CPI Case Summary

Ms. Bynum is a self-referral who agreed to participate in the TPAPN monitoring program. On 11/24/16, Ms. Bynum tested positive for alcohol (ETG - 2510 ng/ml, ETS - 77 ng/ml) and renewed her program with TPAPN. On 2/26/16, Ms. Bynum tested positive for alcohol (ETG - 7980 ng/ml, ETS - 1580 ng/ml). On 4/7/16, Dr. John Lehman conducted an assessment on Ms. Bynum and recommended 90-day inpatient treatment program that Ms. Bynum refused. Additionally, Dr. Lehman stated on assessment that Ms. Bynum is not fit to practice and has a high-risk for relapse.

Mr. Goins is a 52 year old male who presented to the ED via LEO following a 4 day binge on alcohol and requesting help with his dependence. Mr. Goins reports he moved to Asheboro recently and found work, however recently lost his job. He reported a history of alcohol use and depression. Dr. Keith requested an assessment on Mr. Goins.At the time of the assessment Mr. Goins denies suicidal ideation, homicidal ideation, and symptoms of psychosis. He reports 5 days ago he became unemployed. Mr. Goins reports his fiance who is his primary support system left town to go to a doctor appointment in their home state of Georgia. He reports binge drinking for the past 4 days attempting to cope with his recent stressor. Mr. Goins reports calling his fiance last night an expressed to her he need help. He states, "I told her I felt at the time no reason to live." Further Mr. Goins stated, "I just had too much in me last night, I had about 14 of them airplane bottles." Mr. Goins denies a history of self harm. He does report a prior hospitalization for depression in Georgia. He also reports a history of attending substance abuse treatment, which was a positive experience for him.

Webster want to speak with me. Ms. Webster reported she wanted to know if she could get some Ativan. She states, "If I could get some of that Ativan I would only have to drink two beers a day, I can cut back." She was asked about her earlier alleged statements of suicide. At this time Ms. Webster denies suicidal ideation homicidal ideation, and symptoms of psychosis. She states, "No I'm not suicidal, I just wanted to get into detox." she appears tearful at this time. Ms. Webster reports getting out of jail this past Wednesday and drinking since she has been out of jail. Ms. Webster expressed the only times she feels she can be sober is when she is "locked up". This clinician informed Ms. Webster of the Trosa program and Freedom House who informed TACT of having a bed available for Ms. Webster, however she denied both recommendation. After offering recommendations Ms. Webster asks if she could just receive some Ativan. Nursing staff did inform me Ms. Webster has been expected to be med seeking since her arrvial, however it has been more evident throughout this

I made contact with Powell, Jermaine L. DOB 02/02/77, who related he had a verbal argument with his wife (Powell, Denise DOB 02/24/81 over the discipline of their child (Powell, Nathan L. DOB 09/18/12). Jermaine related that Denise has bi-polar disorder and takes medication. Jermaine further related she has mood swings causing them to fight. Jermaine related he and Denise were separated and recently reconciled one (1) month ago. While I having a conversation with Jermaine I observed signs of impairment, he had an odor of an alcoholic beverage emanating from his breath and person.

Patient states that he was on unit in April of this year. Patient states that after discharge he tried to get into a program (Salvation Army in Manhatten), but there were no beds available. Patient reports that he went back to his same enviromemtn, Jersey City and started drinking and using heroin. Patient said that he had no health insurance so he was unable to fill his prescription. Patient reports that he applied for Medicaid and is currently waiting to see if he is going to be approved. Patient stated that he would like to go to Meadowview in Seacucus. Patient states that he reason why he uses is to self-medicate because he has no insurance. Patient stated that he would like to get into long-term rehab that does not require him

The counselor met Johnathan for his scheduled individual session. Johnathan denies any substance use over the holiday weekend. Johnathan states he attend an AA meeting over the holiday as well. Johnathan father share he drink alcohol on the 1st of August when home along. Johnathan acknowledge that it did happen however states he has not drank since that date. Johnathan reports has been jobs seeking. Johnathan and I discuss Building Up to Drink and Drug (BUDD). Johnathan and I discuss way to cope with craving. Johnathan denies any HI/SI at the time of session. Johnathan appears to be is pre-contemplation stage of change as evidence by his willing to practice new skills to address his craving. The counselor next scheduled individual session

D.D. is a 50-year-old, African American male presenting with a number of anxiety and depressive symptoms. The client reports that he came to counseling for “extra support and someone to talk to.” D.D. has been struggling with mental health issues since he was young. Since the age of 15 he has been hospitalized on and off for “hearing voices.” In the early 1980’s he was diagnosed with schizophrenia and prescribed Risperdal to treat the symptoms. Since then, D.D. has been in a variety of mental health settings, including hospitals, day programs, and outpatient treatment. The client has an extensive alcohol and drug use history that he believes impacted his Schizophrenia. In the early 1980’s the client would use alcohol every day “to avoid the voices,” drinking “anything he could get his hands on.” He was also heavily involved with drugs at that time and regularly used marijuana, PCP, cocaine, and heroine. In 2000, the client was sentenced to eight years in jail for four bank robberies. While in jail, D.D. received mental health treatment and alcohol and drug treatment, which was greatly beneficial. When the client was released from jail in 2008, he was drug and alcohol free and was taken off of Risperdal.

Seeking therapy and rehab to work on his low self-esteem and self-worth, as well as bed temper, and negative outlook in life, would be helpful in order for him to remain sober. His views on rehab are positive and negative at the same time. Positive outlook: he will remain sober throughout the program and once he is out. Negative outlook: he will relapse after he is done with the program, and doubts himself. Jr has reported that he will try his best to remain sober throughout the program and after he will change his environment and the people involved in it. Jr’s strengths came from him focusing on improving his lifestyle and having the support of his

Reported history of alcohol and Cannabis use; last use of marijuana 10/25/2016; and alcohol about six month ago. Client appears to have poor coping skills to prevent relapse.

The Diagnostic and Statistical Manual V (DSM 5) describes the essential feature of a substance use disorder as a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. Specifically, the DSM V describes diagnostic criteria as a problematic pattern of alcohol use leading to clinically significant impairment or distress. Mr. Holliday manifested the following:

Michelle is seeking counseling help due to the advice of her lawyer to help her out in her to achieve intoxication or desired affect; withdrawal symptoms are relieved by continued use of the substance; there is a persistent desire or unsuccessful efforts to cut down or control substance use; a great deal of time is spent on activities necessary to obtain the substance; and important social, occupational, or recreational activities are given up or reduced because of substance use. Additional indicators include: self-admission of substance dependence; extensive drug history; family and peer influence; and related legal problems.

The intent of the AUDIT or the Alcohol Use Disorders Identification Test is to recognize individuals whose alcohol ingesting has become risky or damaging to their well-being (Bradly, Debenedetti, Volk, & Williams, 2007). The AUDIT is a 10-item device with fluctuating numbers of reply selections per item, vacillating from three to six selections; its objective is to measure three facets of alcohol misuse; consumption, dependence, and interrelated complications (Bradley, et al., 2007). Reactions are differentially biased such that between zero and four points are conceivable per element (Bradley, et al., 2007). A score of eight or greater is evocative of alcohol problems (Bradley, et al., 2007). This screening implement takes less than four minutes to administrate and performs to be more sensitive to current drinking involvements such as binge drinking in the last 30 days or the regularity of drinking and driving incidents in the last 12 months (Bradley, et al., 2007).

The participant is a 49 year old African American male who began using substances at the age of 13. He was diagnosed with severe alcohol, cocaine, and opioid use. The participant has been incarcerated over the past 32 years. He was recently paroled after completing eight years of a sixteen year sentence in the Illinois Department of Corrections for burglary and theft. The participant is on medications to treat HIV/AIDS and has been diagnosed with Major Depressive Disorder. He was referred to Healthcare Alternative Systems residential program through TASC as a condition of his probation.

SOCIAL HISTORY: Patient admits alcohol ingestion nightly and on weekends. Denies tobacco use and illicit drug us. He is married.

The client is a single, 24-year-old Caucasian male and makes a living as a laborer. The purpose for his assessment was to screen him upon violating his probation. Overall, his profile was consistent and appeared to be valid, although he may have a tendency to deny some of problems/ symptoms, or present himself in a more favorable light. His clinical scales were elevated in the areas of drugs, alcohol, antisocial, depressed, borderline and paranoia, which may have caused him to be rather hypervigilant and suspicious. His antisocial symptoms may indicate that he has a hard time with authority, poor relationships/ interpersonal relationships, and likely have situational depressive responses. The subscales indicate that he may be inclined to feel