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   DUE NO LATER THAN 6/12
Read the case study provided and write a clinical report which includes:
A summary of the major issues facing the client needing to be addressed.
A working diagnosis for the client (with diagnostic summary and rationale) utilizing the following information from the CAGE screening tool and case history information. 
A Mental Status Exam which applies the information from the case history. 
Detailed treatment recommendations determining which modality (family, individual, group, or couples) is most appropriate for this client. Be sure to provide the rational for your choice by integrating information from the case summary.
Recommendations on whether individual is a good candidate for treatment placement (inpatient, residential, or outpatient) and an analysis of the pros and cons for your selection based on a summary of the issues. 
Your paper should be at least 4 pages long. Remember to include a cover page and reference page, and to support your arguments with information drawn from the online content, the textbook, and other credible, scholarly sources to substantiate the points you are making. Apply APA standards for writing and citations to your work.
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Case 5-Laura
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 nights sleep. It has become a very vicious
circle. All this has been going on for about a years 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?”
 Questions-Case 5 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. Ba program would be a second option. However, because this is Laura’s first attempt at detoxification, and her statements on her previous inability to stop her drug use on her own, the counselor would be advised to set up a contingency contract with Laura before placing her in an out-patient program. This contract would acknowledge that should Laura fail to achieve stability in the out-patient program she would then seek treatment in an in-patient program. Laura is also taking a fair amount of stimulants too. Prescription diet pills for weight control, caffeine, and nicotine. These may or may not complicate the treatment picture and you would want to get a medical opinion on these medications as well. It would be prudent to also alert her treating physician about your concerns. It would also be important that Laura be counseled as to the potential that she may experience some weight gain while going through the detox process. Reassure her that this is normal out come at first and that controlling her weight will become easier when she is not taking in all the alcohol. Recommend a good nutritional program with exercise based on the recommendations of her doctor and /or nutritionist. 3. The danger is the potential for an accidental overdose. You will need to educate the client as to the synergistic effects of alcohol and benzodiazepines. The purpose of the detoxification is to slowly and safely withdraw her from these medications and lower the risk of such an event occurring. The other danger is intentional suicide. Laura is facing what may seem to her some overwhelming life tasks. Loss of an important client, possible loss of her job, embarrassment in being referred to an employee assistance program, the stigma of being an alcoholic, and needing treatment, and unresolved grief over the death of her father. All these and other issues may appear to Laura, at this point in time, just too much and she may toy with the possibility of suicide. Also, depressant medications and drugs will skew her view of her situation making it appear more hopeless than it really is. The counselor or case worker needs to constantly monitor Laura’s statements and affect for clues that she may be contemplating suicide. 4. Laura will need to sign several releases of information so counselors and other treatment providers can contact one other. This allows for a freer exchange of information regarding Laura’s situation. It would be necessary that Laura’s doctor(s), those prescribing her benzodiazepines and diet pills, to be informed of her being placed in an alcohol treatment program. Since Laura is here at the request of her employer, he or she, will also have a right to receive minimum information as to whether or not Laura is in treatment compliance and keeping her appointments with the EAP program. With regard to issues of patient confidentiality, two sets of rules usually apply. Those of state law, found in the civil codes pertaining to business and professional standards of practice and professional codes of conduct and ethics. A counselor must be especially aware of what the state laws are regarding a patient’s right to confidentiality in the state where they practice. Another superseding body of laws that pertain to a patient’s right to confidentiality when they are receiving treatment for substance abuse, is the Federal Rules of Confidentiality. This set of laws apply to any federal moneys that support that treatment program. It can even be a non-profit tax exempt organization. In these cases then, the Federal Rules and Regulations will apply and take precedent over state laws. Be sure you know and are familiar with these laws. In cases where the two sets of laws conflict, courts have consistently held with the law that provides the greater protection to the confidentiality of the patient.  5. In the case of Laura and her employer, the employer has the right to know or obtain a limited amount of information regarding Laura’s treatment compliance. The employer does not have the right to more detailed personal information on Laura. That she is keeping her appointments when into a treatment program, expected length of that program, and if she participated satisfactorily in that program is all an employer needs to know. Laura is within her rights to refuse signing such a release. But she should then be aware that by denying the right for her employer to receive this information gives her employer the right to terminate her employment. 6. There is certainly the possibility that Laura may have several dual diagnosis issues. It would be important to begin a process of ruling out both Axis I and Axis II diagnoses as she becomes more stabilized in her treatment program. Medical physicians and psychiatrists split on when to begin intervention regarding a dual diagnosis patient. Suggest beginning medications for major depression or bipolar disorder as soon as there is a reasonable suspicion that this component exists and will influence treatment outcome. i.e., if that antidepressant medication will help that person remain in treatment longer, then why wait. Other equally experienced physicians feel it is necessary to wait to get a clearer picture of the patient before beginning a trial of medications. It is vital that such decisions be left to the medical experts. The therapist’s and counselor’s job would be to pass on any changes they see in the patients affect or demeanor to the medical staff so they can do further evaluations or tests, if necessary. In Laura’s case there are strong indications that she never had the time to grieve the death of her father whom she was very close to. What can start out as uncomplicated bereavement, if not processed properly, can move into depression. In Laura’s case this may have occurred as she began self-medicating her grief with alcohol and benzodiazepines. There is also just a hint that Laura’s father may have been an alcoholic. Getting a good family history and genogram would be one way to explore this possibility. If this is true, then Laura may be genetically predisposed to alcoholism. You also want to decide whether Laura is Bipolar (I or II), Cyclothymic, has Major Depression or Dysthymia. Laura is using Xanax?  for anxiety. Is this a panic disorder? She reports having become less social in recent months. Certainly this can be part of the overall isolation that occurs when a person moves into alcohol dependency. But, you would want to rule out whether she is also suffering from Social Phobia, Panic Disorder with or without Agoraphobia, or Agoraphobia without a history of Panic Disorder. Another question is “What part does her diet pill, caffeine, and nicotine use and abuse play in this picture.” Regarding Laura’s sleep medication, several more questions will need to be clarified. To what extent has her alcohol abuse and other substance use caused her sleep disorder. Alcohol is known to suppress REM sleep and disturb the normal sleep cycle. i.e. Substance-Induced Sleep Disorder. However, you would want to rule out other possibilities such as; Insomnia, Sleep Terror Disorder, Parasomnia NOS, or Sleep Disorder Due to General Medical Conditions. All the above will issues will certainly complicate the substance abuse treatment picture for Laura. 
_____________________________________________________________________________________________________________________________________
Read the case study provided and write a clinical report which includes:
A summary of the major issues facing the client needing to be addressed.
A working diagnosis for the client (with diagnostic summary and rationale) utilizing the following information from the CAGE screening tool and case history information. 
A Mental Status Exam which applies the information from the case history. 
Detailed treatment recommendations determining which modality (family, individual, group, or couples) is most appropriate for this client. Be sure to provide the rational for your choice by integrating information from the case summary.
Recommendations on whether individual is a good candidate for treatment placement (inpatient, residential, or outpatient) and an analysis of the pros and cons for your selection based on a summary of the issues. 
Your paper should be at least 4 pages long. Remember to include a cover page and reference page, and to support your arguments with information drawn from the online content, the textbook, and other credible, scholarly sources to substantiate the points you are making. Apply APA standards for writing and citations to your work. DUE no later than 6/12

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