Jessica came on her own seeking help with her drug use/abuse. She has come to us today to figure out the main cause of her addiction issues. Through this assessment I will be able help Jessica find the proper treatment to aid her in recovery. Although American people only make up 5% of the worlds populations, we use 60% of all illicit drugs (Doweiko, 2015). This assessment is to help Jessica find the right treatment options.
The source of information for this assessment was acquired from the interview process.
All information is based on statements given by the client, her high school officials, and from her parents. Jessica’s parents tried helping her and for short periods she was able to refrain from using, but eventually she relapses.
Jessica was a “typical teenager” she grew up with both parents and her siblings. Jessica is the youngest of four daughters. She enjoyed family activities, had many friends and enjoyed Art and French class while in school.
She has stated that “drugs and alcohol were never a problem; I never drank or smoked in high school.” According to Jessica her boyfriend was the reason she started using heroin. Jessica had never used heroin until her boyfriend jab her with a heroin filled syringe. She started using every few weeks and then escalated on to daily use. Her drug use got her expelled from school just two months from her graduation, she was lying, and stealing money to support her habit.
She tired tp get help, Jessica states “I was going through counseling and I told my therapist about all the lying and using behind my parents back.” Her parents are supportive and have tried to help her without any success.
According to May (2007), Jessica’s current status is most likely the breakdown stage. She is remorseful and has feeling of shame and regret for her actions. The lying to her parents and stealing from them is the biggest source of her shame. She also regrets not finishing school with the rest of her class. According to May (2007) Jessica has loss of will power, she truly wants to quit but battles the urge to use again. She experiences craving which Doweiko (2015) describes as an intense, subjective, emotional and physical experience for the individual that varies in intensity between individuals. Jessica has been sober for 90 days but does feel the urge to use again. She wants to attain her GED or finish high school but struggles daily to stay sober.
Doweiko, (2015) States opioid use or abuse, as diagnosed in the DSM-5 has five sub-forms, opioid use disorder, opioid intoxication, opioid withdraw, other opioid-induced disorders, and unspecified opioid-related disorders. It is the equivalent of a narcotics addiction. Using the criteria mentioned, it is evident that Jessica uses and abuses heroin, therefore it is likely the she has an Opioid Use Disorder (OUD). Jessica has attempted to stop on her own several times without any success. This is common as 50-90% of patients treated for a substance use disorder, they often times relapse within the first 90 days (Doweiko, 2015). Jessica fully realizes the need to quit and she desires to do so.
Jessica was expelled from school after bringing drugs on the senior class retreat trip. She would lie to her parents as well as steal from them to support her habit. She now seems desperate to quit using heroin. She reports having strong cravings which lead her to use again even if only a couple of times.
Throughout school Jessica had good friends with her fellow classmates. Currently, the only friends mentioned are others who use heroin as well. She has a supportive family that is willing to do what they can to help her on her road to recovery.
Jessica does have a job but only because she works for her father. There was no mention of her ever holding any other job, this seems to be her first job.
Jessica works for her father while trying to stay sober, but she has no education and no prospects of a better job. She wants to complete high school or at least obtain a GED. It was not reported as to where she currently resides or if she has any bills to pay.
Jessica’s parents are loving Christians and very supportive, they want to help their daughter but are not sure what to do. Her father gave her a job at his business to give her something to do. The lying and stealing was hard on them but their faith and love for their daughter they continue trying and help her. No mention of how her addiction has affected her sisters.
Jessica has admitted to stealing from her parents and having drugs at a school retreat, which cost her expulsion from school. No current legal issues to report.
There are no reported health issues at this time. Jessica could experience long term effects in the future after getting clean. Some people who use heroin long term have developed: insomnia, collapsed veins for people who inject, damaged cartilage tissue inside the nose for people who snort it, infection of the heart lining and valves, abscesses (swollen tissue filled with pus), constipation and stomach cramping, liver and kidney disease, lung complications, including pneumonia, mental disorders such as depression and antisocial personality disorder, sexual dysfunction in men, irregular menstrual cycles in women (National Institute on Drug Abuse, n.d.). Jessica does seem to suffer from some depression and self esteem issues, each time she has a failed attempt at sobriety, she feels more down on herself. Heroin often contains additives, such as sugar, starch, or powdered milk, that can clog blood vessels leading to the lungs, liver, kidneys, or brain, causing irreversible damage. Also, sharing needles to inject drugs along with impaired judgment from drug use increases the risk of contracting infectious diseases such as HIV and hepatitis (National Institute on Drug Abuse, n.d.). If Jessica continues to use she could possibly overdose on heroin, which can cause mental issues due to lack of oxygen to the brain as well as death.
Jessica comes from a Christian home and her family attended church regularly. Jessica does not believe church helps with her addiction. Jessica did not state if she believes in God or if she goes to church because her family does. Due to her struggle with addiction Jessica could have doubts about God. After multiple failed attempts at staying clean she may battle some feelings of failure and would greatly benefit from a relationship with God. It has been hypothesized that every addiction, at its core, is a disease of the spirit (Doweiko, 2015). Jessica drug use is her attempting to fill the hole in which only God can fill.
Based on the DSM-5 Jessica meets the criteria necessary to consider substance abuse disorder. According to the DSM-5, some of the signs of a substance abuse disorder include preoccupation with continued substance use, intoxication at inappropriate times, reduction in social, occupational, or recreational activities, and continual use in spite of social, emotional, or vocational problems caused by the substance (Doweiko, 2015). Jessica has repeatedly relapsed, the longest she has clean and sober is a few months and then she resumes her heroin use. She states that some relapses are short only a use or two and she tries again and other times she starts using daily again for a longer period of time. Jessica’s cravings seem to get the best of her and she frequently gives in to them. She does feel immense guilt and shame when this occurs and tries to stop using again. Her loving family seems to be one of her main motivators to get and stay sober. The fact that she took the first step and came in and asked for professional help shows that she indeed wants to be sober. She has been in counseling prior to coming in but she was not an any treatment program.
Jessica should be admitted into a detox inpatient for 3-5 days, then admitted to outpatient treatment program for ongoing treatment. She has the support of her family and willingness to get and stay sober. I would also recommend that Jessica attend group meetings such Narcotics Anonymous (NA) or a more faith based group since she was brought up in the church.
According to the continuum of chemical use Jessica falls into level 3. Level 3 is late problem use/early addiction: individuals who fall into this category may be physically dependent on a compound, and possibly also experience the classic withdrawal symptoms for the compound being abused if they should abruptly stop using alcohol or drug of choice (Doweiko, 2015). There are a range of treatments including medications and behavioral therapies that have been shown to be effective in helping people stop heroin use. Medicines include buprenorphine and methadone. They work by binding to the same opioid receptors in the brain as heroin, but more weakly, reducing cravings and withdrawal symptoms. Another treatment is naltrexone, which blocks opioid receptors and prevents opioid drugs from having an effect (National Institute on Drug Abuse, n.d.).
Behavioral therapies for include methods such as cognitive-behavioral therapy and contingency management have been shown to be effective. Cognitive-behavioral therapy helps modify the patient’s drug-use expectations and behaviors and helps effectively manage triggers and stress. Contingency management provides motivational incentives, such as vouchers or small cash rewards for positive behaviors such as staying drug-free. I would also recommend a certified recovery peer coach for Jessica. The peer coach would be someone who has been through similar situations as the client and has dealt with everything someone goes through in early recovery.
A peer coach offers life experience and advice on a level most trained professionals can not offer. The peer coach relates on a personal level and helps with giving advice based on life experience. Client will need a blood workup, followed by a urine drug screen, and a medical examination. Within the medical examination her inability to remain focused will be tested to rule out or determine any underlying diagnosis previously overlooked. These behavioral treatment approaches are especially effective when used along with medicines (National Institute on Drug Abuse, n.d.).
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