Scoring Clinical Vignettes (Self-Examination)—Substance Abuse 6–65

CLINICAL VIGNETTES

Substance Abuse
(Problem Area 5)
6–66 Mastering the Kennedy Axis V

Kennedy Axis V—Substance Abuse (Problem Area 5)

100 No significant problems with drugs or alcohol; no use or almost no use of alcohol; nonsmoker; no
use of street drugs; never abuses substances, even when life’s problems get out of hand; is an example of someone
who is totally free of problems with substance abuse. No symptoms.
90 No more than the average problems and concerns with alcohol; minimal use of alcohol; social
drinker; no use of illegal drugs; history of serious alcohol or drug abuse with over 10 years of sobriety and
minimal, if any, treatment needed to maintain sobriety.
80 No more than slight impairment; drinks to mild intoxication about once a month; smokes cigarettes
daily; experiments with marijuana less than once a year; some mild abuse of over-the-counter medications and/or
caffeine; no more than slight impairment in social, occupational, or school functioning due to substance abuse
(e.g., temporarily falling behind in schoolwork); serious alcohol or drug abuser with over 5 years of sobriety
with minimal treatment needed to maintain sobriety.
70 Mild impairment in social, occupational, or school functioning due to substance abuse, but
generally functioning fairly well; drinks to mild or moderate intoxication 1 or 2 days a week; excessive prescription
drug seeking; experiments with drugs such as marijuana, Valium, Ativan, or Librium once or twice a year; heavy
smoker; unable to quit cigarettes despite numerous attempts.
60 Moderate difficulty in social, occupational, or school functioning because of substance
abuse (e.g., substance abuse results in moderate impairment in job performance and/or conflicts with peers or
co-workers); drinks on a regular basis, often to excess; drinks to moderate intoxication more than 2 days a week;
occasionally experiments with drugs such as cocaine, Quaaludes, amphetamines (speed), LSD, PCP (angel dust),
Ecstasy, inhalants; moderate abuse of over-the-counter medications and/or caffeine; unable to quit cigarettes
despite chronic medical complications; serious alcohol or drug abuser with less than 2 years of sobriety.
50 Serious symptoms; behavior and/or lifestyle is considerably influenced by substance abuse;
moderate drug-/alcohol-seeking behavior; often intoxicated when driving or when working; abusing substances
despite being pregnant; unable to keep a job; marriage failing or failing school due to abuse of alcohol or
marijuana; one alcohol- or drug-related arrest; stealing prescription pads and/or altering or forging prescriptions;
moderate daily use of drugs such as marijuana, Valium, Ativan, Librium; occasionally injects drugs into skin or
muscle; has a morning drug or drink to get going; uses narcotics other than heroin or cocaine on a fairly regular
basis; frequently abuses over-the-counter medications and/or caffeine; use of alcohol or drugs (other than
cigarettes) is beginning to cause some medical complications.
40 Major impairment in several areas because of substance abuse (e.g., alcoholic man avoids
friends, neglects family, and is unable to get a job; student is failing in school and having serious conflicts with his
family or roommate due to substance abuse); occasionally injects heroin or cocaine into his/her veins; occasionally
has an accidental drug overdose; severe alcohol or drug abuser with less than 1 month of sobriety.
30 Drugs or alcohol pervade his/her thinking and behavior; his/her behavior is considerably
impaired by substance abuse; injects heroin or cocaine into his/her veins once or twice a day; abuses substances
without regard for personal safety (e.g., some accidental overdoses and/or auto accidents resulting in medical
hospitalizations); blackout spells; prostitutes self for drugs/alcohol; multiple alcohol- or drug-related arrests; serious
neglect of children due to substance abuse.
20 Functioning is extremely impaired by daily use of drugs such as LSD, PCP, cocaine, heroin,
or inhalants; unable to go for more than a few hours without significant physical and/or psychological craving
for drugs or alcohol; continued use of alcohol or drugs (other than cigarettes) is beginning to cause very
serious medical complications (e.g., liver failure, overt brain damage, AIDS or high risk for AIDS); injects drugs
into his/her veins more than twice a day.
10 His/her life is totally controlled by drugs or alcohol; continually in a state of intoxication or
withdrawal; at extremely high risk of seizures or DTs (delirium tremens) due to withdrawal; continually seeking
drugs or alcohol; numerous alcohol- or drug-related arrests; clear evidence that drugs or alcohol will lead to
severe physical harm or death; numerous instances of drug-related accidents or accidental overdoses resulting in
frequent medical hospitalizations; life-threatening neglect of children due to substance abuse.
NR Not rated
 Scoring Clinical Vignettes (Self-Examination)—Substance Abuse 6–67

Substance Abuse
NAME: Abbott, George
AGE: 35
Pt. has no history of substance abuse. He is a social drinker; however, since losing his job, he has been
drinking to the point of being mildly intoxicated about once a month. He has a family history of alcoholism;
however, he doesn’t think that he is starting to have a problem with alcohol. He states that he in no way
craves alcohol. He states that he just has too much free time on his hands. He hopes that getting job
counseling will help him get back to work, and he will go back to just being an occasional social drinker. He
has never smoked cigarettes.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 80
1) PSY = 100 2) SOC = 90 3) VIO = 90 4) ADL = 90 5) SAb = 80 6) MED = 90 7) ANC = 90
GAF Eq = 95
Dangerousness Level = 80

Explanation of Substance Abuse Rating

No history of substance abuse = 90 or better

Social drinker = 90
Drinks to mild intoxication once a month = 80
Never smoked cigarettes = 90 or better
6–68 Mastering the Kennedy Axis V

Substance Abuse
NAME: Cross, Anthony
AGE: 24
There are no reports of any history of substance abuse. Pt. states that he used to be a social drinker. Pt. states
that he has never had any problems with substance abuse. Doesn’t smoke cigarettes.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 95
1) PSY = 45 2) SOC = 60 3) VIO = 50 4) ADL = 80 5) SAb = 95 6) MED = 70 7) ANC = 80
GAF Eq = 60
Dangerousness Level = 50

Explanation of Substance Abuse Rating

No history of problems with substance abuse = 90 or better

Doesn’t smoke cigarettes = 90 or better
Used to be a social drinker = 90 or better
 Scoring Clinical Vignettes (Self-Examination)—Substance Abuse 6–69

Substance Abuse
NAME: Davis, Richard
AGE: 45
Many years ago, pt. had problems with alcohol abuse. Smokes cigarettes.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 80
1) PSY = 20 2) SOC = 35 3) VIO = 50 4) ADL = 25 5) SAb = 80 6) MED = 80 7) ANC = 70
GAF Eq = 35
Dangerousness Level = 35

Explanation of Substance Abuse Rating

Many years ago, pt. had problems with alcohol abuse = 90

Smokes cigarettes = 80
6–70 Mastering the Kennedy Axis V

Substance Abuse
NAME: Griffin, Paul
AGE: 30
Pt. has a long history of substance abuse, including IV drug use. Staff feels that pt. would continue to abuse
drugs daily if given the opportunity. Staff states that drugs and alcohol pervade pt.’s thinking. Staff states
that pt. is suspected of having neurological damage secondary to the drug use. Pt. states that he has had
hepatitis in the past from drug use. Pt.’s driver’s license is currently suspended because of drinking while
driving. Pt. smokes cigarettes.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 30
1) PSY = 40 2) SOC = 50 3) VIO = 40 4) ADL = 55 5) SAb = 30 6) MED = 70 7) ANC = 50
GAF Eq = 45
Dangerousness Level = 30

Explanation of Substance Abuse Rating

IV drug use = 40 or worse

Drugs and alcohol pervade his thinking = 30
Medical complications (neurological damage suspected) from drug use = 50 to 30
Pt.’s driver’s license is currently suspended because of drinking while driving = 50 or worse
Smokes cigarettes = 80
 Scoring Clinical Vignettes (Self-Examination)—Substance Abuse 6–71

Substance Abuse
NAME: Lane, Barbara
AGE: 25
Pt. has a long history of abuse of alcohol, cocaine, and marijuana. Before her hospitalization, pt. was using
drugs and alcohol several times a day. Pt. freebases cocaine. At times, the abuse was severe enough to cause
blackouts. Pt. continues to demonstrate preoccupation with drugs and frequent drug-seeking behavior. Staff
feels that if given the opportunity, pt. would abuse drugs and alcohol on a daily basis. Recently, pt.’s license
was again revoked because of driving under the influence of alcohol. Pt. is unemployed because of her
problems with substance abuse. Pt. continues to minimize her problems with drugs and alcohol.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 30
1) PSY = 40 2) SOC = 50 3) VIO = 30 4) ADL = 60 5) SAb = 30 6) MED = 70 7) ANC = 40
GAF Eq = 50
Dangerousness Level = 30

Explanation of Substance Abuse Rating

Before hospitalization, pt. was using drugs and alcohol several times a day; if given the opportunity, pt.
would use drugs or alcohol on a daily basis = 50 or worse
Blackout spells = 30
Preoccupation with drugs and frequent drug-seeking behavior = 30
License again revoked because of substance abuse = 50 or worse
Unemployed because of substance abuse = 40
Poor insight into substance abuse (this is a negative factor)
6–72 Mastering the Kennedy Axis V

Substance Abuse
NAME: Palmer, John
AGE: 44
Pt. has a history of extensive alcohol and drug abuse. Staff states that he is preoccupied with drinking.
However, he is less frequently going AWA (away without authorization) to get alcohol. Staff states that there
have been no recent attempts to get other pts. to buy him alcohol. Staff states that if given the opportunity,
he would drink to excess or use street drugs on a daily basis. Pt. states that he is not having any problems
staying away from alcohol. Pt. states that there have been times when he wanted to escape to drink and he
didn’t. Pt. states that he is not having impulses to use street drugs. Pt. states that he does not know why he
drinks. Smokes cigarettes.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 50
1) PSY = 40 2) SOC = 50 3) VIO = 70 4) ADL = 50 5) SAb = 50 6) MED = 80 7) ANC = 70
GAF Eq = 55
Dangerousness Level = 50

Explanation of Substance Abuse Rating

Preoccupied with drinking = 50

If given the opportunity, he would drink to excess or use street drugs on a daily basis = 50
No IV drug use = 50 or better
Smokes cigarettes = 80
No mention of drug- or alcohol-related arrests = 60 or better
History of extensive alcohol and drug abuse (this is a strongly negative factor)
 Scoring Clinical Vignettes (Self-Examination)—Substance Abuse 6–73

Substance Abuse
NAME: Powers, Jennifer
AGE: 35
Pt. has no history of substance abuse. She has never smoked. She is involved with promoting the schools’
“Just Say No Program” through the PTA. She is seen as a model of someone who does not have a problem
with substance abuse.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 100

1) PSY = 90 2) SOC = 100 3) VIO = 100 4) ADL = 100 5) SAb = 100 6) MED = 100 7) ANC = 100
GAF Eq = 100
Dangerousness Level = 90

Explanation of Substance Abuse Rating

No history of substance abuse = 90 or better

Never smoked = 90 or better
Strong stance against substance abuse = 90 or better
Seen as a model of someone who does not have a problem with substance abuse = 100
6–74 Mastering the Kennedy Axis V

Substance Abuse
NAME: Rosenthal, William
AGE: 51
No current or past problems other than being a very heavy smoker.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 70
1) PSY = 20 2) SOC = 10 3) VIO = 45 4) ADL = 20 5) SAb = 70 6) MED = 40 7) ANC = 70
GAF Eq = 25
Dangerousness Level = 15

Explanation of Substance Abuse Rating

Very heavy smoker = 70

 Scoring Clinical Vignettes (Self-Examination)—Substance Abuse 6–75

Substance Abuse
NAME: Scott, David
AGE: 50
Alcohol was reported to have been a significant contributor to his problems at work. Pt. was noted to have
an alcohol problem by an employer about 10 years ago. Pt.’s drinking is said to have increased after the
death of a close friend about 4 years ago. Before the present admission, pt. reports drinking alcohol on a
daily basis (½ to ¾ of a fifth of wine or a six-pack of beer). Pt. does not see alcohol as a problem. Pt. went to
AA in the past; however, he was not interested in any significant involvement in AA. Pt. denies any use of
drugs or alcohol while in the hospital; however, he does not plan to give up alcohol totally. Heavy smoker.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 60
1) PSY = 40 2) SOC = 75 3) VIO = 50 4) ADL = 75 5) SAb = 60 6) MED = 70 7) ANC = 70
GAF Eq = 60
Dangerousness Level = 50

Explanation of Substance Abuse Rating

Problems at work = 60
Drinks on daily basis to mild excess = 60
Heavy smoker = 70
No IV drug use = 50 or better
Factor out no recent use due to hospitalization
Poor insight and long history of alcohol abuse (these are strong negative factors)
6–76 Mastering the Kennedy Axis V

Substance Abuse
NAME: Sellers, Mark
AGE: 63
Smokes cigarettes. No history of drug or alcohol abuse.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 85
1) PSY = 30 2) SOC = 45 3) VIO = 40 4) ADL = 30 5) SAb = 85 6) MED = 40 7) ANC = 80
GAF Eq = 35
Dangerousness Level = 40

Explanation of Substance Abuse Rating

Smokes cigarettes = 80
No history of drug or alcohol abuse (this is a positive factor)
 Scoring Clinical Vignettes (Self-Examination)—Substance Abuse 6–77

Substance Abuse
NAME: Woods, Gilbert
AGE: 28
No problems. Does not smoke cigarettes.

. . . . . .
. . . . .
. . . .
. . .
. .
.

Ratings

Substance Abuse = 90
1) PSY = 20 2) SOC = 35 3) VIO = 35 4) ADL = 30 5) SAb = 90 6) MED = 90 7) ANC = 70
GAF Eq = 30
Dangerousness Level = 35

Explanation of Substance Abuse Rating

No problems = 90 or better
Does not smoke cigarettes = 90 or better
No indication that this is an area of superior functioning = 90
Notes