Case Study
Patient Demographic: Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)
Mental Status Exam: Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c
Presenting Problem: You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.
Other Contexts: The client continues to be compliant with therapy but is having difficulty discontinuing his drug use. He states he uses because it changes his mood and helps him forget about not fitting in at home or school. He explains that when he speaks English or dresses in non-traditional clothing, his family says they feel like, “I’ll forget where I came from. But when I leave the house, all I hear is, ‘Go back to where you came from.’” The client states he began using at the end of 7th grade and started using daily approximately four months ago. He admits to feeling guilty about how his use affects his family but claims, “It’s not like I’m an addict or anything.” His parents arrive today with an interpreter and attend a concurrent parenting group with a psychoeducational component that addresses adolescent substance abuse

Question: According to the DSM-5-TR, what aspects of the client’s clinical presentation qualifies as “acculturation difficulty”?
(A): Rejection, exclusion, and discrimination by those who hold social power in the dominant culture
(B): Rejection, exclusion, and discrimination by those lacking social power in the minority culture
(C): Difficulty adapting to cultural expectations due to demands from the dominant culture impacting treatment or prognosis
(D): Difficulty adapting to cultural expectations due to an inability to balance demands from the dominant culture with the demands from the minority culture

Correct Answer: Difficulty adapting to cultural expectations due to demands from the dominant culture impacting treatment or prognosis
Explanation: According to the DSM-5-TR, acculturation difficulty is a category that “should be used when difficulty in adjusting to a new culture (eg, following migration) is the focus of clinical attention or has an impact on the individual’s treatment or prognosis” Difficulty adapting to cultural expectations due to an inability to balance demands from the dominant culture with the demands from the minority culture does not fit the definition of acculturation difficulty. The category of Social Exclusion or Rejection V624 (Z604) should be used “when there is an imbalance of social power such that there is recurrent social exclusion or rejection by others”(APA, 2022). Therefore, the correct answer is (A)
Competency: counseling skills and interventions