CHCMHS005 Provide Services To People With Co-existing Mental Health And Alcohol And Other Drugs Issues Case Study

Case Study 1 – Ben

Ben is an 18-year-old single male who was born in Melbourne, where he still lives with his mother. His Dad works out of town and is only home on the weekends.

When Ben’s father is home on the weekend he just drinks and watches the football and cricket games on TV. When he gets drunk he yells at his wife and throws things around the house. When he drinks, Ben’s father gets angry. Ben’s Mum also drinks and when they both get drunk they fight. The police have been called to the house several times.

Ben started drinking and smoking when he was in Year 8. He doesn’t like school, because all the kids are talking about is high school and the classes they take, and what they are going to do when they finish school, whereas, he is just trying to figure out where he is going to get money for his next pack of cigarettes. Now he smokes about a pack a day, plus a couple of joints too. Ben has a cup of coffee in the morning before school. At night he drinks a few beers plus a few shots of vodka. On the weekends he is always partying. Ben says he has played around with lots of stuff - trying to see what’s out there. He has tried pot, coke, mescaline, XTC, mushrooms. He says he has even shot up a few times, but doesn’t think it’s a 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 blackout. 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 favourite, aside from cigarettes and coffee, it’d be speed.”

When Ben was eight his parents took him to see a doctor because they said he was out of control. The doctor diagnosed Attention Deficit Disorder and gave Ben Ritalin.

According to Ben, that helped a little but now, except for “partying”, he doesn’t take any medication.

Question 1

Based on the information Ben gave you, what other information would you need to determine Ben’s level of drug use?

Question 2

Where would you place Ben on an addiction scale measuring recreational to habitual use, given the information you have?

Question 3

What in Ben’s family history might lead you to suspect that there may be a genetic component to his drug abuse problems and should be evaluated further?

Question 4

What in Ben’s medical history might lead you to suspect that he may have a dual diagnosis problem?

Question 5

What in Ben’s environment might lead you to believe that environmental factors may also play a role in his drug use?

Case Study 2 – Nicole

Nicole 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 (EAP). Nicole is 35-years-of-age and presents herself as a no nonsense business professional, who lives alone. She is frank and honest about the events that have brought her to this position.

Nicole says that although she tells herself that she will only have one or two glasses of wine with dinner, she usually finishes the whole bottle. “About five years ago I started having trouble sleeping and started to take a tranquiliser (5 mg Valium) I normally take one or two pills, two to four times a week to help me sleep through the entire night.”

In the morning Nicole 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 but she fought it and lost herself in her work.

Nicole makes it a point to work out at least three times a week in the morning before going to work. In addition to the medications already mentioned, Nicole 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 she has noticed that she has been steadily increasing her use of wine.

“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 of wine 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 antianxiety 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.”

According to Nicole, last week she reached a crisis point. She had to meet the firm's top client at a business luncheon, but could not get out of bed that morning. It took all her willpower to finally get up and get dressed, which made her 20 minutes late.

Nicole 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.

"My client spoke to my boss and then cancelled his account with me. The next day I met with my boss and he recommended (ordered) I make an appointment with our EAP rep or be terminated. I’m really scared. Work is all I have. I can’t afford to blow it.”

Question 6

What would your initial assessment of Nicole be?

Question 7

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

Question 8

Given Nicole’s emotional situation and the medications she is taking, what if any dangers do you need to be aware of?

Question 9

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

Question 10

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

Question 11

What possible dual diagnosis issue(s) might Nicole have and how would you confirm this possibility?

Case Study 3 – Jacob

Jacob is a 23-year-old single male who chose to move to Sydney instead of going to university in his home town. He has been working as a bricklayer apprentice for the last few years and soon will get his trade certificate.

“Then I could bid on city jobs and make a very comfortable living”.

Jacob no longer has contact with his parents, who he says are very disappointed in him. When he wants a bit more spending money, he works on cars and motorcycles on the weekends. He reports an active social life with his friends and all of them do some kind of drug or another. Last year Jacob tested positive for HIV.

“I’m not really sure how I got it. I’m always very careful about my needles, so someone must have spiked the dope. I don’t want to go into it, but I was really pissed off and angry when I got the news. HIV is clearly a Liberal conservative plot to wipe out the workers.”

Jacob cannot rely on his parents for financial assistance or to tap into any health insurance as a student dependent. Furthermore, he does not believe he could get health insurance now. Jacob has prescriptions for AZT and 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.”

Jacob prefers “smack” and he also likes to do “speedballs” when he can score these drugs. He loves the rush. Jacob says he doesn’t do any other drugs but has tried them all. Occasionally he will drink some Scotch, but lately his stomach has been really giving him trouble. Jacob says that sometimes it will feel like multiple stab wounds in his gut that can go on for hours and scares him. Jacob has seen his doctor and she prescribed some Demerol and an antacid. He’s pretty sure it’s related to his HIV.

Jacob 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, if the AIDS thing and life gets too unbearable, I know I don’t have to take it.”

Question 12

Jacob states that he “prefers to do ‘speedballs”. Based on your readings, please describe what a “speedball” is?

Question 13

Based on the information Jacob has given you, what would your initial assessment be?

Question 14

What would your recommendation for treatment and medical intervention be for Jacob based on your initial assessment?

Question 15

Jacob uses a number of street terms you may not be familiar with. How would you handle a client like Jacob who uses street terms you may not recognize or understand? Why do you think Jacob is using these terms?

Question 16

What do you think about Jacob’s statements of suicide? How would you handle this issue with Jacob?

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