After completing the case narrative (that does not include a diagnosis), construct a summary of the assessment and DSM-5 Diagnosis.

Current Presenting Symptoms and Circumstances

My name is Caty, and I am 25 years old. I currently live in the city of Huntsville, Alabama. I am facing some challenges at the moment, and I was recommended to come to you to receive some help. I honestly have had some struggles with nicotine and alcohol use for the past six years. The last time that I used my vape was this morning, and have been using it for the past 30 days. The last consumption of alcohol was this past weekend, and it just resulted in me having the worst hangover possible. In recent days I have noticed that I reach for my vape even when I do not want to smoke just out of habit.

Then, when I drink alcohol, I can not just have one glass I need to have the whole bottle just to feel excited or the life of the party. At night I can not sleep well and wake up feeling nauseated. My friends and family members say that it is hard for me to concentrate in conversations or that I always need my sunglasses wherever I go. I use my sunglasses to block out light because my eyes hurt, and people think I am just ignoring them, but I am not. When I am like this, I just tend to doze off anywhere and feel like I can not be in the moment without my vape or a bottle of liquor near me. I usually feel really down on myself and tired most of the time. Things that used to interest me do not anymore, or I just give up and walk away to something else that I might be good at. Sometimes, I just feel like nothing I do will be good and that the world would be better without me being in it. If I can not be the life of the party or get people interested in talking with me, then I find myself hitting that vape outside. I had started having thoughts about suicide in recent months, but sometimes I think if I keep on drinking then maybe it will drown those thoughts away. Then I feel better because I can not hear those thoughts anymore. When I do not feel depressed or lonely, I stop using my vape for a while, and then my friends start coming around again. Then the cycle happens all over again when I have thoughts of suicide or loneliness. It is not hard for me to make friends, but it is surely easy for me to get rid of them fast. I think that most of the people around me only use me for laughs or to use me as the topic of the night. I never really have talked to anyone about these feelings I have, but deep down I feel that if I start talking, then someone might walk away because it is too much baggage for them. So I never tell anyone that is in my life. I have had past intimate relationships that always ended in failure due to me always thinking they would leave me too. Trust has always been hard for me to accept from someone else. At night I have trouble falling asleep because all I can think about at night is hitting my vape again or just all the things I did wrong in my life. I have issues with eating most of my meals because I rather breathe in nicotine than have some chips. My struggling with sleeping currently is causing me more stress which makes me turn to nicotine. When I do not use nicotine, I start to enjoy making plans with people. Last year I went on a trip to Florida with some college friends. The trip was great, and I made some good memories; then the last day of the trip came, and I started feeling down and did not want to do any of the activities that the girls planned. I turned to nicotine and alcohol since then, and I have not been in contact with my group of friends since.

Family History

I am currently living on a couch with one of my co-workers who is now my roommate. I did previously live with my parents and little siblings, but then I started smoking my nicotine around my siblings and grabbing beer after beer from the fridge every night, so my parents made me leave until I quit.

My parents will not let me see my siblings because I am a bad influence. I miss my sister and brother so much. My parents monitor my text messages to my siblings because they do not trust me due to asking for my from my little sister so I could get a new vape from the gas station down the road. My siblings are my everything, and I would do nothing to influence them or put them in any danger physically or health-wise. I have no idea how my siblings are doing because it has been 6 months since I have seen them. I have struggled since I have not got to see my siblings. Sadly, I could not even attend my sister's 15th birthday dinner. I was so depressed and upset with who I was. Every day I would lay on the couch pinching myself to do better. Growing up, my parents were always very sweet people who never abused substances and were a good influence on the entire family. They were that couple everyone wanted to be.

I used to make straight A's and work several jobs to get into college. Once I got into college, my roommate invited me to several parties where I was introduced for the first time to nicotine and an overload of alcohol use. Night after night I did not study my physics homework, but I studied where the next party was going to be. Luckily I barely finished college and have an entry-level job right now. My siblings are doing well in school and have many friends, so it is a fear of mine that they will end up like their sister. She and my little brother are currently everything parents want in all their children. It's like I was an example child that they used to teach my siblings not to be. My parents are constantly saying that I need to quit and go to rehab. I get very sad and angry because I believe they think I was a mistake and a disappointment. I have not talked to them in a few months, and it is hard for me to have a civil conversation without getting into a fight. When I was growing up, it wasn't all that bad as it is currently. My life was a standard life that seemed pretty normal. It all started in the last six years. My relationship with my family has never been the same, sadly, because it is all my fault is what they tell me. I would love to have a great relationship with my parents again, but I can't even tell if they actually want me around my siblings or their lifestyle. I just don't want the embarrassment at the dinner table again because they have a daughter like me.

Education and Employment History

I would like to go back to school and get a master's degree at some point in my life. I know that this is not going to happen unless I get the help that I need. I finished my bachelor's degree in Communication barely in 4 years. I don't know if I could get into a master's program with my low GPA and terrible record. I would want to get my graduate degree in Licensed Professional Counseling, I want to help people who are like me because sometimes it is easier for someone who has gone through the same situations to talk to. I have wanted to always work with people my entire life. I feel like communication is important between people.

In school, I was always the counselor of my group of friends who had all the answers or that shoulder to cry on when nobody else was there. I would still want to do that for anyone going through tough situations. In my job right now, I kind of feel stuck and just answering phone calls. During my lunch break, I always fear that my co-workers are talking behind my back as if they know what is going on. I never really got into much trouble in school except for talking during silent time. Just your average annoying child who loved to talk to people. I was shy when it came to joining clubs, but then some friends would ask me to join, and soon enough, I was thriving. But now it feels as if I am a wallflower watching everyone else talk and socialize. I always focused on both grades and friendships. I worked in high school and college. My parents taught me at a young age if you want something, work for it, and lately, I feel like I have been ignoring that. Without my family, my entire world, and my friendships, I feel lost with no place to go. My

My parents gave me some rent money, but I used it on nicotine and alcohol within the first week. Now, instead of buying groceries, I buy my addictions and survive on my roommate's leftovers.

Medical, Psychological, and Substance Abuse History

Ever since I was 16, I have always gotten the flu and strep throat. I get either one at least twice a year now. I have never been hospitalized with anything, but I do have asthma which is scary sometimes if I do not take my inhaler with me. A girl that likes smoking but has asthma how ironic is that? I haven't seen my doctor in about a couple of years, so I just self-diagnose myself through Google and get over-the-counter medications. Luckily I have not been diagnosed with anything other than asthma. There are times when I am smoking that my asthma gets really bad, especially when I am chain-smoking due to when I am stressed. I tend to lose my inhaler sometimes, which is expired because I can not afford a new one. So I just really hope for the best sometimes. If it gets really bad, just do breathing exercises without going to the ER. I can not afford to go to a hospital right now. When I first started having difficult breathing spells with my depressive mood going up and down, both my parents suggested I go to a therapist. I honestly saw a therapist once and laughed at them, then left. I never went to therapy again until now. I felt no one could fix me at this point, so why should I listen to this stranger? I wasn't hurting anyone by vaping or having more than a couple of drinks is what I thought at the time. I did not realize it cost me everything and everyone I loved. When I was growing up in my household, I was never introduced to nicotine or alcohol abuse. Now, my parents would drink one beer or a couple of cups of wine and then be done. I just never learned to stop or have a boundary point for myself. I started using my roommate in college's vape once in a while, and then that turned to me getting one myself. I was catching myself using it multiple times a day. I also had times when I was clean and didn't use my vape at all, which was good because it saved me money. So it has been off and on for at least 6 years.

Social Support History

In the past year, I have lost friends or have pushed them out of my life. So at times, I feel like I do not have friends in my life anymore. I occasionally bump into some people from college in the local grocery store and exchange a few words, then go our separate ways. I feel lonely most of the time. I tend to just keep to myself because I do not want to drag anyone else into my addiction or disappointed life. In college, I met this guy, and we hit it off right away and were together for about a year. He switched schools due to a better program, and we slowly lost a connection. We then broke up, and I have not been in a serious relationship like that since. I do believe that if I started a relationship with someone right now, they would just leave me. I have a hard time going out and meeting new people because my anxiety goes through the roof. I have to drink a few bottles before I agree to go out. I do not have family right now to call to ask for advice since I am cut off, and my roommate has her own life. So, in reality, I am all alone. When my roommate is home, we only say a few words, then go into our rooms and act like we do not exist. Sometimes I want to call my parents and tell them I am sorry. But it always ends up in some kind of fight and tears. My father wants nothing to do with me, period, but sometimes I feel like my mother wants a connection still. I started attending church every couple of weekends, and I loved the worship music. The people there made me feel safe and not judged. I am a backseat kind of person who avoids the front row. Sometimes I miss going to that small church and being around all those people, and then I think I am not good enough to be around those lovely good people who never struggled with addiction like me.

Legal History

I have never been arrested for anything, but honestly, I should have for all the mistakes that I have made in my past. I did get into a fight in a bar before because this lady thought I was looking at her husband. I was not looking at anyone in general I was probably so intoxicated I was just stumbling around looking at anything. She confronted me about it and then swung her fist at my face, then turned into a fight. She was charged with assault and ended up having to stay in jail for the night. I had to do community service for 12 months with no reports of intoxication and go to an AA group once a week. I received a ticket for speeding in a school zone before and paid my ticket. I felt ashamed that I was speeding for no reason at all. My parents were unhappy with me and wanted to take away my car, which they did for a solid year. So I used the bus during that time. Other than those couple of times, I never had any issues other than smoking in a nonsmoking area. But to me, I should have never even been in those situations.

Assets and Liabilities

In the past, I have had times when I worried about my financial situation because I was using my paycheck on vapes and various bottles of Liquor. My parents would lend me some money for groceries, but it was not used for that. I would take food from my college cafeteria or my roommate's food pantry. Now, in my current situation, I am still worried and unsure of what I am going to do if I have no money to cover rent. I only have a couple hundred to put towards my bills, and I am trying really hard not to go down the street and grab a new pod for my vape. My bank account is almost empty most of the time. I am in constant worry, and this is the life that I created for myself. I have no car, but I do own a used bike to get to work, or I use the bus systems during the winter. I don't know where to go from here financially, and I barely have any support system. I am lost and scared.