Review each case study, then choose one case to assess then answer the following questions. APA AND USE THE ATTACHMENTS FOR RESOURCES AND TO SITE YOUR WORK.
- What is the person’s drug of choice?
- How do their intersections (gender, ethnic background, sexual orientation, income level, military service) impact your assessment of treatment types? (research question in the library)
- What level of treatment is appropriate for this person based upon the continuum of care for treatment and why? (be specific with client history and behaviors which support your decision.)
Case 1-Suzanne S.
Suzanne has come by the free “drop-in” counseling clinic were you work to get some information and advice. Suzanne is a 22-year-old single White woman who has been living with her
boyfriend Jack in Manhattan’s lower east side for the last four years. She and Jack have been heroin addicts for as many years.
When Suzanne was 10 years old, her father, whom she says was a very heavy drinker, left her mom and the kids and never came back. At 14 she started drinking and smoking marijuana. At 16 she had dropped out of high school and at 18 she moved in with Jack. He introduced her to heroin. She reports using about a 1/2 gram of heroin per day just to be able to function and feel comfortable. In order to pay for the heroin and pay the rent on their apartment, Jack doesn’t work, instead, she works the streets at night. She usually drinks four or five beers each night before going out to work. If she can’t score enough heroin, she will try to score either some Valium or Klonopin to “tide me over until I can get some ‘horse’”. She says she has tried cocaine but, “I really didn’t care for the high all that much.”
Suzanne tells you that the alcohol and heroin help to calm her nerves and get her through the night. She and Jack are not having sex all that much. When they do make love he never wears a condom. He says that’s what makes him different from her “john’s” “ Which is true because I won’t work without a condom.”
Lately she has noticed that her breasts have become swollen and more tender. She also hasn’t had her period in the last 12 weeks. She is pretty sure she is pregnant and knows it’s her boy friends baby. However she not sure she can stop using dope or work to have the baby even though Jack wants her to keep it. She really confused at what she should do and is her asking for you to help her make some decisions. Her friend who works with her at night told her not to stop using dope if she is pregnant “ Because it’s worse for the baby than to keep using.”. “ I just don’t know what I should do?”
John is an African American older man in his late sixties. He is a veteran from the Vietnam War. He is a bit disheveled in appearance and smells as if he has urinated himself. He is accompanied by his landlady. The landlady tells you that she found him earlier this evening trying to enter his apartment door. He was sweaty, his eyes where dilated, and his hands were trembling so badly that he could not get the key in the door. He kept calling her by another name and saying he was trying to get into his office to do some work. She knows he retired years ago, has lived in her apartments for over a decade, and knows her real name. She has heard him previously at night loudly yelling and maybe throwing things.
His blood/alcohol level is low and his speech is not slurred. He appears pale and sweaty. He can correctly identify himself but, also appears confused. He is unable to tell you the month or season. His nose and cheeks are red with tiny spider veins and his stomach distended and when he extends his hands out in front of him, they are very tremulous. His demeanor is polite and apologetic to you and the staff.
He reports to you that in the past he has had a problem with alcohol, but was sober for twenty years after attending a VA outpatient treatment program. He then admits to relapsing three years ago. His wife died and he could not deal with the grief. John starts to cry. His adult children will not let him see his grandchildren because he can be violent when he drinks. He is trying to not drink. He reports not having a drink for the past two days, but keeps feeling worse.
Laura is a very successful businesswoman, African American, in the high-stress high-powered world of corporate finance. She has been referred to you by the company’s employment assistance program. Laura presents herself as a no nonsense business professional. She is frank and honest about the events that has brought her to your office.
Laura tells you that although she tells herself that she will only have one or two glasses with dinner, she usually finishes the whole bottle.“ About five years ago I started having trouble sleeping and started to take a tranquilizer (5 mg Valium ) I normally take one or two pills every two to four times a week to help her sleep through the entire night.”
In the morning, she drinks at least 3 to 4 cups of coffee daily, even on the weekends. She noticed that her sleeping problems developed around the same time her Dad died. He was only in his early 50’s and they were very close. His death hit her hard and she says she wanted to give in to a big depression. However, she fought it and lost herself in her work. She makes it a point to work out at least three times a week in the morning before going to work. In addition to the above medications, Laura is also prescribed Xanax as needed for panic attacks and diet pills (amphetamine congeners) to control her weight, a problem she had since she was a child. Over the last year she has become more reclusive. She can barely make it to business dinners and after-work functions. Lately however, she has noticed that she has been steadily increasing her use of wine. Before, she would only have a few glasses with dinner but now
“….more often than not I finish off the bottle before going to bed. I just can’t seem to stop. A lot of times I will come home and tell myself that I’ll only have one glass and no more but by the time I go to bed, the bottle is empty and I’m deciding whether I should open another or not. I never used to drink to excess or take anti-anxiety medication before. Now I can’t seem to stop drinking or taking these ‘downers’ at social events. I can’t seem to control when I take them and things are happening that I’m not too happy about. Of course the alcohol adds to my weight problem which then causes me to take more of my Redux. Then I have to increase my Xanax to calm my nerves and also take my Valium to make sure I get a full nights sleep. It has become a very vicious circle. All this has been going on for about a years but last week put the “cherry on the pie.”
Laura tells you that last week she was to meet the firm’s top client at a business luncheon. She could not get out of bed that morning. It took all her willpower to get up and get dressed. As it was, she was still 20 minutes late, “which is inexcusable.” She was so nervous and sick she had to excuse herself in the middle of her presentation. In the bathroom she took another Xanax to calm her nerves. Then at the luncheon she could not stop herself from ordering several glasses of wine and had to be assisted to her car after the meeting was over.
“My client spoke to my boss and staff and then canceled his account with me. The next day I met with my boss and he recommended (ordered) I make an appointment with our EAP program (or be terminated.) I’m really scared. Work is all I have. I can’t afford to blow it. Do you mind if I smoke?”
Lloyd is a 28 year old single male from Mexico, who chose to move to Dallas, Texas instead of staying in Mexico. His sexual preference is for men which is a significant reason he left Mexico. He has been working as a plumber’s assistant for the last couple of years and will soon be able to have his own business. As it is, he makes pretty good money when jobs are around. During lean times he works on cars and motorcycles on the side. He reports an active social life with his friends and all of them drink or do some type of drug or another.
Last year Lloyd tested positive for HIV. He’s not really sure how he got it. He is always very careful about his sexual partners “so someone must have lied.” He doesn’t want to go into it but he was really “pissed off and angry” when he got the news. He tells you; HIV is clearly a Republican plot to wipe out the immigrants. Since he works as an immigrant, he has no insurance. “ And I sure as hell can’t get insurance today with my HIV status.” Consequently, paying for his medication that his doctor has prescribed has been sporadic at best. He has prescriptions for protease inhibitors but he has not been able to take them consistently because they are too expensive. “ Either way you look at it I’m screwed.” He could go to Mexico for the HIV treatment, but feels he will be killed. When asked why, Lloyd discloses“I like to dress in women’s clothes. I feel more feminine when I dress in
Lloyd prefers using alcohol but occasionally will use ecstasy when at clubs or sex parties. He drinks mostly beer, but will drink some Scotch to get a better “buzz.” Lately, his stomach has been really giving him trouble. Sometimes it will feel like multiple stab wounds in my gut that go on for hours. It really has me scared. He’s seen his doctor and she prescribed some Demerol and an antacid. He’s pretty sure it’s related to his HIV. Lloyd tells you quite frankly that when he gets too bad and too sick from the AIDS he’ll take himself out. “ Hey, I think of suicide from time to time. If it gets really bad, I mean the AIDS thing, and life get too unbearable, I know I don’t have to take it”.
Jane is a 19-year-old White, upper income, University student who has just been transported to the chemical dependency unit at the local hospital. You are asked to do an assessment on her to see if she needs to be admitted for a drug problem or sent to the psychiatric unit for further observation.
You meet with Jane and notice that she is barefoot, wearing loose 60’s style clothing and her eyes are very dilated. She tells you the following story in a rapid pressured pattern of speech.“ A few hours ago I was at the Metallica concert and got to thinking that James (lead singer) was talking to me in my head. He told me not to leave the stadium, so I didn’t. Everyone else left, my ride left, but I just couldn’t. Then I got here somehow. I remember thinking I wouldn’t get through and would really lose my mind, especially when that pay phone I was using started melting in my hand. I felt I had to talk really fast before it melted. I really don’t remember much of the concert or anything from this morning. I do remember that I had trouble getting to my feet to walk up the stairs to my seat. I remember we all passed around something and the next thing I knew, I started feeling really restless. I just couldn’t sit still. I was jumpy, nervous, and sick to my stomach. My heart was racing and I was sweating, even though it wasn’t very warm out. I was high and really got into the people and the whole scene. The scenery was fantastic and I could actually see the sounds— there were waves and triangles dancing in front of my eyes to the music. Then it got scary. Things got blurry and faces started looking mean and ugly. That’s when I started hearing James in my head telling me not to leave the stadium. Then I was all alone and called for help.”
Jane has no previous history of mental health problems and she has no police record.
Though young, she does have a long history of drug use. Jane started smoking “pot” daily at age 13. Her weekends were spent doing many different types of hallucinogens. LSD, XTC, mescaline and “shrooms”. Jane tells you her mother and father divorced when she was 10 years old. He was career military and they moved about every two years. She remembers always feeling lonely and started taking drugs because she felt it made her more interesting to be with. It also was a way to relieve the boredom and loneliness. She finished high school with average grades and wasn’t sure what to do next. But, when her Mom was about to get married, she told Jane she had to “go away to college.”