Case Example: Vinnie

Vinnie is currently 28 years old, divorced and lives at home with his parents. He completed a residential program for SUD about two months ago and is currently participating in an intensive outpatient program. He also attends AA and NA meetings about four times a week.Vinnie had begun using alcohol and cannabis when he was a sophomore in high school. He indicates that he began to use more regularly in his junior and senior year but managed to keep his grades up and stay out of trouble. Upon graduation,Vinnie went off to college; however, he pledged a fraternity in the second half of his freshman year and his grades plummeted. By the second semester of his sophomore year, he had stopped going to classes and was eventually academically dismissed. When Vinnie returned home, he was able to land a job with his uncle, working as car salesman. It was there that Vinnie met his wife-to-be,Joann and they married when Vinnie was 22 years old. Unfortunately, Vinnies drinking and cannabis use became more frequent and more problematic. He received a DU1 and was also arrested for assault after getting into a fight in a bar. There were nights where Vinnie would not come home, which infuriated Joann, who eventually gave him an ultimatum that either he stop drinking or she would seek a divorce.Vinnie stopped drinking for a few weeks but then eventually relapsed. Joann felt that she wasn’t “married to an adult but to a teenager.” She felt that she had to handle the responsibilities of paying all the bills, cleaning the house and food shopping. Most months Vinnie wouldn’t even contribute financially to the household bills. Instead, he would spend money on cannabis, drinking with his friends and sports gambling. When Joann filed for divorce.Vinnie moved back in with his parents, blaming Joann for “not understanding him.”

Case Conceptualization

Vinnie provides an example where early alcohol and drug use in teen years interferes with normal adult development. Joann’s frustration that she felt she was “married to a teenager” was probably an accurate reflection of Vinnies being irresponsible. Interestingly, there have been a few follow-up studies of longterm cannabis users which found that these individuals often do not complete education beyond high school, they have difficulty in establishing a career path and instead jump from job to job and also have difficulty establishing long-term intimate relationships (see Green, Doherty, & Ensminger, 2017; Brook, Zhang, Leukefeld, & Brook, 2016; Juon, Fothergill, Green, Doherty, & Ensminger, 2011; Washburn & Capaldi, 2015).These findings certainly apply toVinnie, as he appears to be functioning more like an adolescent than an adult. Also, he is unable to take responsibility for the failure of his marriage and instead places blame on his wife, which is also common for individuals struggling with SUDs.

Advantages and Limitations of Developmental Models

The developmental models described above are extremely helpful to addictions counselors in being able to assess where their client may be in terms of the downward progression so common to many of the substance use disorders. The course or progression of active SUDs are truly a downward spiral in which individuals tend to get worse over time in a progressive manner.Yet the developmental models are also helpful in describing what recovery would look like in someone who is truly focusing consciously on his or her recovery. The disadvantage, however, is that with human growth and development, people do tend to progress at different rates cognitively and emotionally (see Boxed Item 10.1).

Boxed Item 10.1 Advantages and Limitations of Developmental Theory

Advantages

• • Developmental theory describes both the downward progression as well as the progression of recovery
• • Developmental theory helps to explain how and why SUDs impact on cognitive-emotional development which can persist into recovery
• • Developmental theory helps to explain expected challenges that an individual faces as he or she progresses from early to middle to later recovery

Limitations

• • SUDs do not impact all individuals in the same way.
• • higher functioning individuals with SUDs may not experience the same progression as someone who has suffered many or extreme losses
• • although there are expected changes that may occur in recovery, not everyone will develop cognitively or emotionally in the same way or at the same pace