1. What type of an assessment would you use and why?
1. Using DSM 5 Diagnostic Criteria, what might be actual or possible diagnoses you would consider?
1. What additional information would you ask to fully asses this individual?
1. What type of etiological theory do you feel applies?
1. What might be pertinent issues for the treatment plan?
1. What might be special issues to consider?
1. Who should be involved in the client’s treatment? Why?
1. How would you involve family/significant others?
1. What community services might you refer this client to?
CASE STUDY #1 LAURA
Posted on: Sunday, November 11, 2018 8:27:45 AM CST
Laura is a very successful businesswoman 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?”
CASE STUDY #2 REESE
Posted on: Sunday, November 11, 2018 8:30:44 AM CST
Reese is a 18 year old single male who was born in Los Angeles, California, where he still lives with his mother and his brother. His dad is a sales rep and is on the road during the week.
“When he’s home on the weekend he just drinks and watches the ball games on TV When he gets drunk he yells at me and my mom and throws shit around the house. He drinks all the time that he’s home but he can’t hold his booze. Like he’s a total lightweight. Mom also drinks. Watch out when they both get ‘lit.’ Man, the fur really flies. We’ve had the cops out several times. I just take off when they start gettin’ into it. I started drinking and smoking when I was 13, in the eighth grade. It was a total drag, not that any of the other grades were any better, but all the kids were talking about high school and the classes they were going to take, and me, I was just trying to figure out were I was gonna get money for my next pack of cigarettes. Now I smoke about a pack a day, plus a couple of joints too. I have a cup of coffee in the morning before school and that’s it. At night I’ll drink 3 or 4 beers plus a few shots of vodka. On the weekends is when I really get down to partying. I’ve played around with lots of stuff. You know, trying to see what’s out there. I’ve tried pot, coke, mescaline, XTC, mushrooms. I’ve even shot up a few times. It’s no big deal. When I’m partying, I like to mix things up a bit. Maybe do some tequila and mushrooms, depends on what’s going on and who’s around. If I drink too much I black out. I’ve even OD’d a few times. But, hey, it wasn’t any big deal or nothing. I do like speed though. If any drug is my favorite, aside from cigarettes and coffee, it’d be ‘speed.’ I saw a doctor when I was eight. My folks took me. They said I was out of control. The doctor said I had attention deficit disorder and gave me Ritalin? . It helped a little, I guess. I don’t know much about it. Right now, except for partying, I don’t take any medication. Then there’s my brother, a complete math ‘geek’. Always gotten good grades, never been in trouble; responsible, dependable, healthy and clean. He’s a parent’s wet dream and I’m his evil twin brother.”
CASE STUDY #3 SUZANNE
Posted on: Sunday, November 11, 2018 8:32:04 AM CST
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 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?”