Case Formulation Assignment
By: Rickard Jean-Noel
October 7, 2020
Laura is a middle age woman in her late forties that seem to be going through an incredibly stressful and difficult time in her life. She is married and has two teenage daughters. On top of that, she works in the incredibly stressful world of corporate finance. Within this field, she has to keep up this persona of this “no nonsense business professional”. She is also dealing with the recent death of her father, her alcohol addiction, and her opioid (Xanax) addiction. This unfortunately is a common story amongst individuals working in high demand stressful environments. They are often times drain and put under so much pressure at work that they search for an escape once they have reached home or attempt to find ways to “unwind”. Often times, they use drugs and alcohol to do so. This sometimes results in addiction or dependance. This would seem to be what is occurring with Laura.
Our initial impression of Laura is that the stresses of her everyday life is becoming overwhelming and is causing her to have some sort of breakdown. This is leading her to substance abuse, and she is beginning to put herself and other in harms way. Due to her abuse of alcohol and Xanax, she was in a serious car accident where her car was totaled. She is therefore lucky to be alive and is lucky to not have harmed anyone else in the process. She is behaving very recklessly, and it is not only affecting her, but it is also affecting her family and her employment.She has also gone through great lengths to continue to feed her Xanax addiction by obtaining multiple doctors to provide her with prescriptions. This is further proof of her dependence.
We would approach Laura carefully and very diligently. Given her level of shame that she has in regard tobehavior in front of her children, we would not like to add to that. We would also have to be careful when addressing her addiction, because we would not want her to take flight. We haveseen previously that she was quick to search and switch doctors when she was confronted about her abuse of Xanax. We can also conquer from herprofession that she might have a strong personality. As she is described as a “no nonsense business professional”, she might be quick to dismiss or disregardany diagnosis made on her behalf. Regardless to the fact that we might have to tread softly, it would still be in the best interest of ethics to have Laura receive treatment. It would be wise to refer her to a drug treatment program, as well as anAA/NA 12 Step Group Counseling. To be completely blunt, Laura has problems, and she is now also a problem to others as well. Because she is drinking and abusing drugs while driving, her actions can also be seen as criminal and this could lead to possible incarceration, or worst death. Therefore, is it particularly important that she receives treatment as soon as possible.
After reviewing the facts provided, we have conclude that we can diagnosis Laura with “Substance Use Disorder. According to the DSM-5, “substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress.” As with most addiction problems, despite any consequences a person who has a problem with either alcoholism or drugs suffers, they will generally continue to use their drug of choice. They may make half-hearted attempts to stop or cut back their use, usually to no avail” (American Psychiatric Association, 2013). The DSM-5 goings on to state that in order for someone to be diagnosed with a substance use disorder, they must be displaying 2 out the 11 symptoms within a 12-month period. We will now see which ones apply to Laura from the following:
- Taking the substance in larger amounts or for longer than you are meant to.
“She often takes five or six times the prescribed dose of Xanax.”
- Wanting to cut down or stop using the substance but not managing to.
“although she promises herself that she will only have one or two glasses of wine per day, she routinely finds herself finishing the whole bottle and sometimes half or more of a second bottle”
- Spending a lot of time getting, using, or recovering from use of the substance.
“When her physician presented his concerns about the amount of Xanax, she was taking on a regular basis she began to search for other physicians in order to obtain more prescriptions for Xanax. She now takes Xanax during the day as well as at night when she is feeling stressed.”
- Cravings and urges to use the substance.
- Not managing to do what you should at work, home, or school because of substance use.
“she has missed a few important business meetings lately. This has made her feel quite upset with herself and guilty because she has lied to her boss about the reason for her absences”.
- Continuing to use, even when it causes problems in relationships.
“Laura admits that she felt ashamed and guilty when her children told her that they felt embarrassed by her behavior. Laura’s husband has told her the car accident terrified him and he wants her to get help.”
- Giving up important social, occupational, or recreational activities because of substance use.
- Using substances again and again, even when it puts you in danger.
“Of major concern to her family is that she recently totaled her car in a crash on the way to work on a morning that she had a very bad hangover from drinking the night before”
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
“Laura notices that her mind is quite fuzzy in the mornings and she cannot remember certain things from the evening before”.
- Needing more of the substance to get the effect you want (tolerance).
“Laura reports that it seems to take more wine these days to help her feel relaxed at the end of a stressful day”.
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
Because we were able to identify that she meetsat least 8 of the criteria for Substance Use Disorder, we can now conclude that she has a SevereSubstance Use Disorder (American Psychiatric Association, 2013). Because she has a SevereSubstance Use Disorder, we would strongly recommend for her to be referred to a physician to be assessed for medical detoxification/stabilization. This is because she is regularly abusing substances and it is affecting her everyday life and the lives of those around her. Her abuse has also proven to be dangerous and could be deadly, specifically if she continues to operate a motor vehicle or any heavy machinery. It is also affecting her work life and she is also putting her health at risk. Because of the severity of her addiction and the potential hazardous outcome, we believe that it would be best that she goes to detox.
In regard to her treatment plan, because she is currently addicted to alcohol and an opioid (Xanax), medical detoxification will be required. We would suggest that she is admitted to an inpatient drug facility. This will help her with her withdrawal, and it will also give her a break from her stressful occupation. She can then do AA/NA group counseling 12 Step, as well as behavioral therapy. Medication might be needed, however we would not want to give her medication so soon because of her history of prescription drug addiction and abuse. Therefore, she might also require medication monitoring. Overall, this will not be a short process and we believe that group therapy will work because there will be others such as sponsors to hold her accountable.
We believe that her family should be involved in her treatment. Since they are concerned and were dealing with the results of her addiction, they should be involved in helping her to get clean as well. We believe that her family should be involved in the intervention and be there to hold her accountable. Her family should also be there to help her to avoid triggers, such as not having alcohol in the home. Her husband should also be more involved with her and her doctors so that she is not using multiple doctors to complete prescriptions for Xanax. Her family should also not allow her to drive if she is drunk or is suffering from a hangover from drinking or from withdrawal. Like earlier stated, this will be a long process and it would be best that all hands are on deck in order to help Laura.
Though Laura’s situation seems grim, there is hope. If an intervention is stage and is successful, then she will be able to recover from her addiction. It is important for her to be willing to accept assistance and to also admit that she has a problem. Once she is able to admither problem and is able to accept and obtain assistance, she will then become an active member of society, a better mother, a better wife, and a better person.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.