PS497 Unit 2 Case Formulation Paper Example

Six Criteria and a Beer Fridge in the Garage: A PS497 Unit 2 Case Formulation Paper

[Student Name]

Purdue University Global

PS497: Bachelor's Capstone in Addiction

Unit 2 Case Formulation Paper

[Instructor Name]

[Date]

The writer, the program, the client and every detail are composite and illustrative; the sources cited are real.

Wes

Wes is forty-one and drives a beverage delivery route in Boise. He began drinking heavily about eight years ago, when a fall off a roof damaged his back and he traded roofing for a lower-paid delivery job. By last summer, he was drinking twelve to fifteen beers most nights, mostly alone in his garage after his wife and two teenage children went to bed. A routine physical showed elevated liver enzymes, and his physician referred him to our outpatient program. He completed our eight-week intensive outpatient program in September and was drinking again within three weeks.

As case manager, I do not diagnose. This formulation draws on his counselor's diagnostic assessment, his treatment record and my contact with him, used with his consent for this capstone.

Diagnosis

Using the DSM-5-TR (American Psychiatric Association, 2022), his counselor rated his alcohol use disorder as severe. Wes met six of the eleven criteria at intake: drinking beyond what he meant to, failed attempts to cut back, craving, continued drinking despite arguments with his wife about it, tolerance, and withdrawal symptoms of shakiness and sweating on mornings after he tried to stop. Hasin et al. (2013) explain that DSM-5 combined the earlier categories of abuse and dependence into one disorder with a severity scale and added craving as a criterion, recognizing it as central to relapse. Six criteria place Wes at the threshold of severe.

How His Drinking Began

Several factors combined. His father drank heavily, which may have contributed genetic and learned risk. The back injury brought chronic pain, a loss of the work he took pride in and a drop in income, and he found that beer eased both the pain and the shame. His drinking shifted from social weekend drinking with his old crew to solitary nightly drinking.

What Maintained It

What keeps a problem going often matters more for treatment than what started it. For Wes, five factors maintained drinking. The garage had become his only private space and was stocked with beer. Evenings after his route were long and unstructured. Back pain was worst at night. He avoided telling his wife when he felt low, so stress built until he drank. And his drinking relieved early withdrawal symptoms, reinforcing it.

Why the Relapse Happened When It Did

Witkiewitz and Marlatt (2004) proposed a dynamic model of relapse in which many factors, including stress, craving, coping skills, self-efficacy and the person's environment, interact, and in which small changes can trigger sudden shifts back to drinking. Relapse is understood not as a single failure but as the outcome of a system under strain, with high-risk situations at its center.

Treatment had supplied structure three nights a week; when it ended, nothing took its place.

During intensive treatment, Wes's evenings were structured three nights a week, his coping skills were practiced in group and his counselor checked in regularly. When the program ended, the structure disappeared, the garage still held beer, his back pain continued and his confidence after graduation may have lowered his guard. A difficult route day and an argument with his son led to his first drink. In the model's terms, his high-risk situation met lower coping support and a sudden change followed.

The Pain Question

Wes's back pain deserves its own place in the formulation, because it sits at the junction of his body, his mood and his drinking. He described evenings as the worst time for pain, after hours of lifting cases on and off the truck, and said a few beers "took the edge off enough to sleep." Alcohol may dull pain briefly, but heavy drinking disrupts sleep later in the night and can worsen mood, so the relief he felt likely fed the very problems he was treating. His counselor and physician discussed non-opioid pain options, physical therapy and a sleep routine that did not depend on alcohol. For the formulation, pain is both a trigger and a maintaining factor: it raises the chance of drinking on bad nights and keeps alcohol in the role of medicine. A continuing care plan that ignored pain would leave one of his strongest triggers untouched.

What the Family Saw

Wes's wife, at a family session during intensive treatment, said she had noticed his drinking increase each winter, when his route ran longest in the dark and his back stiffened in the cold. That seasonal pattern was new information to his counselor and to Wes himself. His relapse came in early October, as the days shortened. Family members often see patterns that a client and a program miss, which is one reason the capstone will ask families, with clients' consent, to take part in continuing care.

What the Formulation Suggests

Wes did not need to repeat intensive treatment; he had learned the skills. He needed support that would continue into the period when risk rose: regular contact, help applying skills to evenings and the garage, a way to reach someone quickly when craving hit, and a plan for pain. That points toward continuing care, the focus of my capstone.

Level of Care

The formulation also informs the level of care. Wes's withdrawal had been mild, he had a supportive home and a job to keep, and he had completed intensive treatment successfully before relapsing. Those factors did not call for a residential stay. What changed after graduation was the amount of contact, not the severity of his disorder, so the answer was more contact at a lower intensity for a longer time.

Strengths

The formulation also includes strengths. Wes wants to keep his job, which requires a clean driving record. His wife supports his recovery and agreed to remove beer from the garage. He liked the skills group and said it made sense to him. These are the foundations a continuing care plan can build on.

Conclusion

Wes meets criteria for severe alcohol use disorder under the DSM-5-TR, with craving and withdrawal among his six criteria. His drinking began with injury, lost work and family risk, and was maintained by an unstructured evening routine, a stocked garage, pain and avoided feelings. Witkiewitz and Marlatt's dynamic model explains why the end of structured treatment brought relapse, and the formulation points to continuing care rather than another intensive program.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Hasin, D. S., O'Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851. https://doi.org/10.1176/appi.ajp.2013.12060782

Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59(4), 224-235. https://doi.org/10.1037/0003-066X.59.4.224