Hypothetical Recovery: The Case of Roman Zemlin (Non-Fandom)

ORIGINALLY WRITTEN: MARCH 2023

DISCLAIMER: I, in no way, shape, or form, a practicing professional. The basis of the project is purely hypothetical, so in a practical scenario, the choices for intervention may differ from what I’ve researched. Information and recommendations within this analysis may be outdated or not as supported as alternative recommendations.

CONTENT WARNINGS: Alcoholism, Drugs, Detailed Medical Descriptions

This was a little project I did for one of my bachelor's courses! We had to develop a case scenario for an individual with chronic substance misuse, and my dumb brain made it about Roman.

So consider this a hypothetical look into a recovery arc.

This wasn’t part of the assignment, though I used details from this within presenting the case file. So, as an exclusive bonus, y’all get a proper (though shortened) intake assessment form. Consider this the Expanded and Enhanced™ Edition. I have opted to create a proper mock form for this exercise, opposed to trying to format everything using HTML styling or simple text styling, like the original iterations of this post.

This next portion is just describing the above information with a bit more context and nuance… aka these were the speaker notes I had to put for my slides. Made some relevant adjustments here.

PSYCHOSOCIAL HISTORY

Roman’s grandfather was unaware of Roman’s substance dependence until Roman had to be hospitalized for alcohol poisoning a second time. During this hospitalization, the grandfather (Alexey) disclosed to care professionals that his biological parents both struggled with substance dependence involving alcohol and methamphetamine. Once more, Roman experiences temporary abstinence after the inpatient stay but resumed drinking within the second month of abstinence.

RELEVANT MEDICAL HISTORY

In addition to the hospitalizations, Roman notes that when he is not binge drinking, he experiences low mood and irritability that results in arguments with his grandfather. He does not have insurance coverage due to being “unemployed”, and his grandfather has been helping to pay the medical bills.

CRIMINAL HISTORY / LEGAL STATUS

[REDACTED; NON-CANON TO CHARACTERIZATION]

Deciding what models of intervention and rehabilitation is a challenging task on its own, though especially so when dealing with complex cases.

Luckily, what makes Roman an “easier” client is that he already exhibits motivation to make change. While not outright wishing to quit drinking, he does acknowledge his problems and wants to do something about them. I feel his problem area would be maintaining this motivation and keeping a stable support system.

Based on the research I conducted, I would approach Roman’s case following the General Systems Theory of Recovery and the Biopsychosocial Model of Relapse Prevention. Brief definitions of each as follows:

• General Systems Theory (GST) of Recovery: A theory of interacting processes and the way they influence each other over time to permit the continuity of some larger whole [SRC]. In social work, this typically looks at how the family interacts with and builds the recovery process.
• Biopsychosocial Model of Relapse Prevention: Biological/genetic, psychological, and sociocultural factors contribute to substance use and all must be taken into consideration in prevention and treatment efforts [SRC].

Why these approaches?

In discussing GST, the family plays an important role in the success of recovery. Most individuals follow a better recovery path when they have stable support systems. Similarly, for most individuals, the most influential social support system they have is family (however that is defined, be it biological or developed/found). And, just as family influences recovery, the recovery process can change the dynamics within the family. For example, continual hospitalizations create the potential for financial strain. This, and the exhibition of substance abuse within the household creates emotional/mental strain, as it’s an experience that has been lived (re: Roman’s biological parents and the falling out they had with Alexey prior to Roman’s conception).

In discussing the biopsychosocial model, there are several factors that are influencing Roman’s current risk for relapse. On a biological level, alcohol dependence has led to alterations in neural physiology (re: notable depressive and aggressive mood states; memory inhibition) and motor functioning (e.g., hand tremors, nausea, migraines, etc.). On a sociological level, we circle back to conflict within the family structure, which creates stress. This influences the psychological aspect, as a lack of healthy coping mechanisms is substituted by turning to the bottle when this stress reaches a critical point.

So, what treatment interventions align with these approaches and apply to Roman’s case?

To answer this, we have to understand what Roman’s treatment goals are. What is he looking for out of pursuing treatment? Is it total abstinence? Harm reduction? Does he want to focus on the individual aspect, or does he want to take a holistic approach? Luckily, we know the answers.

TREATMENT GOALS

• Reduce Alcohol Consumption: Roman wants to get a handle on his substance use. His dependence presents a challenge, thus taking a total abstinence approach would cause more harm than good.
• Improve Family Relationship: Roman wants to forge a close relationship with his grandfather since he is the only biological family member he has contact with.

Again, then, what treatment interventions align with these approaches and apply to Roman’s case?

• Harm Reductive Intervention: Rather than focusing on total abstinence, interventions should focus on moderation. The parameters for moderation are based on the client’s behavior and perception, with guidance provided by practitioners.
• Benzodiazepines: Due to the severity of Roman’s alcohol dependence, prescribing this family of tranquilizers will help combat the body’s physiological responses to stress induced by withdrawal states.
• Cognitive-Behavioral Therapy (CBT): As an individual, Roman may benefit from this intervention as its focus is to challenge harmful mindsets and build healthy coping skills. Of course, I have to note that this intervention does not work for everyone, as its theoretical framework and general practice fall less into challenging and navigating cognitions and more into placing blame on the client. I despise the way many practitioners use this modality to uphold their own internal biases and create a punitive environment within the office.
• Family Therapy: In addition to individual counseling, Roman may benefit from attending therapy alongside Alexey to help both establish a neutral, safe space to discuss notable concerns and develop key communicative skills to (hopefully) reduce the likelihood of conflict.

And that’s that on that!

Will I implement any of this into his characterization? It depends on the verse. Within baseline canon, no.

However, within verses where he’s developed into serious relationships with others (whatever the nature of those relationships be), it’s entirely possible he would seek treatment like this.