked as a medical assistant in a local clinic. Preston’s father, Mark Allen, held various semiskilled jobs during Preston’s childhood and is currently employed in a food processing plant. The couple divorced when Preston was 15 years old, following a tumultuous relationship characterized by frequent verbal arguments and (on two occasions) physical altercations requiring police involvement. Preston’s father has a history of arrests ranging from physical assault, breaking and entering, driving while intoxicated, and possession of marijuana with intent to distribute. Preston has little contact with his father today.
As a preschooler, Preston added to his parents’ troublesome family life by showing hyperactivity, impulsivity, and inattention. His mother described him as a “risk-taker” and “daredevil” who “couldn’t sit still or take no for an answer.” Preston always seemed to be in motion, up to mischief, or doing things to gain the attention of others (either good or bad). A psychological evaluation conducted when Preston was 7 years old also indicated significant oppositional and defiant behavior toward his mother, who reported feeling “totally stressed out” by his hyperactive and noncompliant behavior. Preston’s behavior problems continued into elementary school. He was frequently reprimanded by teachers for talking, leaving his seat, and breaking class rules. He would deliberately annoy classmates, largely to escape the monotony and boredom of the classroom. His classmates came to fear and despise him. Preston was referred to a special education program for children with learning delays and “emotional disturbance.” The school counselor’s report described him as “a boy whose behavior problems mask underlying feelings of sadness and loneliness.” The counselor suggested that his mother become more involved in Preston’s schooling, but her hectic work schedule and marital stress interfered with her ability to devote more time to her son. In junior high school, Preston had been rejected by most youths his age and began associating with older adolescents from the adjacent high school. These new friends, who had behavior problems themselves, introduced Preston to more serious, antisocial acts. Preston began skipping classes, staying out late without his mother’s permission, and using nicotine and alcohol. Preston noticed that vaping increased his concentration while, at the same time, reduced tension and anxiety. He used alcohol (and later marijuana) to get “messed up” and enjoy himself with his friends. For the first time in his life, Preston felt like he had a group of friends who liked him “for who he was.” Unfortunately, Preston spent considerable time and effort trying to access these substances. As his substance use increased, his school attendance and performance plummeted. In high school, Preston had begun stealing prescription pain medications from his father and paternal grandmother. He initially used these medications recreationally with his friends. However, he soon began taking them daily to alleviate anxiety and avoid withdrawal symptoms (e.g., headache, nausea, tension). When his father moved out, Preston lost access to these medications. He began using heroin, which he obtained from the “friends of friends” in his neighborhood. Preston became dependent on heroin relatively quickly and used nearly any means necessary to obtain it. At the age of 16, Preston and two young men were arrested for stealing items from parked cars with the intention to sell these items to purchase drugs. Preston was also found in possession of marijuana and prescription medication, which he often sold to high school students to help support his own drug use. Now 17, Preston was referred for inpatient treatment to help him discontinue heroin and other substances in a controlled, medical environment. “I really want to change,” he told the substance abuse counselor who conducted his initial interview. “I’m ready to turn over a new leaf. I hope that you’ll give me one more chance to turn my life around.” The counselor reviewed Preston’s psychological and medical records. He noticed that Preston had used these same words to describe his situation many times before.”
Questions:
1. Review the DSM-5 diagnostic criteria for Substance Use Disorders. Which signs and symptoms does Preston show?
2. How does Preston’s psychosocial history reflect the negative reinforcement pathway for substance use disorders?
3. How does Preston’s psychosocial history reflect the positive reinforcement model for substance use disorders?
4. What other psychological disorders are often co-morbid with substance use disorders?
5. What evidence-based psychosocial treatment might be helpful to adolescents like Preston, who have serious substance use problems caused by multiple environmental factors?
