Actively participate in weekly discussions. To do this, you must submit a substantive scholarly response for the weekly topic discussion. Each post should demonstrate your achievement of the participation criteria (see grading form). In addition, you must respond to at least two of your fellow classmates. However, once you submit your primary post and your mandatory response to two fellow classmates, you may add to any discussion you find interesting. The responses to other students should also be substantive posts that contribute to the conversation by asking questions, respectfully debating positions, and presenting supporting information relevant to the topic. Be sure to integrate in-text citations from the course material and/or other academic sources to demonstrate your understanding of the concepts. Interpret and paraphrase rather than quote directly.

To earn full credit, you need to answer each of the questions correctly and fully with substance making at least 2 reference in addition to the unit material, text, or other academic source, and meet the length requirement of 200-350 words minimum. Your responses should be clearly written and consist of original ideas rather than a recap of what others contribute. Avoid “great post”. If you agree, support your agreement in your own words. Do not repeat the questions!

Background for Question 1:

Case histories are designed to help test your ability to think their way through situations involving drug abusers and addicts. This allows you to make tentative assessments of the patients and eventually to make responsible suggestions for treatment plans and goals. It is a way to see if the knowledge and skills that you have learned in school and from reading the chapters in this textbook can now be applied in a hypothetical case setting. This case is a composites of an actual client case.

HOW TO APPROACH A CASE STUDY

While there are no definitive “right” answers, there are some responses that are more appropriate than others. The trick is to first use only the information given. Do not make up information that is not in the text of the case study. If the case says they are drinking alcohol, don’t make up that they are also doing cocaine if it hasn’t been mentioned anywhere in the case. Use only the given information. If you think a question wasn’t asked, you can say, I would want to ask him or her this. Just don’t fill in their answer. Think of the person in the case as a real live patient sitting in front of you and asking for help. Put on your best counseling hat or simply thinking cap and approach the case from several levels. Try not to view the case from just a medical pharmacology approach but use or think about other clinical issues that might be involved. Think about other resources you can connect this person to and think about important referrals you would make for this patient or client, e.g., medical referrals, psychological evaluations, urine or toxic screens, etc. The case begins with the patient or client showing up at the clinic. You will be given a brief history and some specific issues embedded in this text. Your job is to pull that information out and use to make a tentative assessment and develop a plan of action. In reading a case, first look for dangers. Is there anything in the body of the information that can be dangerous to the patient or client. An example would be if the patient appears depressed, think about their potential for suicide. That’s a danger. If they have in their position several medications that can be lethal, that’s a danger. Once you have recognized it, how will you handle it? What are you going to do to remove this danger?

Case Study

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 night’s sleep. It has become a very vicious circle. All this has been going on for about a year 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 Questions (provide a detailed response to each question based on the information provided and your reading of the text and film.

1. What would your initial assessment of Laura be?

2. What would you say Laura’s main drug of choice is and do you think she will need to be placed in a detoxification program to address this problem?

3. Based on Laura’s emotional situation and the medications she is taking, what if any dangers do you need to be aware of?

4. Based on the information Laura has given you who would you need to contact to advise them of Laura’s situation and what would you need from Laura to make these contacts?

5. If Laura’s boss calls your office to find out how Laura is doing how would you respond to his inquiry? What are his rights to know if Laura did keep her appointment with you?

6. What possible dual diagnosis issue(s) might Laura have and how would you do to confirm this possibility.

7. Are there any other issues that you feel may need to be addressed in this case?

 
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