Relapse Prevention Plan Paper

Case Study Scenario #4: Legally Speaking…

You are a Licensed Substance Abuse Practitioner working in a governmental outpatient facility with 10 other

licensed professionals and 2 clinical supervisors. The intake department forwards you the referral and

assessment information for Brianna a 23 year old Hispanic female who is being referred to you for substance

abuse treatment.

Within her intake packet, you find her drug history which details her heroin usage since she was 15 years old,

history of prostitution and molestation, frequent incarcerations for petty theft, armed robbery, domestic

violence history and prescription fraud (opiates) charges, which led to her current probationary status for 15

years.

Also within this packet you find a release of information that Brianna signed when she first initiated probation.

It gives you permission to release all screening, assessment, appointment, drug screens and any other treatment

related information to her probation officer throughout the life of her probationary status (15 years).

Before meeting with Brianna, you receive a telephone call from the probation officer, Ms. Smith who

introduces herself as the supervising officer and requests biweekly status reports on Brianna. Ms. Smith also

informs you that if Brianna does not complete treatment or is unsuccessfully discharged, she will be placed

back into incarceration. You agree to the status reports and obtain the necessary information (e.g. telephone

and fax info etc) to comply with this request. After your call, you contact Brianna and then schedule your first

session.

Brianna comes to the first session with her clothing disheveled and with a noticeable body odor. She states that

she has been up all night “trying to get used to being out you know?”

She informs you that she was just released from incarceration the week prior to your meeting after serving 4

years on prescription drug and heroin charges.

During the first meeting she has questions regarding confidentiality and what is or is not reported to Ms.

Smith.

You discussed with her your role as a treatment provider and that you will give her a copy of all urine drug

screens however these copies will also be provided to her officer as long as there is a release on file to which

she is agreeable.

For the first month, Brianna requests to have appointments at the same time every week and produces all

negative drug screens. She has been attending all treatment meetings however she refuses to attend any outside

support groups “Because I have supportive friends already” and seldom completes and relapse prevention

homework or other outside activities to prevent relapse “I have been able to do this good without it, so I don’t

need that stuff.”

Her dress and grooming has improved and it appears that things are looking up for her.

After 45 days of treatment, Brianna misses her appointment and you have to reschedule. She is adamant that

she does not want to come in the same week of her missed appointment and requests that you see her in two

weeks.

You inform Brianna that while you can see her in two weeks, your report to Ms. Smith is due by tomorrow

evening and that this missed session will have to be reported.

Brianna reluctantly agrees to come in this afternoon.

Upon arrival, she again is disheveled and presents with bags under her eyes. It is 85 degrees outside however

Brianna is shivering and wearing a sweatshirt. She states that she is trying to get over a flu and has had a bad

case of diarrhea and vomiting.

Skeptical about her appearance and presentation, you request to receive a urine drug screen sample.

Brianna refuses stating “You only do those on Wednesdays and Thursdays, today is Tuesday so I don’t have to give a sample today.”

Again you request a sample and inform Brianna that urine drug screens are random. You also inform her that a

refusal to give a screen will be reported to her probation officer.

She reluctantly provides a sample but then states that she cannot stay for her session.

The following Thursday, you receive multiple calls from Brianna inquiring into her urine drug screen results.

You have not received them as of yet however this is the first time she has requested to find out the results so

soon.

A few hours later, you receive the results and they are positive for Cocaine, Heroin and prescription

medication.

You contact Brianna and inform her of the urine drug screen results. She denies using any drugs and then

requests to rescind (take away) her release of information for her probation officer.