Final - Case Conceptualization Project

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Case Conceptualization Project Symptoms of Substance Abuse One symptom that is a concern of substance abuse disorder for Oliver is his use of multiple substances. Oliver consumes alcohol often, about 4 beers a day, on top of his frequent marijuana use which is a sign that points to a substance use disorder. His excessive substance use not only raises potential health concerns, but also might impact his ability to be an involved parent. Oliver has also been having difficulty sleeping as well as suicidal thoughts which are both things that can contribute to a substance use disorder. According to the National Institute of Mental Health (2023), mental health disorders have been shown to contribute to substance use and people may use substances to self medicate. There were also a couple of symptoms that I saw as being possible concerns of family problems within Oliver’s family. The strained relationship Oliver has with his father as well as having witnessed domestic violence as a child are both potential contributing factors to Oliver’s suicidal thoughts. Oliver’s history of witnessing domestic violence on top of having a history with the legal system for domestic violence is concerning. The domestic violence incident with his ex wife Lily being fueled by alcohol points to a pattern of violence linked to substance use. Additionally, the loss of contact with his daughter Nova as a result of the divorce also probably puts a strain on Oliver’s mental health. Systems Theory Implications Applying systems theory to Oliver’s case can be helpful in understanding how family systems are affected by addiction. One concept in systems theory is circular causality and that means that two or more people in a family system mutually influence each other (Reiter, 2019). In Oliver’s context, he needs to recognize that his substance abuse and poor mental health are influencing other members of his family, including his children. In a parent child relationship, it might look like a parent trying to assert control over a child and that child pushing for individuality in response (Reiter, 2019). The push for individuality causes the parents to assert more control and the cycle continues. I can see this being an issue in Oliver’s family as his son Steffan continues to have behavioral issues in school. Boundaries are another key concept of systems theory. Boundaries are like invisible guidelines that govern relationships and interactions. Individuals can set boundaries with anyone and there are 3 types, rigid, diffuse, and clear. With diffuse

boundaries, too much information flows back and forth whereas not enough information is flowing with rigid boundaries (Reiter, 2019). In Oliver’s case, the strained relationships that he has with his father and daughter might be linked to rigid boundaries which causes issues in families. Rigid boundaries are especially common in addicted families. These types of boundaries allow for unhealthy secrets within families as subsystems are likely to keep information from one another (Reiter, 2019). It is also common for addicted families to be involved in closed systems which means information does not easily flow between systems. Children in closed systems are unlikely to talk about issues going on inside of the family system to anyone at all, inside or the system or out. Culture and Family Background Considerations Oliver’s family background plays a role in this case because Oliver’s father seemed to have possibly had a substance use disorder along with many other family members on his paternal side. There's definitely a genetic factor that plays a role in addiction. Also, since Oliver’s father had an alcohol supply in the home when he was young, Oliver was able to take from this supply and start drinking at the age of 12. His mother also struggled with major depressive disorder her whole life. Oliver’s family history of addiction and mental health issues suggest that there may be a generational pattern of these problems in his family. Having witnessed domestic violence as a child also could have been a traumatic experience that contributed to Oliver’s substance abuse. Family Roles A possible role that Oliver might play is the dependent. The dependent is the person in the family that is using substances (Reiter, 2019). Their addictive behavior is usually something that stems from unresolved conflict in the family. In Oliver’s case, I think he has a lot of unresolved conflict with his father that contributes to his dependency issues. Dependent people also have a tendency to move away from a variety of responsibilities such as their career, parenting, or emotional well-being. When that is happening, other family members have to adjust their roles to pick up the slack of the dependent. Mia, Oliver’s current wife, might play the role of the enabler. As the dependent starts to progressively underfunction, the enabler will pick up some of that slack and start over functioning which causes the dependent to underfunction more, and the cycle continues (Reiter, 2019). The enabler becomes more and more responsible for the addicted person and it allows the addict to not have to face any consequences of their addiction. If Oliver’s addiction is causing him to be uninvolved with his children, Mia will

have to pick up that slack and Oliver never faces any real consequences. Especially because of the concerns Mia has expressed about Oliver’s drinking, I think she fills this role. Anger is a primary emotion of enablers and I can see Mia being angry as addiction is clearly getting in the way of her family life and she does not think that Oliver can stop on his own. Oliver’s daughter Kinsely might play the role of the hero or responsible child. The hero is typically the oldest child in the family, but doesn’t have to be (Reiter, 2019). They are the child that does well in school, sports, and other extracurricular activities. Kinsely is excelling in school. She is in the gifted program and is at the top of her class. These characteristics fall in line with those of the hero. Their success is their way of proving that their family does not have a problem (Reiter, 2019). Additionally, when the dependent starts moving away from their responsibilities, the hero is likely to take on some parenting roles. Heroes take on the role to gain some positive attention and to increase their families' sense of self-worth. I can see Oliver’s son Steffan playing the role of the scapegoat. The scapegoat is likely to be engaging in some sort of delinquency that moves the attention in the family away from the substance abuser (Reiter, 2019). Steffan has been struggling academically in school as well as behaviorally as he has been getting into fights with peers. When the family's attention is focused on Steffan’s misbehavior, it distracts people from Oliver’s substance use issue. Additionally, the scapegoat is gaining attention just like the hero is, but the attention they gain is negative (Reiter, 2019). The scapegoat is protecting the family in a different way than the hero by shifting all negative attention on to themselves. Other Family Issues One issue to explore when starting therapy with Oliver’s family is the issue of domestic violence. Given Oliver’s history with domestic violence and the fact that 40- 60% of domestic violence incidents involve substance abuse (Reiter, 2019), I think that it is always something to think about when working with Oliver and his family. Oliver might be likely to abuse substances and engage in domestic violence again, especially if his pattern of worsening substance use continues. Another issue in Oliver’s family is dual diagnosis. Oliver seems to be struggling with a substance use disorder and his thoughts of death suggest that he may be suicidal or depressed as well. Comorbididty, or having dual diagnosis, doesn't mean that one disorder causes another, but they do usually interact with one another. It is not good for Oliver because he may self medicate to treat his depression using alcohol, and in turn, the alcohol makes him more and more depressed so it’s an endless cycle. It is important for therapists working with people with dual diagnosis to know which disorder had the earliest onset and if the disorders are

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