Case Study V

304.30 (F12.20) Cannabis Use Disorder (CUD)

Name U. R.

Age 25 years

Gender Male

Education Intermediate

Religion Islam

Place of region Gujrat

Economically dependent/independent Independent

Occupation None

Siblings 4 (2 brothers, 2 sisters)

Birth Order 1st born

Parents Alive/Dead Alive

Father’s occupation Engineer

Mother’s occupation House wife

Marital status Single

Referral Self

Family Ailment History None

Current hospital Psych Aid Hospital Presenting

‫میں نے چرس کالج م یں پہلی دفعہ لینا شروع کی تھی۔ نئے دوستوں نے مجھے ورغال کے‬

‫اور سپنے دکھا کے چرس پالی تھی۔ پہلے مجھے بہت مزا آتا ہے م یں جب جب لیتا مجھے‬

‫اچھا لگنے لگا لی کن کچھ عرصہ بعد میری طبیعت خراب ہونا شروع ہوگئی اور مجھے‬

‫اسکا نشہ ہ وگیا اسکے بغ یر م یرا سر گھومنے لگا اور جب می نے یہ چھوڑنے کی کوشش‬

‫کی تو م یرے بس میں نہ یں رہا۔‬

Clinical Symptoms According to DSM (V)

A problematic pattern of cannabis use leading to clinically significant impairment or

distress, indicated by following symptoms, occurring within a 12-month period;

1. Cannabis is often taken in larger amounts and over a longer period than is intended.

2. There is a persistent desire and unsuccessful efforts to cut down and control cannabis

use.

3. A great deal of time is spent in activities necessary to obtain, and use cannabis and

recover from its effects.

4. Craving, and strong desire to use cannabis.

5. Continued cannabis use despite having persistent social and interpersonal problems

caused by the effects of cannabis.

6. Important social, occupational, and recreational activities are given up because of

cannabis use.
 7. Development of tolerance towards cannabis.

8. Withdrawal symptoms.

Duration

3 years History

Family History

The client was from a middle-class family, parents and 4 younger siblings. His

father was a 55-year-old engineer. He has no history of substance abuse and maintains a

healthy lifestyle. He was supportive but has become increasingly concerned about his

son cannabis use and its impact on his life. Client mother is a housewife who takes care

of home and her children she was worries and disappointed in her son actions. She has a

history of undiagnosed anxiety and depression. She felt helpless and overwhelmed by his

substance use. There is a history of substance use in client's extended family. His

maternal uncle struggled with alcohol use disorder, which led to significant family

conflict and eventual estrangement.

Personal History

The client grew up in a suburban neighborhood and had a relatively stable childhood.

He excelled in school and was involved in various extracurricular activities.

He completed high school with good grades and attended college, majoring in Business

Administration. However, his academic performance declined significantly over the

He had several part-time jobs but struggled to maintain consistent employment. His

current job performance is affected by his cannabis use, leading to frequent absences and

poor productivity. He initially had a wide circle of friends and a healthy social life. Over

the past three years, his social interactions have increasingly revolved around cannabis

use. He has lost contact with many of his non-using friends and primarily associates with

his cannabis-using peers. The client reported frequent use of cannabis, often several

times a day. He experienced withdrawal symptoms such as irritability, anxiety, and

insomnia when he tries to cut down or stop using. He has also noticed a decline in his

physical health, including weight loss and respiratory issues.

Behavioural observation

The client was nervous and looking pale, he had rapid eye movement, hand tremor,

and involuntary body movement. He was well dressed and neat. He maintained poor eye

contact. He was looking here and there mostly. He answered questions but he was unable

to understand some questions in his first attempt and often requested to repeat the

question.

History of present illness

Premorbid personality

The client, prior to his cannabis use, exhibited a generally positive and outgoing

personality. He was known for his sociability and active participation in both academic

and extracurricular activities. In high school, he was an enthusiastic student, always

athletically inclined, participating in the school’s soccer team and maintaining a regular

fitness routine. His friends and family often described him as dependable, ambitious, and

responsible. He had a clear vision for his future, aiming to excel in his studies and build a

successful career in business administration. He enjoyed strong, supportive relationships

with his family and peers, often being the one to mediate conflicts and offer assistance.

He was resilient, able to handle stress well, and demonstrated a high level of emotional

intelligence, making him a trusted confidant among his friends.

Onset of illness

The onset of Client’s cannabis use disorder can be traced back to his sophomore

year of college. During this time, he started associating with a new group of friends who

were regular cannabis users. Initially, his use was occasional, limited to social gatherings

and weekends. However, as he continued to spend more time with this group, his

consumption began to increase. The peer pressure to fit in and the allure of the temporary

relief from academic stress led him to start using cannabis more frequently. Within a few

months, his casual use escalated to daily consumption. This period coincided with

noticeable changes in his behavior and academic performance. He began missing classes,

neglecting assignments, and isolating himself from his nonusing friends. His once robust

academic performance deteriorated, and he found it increasingly difficult to maintain

focus and motivation. Despite recognizing these negative changes, he struggled to cut

back on his use, finding himself trapped in a cycle of dependency. Over the course of

three years, his cannabis use became more pervasive, impacting various aspects of his

life and leading to the development of cannabis use disorder.

Informal assessment

Informal assessment was done through basic observation and interviews. The

client had a proper insight into his problem, he was very cooperative and it was very easy

to develop rapport. He gave to the point answers to the question, he was conscious about

his surroundings. He had a good motivation level. He was well dressed. The speech of

the client was appropriate and understandable. He had difficulty in understanding some

questions. He had hand tremors as well and his body was shaking.

Formal assessment

The formal assessment includes application of the following test

• Mini mental status examination (MMSE)

• Drug Abuse Screening Test (DAST-10)

Mini Mental Scale Examination (MMSE). The client scored 19, which

indicated some cognitive impairment in him.

Orientation. The subject scored 7 out of 10 on orientation tasks, his scores

indicate that his orientation towards time and place was not completely intact.

Registration. The subject registered 3 out of 3 objects which indicates his intact

registration ability.

Attention and Calculation. The client scored 2 out of 5 with indicates his poor

concentration and attention.

short term memory.

Language. The client scored 2 out of 2 on naming task which indicates that he

has no problem in language functions

Repetition. He scored 1 out of 1 which indicate his intact comprehension and he

was able to repeat the sentence.

Stage command. He scored 1 out of 3 which indicate that he was not able to

follow the command.

Writing. The client scored 0 out of 1 on writing task which indicate poor motor

coordination.

Reading. The clients scored 0 out of 1 on reading task which indicate his poor

reading ability.

Copying. The client was unable to draw the pentagon which indicated his poor

visuomotor coordination.

Drug Abuse Screening Test (DAST-10). The client scored 7 on this test which

indicates that severe level of problems has resulted in client’s life due to drug abuse. His

response on item 1 indicate that he abuse drugs other than those required for medical

reason, he was also unable to stop abusing drugs, due to such activities he neglect his

family, he felt guilty and bad for whatever he done till now, he was also engaged in

illegal activities to obtain drug, he had experience medical problem as a result of drug

use (i.e. memory loss) and he also experienced withdrawal symptoms when he stopped

taking drugs, all of these symptoms are indicated by his responses on item no.
 ,3,4,5,6,7,9,10 respectively.

Case formation

The client is a 25-year-old male with a three-year history of cannabis use

disorder, which began during his sophomore year of college due to peer pressure and

association with a group of regular cannabis users. Initially a high-achieving, sociable,

and responsible individual with clear career aspirations in business administration, his

personality and behavior underwent significant changes as his cannabis use escalated.

His once strong academic performance declined, he struggled with consistent

employment, and he became increasingly isolated from his non-using friends and family.

He experiences withdrawal symptoms and acknowledges the detrimental impact of his

cannabis use on his physical and mental health, including increased anxiety and

depression. Despite his awareness of these issues, he feels unable to stop using cannabis

on his own. The presence of substance use in his extended family and his mother’s

history of anxiety and depression may have further influenced his vulnerability to

developing cannabis use disorder.

Tentative Diagnosis

304.30 (F12.20) Cannabis Abuse Disorder

Psychological theories
Biological Approach

This approach revealed that cannabis users had greater functional connectivity

than controls in the ventral striatum and midbrain, important brain regions for reward

circuitry, as well as the brainstem and lateral thalamus (Manza et al, 2018). Based on the

research, it may be inferred that the initiation of addictive behavior may have been

caused by the stimulation of the brain's reward system. The same might happened in case

of this present client.

Positive Reinforcement Model

This concept states that people will continue to use drugs in an attempt to relive

the pleasurable feelings they experience from using psychoactive substances. According

to studies conducted on humans, all psychoactive substances can be enjoyable to some

level (Strain, 2009). Whether or not someone chooses to try to continue using drugs is

influenced by positive reinforcement both during and after drug usage. This paradigm

can be applied to the current situation as the client used drugs recreationally before

developing a drug addiction.

Social Learning Theory

Albert Bandura in his social learning theory postulate that human behaviors are

reciprocal interactions among cognitive, behavioral and environmental factors. The

continuous degree of influence of reinforcement is affected by cognitions that determine

which environmental factor is important and it should be interpreted. Observational

learning classifies why a person begin to experiment with a drug, and why does he
 continue even with initially negative experience e.g., nausea. In case of the present

client, he modeled the behavior of his friends.

Peer pressure and a person's social environment have an impact on substance

misuse. Research indicates that peer pressure has a significant role in encouraging the

use of alcohol and marijuana. This conclusion is supported by the patient's current

situation, where peer pressure contributed to the client's drug addiction.

Therapeutic Recommendation

Following therapeutic plan might prove helpful in this case.

Dialectical behavioral therapy. This therapy is a rapidly expanding kind of care

that helps people kick drug addiction. The patient in dialectical behavior treatment for

drug addiction is exposed to several real-world scenarios. The information was utilized

by the therapist to create a picture of the patient's conduct, particularly with regard to

drug usage (Neale & Davison, 1998).

Group therapy. The main form of treatment in the majority of rehabilitation

programs is group therapy. The client gains knowledge from the group about his

relationships with his family, his physical and mental health, and other pertinent topics

(Leshner, 1997). Hearing from others will therefore be very beneficial to the individual

and aid in coping with social pressures. It is advisable to motivate the client to renounce

his prior social connections, since they have played a significant role in his drug use.

Assertive Training should be used for the client. Assertiveness should be taught

in which the client can be able to say 'no' to people around him providing drugs. (Neal

and Davison, 1998).

recuperate. It entails getting in touch with the client and people who are close to him in

order to support actions that are not consistent with drug use. It's crucial to prevent the

client from going back to his current workplace for an additional month. Exercise, a busy

schedule, and physical activity can all be very beneficial in preventing relapses.

Davison and Neal, 1998).

Prognosis

The client's prognosis appears to be mildly favorable as the client was motivated

to quit drug addiction but he was taking drugs from last three years which is a long time

References

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disorders (DSM-5). American Psychiatric Pub.

Tombaugh, T.N, McIntyre, N.J. (1992). The mini-mental state examination: A

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Rotter, J.B, (1964). The Rotter Incomplete Sentences Blank Test

Bandura, A. (1974). Behaviour theory and the models of man. American Psychologist,

29, 859- 869.

Gavin, D. R., Ross, H. E., & Skinner, H. A. (1989). Diagnostic validity of the drug abuse

screening test in the assessment of DSM-III drug disorders. British

Genovese, J. E. C., & Wallace, D. (2007). Reward sensitivity and substance abuse in

middle school and high school students. The Journal of Genetic Psychology;

Research and Theory on Human Development, 168(4), 465-469.

Skinner, H. A. (1982). The drug abuse screening test. Addictive behaviours, 7(4), 363

371.