Evaluating Substance Abuse Client Cases

Jerry has been a daily heroin user for the last 7 years. He is HIV positive and has recently been diagnosed with hepatitis C. Jerry believes that both of these illnesses were contracted through the use of shared needles. As a condition for treatment of hepatitis C with interferon, Jerry must agree to undergo treatment for his heroin addiction. He is considering the “methadone cure,” which includes daily doses of methadone to replace the heroin. He is not sure that he is willing to give up his heroin use. In fact, he used immediately before coming to his most recent counseling session. Jerry feels torn, but he knows that his life depends on this choice. What might be some compelling information for a client in this situation to know? What is your role as a mental health professional in advocating for treatment?
For this Discussion, review the case studies in the Learning Resources and select one case study. Consider the factors used to determine the appropriateness of the medication used to treat a client’s substance abuse.

An      explanation of the factors that indicate the appropriateness of the      medication in potentially treating the client’s substance abuse
An      explanation of the expected side effects of the medication and the mental      health professional’s role in monitoring these side effects
A      justification of the medication to advocate for its use to encourage the      client to continue with treatment

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3 Case studies choose one
Substance Abuse Case Studies Case 1: Constantine
Constantine is a 28-year-old Turkish immigrant. He has been told that he must stop drinking or his life will be in jeopardy. Constantine moved to the United States at 18 to study economics. During his first year of college, he tried alcohol for the first time and was quickly “hooked.” He drinks nightly and cannot recall how many drinks he has had. Constantine says that he drinks, “at least a bottle of scotch” every night. Over the past 10 years, he has come to realize that he has a problem. This was not an urgent issue until recently, when he developed pancreatitis. His doctor informed him that his drinking has already caused some damage to his liver, which is very “fatty.” In fact, there are some areas of his liver that may never recover, even if he stops drinking. If he does not stop, though, he will eventually either need to have a liver transplant or he will die from complications of cirrhosis. Constantine decided to take his doctor’s advice and will be participating in a day treatment program at your counseling clinic. He tried to quit drinking once in the past, and his blood pressure skyrocketed. Constantine worries that this might happen again.
Case 2: Joey
Joey is a 30-year-old Italian-American graduate student studying counseling at an online university. He was drawn to the program in hopes of learning more about himself. Joey eventually wants to help others after he first figures out how to help himself. He considers himself to be a “partier.” He began using ecstasy and cocaine during college. Joey considers his college years to be the best times of his life. Later, though, he tried heroin. He first snorted it but eventually agreed to “mainline” it (shoot it directly into his veins). He describes this event as singular in his life—nothing after it would ever be the same. At that point, everything was in the context of when he would use the drug next and with whom. He plans his most extravagant parties for weekends, but it seems that he is always “on the nod” now. Joey is worried about a trip that he has coming up. He will be attending a counseling program “residency” in a city across the country. How will he score? He has to take the drug. He’ll get sick otherwise. In light of this, he decides it might be time to try to quit. But how? He doesn’t even know how to cut back. Joey is planning to take a “huge hit” on his way in. This way, he figures, he’ll be safe on his way in and he can have “one last hurrah.” © 2014 Laureate Education, Inc. 
Case 3: Angela 
Angela is a 41-year-old African-American woman from Durham, NC. She has been smoking cigarettes for as long as she can remember. Lately, though, she has noticed that her friends have all quit and seem to be coming around less often. She figures their absence is due to the cigarette constantly, firmly planted between the index and middle fingers of her right hand. It is time to quit. Angela does not consider herself to be an “addict” because she does not use “drugs.” She does not drink alcohol and she does not take pills—“nothing.” She does, however, smoke between two and three packs of cigarettes per day. She has tried to quit once, using a nicotine patch, but “it didn’t even slow [her] down.” Angela thinks that cognitive behavioral treatment might be something that she would like to try, but that she will most likely need some medication as well. “I just like smoking, I’m going to like it, and need it, and want it all of the time. If I’m going to quit, I gotta be able to get my mind off it,” she says.

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