Miranda Palmer Substance Abuse Counseling March 19, 2002 Interviewer: Steve Lynn Dominguez is a twenty-eight year old woman married with four children. The Department of Employment and Training (DET) has referred her for a positive drug test showing high levels of Vicodin. The client could not produce a prescription in her name to account for the levels. The client attends the drug and alcohol assessment as a condition of her Tanf Grant but does not believe she has a problem. Her husband is the provider of the medication that she takes. She has been using Vicodin consistently for over a year now. She generally minimizes the use of the Vicodin, and forgets how much she takes. Her use of Vicodin led to poor job performance, and the employer suspected drug use. She cannot continue through DET unless she ceases her use of a non-prescribed drug. She is unwilling at this time to see her drug use as affecting her life in a negative way. Client has no history of abusing any other drugs. Other drugs have been used minimally, sporadically, or not at all. Withdrawal symptoms are not evident as she is currently using Vicodin. Client has no current or past legal involvement. Furthermore, her husband is physically, verbally, and sexually abusive to her on a regular basis. She has no history of prior violent relationships. The client has a history of abuse as a child. The drug use is encouraged by her relationship and he seems happier when she is using. She reports that he likes that she is “less frigid” when taking Vicodin. Incidences of Spousal Rape have been common throughout their marriage, and the Vicodin is used to that end as well. She does not show a strong dependence on any other individual in her life.
DSM I:
305.9 Vicodin Abuse 995.81 Physical Abuse of Adult 995.83 Sexual Abuse of Adult DSM II: None DSM III: None DSM IV: Inadequate Social Support DSM V: GAF = 50 (Current) Self-Assessment: It was interesting playing a role. I found myself as the client not really wanting to give a lot of information. I am sure I seemed combative at times, but it was the way that I felt. I think it makes me understand how important it is that the person wants the assessment. When I put myself into the situation of being forced into an assessment, I responded accordingly. It helped me to understand where clients are coming from when they are “non-compliant.” It also makes me think more strongly about the idea of motivational interviewing. I think it is important to have the clinical skill to find out where people are in the perception of the issue. I don’t know if that is something that eventually I will just “know,” or whether I will have to ask. I liked the assignment, I don’t know if my interviewed like me.