BACKGROUND: This assignment is based on the clinical history provided with these instructions. It requires students to apply concepts learned in sections on closed head injury and alcohol use disorder/addiction. This assignment contributes 25 points to the point total for the course.

ASSIGNMENT: In 2-4 pages of typewritten text respond to the following issues: 1.(5 points) Based on the clinical history information what were the likely sites of injury in the brain? 2.(5 points) Explain why the draining of the subarachnoid hematoma was made an emergency priority in this case. 3.(5 points) Based on the assessment of memory functioning, how severe was the closed head injury? (Strub & Black Scale) 4.(5 points) Based on the DSM 5 criteria for Alcohol Use Disorder how would you rate Adam’s drinking issues in terms of severity? 5,(5 points) After reviewing Cloninger’s (1987) types of alcohol addiction do you see Adam as a type 1 or type 2 and why? Clinical Case History (from the files of David C. Bruner, Psy.D.) PRESENTING SITUATION: Adam is a 62 year old married male who is living with his wife of 30 years. In late December 2017 he was brought to a hospital emergency room by EMT ambulance for evaluation. He was unconscious at the time of E.R. admission. His wife, who accompanied him in the ambulance, reported that he had fallen down the basement steps and hit his head on the floor. She heard the fall, found him in an unconscious state, and called the EMT service. E.R. doctors noted the smell of alcohol on Adam’s breath during their examination. A CT scan of the patient’s head done in the E.R. revealed a Subarachnoid Hematoma forming in the area of the Prefrontal Cortex. Adam was immediately sent to neurosurgery where the subarachnoid hematoma was drained and the bleeding stopped. He then spent a week under close observation on a Neurology Unit. Three days after the injury he regained consciousness. At that point he could remember events before the accident, but had difficulty learning and remembering new information. After three more days his memory functioning began to return to normal. He was then able to learn and remember caregivers’ names, appointments etc. It was recommended that he remain in the hospital for a second week to guard against a possible relapse into unconsciousness. After his release from the hospital he went back to his usual routine of activities with weekly medical appointments, but did not return to work. BACKGROUND INFORMATION: Adam was employed as a sales representative for a company that made medical equipment. According to his wife he had maintained a stable work history in the sales field since his 30’s. She also stated that he had been relatively healthy with no major medical conditions. When asked about alcohol use she admitted with some embarrassment that he frequently drank whiskey to the point of intoxication. She said his alcohol use was a frequent source of conflict in their marriage. She had not been able to get him to stop drinking, but he did agree to only drink at home. He had followed this practice for the past five years. She reported that he had not missed work because of alcohol use, but would drink heavily on weekends and during vacations. According to his wife, Adam was proud of the fact that he had never missed work because of drinking. Over the years of drinking Adam gave up previously enjoyable hobbies and relationships with friends. This contributed to the strain within the marriage. According to Adam he began drinking heavily in his mid 20s because of work-related stress. Prior to this he would drink only in the company of friends when they pressured him to drink. Looking back over his life he expresses some guilt about how drinking has damaged important relationships, but does not believe there is anything he can do about it now.