Hartford Dispensant: A Case Study

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

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.

The counselor met with the patient for her scheduled Addiction Severity Index assessment. The patient is a 54 year old black male. The patient states he is single with no children. He report currently lives with sister in law of his decease brother. The patient reports having a 14 years of education however no degree. The patient report receiving disability for mental health disorder. The patient reports he is currently not on probation. The patient reports he last use Cannabis 7/17/15 and started using at the age of 13 and smokes 3 to 4 times a week at least 2 joints. He also report using Alcohol 7/20/15 a 40oz beer and usually drank a couple a day. The patient denies any issues with HI/SI. Patient also reports he is taking his medication as prescribed. The patient appear to be in the pre-contemplation stage of change. The patient next scheduled individual session with the counselor is on Monday, July 27, 2015 at 02:30p

ICM met with Mr. Hurley at New Start one located at 3653 N. 15th street t to assess Mr. Hurley’s needs and to complete paperwork for his activation. Mr. Hurley is a 41 year old Caucasian male who self- reports using Heroin since the age of 25. Mr. Hurley denied a history of other substance use; however, his referral noted a history of Cocaine and Marijuana use. Mr. Hurley is currently residing at New Start 1 and has been there for approximately two weeks. He stepped down from a level 3B care at Miracles in Progress. Mr. Hurley shared with ICM that his longest period of abstinence was for 8 years, but he could not recall details of his sobriety. During, this encounter Mr. Hurley was very talkative and engaged well with ICM. Mr. Hurley stated that he was hospitalized in the past on multiple occasions

The Larimer County 8th Judicial District Adult Drug Court program is a governmental agency that provides helps to individuals within the judicial system with drug abuse related offenses gain the tools for success to become a positive member of the community. The clients in this program have voluntarily chosen to be in this program and follow the terms and conditions of their probation as signed by a drug court contract that follows there terms and conditions set by the court. This may seem like a forced step or little step to some, but in reality, this is the first biggest step for drug abuse individuals because it means they are admitting they have a problem with drug abuse. Now it’s the Adult Drug Court team’s opportunity to provide the

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.

The issue that I will be researching and attempting to change is to limit the amount of weed dispensaries, and make sure to give a cut of the profit to schools or other organizations. I am choosing this issue because in Colorado weed dispensaries are taking over lots of real estate and not helping the community.

Objectives/Progress: As the Pt. has participated in the AMS program since 8/24/16 and he has been able to maintain abstinence from all illicit drugs for 6 months straight t. Pt.'s UDS has shown no evidence of drug use or lapse/relapse. Pt. is currently in the action stage of change as indicated by reminding himself of how much progress he has made and ability to change his behavior and achieve goals during the past quarter. He has currently obtained a full-time job as a shelving installer. Patient reports as scheduled to receive maintenance medication services as instructed by AMS Doctor and attends all mandatory one therapy session once a month. He continues to share his understanding of being powerless and unmanageable over his addiction. During the next quarter sessions, Counselor will support a realistic view of change through small steps.

Problem #5 Illicit opiate use Goal(s): To become drug free Status: Active Objectives/Progress: Pt. has not done well in achieving his goal of maintaining abstinence from all illicit substance use over the last quarter as evidenced by his positive UDS. Patient’s last urine screen results indicate that opiates have been used. Pt. reported that he was able to be clean from more than 30 days but he used drugs while walking through his neighborhood. Counselor expressed concern and disappointment about his recent relapse on heroin. During last month session, Pt. recognized the danger of the situation and how he will avoid the acquaintance that offered him drug. Pt. has failed to move to Phase 1 of the AMS of DE TX program due to his four positive UDS since entering the program on 7/6/16.Counselor will meet with Pt. to examine pt.'s motivation to stay clean, how to deal with triggers in order to achieve continued abstinence, to help him recover from his recent relapse and reenter the change process.

Client was considered to be in semi-compliance with treatment during this reporting period. Client attended two secheduled groups with two absences. UA were negative for all tested substances. Client reported participating in self-help meeting regularly; verification was provided. Treatment attendance needs to be improved in 30 days.

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

Substance Use History: The patient denies any drug or substance use except for Alcohol and Marijuana; started using in high school and everyday use.

Over the past several years marijuana addiction rates have escalated in South Carolina. Statistics from the Treatment Episode Data Set noted that in 2010, close to 55% of all South Carolina drug rehab admissions cited marijuana addiction as their primary reason for seeking treatment. This is a drastic increase from previous years when the percentage of marijuana addiction cases totaled just over 30% in 2006 and nearly 40% in 2008. Likewise, other substances of abuse resulting in South Carolina drug rehab enrollments during 2010 included cocaine and crack addiction (close to 20%), other opiates addiction (close to 20%) and stimulant addiction (around 5%).

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