Case Problem 5 Illlicit Opiate Use Goal

There are a variety of treatment modalities, both conservative and emerging, that clinicians, therapists, and doctors use to treat heroin and opioid dependence. Cognitive behavioral therapy (CBT), motivational interviewing (MI), 12 step programs, and acceptance and commitment therapy (ACT) are just a few that have been used in the past, and even today, in the treatment of substance dependence. Medication-assisted treatment (MAT) is yet another form of therapy; particularly for opioid and heroin dependence, that has been around for decades. However, it has recently begun to spark interest and controversy in light of the growing epidemic.

During the last seven months whilst working at a men’s shelter (Cornerstone Community Association, in the heart of Oshawa, which some may say is the drug capital of the Durham Region) many of the shelter guests (men who stay in the shelter) have disclosed being on the methadone maintenance program, stating as a result of being addicted to opioid drugs. I have chosen to write about this psychoactive drug because I want to explore, become more knowledgeable and more confident when talking about this complex drug.

¨ More than a quarter of a million Americans are enrolled in methadone clinics, where they participate in “methadone replacement” or “methadone maintenance” to treat narcotic addictions to heroin or morphine, or prescription painkillers like oxycodone, hydrocodone, OxyContin or Vicodin.¨ (Novus Detox, 2016) Clinics that treat opioid addiction use several combinations other than methadone to be effective. In addition to daily methadone treatments, there are also random drug test to make sure the individual is complying with the program. There is also individual and group counseling that provides education and support with each being customized with goals set forth by the patient. Some addiction require patients struggling to seek professional help with a psychiatrist and/or speciality

Rosa Cunningham (full name is Rosa Lee) is a 53 year old African American female client of average height, slight build, and is appropriately groomed. She has 8 children, 2 of them being female and 6 males, all adults. Rosa is a widow and reached this status after being separated from her deceased husband for many years. Rosa is currently hospitalized for pneumonia, and has been hospitalized several times in her life for diferent illnesses. Rosa’s medical history as self-reported is HIV and seizures. Rosa is a heroin addict and has been this way for several years. Rosa is involved with the local methadone clinic and receives 55mg of methadone daily. Even by receiving this daily dose of methadone, Rosa continues to use heroin. Rosa has several legal and health issues that are present also, despite which she continues to use heroin. Rosa has a lengthy criminal history to include arrests for prostitution, larceny, and selling drugs. The reason for today’s assessment is a referral made by the social worker at the hospital in which Rosa is a patient at and discharge planning is to be made for aftercare.

D-Met with the patient as the Women's Group was cancelled due to low attendance. This writer addressed with the patient about her AWOL status, at which the patient started to get emotional as she is struggling with transportation, borrowing her mother's car, her husband is still having issues getting into the Hartford Dispensary-tested postiive for methadone, and too much stressors in her life, which is causing the patient to not eat. This writer validated the patient's feelings, provided support, and made suggestions. The patient admits to relapsing yesterday by purchasing 10 bags of heroin, but using 6 and gave her husband 4 bags-use of method was IV. The patient feels guility of using, but her stress factors are overbearing her recovery process and the patient struggles with coping. She then says, " When I come to the Women's Group, I feel good....I was hoping there was going to be group today....I don't know." This writer provided empowerment and encouragement to the patient to focus on her recovery process and proceeded to discuss risk factors of what she will lose.

Does anyone you know and or love currently struggle with opioid addiction? Have you witnessed the loss of a life due to opioid addiction? Opioid addiction is a major issue we are all facing the United States either directly or indirectly. The opioid epidemic has continued to grow yearly, and shows no real solutions in the trend of it slowing down or it coming to an end. Doctors are well aware of this information and are working to reduce the number of opioid abuse cases created at the source. There are options available to addicts including but not limited to inpatient rehabilitation programs, detoxification programs/facilities, and outpatient counseling support. These options cost a significant amount of money, unaffordable to most addicts,

Mental health: Client reported that he is currently waiting for an appointment for MH services from his OTP. The client reported his intention to continue attending a PTSD support group while in the program. Client denied having any S/I and H/I at this time.

An opiate-dependent person does not have the inability to think clearly and adapt easily into a life without the opiates. When an addict is presented with the challenge of stopping the use of opiates, the brain needs it more than ever before. Even long after the withdrawal symptoms are gone; an addict must deal with post acute withdrawal syndrome (PAWS). The syndrome lasts from six to eighteen months after the last use. It has importance to the recovering addict’s ability to benefit from recovery, treatment, function effectively on the job, interact with family and friends, and regain emotional health.

Pt. has been in the AMS program for 2 years. Pt. has had no positive UDS results for two years. Pt. is on a dose of 150 of methadone and he is responding as expected to his prescribed medication. Pt. demonstrated responsible attitude by attending monthly AMS groups faithfully. Pt. has discontinued all illicit drugs use and now he has used financial income in a more self-sustaining manner. Pt is effectively addressing this area by making regular payments as scheduled. Demonstrates treatment maturity and appropriately participating in medical treatment services. Pt. was taught calming strategies, such as relaxation and breathing techniques as indicated by previous counselor documentation. Pt. was assigned to this writer caseload and counselor

The primary intent regarding addiction from the social work perspective should be to help the general public understand that persons addicted to opioids, much the same as victims of any chronic relapsing disease, deserve to be treated with compassion and respect as they seek access to medical treatment for their disease. Having that foundation, the use of methadone can be a very efficient, non threatening alternative treatment. Social services should be meaningfully incorporated into the process at the onset of one becoming involved in the legal system by way of addiction. Policies and procedures that greatly enhance the assessment, intervention, and treatment of addiction should be as visible and available as the authority figure prominently appears in

Met with client for ISP review and to discuss treatment progress. Client appeared to be stable and engaged in the conversation. Client reported that she completed the FAFSA and is planning to go to Everette Community College in the summer. Client reported no use of substances. Client reported coping with temptation by walking away from the situations. Client was reminded that her relapse potential was moderate to high at this time and that she thus would be cautioned to avoid any unintended consequences; with help and support from treatment and her family, client would make his treatment a success. Reviewed ISP in Dim.5 dated 11/29/17, reported completion on approach C, but was unable to identify which peer pressure could be positive (approach

For my relapse prevention research paper, I wanted to choose a substance/individual combination which would be convoluted, devoid of a simple or straightforward treatment plan. Due to my interest in healthcare, I decided to address an increasingly prevalent issue in the field, substance dependence to clinically-prescribed opiates. According to the National Survey on Drug Use and Health (NSDUH), the number of opiate prescriptions written in the United States has skyrocketed over the past two decades. In 2013, the United States Department of Health and Human Services reported that there were an estimated 1.9 million illicit opiate users in the United States who were either abusing or dependent prescription pain

Mr. Barreto has a substance abuse history which includes abuse of marijuana, methamphetamine and cocaine. He began using marijuana at 15, cocaine at 16 and methamphetamine at 17. He cited his use of marijuana as an every other day occurrence, however his cocaine and methamphetamine use was more frequent. He reported that he prefers cocaine over methamphetamine and used both these substances interchangeably based on availability. His use stemmed from his involvement in construction and needing to be productive and alert at all times. Mr. Barreto denied any history of substance abuse treatment aside from RDAP. He identifies this substance as truly problematic and detrimental to his functioning. According to Mr. Barreto, he has been clean and

Counselor met with Pt. for an individual session. Counselor and Pt. discussed her progress in treatment and description of her medication compliance. Pt. reported wanting a higher dosage of methadone to side effects (cold). Pt. mentioned that she would like to switch to Vivitrol medication because she is going to move with her mother house in Lewes, DE and she cant come to the clinic everyday. Pt. requested, discussed and completed an AMS Modality Switch form. Counselor encouraged Pt. to talk about her current triggers and possible solutions she can plan ahead of time. Pt. stated, "I have no triggers." Counselor elicited the client’s perceptions on her several positive urine analysis. Pt. indicated that she use crack cocaine when she is depressed.

The client for this paper is a twenty-seven-year-old single mother to a six-year-old son. The client was raised in a hardworking middle class family in which her father built a successful business. Her parents divorced when she was ten years old, and she reports she never heard them argue before they announced to the family they were separating. The client describes the divorce as “ugly.” She started smoking marijuana with her friends at the age of fourteen which led to her opioid intravenous addiction by the age of eighteen. The client’s drug of choice is hydrocodone. She admits she has never tried to abstain from her drug use and has been arrested over twelve times as a result of her addiction. Her last drug charge resulted in a six-year prison sentence at the age of twenty-three. The client is currently court ordered to successfully complete an in-patient drug treatment program for up to eighteen months. If she successfully completes the program, she will be released two years early from her sentence. The client has been diagnosed with 304.00 (F11.20) Opioid Use Disorder – Severe which continues to make her eligible for treatment. Client is Hepatitis C positive.