|Annotated Bibliography, which includes a cover page, a thesis statement, and an APA formatted listing of 8-12 articles to be used in the Case Study Analysis. Each article entry should have include a brief summary of the article and some critical analysis about its findings (to be written in your own words—copying or paraphrasing the article abstract is not permitted). Your paper should be a minimum of 3 pages (excluding Title Page).
Each article must be evidence-based – meaning each is a report of findings arising from experimental research conducted by the article author[s] and not opinion articles or publications summarizing multiple research studies – peer-reviewed.
These case studies are a collaborative effort. Many of the original works were found on various sites on the internet; all were edited by Dr. Karen Rhines for use in APUS course PSYC620: Substance Abuse and Addiction.
Each of the cases below provides a solid framework for use in the assigned Case Study Analysis paper. Some provide more detail than others. Students should select a case and use it as a platform for the analysis while taking some liberties, should they desire to, to add details to flesh out the case. Students may also wish to complete an imaginary substance use assessment based on the information reported by the client.
Case 1: Suzanne
Suzanne has come by the free “drop-in” counseling clinic were you work to get some information and advice. Suzanne is a 22-year-old single woman who has been living with her boyfriend Jack in Manhattan’s lower east side for the last four years. She and Jack have been heroin addicts for as many years. When Suzanne was 10 years old, her father, whom she says was a very heavy drinker, left her mom and the kids and never came back. At 14 she started drinking and smoking marijuana. At 16 she had dropped out of high school and at 18 she moved in with Jack. He introduced her to heroin. She reports using about a 1/2 gram of heroin per day just to be able to function and feel comfortable. In order to pay for the heroin and pay the rent on their apartment, Jack doesn’t work, instead, she works the streets at night. She usually drinks four or five beers each night before going out to work. If she can’t score enough heroin, she will try to score either some Valium™ or Klonopin™ to “tide me over until I can get some ‘horse’”. She says she has tried cocaine but, “I really didn’t care for the high all that much.”
Suzanne tells you that the alcohol and heroin help to calm her nerves and get her through the night. She and Jack are not having sex all that much. When they do make love he never wears a condom. He says that’s what makes him different from her johns, “Which is true because I won’t work without a condom.”Lately she has noticed that her breasts have become swollen and more tender. She also hasn’t had her period in the last 12 weeks. She is pretty sure she is pregnant and knows it’s her boyfriend’s baby. However she not sure she can stop using dope or work to have the baby even though Jack wants her to keep it. She really confused at what she should do and is her asking for you to help her make some decisions. Her friend who works with her at night told her not to stop using dope if she is pregnant “Because it’s worse for the baby than to keep using. I just don’t know what I should do?”
Case 2: Reese
Reese is a 18 year old single Hispanic male who was born in Los Angeles, California, where he still lives with his mother and his brother. His dad is a sales rep and is on the road during the week.
According to Reese, “when my dad is home, he just drinks and watches the ball games on TV. When he gets drunk he yells at me and my mom and throws shit around the house. He drinks all the time that he’s home but he can’t hold his booze. Like he’s a total lightweight. Mom also drinks. Watch out when they both get ‘lit.’ Man, the fur really flies. We’ve had the cops out several times. I just take off when they start gettin’ into it. I started drinking and smoking when I was 13, in the eighth grade. It was a total drag, not that any of the other grades were any better, but all the kids were talking about high school and the classes they were going to take, and me, I was just trying to figure out where I was gonna get money for my next pack of cigarettes. Now I smoke about a pack a day, plus a couple of joints too. I have a cup of coffee in the morning before school and that’s it. At night I’ll drink 3 or 4 beers plus a few shots of vodka. On the weekends is when I really get down to partying. I’ve played around with lots of stuff. You know, trying to see what’s out there. I’ve tried pot, coke, mescaline, XTC, mushrooms. I’ve even shot up a few times. It’s no 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 black out. 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 favorite, aside from cigarettes and coffee, it’d be ‘speed.’ I saw a doctor when I was eight. My folks took me. They said I was out of control. The doctor said I had attention deficit disorder and gave me Ritalin™. It helped a little, I guess. I don’t know much about it. Right now, except for partying, I don’t take any medication. Then there’s my brother, a complete math ‘geek’. Always gotten good grades, never been in trouble; responsible, dependable, healthy, and clean. He’s a parent’s wet dream and I’m his evil twin brother.”
Case 3: Laura
Laura, a 40 year old African American woman, is very successful 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. According to Laura, “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 me 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 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 night’s 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?”
Case 4: Lloyd
Lloyd is a 23 year old single male who chose to move to Dallas, Texas instead of going to college. He has been working as a plumber’s assistant for the last couple of years and will soon get his union membership. “Then I could bid on city jobs and make a very comfortable living.” As it is, he makes pretty good money when jobs are around. During lean times he works on cars and motorcycles on the side. He reports an active social life with his friends and all of them do some type of drug or another. Last year Lloyd tested positive for HIV. He’s not really sure how he got it. He is always very careful about his needles “so someone must have spiked the dope.” He doesn’t want to go into it but he was really “pissed off and angry” when he got the news. He tells you, “HIV is clearly a Republican plot to wipe out the Liberal Democrats”. Since he works as an independent contractor, he has no insurance. “And I sure as can’t get insurance today with my HIV status.” Consequently, paying for his medication that his doctor has prescribed has been sporadic at best. He 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.”
Lloyd prefers to do “speedballs” when he can score those drugs. He loves the rush and even boasts that he can get a full count (1 gram) that’s at least a “……’ten hitter’ for a C note”. Most “bumpers” on the street will have to pay twice as much for half the quality.”
Lloyd 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. Sometimes it will feel like multiple stab wounds in my gut that go on for hours. It really has me scared. He’s seen his doctor and she prescribed some Demerol™ and an antacid. He’s pretty sure it’s related to his HIV. Lloyd 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 the AIDS thing – and life get too unbearable, I know I don’t have to take it”.
Case 5: Jane
Jane is a 19-year-old University student who has just been transported to the chemical dependency unit at the local hospital. You are asked to do an assessment on her to see if she needs to be admitted for a drug problem or sent to the psychiatric unit for further observation. You meet with Jane and notice that she is barefoot, wearing loose 1960’s style clothing and her eyes are very dilated. She tells you the following story in a rapid pressured pattern of speech.
“A few hours ago I was at the Metallica concert and got to thinking that James (lead singer) was talking to me in my head. He told me not to leave the stadium, so I didn’t. Everyone else left, my ride left, but I just couldn’t. Then I got here somehow. I remember thinking I wouldn’t get through and would really lose my mind, especially when that pay phone I was using started melting in my hand. I felt I had to talk really fast before it melted. I really don’t remember much of the concert or anything from this morning. I do remember that I had trouble getting to my feet to walk up the stairs to my seat. I remember we all passed around something and the next thing I knew, I started feeling really restless. I just couldn’t sit still. I was jumpy, nervous, and sick to my stomach. My heart was racing and I was sweating, even though it wasn’t very warm out. I was high and really got into the people and the whole scene. The scenery was fantastic and I could actually see the sounds—there were waves and triangles dancing in front of my eyes to the music. Then it got scary. Things got blurry and faces started looking mean and ugly. That’s when I started hearing James in my head telling me not to leave the stadium. Then I was all alone and called for help.”
Jane has no previous history of mental health problems and she has no police record. Though young, she does have a long history of drug use. Jane started smoking “pot” daily at age 13. Her weekends were spent doing many different types of hallucinogens. LSD, XTC, mescaline, and “shrooms”. Jane tells you her mother and father divorced when she was 10 years old. He was career military and they moved about every two years. She remembers always feeling lonely and started taking drugs because she felt it made her more interesting to be with. It also was a way to relieve the boredom and loneliness. She finished high school with average grades and wasn’t sure what to do next. But, when her Mom was about to get married, she told Jane she had to “go away to college.”
Case 6: John
John, a fit man in his 20s, attended an initial appointment with his new primary care physician, during which time his prior military history came to light. John recalled the anxiety he experienced when he received his military orders for deployment to Iraq. Prior to the notice of deployment, he smoked cigarettes only occasionally, maybe 1 or 2 cigarettes a day. As the time for deployment approached, he started smoking more cigarettes and by the time he arrived in Iraq was up to a full pack a day. Throughout the 12-month deployment, he steadily increased his smoking with peak consumption of nearly 40 cigarettes a day. John suffered several significant combat-related traumas resulting in mild physical injuries.
Upon return to the United States, John completed his military obligation and left the service. Although still experiencing some lingering physical and emotional pain from his tour of duty, he felt he was improving except in one area – his use of tobacco products stubbornly persisted, despite efforts to quit. The 2 packs of cigarettes a day was not only expensive, it was no longer enjoyable. When questioned, John admitted that only the first cigarette of the day was truly enjoyable. In addition, John’s wife was complaining that the expensive habit was creating an unnecessary financial strain on their meager resources.
Despite his apparent willingness to consider quitting the use of tobacco, John readily admitted he was frightened by the prospect. He recognized that his unresolved emotional issues from the war offered a reason not to tackle another problem at this time. The doctor asked John to consider a smoking cessation program, which John agreed to do. They scheduled a follow-up appointment in 2 weeks.
Case 7: Peter
Peter is 32 years old. He currently works as a manager in a large local business and is married with a two-year old daughter. He reports that his job is very stressful – he works long hours and has to attend a lot of meetings and work functions. He says he began drinking about 5 years ago to help manage the pressure at work and especially social discomfort when he attends functions. Peter has been attending Alcoholics Anonymous on and off for over 12 months but has not been successful in controlling the amount or frequency of his drinking. He admits to using heroin in the last 4 months as well as increasing amounts of alcohol to help him cope. Peter scheduled a visit to his primary care physician and arrived for the appointment in a very distressed state. He reported that his wife had asked him to leave the house due to his constant mood swings and heavy spending on drugs and alcohol; she does not want him around their child in his current state. Peter reports that he has managed to hold down his job but is worried that he may lose his job as well as his family. He is having difficulty sleeping and concentrating at work and reports feeling guilty and worthless. He denies having suicidal thoughts. He indicates that he wants to stop using heroin and reduce his alcohol consumption.
Case Study Three Summary
I chose to do Case Study number three. I chose this study because it sits close to home because so many of my friends have dealt with this and I never really knew what to do to help them other than hit the depression head on and the rest would follow. I want to learn more about substance abuse and misuse and this will help me get the answers that I need to help the women of my group home I plan to open. I have always been interested in this area of Psychology but undergrad did not have the classes.
Laura is dealing with grief. Grief causes one to usually eat improperly or not sleep well, and they experience physical ailments such as stomach or chest pains, headaches, chronic fatigue, and mood swings. Laura is not eating healthy, her stomach aches her when she is anxious, she has chronic fatigue, and mood swings. She believes that the sleeping pills are working but it is only causing more issues because it is not fixing the problem and the body is now dependent on the sleeping aids. She thought she had fought off depression but she was not even close by burying herself into her work. Depression is common following loss. Alcohol is a central nervous system depressant, and it can magnify such symptoms of depression as sleeplessness, chronic fatigue, nervousness, abdominal symptoms, and the inability to concentrate. Alcohol will increase the intensity of any of these conditions. She is drinking coffee during the day to stay up due to the insomnia and maybe to even concentrate. She takes a sleep aid, drink alcohol and during the day takes Xanax to feel better around people because she feels she has anxiety. Anxiety in fact comes from being depressed for the Valium and alcohol causes depression. She can keep her job and through cognitive therapy I could help her fight her need for her alcohol and sleep aids. At the moment she has six of the symptoms listed in the DSM-5 so she has severe substance use disorder.
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