Pedro is a 24-year-old single Mexican American male, and the oldest son of his first-generation American migrant farming parents. Pedro has three younger brothers who all looked up to him while growing up. The family was proud of Pedro the day he enlisted in the United States Army. He engaged in combat several times while in Iraq but was spared injury until the day the Humvee he was riding in ran over a roadside Improvised Explosive Devise. The vehicle’s extra armor plating protected Pedro from the flying shrapnel; however, the explosion’s shock waves caused him to suffer from symptoms consistent with a closed head injury. Also, the force of the explosion ruptured his ear drums, permanently impairing his hearing. Pedro was honorably discharged following a medical examination and returned to Northwest Ohio. He felt disconnected from the person he was before he left for military duty. He had difficulty falling asleep almost every night and found himself frequently thinking about what he had seen and experienced while in combat. He felt alone and isolated from his family, who had returned to Texas for the winter. To support himself, he accepted an offer to work as a manager at a local grocery store. He quickly found it difficult to motivate himself to go to work each day. His employer, a Vietnam-era veteran, felt obliged to continue Pedro’s employment out of loyalty to a fellow soldier, but made no effort to hide the fact that Pedro’s work was inadequate. He liked to complain to his subordinates about catching Pedro staring off into space and how he often came late and left early. As time wore on, Pedro found himself spending more time at the Veterans of Foreign Wars (VFW) Post in the next town over. Initially, he would drive to the VFW after work in anticipation of the kinship he felt alongside others who had been in the service. After a while though, he noticed that his mind was focused more on the beer he drank than on those with whom he drank it. On more than one occasion, he found himself drinking until closing time. Over the course of the last month, Pedro took to sneaking a few bottles of beer in the storeroom before getting off work. He rationalized this behavior because he felt that he was underpaid for his services and drinking helped him both take the edge off and make the drive to the VFW a little easier to tolerate. Last week, Pedro crashed his car into a parked vehicle and landed in a ditch on the drive home from the VFW at 2:00 in the morning. He was found, passed out at the wheel, by a sheriff’s deputy and transported to the local hospital. Although his car was totaled, he escaped the accident uninjured. He was cited for driving under the influence and for destruction of property. Pedro and the counselor met for approximately 2 hours, during which time he completed the MAST, SASSI-3, and the counselor-administered ASI. Pedro’s responses to the MAST produced a score of 12. The SASSI-3 classified Pedro as likely substance dependent based on his elevated FVA scale score. The results of the ASI were consistent with the MAST and SASSI-3 but further suggested that Pedro receive a referral for a dual-diagnosis assessment to rule out additional psychological concerns (post-traumatic stress disorder in particular). Pedro’s counselor concluded that his presenting features supported the following DSM-V diagnoses: Axis I: 303.9 alcohol use disorder (Rule out 309.81 Posttraumatic Stress Disorder) Axis II: 799.9 Deferred Axis III: None, by patient report Axis IV: Occupational Problems, Legal Problems Axis V: Current GAF: 55 Past year GAF: 70 What would a treatment plan for Pedro look like if Pedro followed through with the counselor’s recommendation for inpatient alcohol dependence treatment? What cross-cultural considerations may need to be addressed in this case?
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