PS526 Unit 3 Process Addiction Case Study Example

Packages on the Porch at Night: A PS526 Unit 3 Case Study of Compulsive Buying in a Casino Dealer Newly Sober From Alcohol

[Student Name]

Purdue University Global

PS526: Advanced Addictions Counseling

Unit 3 Process Addiction Case Study

[Instructor Name]

[Date]

The client, her family, the treatment center and every detail of the case are composite and illustrative; the sources cited are real.

Identifying Information and Referral

Annette is 52 and has dealt blackjack at a Deadwood casino for nineteen years. She entered our residential program in March for alcohol use disorder and moved to our outpatient aftercare group in May. In July her husband, Dale, called the center. Packages were arriving on their porch almost every day, many unopened, and he had found statements for three credit cards he did not know about. When I raised it with Annette, she cried and said, "I stopped drinking, and now I can't stop this."

History

Annette says she has always liked to shop, but before this year she stayed within her budget. During her drinking years, she drank after her night shifts, which end at 2:00 a.m. Since she stopped, those hours have filled with shopping apps on her phone. She buys clothes, kitchen gadgets and gifts for her grandchildren, most of which she never uses or gives. She describes a rush when she clicks "buy," relief for a few minutes and then shame when the package arrives. She hides packages in the garage and has opened two cards in her own name. Balances on the three cards total about $38,000, and she has missed two payments.

Is This a Disorder?

The DSM-5-TR does not include compulsive buying as a diagnosis; gambling disorder is the only behavioral addiction it recognizes as a formal disorder. Compulsive buying is studied as a behavioral addiction and as an impulse control problem, and clinicians may describe it under other specified impulse control or related categories while noting that the manual does not name it. For Annette, the practical question is less which label fits than whether the behavior causes distress and harm, which it clearly does.

Maraz et al. (2016) pooled 49 prevalence estimates from 40 studies across 16 countries and estimated that about one adult in twenty shows compulsive buying behavior, with higher rates in some groups, such as university students, and in studies using certain screening tools. The figure tells Annette that she is far from alone, which mattered more to her than any diagnosis. She asked to read the study's abstract herself and kept it in her notebook.

Substitution or Coincidence?

Annette's buying rose just as her drinking stopped, during the same late-night hours. It is tempting to say one addiction replaced another. A safer reading is that the hours after a night shift, once filled by drinking, are now filled by something else that offers quick relief from the same feelings: loneliness, a body still wired from a loud casino floor and a long-running sense that she is never enough. The buying and the drinking appear to serve the same function.

Annette did not trade alcohol for shopping; she kept the 2:00 a.m. problem and found a new answer to it.

What the Evidence Says About Treatment

Hague et al. (2016) reviewed 29 treatment studies of compulsive buying, 17 of psychotherapy and 12 of medication. Group psychotherapy, mostly cognitive behavioral, and medication both showed large effects in some studies, but only five studies met high standards of quality, and the risk of publication bias was substantial. Longer treatment was linked to better results for medication but not for psychotherapy. The evidence, in other words, is promising but weak.

CBT's core elements for substance use, described by McHugh et al. (2010), translate well to buying: a functional analysis of triggers and consequences, skills for managing urges, problem solving and planning for high-risk times.

Functional Analysis

We mapped Annette's chain. The situation is 2:15 a.m., home from her shift, Dale asleep, house quiet. The thought is, "I deserve something nice after that table." The feeling is restless and empty. The behavior is opening a shopping app in bed. The short-term consequence is a rush and then relief. The long-term consequences are debt, hidden packages, lies to Dale and shame that she says is "worse than a hangover."

Treatment Plan

The plan has four parts. First, environmental controls: Annette deleted the shopping apps, Dale and she agreed that her cards would be frozen for ninety days and she will shop only with a list and with Dale for anything over $50. Second, a new routine for the hours after work: a shower, a cup of chamomile tea, a call to her sister in Arizona, who is awake at that hour, and a book she has wanted to read. Third, CBT sessions every week focused on the thought "I deserve something" and on tolerating urges without acting on them, using the same urge surfing skills she learned for alcohol. Fourth, referral to a credit counseling service to set up a repayment plan, and two joint sessions with Dale on trust and money.

Given Hague and colleagues' finding that group psychotherapy showed promise, I also asked whether a group might help. No buying group exists in the Black Hills, so I will check whether an online group led by a licensed clinician is available.

Risk to Sobriety

The buying problem also threatens Annette's recovery from alcohol. Her shame about the debt and the hidden cards could become a trigger to drink. Her aftercare plan now includes the buying problem explicitly, and her sponsor knows about it with her permission.

Goals

Within two weeks, the apps are deleted and the cards frozen. Within eight weeks, Annette reports no purchases outside the agreed rules and keeps a log of urges. Within three months, a repayment plan is in place, and she remains free of alcohol.

Limits

Compulsive buying lacks an agreed diagnostic definition, and the treatment evidence is weak, as Hague and colleagues found. The plan relies on CBT principles borrowed from substance use treatment, which seem to fit, but which have not been tested for clients like Annette.

Conclusion

Annette's compulsive buying is not a DSM-5-TR disorder, but it causes real harm and appears to serve the same function her drinking did. Maraz and colleagues' prevalence data show it is common, Hague and colleagues show treatment evidence is promising but limited, and McHugh and colleagues' CBT elements provide a structure. Controls on access, a new routine for the hours after work, CBT and help with debt address the behavior and the 2:00 a.m. problem behind it.

References

Hague, B., Hall, J., & Kellett, S. (2016). Treatments for compulsive buying: A systematic review of the quality, effectiveness and progression of the outcome evidence. Journal of Behavioral Addictions, 5(3), 379-394. https://doi.org/10.1556/2006.5.2016.064

Maraz, A., Griffiths, M. D., & Demetrovics, Z. (2016). The prevalence of compulsive buying: A meta-analysis. Addiction, 111(3), 408-419. https://doi.org/10.1111/add.13223

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511-525. https://doi.org/10.1016/j.psc.2010.04.012