Case Study – Substance Use and the Adolescent


BW is a 17-year-old college male presenting to the outpatient department in the company of the mother, who reports that the son has been smoking a rubber-based adhesive for the last one year. BW comes from a low socio-economic status, and has been on alcohol for a few months, which has progressed to above 120mls of consumption a day. He reports no past history of head injury, seizures or hyperactive disorder. His father was an alcoholic, who passed on two years ago due to hypertension complications. BW complains of tinnitus, nose bleeding, salivating and decreased cognitive ability due to the drug. He however denies symptoms of hallucinations, violence or confusion. The mother reports that the son often steals money from her for drugs. She also reports that the son has generally poor hygiene, and his room is quite unkempt.

Case Study - Substance Use and the Adolescent

DSM Diagnosis of the Client

Substance abuse disorders arise from excessive use of drugs, which activates the brain reward system that reinforce behaviours. DSM V recognizes various classes of drugs including alcohol, stimulants, opioids and sedatives among others (Alozai & Sharma, 2020 Case Study – Substance Use and the Adolescent) that are often abused. Alcohol abuse causes dependence that implies the victim cannot function as before without alcohol. DSM-V diagnostic criteria define dependence and abuse as the common types of substance use disorders. ICD-10 criteria for substance use disorders refer to dependence as ‘harmful use’.


Drug dependence is diagnosed when the patient presents more than three of the seven signs in the criteria within a period of 12 months. These signs include tolerance, withdrawal, large amounts of consumption, persistent desire to cut down, great time spent in acquiring the substance, reduced functionality and persistent use despite knowledge of problems caused by the substance (McLellan, 2017). Substance abuse is a diagnosis for patients who do not meet the criteria for substance dependence but have experienced one or more of the four signs for a period of 12 months. These signs include failure in social obligations, persistent use in situations that are detrimental, recurrent legal-related problems and continued use despite persisting social problems.

Early interventions are critical among adolescents and adults with signs of substance misuse or abuse. Individuals with binge drinking are characterised by 4 drinks (among women) or 5 drinks (among men) in one occasion. This group is highly susceptible to effects of substance abuse. BW is a teenager, who reports of daily drinking that has increased to over 120mls a day. His tolerance is evident with his dull behaviours when he does not drink, which prompts him to steal money. He also reports salivating and experiences of muscle rigidity when he runs out of the smoking substance. To intervene in the case of BW, patient screening and assessment is essential. Screening and assessment of behaviours is the first step of intervention and is designed to identify tolerance and dependency rates (Fluyau & Charlton, 2021). The screening utilizes present assessment tools that include either self-reporting or clinical tests such as urine drug levels before initiating the treatment plan.

Additional Assessment

A detailed history and physical exam for patients with a history of substance abuse provides information about present social risk factors and triggers that drive the behaviour. Physical examination looks for personal hygiene, signs of injection, significant weight loss and signs of intoxication. A mental status exam assesses the behaviour, appearance, speech, perception, insight and mood. CAGE questionnaire assesses alcoholism by screening for cut down, guilt, eye opener and annoyance (Nehring & Freeman, 2021). Clinical tests are indicated to identify the contents of the substance abused and kidney clearance. Assessment also looks for insight to recommend possible rehabilitation for addiction recovery.

Additional Individuals that might be included

The treatment plan entails a multidisciplinary approach for optimal effectiveness. The intervening team involves medical practitioners, therapists, a psychiatrist, pharmacist and social worker. Addiction therapy addresses behavioural change, hence is hugely dependent on counselling. The disorders derail not only the personal self-care activity, but also interpersonal relationships. For this reason, healing is directed to all parts of the patient’s life (Campanela et al., 2019), hence leverages the holistic model of care. It addresses the mind, the body and spirit as a single system. Addiction to substances is a cognitive malformation cultured by neurobiological and chemical processes in the brain. Drinking and substance abuse endangers such body organs as the heart, the muscles, kidney and liver. Meditation, mindfulness and yoga are among the essential recovery mechanisms that embody the spiritual human.


Substance abuse and dependency among adolescents is a major disorder and cause of addiction. Signs of dependency include derailed social functioning, disrupted interpersonal relationships and health commodities (Campanela et al., 2019). Socio-economic and financial implications derail the individual’s potential due to increased financial burden. A comprehensive physical examination and history taking enables the intervening practitioner to determine tolerance levels and hence regulate the treatment regimen. A multidisciplinary and holistic approach involving a psychiatrist, psychologists, nurse practitioners, clinicians, social workers and pharmacists is necessary to address such disorders. Given the extent to which it derails one’s objectives, especially among youths and young adults, there is need for immediate intervention once an individual present with symptoms that indicates possible substance abuse.

Case Study – Substance Use and the Adolescent References

  • Alozai, U. & Sharma, S. (2020). Drug and Alcohol Use. StatPearls Publishing; Available from:
  • Campanella, S., Schroder, E., Kajosch, H., Noel, X., &Kornreich, C. (2019). Why cognitive event-related potentials (ERPs) should have a role in the management of alcohol disorders. Neuroscience &Biobehavioral Reviews, 106(), 234-244. doi:10.1016/j.neubiorev.2018.06.016
  • Fluyau, D. & Charlton, T. E. (2021). Addiction. StatPearls Publishing. Available from:
  • McLellan A. T. (2017). Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare. Transactions of the American Clinical and Climatological Association128, 112–130.
  • Nehring, S. M. & Freeman, A. M. (2021). Alcohol Use Disorder. (2021) StatPearls Publishing; Available from: