COUN6204 Week 6 Assignment Latest 2022
COUN 6204A Week 6 Assignment…04.04.22
Assignment: Assessing Opioid Use Through Interviews
The opioid class of drugs include the following prescription drugs: hydrocodone (Vicodin®), oxycodone (OxyContin®), oxymorphone (Opana®); propoxyphene (Darvon®); hydromorphone (Dilaudid®); meperidine (Demerol®); and diphenoxylate (Lomotil®). Heroin is also considered an opioid. These drugs bind to the opioid receptors in the brain and assist in the perception of pain and in reward. Opioid receptors are also located in the brain stem where automatic processes critical for life, such as breathing (respiration), blood pressure, and arousal, are controlled. With continued use, opioid users often experience a physiological dependence on the substance.
For this Assignment, review the Opioid Use case study in the Learning Resources. Consider how you might conduct an intake interview to assess Janelle’s opioid use.
In a 2- to 3-page APA-formatted paper, address the following:
• Describe the type of interview you would use to assess Janelle’s opioid use and explain why
• Explain the benefits and limitations of using this type of interview
• Explain one potential ethical and one potential legal issue in conducting this type of interview with Janelle
Week 6 Case Study: Opioid Use Case Study: Janelle is a 28-year-old African-American female who presented for an assessment due to recent problems with the court system. Janelle had recently been pulled over for speeding during which time the officer discovered that she had prescription narcotics (oxycodone) in her possession for which she did not have a valid prescription. Janelle was offered a plea bargain to participate in the county’s drug court program. This program allows her to participate in counseling in lieu of serving time in jail for her offense. Janelle arrived to the initial counseling appointment on time. She was dressed appropriately for the weather. Janelle was alert, oriented, and did not appear to be under the influence of any substances. Her gait and motor activity was unremarkable. She appeared to demonstrate the ability to sustain attention throughout the duration of the intake interview. Concentration skills appeared to be intact, and there was no evidence of psychomotor agitation. Janelle appeared to be a reliable historian, and she was able to recall both recent and long-term events without any apparent impairment of her memory skills. Janelle appeared to have fair insight into her current difficulties. After reviewing the limits of confidentiality and obtaining informed consent, the counselor provided a brief overview of the counseling process and her role in providing services to Janelle. The counselor then began conducting a clinical interview to determine the extent of Janelle’s substance use and to determine the presence of any other mental health issues: Note to students: Please note that this example is a segment of a lengthier intake interview. A traditional intake interview is 60–90 minutes in length and would typically cover basic demographic information, include a medical history, and assess for potential lethality issues. Counselor: Well, Janelle, I understand that you’re here because of a legal issue involving the court system. Can you tell me a little bit about that? Janelle: (shrugs) There’s not much to tell. I got stopped for speeding. I was only going a few miles over the limit. The cops stopped me and I had some stuff on me. I got arrested for possession. I had to go to court and now I’m here. That’s about it. Counselor: You had some “stuff” on you. © 2012 Laureate Education, Inc. 2 Janelle: Yeah, pills, oxys. Counselor: Okay, well, if it’s okay with you, I’d like to talk about the oxycodone. How much would you say you use on any given day? Janelle: That’s the thing. I don’t really use that much. A few pills here or there. It’s not like I’m shooting up heroin or anything. I just have a lot of pain. The pills help with that. Counselor: You use the pills primarily to help with your pain. Can you tell me more about that? Janelle: Yeah, exactly. I mean, I don’t have a prescription for them or anything. So, I’ve been buying them from a friend. But a few months ago, I got into a car accident and had a lot of back pain. The doctor prescribed Vicodin, which worked really well at first. Then it stopped working, so I started taking a friend’s oxys and they made me feel a lot better. So I just kept taking them. Now I feel like I need to take them just to get by. Counselor: Switching gears for a second, can you tell me about any other substances you might use, in addition to oxys? Maybe alcohol or cigarettes? Janelle: Yeah, I drink, mostly just on the weekends though. I hate smoking cigarettes. I mean, I’ve tried other stuff too. But I don’t do any of that stuff now. Counselor: Can you tell me about some of that “other stuff”? Janelle: In high school I liked to smoke weed, but who doesn’t do that in high school? I wouldn’t say I had a problem with it, but I probably did it every day for about a year or so. I’ve also tried ecstasy and cocaine. But I didn’t like them and don’t do them now. Counselor: Any other substances that you’ve used? For example, have you ever tried pills like Valium or crack cocaine or heroin? Janelle: I’ve taken Xanax before—those are like Valium, right? I actually really liked those, but they are hard to find, at least for me. I’ve never done crack or heroin. I can’t imagine doing either one of those, especially heroin. I’ve had some friends who have started using it, and it’s just crazy how it messes you up. Counselor: Okay, so if I can summarize what we’ve talked about so far: You use oxycodone right now, but you’re only using it to help with pain. You also drink, mostly on the weekends, and in a social setting. In the past, you’ve used marijuana, ecstasy, Xanax, and cocaine, but you’re not currently using any of those substances. Does that sound about right? Janelle: Yeah, that’s right. © 2012 Laureate Education, Inc. 3 Counselor: Good, I’m glad we’re on the same page. I’m wondering if you’ve ever had any legal problems with substances, before getting picked up this time? Janelle: (sighs) Yeah. I had a DUI about a year ago. I was leaving the bar and I got picked up. Had to go through a weekend driver intervention program to get my license back. Counselor: Okay, anything else besides that DUI? Janelle: No, I’ve never been in trouble besides that DUI, and now, obviously. Counselor: Sometimes when people use substances, it can create problems in work or in relationships. Have you had any problems in either of those areas? Janelle: Not really. I work in a restaurant, I’m a waitress, and you know how that goes. Everyone who works there uses something. Half the staff snorts cocaine in the bathroom. I’ve had to call out a couple times because I couldn’t score any oxys and I was in too much pain to be able to get through my shift. But I’ve never been disciplined or anything. I actually think I work better when I’m on oxys. I’m more relaxed, I definitely feel better, and I don’t let work stress get to me. Counselor: You’ve not noticed that oxys have caused a problem for you at work, and, in fact, it feels to you like they help you perform better. Janelle: Yeah, I know that sounds stupid but that’s how it feels. Counselor: I appreciate your honesty, Janelle. This information will help me better understand how I can be helpful to you during our time together. Janelle: Thanks. I guess it’s weird to have to talk to someone about all of this, but it’s not as bad as I thought it was going to be. Counselor: I’m glad to hear that. Can we talk about the impact of substances on your relationships? Maybe relationships with your family and friends? Janelle: (hesitates for a moment) Well, my parents are basically not talking to me right now. When I got the DUI they were pissed. Now they are just kinda done with me. I guess I should back up. I’m an only child. My parents are still married, I had a very normal childhood and was raised the “right way.” So I guess they have a hard time understanding why I didn’t turn out “right.” Counselor: You’re using the word “right.” Is that your word or theirs? Janelle: It’s what they keep saying. They had big plans for me. They wanted me to be a doctor or a lawyer, or something more than a waitress. I tried the whole college thing, but I have a hard time focusing. I don’t know…maybe I have ADD or something. © 2012 Laureate Education, Inc. 4 Counselor: So you tried college, but it didn’t work out for you? Janelle: Yeah, I made it through about 2 years. But my grades were terrible. I had a hard time even bringing myself to go to class after a while. It was like, what’s the point? Counselor: It sounds like you got pretty down on yourself. Janelle: Yeah, I did. I felt like I was disappointing my parents. Counselor: It certainly sounds like you value your family, even though things are kind of strained right now. Janelle: Yeah, I do. I’ve always looked up to them. My mom’s a teacher, and my dad is a financial planner. They always have just done everything right. I know they don’t approve of my lifestyle or the choices I’ve made, and I just feel like I let them down. Counselor: I imagine it must feel quite burdensome, carrying that weight of feeling like you’ve let them down. Janelle: (tearful) Yes, it does. . Counselor: Well, I certainly hear from you that your family is important to you. I’m wondering if there are any other relationships that you value which may have been impacted by your substance use? Janelle: Well, at this point, all the people I hang out with use something. Most of my friends are people that I work with, and they all use. Those are the people that I usually go out and drink with on the weekends. So my use hasn’t really affected my friendship… maybe the opposite? I probably use more because of the people I hang out with. Counselor: Your friends in a way contribute to your use. Janelle: Yeah, I would say so. Counselor: Okay, what about other relationships? Maybe a significant other? Janelle: (hesitates for a moment) Um, well, that’s another issue. I’m a lesbian and my parents have a huge problem with that. In fact, they probably have a bigger problem with that than my drug use. They keep saying that it’s a phase I’ll grow out of or that I’m just doing it for attention… but anyway, I do have a girlfriend and our relationship has probably been affected by my use. Counselor: So similar to your relationship with your parents, you’ve noticed that your relationship with your girlfriend has been affected by your use? © 2012 Laureate Education, Inc. 5 Janelle: Yeah, she doesn’t use anything at all. In fact, she really doesn’t even drink. And she hates that I use pills. We get into fights about it all the time. We’re really not even speaking right now, after this last arrest. I worry that she’s probably going to leave me if I can’t get my act together. Counselor: You feel like she’s reached a kind of the proverbial “last straw” with you. Janelle: I do. She’s a great person and she wants to be supportive, but how much can she really take? I keep telling her that I’ve got everything under control, but then I go and get arrested and now I have to complete this court program to avoid having a felony on my record. I feel like I’ve messed things up for the last time. And the thing that really stinks is that, otherwise, outside of my use, we have a good relationship. We’ve been together for about a year, she’s someone that I can totally see spending the rest of my life with. But I don’t know if that’s going to happen now. Counselor: If I can summarize for a moment, in both your relationship with your parents and your relationship with your girlfriend, you feel like it’s to the point where there may be some long-term damage. And, please correct me if I’m wrong, what I think I’ve heard so far is that the damage might be, at least in part, related to your substance use. Janelle: Yeah, I guess I would have to say that’s a true statement. I’ve never really considered myself an addict or anything, and I don’t think I do now either, but I guess it’s hard to deny that the pills and drinking are costing me something. Counselor: I think we’re off to a good start, Janelle. And I want to commend you for being honest with me. It’s tough to talk about a lot of this stuff, and you’ve demonstrated a lot of strength by coming in here and doing just that. I hope in the rest of our time together, we can continue to explore these issues, and maybe, if you’re interested, we can decide how we might go about working on some of this stuff. How does that sound? Janelle: That sounds good. I was really not happy about having to come here. But I think that this is something that might be good for me. I think I’ve been ignoring a lot of this stuff for a long time. So maybe it’s time I started to address it. Counselor: That’s exciting to hear, Janelle. I’ll look forward to continuing our work next week. Janelle: Okay, thank you.
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