Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

LISA, I know I don't need help. I don't need anything. Jeremy promised me that everything is going to be okay. And when you love someone like I do, you got to believe him. Right? 

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ALLY (ph) Really, come on. I'm missing first period. And now you want me to be late for my second class. Can we do this during my third period break? 

UNKNOWN I… I'm sorry, Ally(ph) but principal Michaels requested that you and I take some time this morning and talk. I… I know we worked together before right now, I'm going to have to put on my professional app. 

ALLY (ph) That's ridiculous. Why? 

UNKNOWN Well, maybe you can tell me why. 

ALLY (ph) I have a class waiting for me. 

UNKNOWN Well, you been frequently late for your classes. In fact, let's say uh… 22 days so far this year? 

ALLY (ph) It has not been 22 days. 

UNKNOWN Yes, it has, something not right here at school or something not right at home. 

ALLY (ph) My personal life is fine. And personal. 

UNKNOWN I know you haven't changed addresses so it can't be the traffic. 

ALLY (ph) Jesus. The History Department had a party last night a Darrel's(ph). Why don't you bring him in here and question him? 

UNKNOWN So are you saying the Darrel's(ph) party is the reason that you were late? That was last night? I don't understand. 

ALLY (ph) Okay. Alcohol was served. We had a bit much to drink. Not just me. We're adults here. And I mean, the… the school host of social hour on campus every month. 

UNKNOWN So what are you saying? Are you saying that you were drunk? 

ALLY (ph) I drank, but no. 

UNKNOWN Were you intoxicated enough that you passed out? 

UNKNOWN I woke up and Darrel's(ph) cash responding. And, and fuck him for not waking me. He came to school on time but let's be there lying on the couch. 

UNKNOWN Have you passed out other times? 

ALLY (ph) We have all passed out at times. I'm sure I've seen you drunk at those parties. 

UNKNOWN Are you still feeling intoxicated this morning? 

ALLY (ph) No, Course not. 

UNKNOWN Have you ever been drunk? While you were here teaching? 

ALLY (ph) No. 

UNKNOWN I'm asking that because we've had complaints. 

ALLY (ph) Complaints from who? 

UNKNOWN Students, parents. 

ALLY (ph) Well, bring him in. Let them tell that to my face because it's totally not true. 

UNKNOWN They've complained that at different times you came into class and then you ordered the kids to read from their textbook or you ordered the kids to copy notes from the board while you were sleeping with your head on the desk. 

ALLY (ph) You have to be kidding me. 

UNKNOWN Several students and several parents have complained. 

ALLY (ph) Exactly who, Alexis? Do you know how many problems she's created for the teachers at the school? 

UNKNOWN But you were drinking last night. And it sounds like you drank enough that you passed out and had to sleep on Darrel's(ph) couch? 

ALLY (ph) Yes. I mean, I did. 

UNKNOWN So, is there something going on in your personal life? 

ALLY (ph) No. 

UNKNOWN How's Ryan? 

ALLY (ph) Ryan? First time I've known you to travel slow here. We split up before the school year started. Last summer. 

UNKNOWN What happened? 

ALLY (ph) I'm really, really uncomfortable sharing anything about my relationships with you. 

UNKNOWN Okay, that's fair. That is your personal life. 

ALLY (ph) Is there any reason I just can't walk out of this office right now? 

UNKNOWN Well, I don't know the specifics of what the Board of Education would decide if you don't cooperate, but I'm guessing at something pretty serious. 

ALLY (ph) This is unbelievable. 

UNKNOWN Wait, wait. Wait a minute. The administration asked me to speak with you. The school wants to work with you if you'll cooperate. And as someone who really likes you. I am warning to understand. I'm hoping to help you. So just, okay, thank you. Good. Now, what's going on? 

ALLY (ph) I don't know. 

UNKNOWN Okay. How much did you drink last night? 

ALLY (ph) Too much. 

UNKNOWN How often do you drink too much? 

ALLY (ph) I don't know. 

UNKNOWN How much would you estimate that you drink in a typical week? 

ALLY (ph) Every night. 

UNKNOWN Do you drink with friends, family, by yourself? 

ALLY (ph) Alone. Once in a while I'll go to a bar with my friends or drink at school functions. Where I might add they do supply alcohol liberally. 

UNKNOWN Yes. 

ALLY (ph) They're removing our social hours to downtown. 

UNKNOWN Do you go out and drink other than with friends? 

ALLY (ph) Occasionally. 

UNKNOWN Do you drink alone at home? 

ALLY (ph) Few glasses of wine while a grade takes the edge off the day. 

UNKNOWN Takes the edge off. 

ALLY (ph) Yes. The kids here are getting worse by the year. The teachers talk about it. We all know what's going on. They become they just become more… more vicious, more mean. I'm talking about kids who have no hint of remorse, no empathy, no thoughtfulness for others. When was the last time you try teaching them? 

UNKNOWN I have to admit it has been a while. 

ALLY (ph) Just last week, I caught Alexis filming me on her phone. I was bent over picking up trash a student through on the floor. It was not flattering. And you know what she did? 

UNKNOWN No. 

ALLY (ph) Send it out to the whole grade adding a really obscene title. 

UNKNOWN Was she punished? 

ALLY (ph) Do the kids here ever get punished? All she caught was a bucking set down with their neuter principal. And then her mom comes threaten Sue again and naturally our fearless leader backs down. Michaels humiliated me. Did the administration tell you that? 

UNKNOWN No. 

ALLY (ph) Humiliated me. I work for a place that has no backbone, no spine. Who runs this place here? The students or the teachers. 

UNKNOWN Sounds horrible. 

ALLY (ph) And it goes on day after day. Rich kids who have no respect while you struggle to teach. I'm trying to pay bills here. Pay uh… pay the gas, driving shitty car, pay off student loans. 

UNKNOWN That does sound like a lot of stress. 

ALLY (ph) Sounds like. 

UNKNOWN Do you like teaching? 

ALLY: (ph) Once upon a time when it had meaning. 

UNKNOWN: What about now? 

ALLY: (ph) We aren't supported. 

UNKNOWN: Do you think all of this stress is contributing to your drinking? 

ALLY: (ph) Of course it is. 

UNKNOWN: Do you drink during the day? 

ALLY: (ph) No, no, absolutely not. 

UNKNOWN: When you do drink, how much do you drink? 

ALLY: (ph) Enough. 

UNKNOWN: Enough to pass out? 

ALLY: (ph) If I'm lucky. 

UNKNOWN: How much do you have to drink to get that feeling of being intoxicated? 

ALLY: (ph) Five or six glasses of wine, a couple of mixed drinks. 

UNKNOWN: Do you think that's more than it takes most people to get intoxicated? 

ALLY: (ph) I don't know, but… but I can. 

UNKNOWN: So, so do you think alcohol affects your body differently than it affects your friends? 

ALLY: (ph) Yes, alcohol affects. Yes. 

UNKNOWN: Do you drink more than your friends and the other teachers? 

ALLY: (ph) I… I drink, but… but you're not understanding it, it affects me differently. 

UNKNOWN: Has it prevented you from doing things or interfered with relationships? 

ALLY: (ph) Are you specifically talking about Ryan here? 

UNKNOWN: Yeah. 

ALLY: (ph) Okay, Ryan did not leave me because I drink. 

UNKNOWN: Okay. 

ALLY: (ph) I'm seeing someone new. We weren't even together for a year. 

UNKNOWN: Is drinking wine, beer, other alcoholic drinks in the evenings. Is that something new for you? Or was that something typical than your past? 

ALLY: (ph) No. Look, my father was an alcoholic growing up. When I was really little he drank. He got into AA and got sober. Mom was very supportive of him, but extremely strict with us in drinking. 

UNKNOWN: How did you feel about her being so strict with alcohol? 

ALLY: (ph) As a teenager it sucked. I went out with my friends I got drunk. And then freshman year was a huge vendor. Eventually I just I mellowed out. 

UNKNOWN And after college? 

ALLY: (ph) In grad school I drank here and there but not much. 

UNKNOWN: Do you think your alcohol intake is less that when you were in college or is it gone the other way? Has it increased recently?  

ALLY: (ph) More. 

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Training Title 151

00:00:15>> I see in your chart that you asked

00:00:15 your family physician to

00:00:20 prescribe oxycodone for your elbow pain,

00:00:20 and that your family physician

00:00:25 is worried that some of other medications,

00:00:30 drugs you may use may interact with the oxycodone?

00:00:35 >> Oxycodone is that's the same as OxyContin?

00:00:35 >> Yeah. Oxycodone is the generic name.

00:00:40 >> Yeah, I did ask for OxyContin,

00:00:45 but I don't take any other medications or drugs.

00:00:50 I'm opposed to putting anything unhealthy in my body.

00:00:55 >> Okay. What else have you tried?

00:01:00 >> Nothing else works.

00:01:00 >> Ibuprofen, acetaminophen?

00:01:00 >> Not even close.

00:01:05 >> No?

00:01:05 >> Yeah. I mean,

00:01:05 I'm allergic to codeine.

00:01:05 >> Allergic?

00:01:05 >> Yeah, like in Tylenol three.

00:01:10 A little while back, my friend

00:01:10 was in a motorcycle accident and had some leftover,

00:01:15 and I tried one of those,

00:01:15 and I was way allergic.

00:01:20 >> What was the allergic response you had?

00:01:25 >> My face flushed like real bad,

00:01:25 besides it didn't work.

00:01:30 >> Have you tried morphine?

00:01:30 >> Well, that's addictive, isn't it?

00:01:35 >> Yeah, well all the pain medications

00:01:35 or most of them are addictive.

00:01:35 Anti-inflammatory medications are not usually addictive.

00:01:45 >> Yeah, I tried morphine and the codeine, didn't work.

00:01:5 >> Okay.

00:01:50 >> Yeah, I get headaches too,

00:01:55 so ideally I need something that works for both.

00:02:00 I'd rather not take two medications if I don't have to.

00:02:05 Less medications the better,

00:02:05 that's what grandma always said.

00:02:05 >> Grandma? Okay.

00:02:05 >> Yeah.

00:02:10 >> Have you ever tried Dilaudid?

00:02:10 >> Yeah. They gave that to me in the ER once,

00:02:15 but just made me dizzy and constipated.

00:02:20 Constipated for like a month.

00:02:25 >> Oh, wow.

00:02:25 >> I almost had to go back to

00:02:25 the hospital for constipation.

00:02:25 Can you imagine having to go to

00:02:25 the hospital for constipation?

00:02:30 >> Oh my goodness.

00:02:30 >> Yeah, that's how bad it was.

00:02:30 >> Have you tried Demerol?

00:02:35 >> Yeah, it kind of worked for my headache.

00:02:40 It comes in a shot, right?

00:02:40 >> Yeah. An injection.

00:02:45 >> Yeah, they gave that to me at the hospital.

00:02:45 But that's the thing, you

00:02:50 can only get it at the hospital,

00:02:50 so it's not like it's going to work for me every day.

00:02:55 It didn't do anything for my elbow.

00:02:55 OxyContin it's the only thing that works for both.

00:03:00 The only thing that works for both.

00:03:00 >> You do seem set on the oxycodone?

00:03:00 >> Because it works.

00:03:05 >> What else have you tried other than medications?

00:03:10 >> Other than medications?

00:03:10 >> Yeah.

00:03:10 >> Yoga.

00:03:10 >> Okay.

00:03:10 >> Yeah. Tried that. Other kinds of meditation.

00:03:20 I mean, that's the thing with meditation is,

00:03:20 it works while you're doing it,

00:03:25 but then as soon as you stop, zilch. Biofeedback.

00:03:30 >> Good.

00:03:30 >> One doc tried that, same thing.

00:03:30 Works while you're doing it,

00:03:35 but then when you stop doesn't help at all. What else?

00:03:40 Like warm, hot compresses,

00:03:45 candles, long walks on the beach, massages.

00:03:50 >> Wow.

00:03:50 >> My boyfriend is really good at massages actually.

00:03:55 He's studied with this guru in India.

00:03:55 >> Oh, wow.

00:03:55 >> Yeah, swear to God

00:04:00 >> You have tried a lot of solutions.

00:04:00 Let me ask you more about your medication history.

00:04:05 >> I only take stuff for my headache and my elbow.

00:04:10 >> Okay.

00:04:15 >> Like I said, I don't like

00:04:15 putting unhealthy things in my body.

00:04:15 Vitamins, I take vitamins.

00:04:20 >> Yeah? Okay.

00:04:20 >> Like fish oils, some supplements,

00:04:20 but nothing corporate, nothing pharmaceutical.

00:04:25 I don't want to put that in me.

00:04:30 Even coming here today,

00:04:35 asking for this, it goes against my values.

00:04:35 >> I see. Okay.

00:04:35 >> But I got to function.

00:04:40 >> Do you drink alcohol?

00:04:40 >> On special occasions

00:04:45 like weddings, funerals, birthdays.

00:04:50 I got a ton of friends, so

00:04:50 whenever we have a birthday we're going to drink.

00:04:55 Let me think, like holidays,

00:04:55 New Years, and Christmases.

00:05:00 There's Christmas and then we also celebrate

00:05:05 Russian Orthodox Christmas on January 7th.

00:05:10 >> How often on the average?

00:05:15 >> When you add it all up,

00:05:15 once, maybe twice a week, I guess.

00:05:20 >> Will you drink enough to get intoxicated?

00:05:20 >> Depends on who I'm drinking with.

00:05:25 As Zane, that's my boyfriend,

00:05:30 he drinks a lot, so

00:05:30 I drink a little more when I'm with him.

00:05:30 >> Any legal problems from the drinking?

00:05:35 >> Once. So dumb.

00:05:40 Yeah, just one little charge for drinking.

00:05:45 I was the tiniest little bit over the limit.

00:05:45 So yeah, I got that and I had to take that course,

00:05:50 that stupid, boring course.

00:05:50 But I learned my lesson. If you're

00:05:55 a little bit over the limit,

00:05:55 stick to the back roads.

00:05:55 >> So you will still drive?

00:06:00 >> Well, yeah, but I'm super careful.

00:06:00 >> You think after you've been drinking,

00:06:05 that's an okay idea to drive?

00:06:05 >> It's better than letting Zano drive.

00:06:10 >> Zano?

00:06:10 >> Zane, Zano, same person.

00:06:15 Yeah. He doesn't even have his license anymore.

00:06:15 Not that it stops him.

00:06:20 >> What about marijuana?

00:06:20 >> Do I use it?

00:06:25 >> Yeah.

00:06:25 >> Marijuana medically helps with my headaches,

00:06:30 so yeah, I use it.

00:06:35 It's my right. Yeah, it's

00:06:35 your right. It's everybody's right.

00:06:40 >> How often?

00:06:40 >> Not often.

00:06:45 Two, four times a week, sometimes none.

00:06:50 It's expensive. Then when you do get some,

00:06:55 suddenly everybody is your best friend and you

00:06:55 got to share, you know how it is.

00:06:55 >> Do you ever grow marijuana?

00:07:00 >> I used to. But then we

00:07:05 moved and it's not legal in this backward state.

00:07:05 Where we live it's pretty public,

00:07:10 its not really private.

00:07:10 >> Do you ever have any side effects

00:07:15 from using marijuana like memory problems?

00:07:15 >> I was born with memory problems,

00:07:20 Doc, I don't think it's from the marijuana.

00:07:20 >> Any legal trouble with the marijuana?

00:07:25 >> Once. I mean, I'm super careful.

00:07:30 But Zano, he went away for

00:07:30 a year for selling

00:07:35 the tiniest little bit to an undercover cop,

00:07:35 which is total entrapment,

00:07:40 which is how I lost custody of Camper.

00:07:40 >> Camper?

00:07:45 >> My son.

00:07:45 >> Oh.

00:07:45 >> Yeah. He's staying with

00:07:45 my ex-husband’s parents right now.

00:07:50 They take good care of him.

00:07:50 >> How long have you been divorced?

00:07:55 >> Oh no, I never married that guy.

00:07:55 >> Oh.

00:07:55 >> No way I would marry that jerk.

00:08:00 No, I don't know.

00:08:00 It's been like four years since I've even seen him.

00:08:05 Something like that, four years.

00:08:05 >> What happened?

00:08:10 >> Lucas, my ex,

00:08:10 he freaked out because he caught

00:08:15 me doing just a few lines of coke,

00:08:15 but everybody was doing it back then.

00:08:20 Anyway, his mom found the mirror,

00:08:25 and the razors, and Lucas said I had to quit.

00:08:30 For whatever I lied,

00:08:35 and when he caught me,

00:08:35 I know it was bad to lie about that,

00:08:40 but I don't know it's in the past.

00:08:45 Water under the bridge. You live, you learn, you move on.

00:08:45 >> Right. Do you use cocaine now?

00:08:50 >> No, hardly ever.

00:08:55 I don't know, it's been like a month maybe,

00:08:55 or two months or something since I have.

00:08:55 >> Any legal problems from using cocaine?

00:09:05 >> No, we hardly ever do it.

00:09:10 >> Have you thought about stopping altogether?

00:09:15 >> I hardly ever do it.

00:09:15 Hardly even counts.

00:09:20 I don't know, when I do it,

00:09:20 it's just to relieve tension

00:09:20 or it's this thing Zano

00:09:25 and I do to bring each other closer together,

00:09:30 but I could quit anytime I wanted, easy.

00:09:35 >> Does your boyfriend have children?

00:09:35 >> Yeah, he's got two kids.

00:09:40 Yeah, but we don't see them much.

00:09:45 His other with his ex.

00:09:45 >> Oh?

00:09:50 >> She's a real snobby type. You know the type?

00:09:50 It is a freaking tragedy

00:09:55 because I see his two kids

00:09:55 just going down that same path.

00:10:00 They're just two little snobs.

00:10:00 It's a real shame.

00:10:05 We're not allowed to see them anymore though,

00:10:10 so I guess like what's the difference?

00:10:10 She went to court and said we were unsuitable.

00:10:15 Not suitable.

00:10:20 Says it all real nice in court,

00:10:20 and then not so nice over the phone,

00:10:20 if you know what I mean?

00:10:25 She's a real bitch.

00:10:25 >> Any other drugs?

00:10:25 Ecstasy? LSD?

00:10:35 >> This is going to make me sound like I'm

00:10:35 some 1970s hippy, druggo person.

00:10:40 I've tried ecstasy twice,

00:10:45 just twice, and LSD once, last year.

00:10:50 That was a bad trip. I am not doing that again.

00:10:55 >> Anything else?

00:10:55 >> Like what?

00:11:00 >> Stimulants?

00:11:00 >> Like power drinks if I need to stay up?

00:11:05 >> Sure

00:11:05 >> Caffeine, I drink a lot of coffee.

00:11:10 I don't know if cigarettes,

00:11:10 do they count as stimulants?

00:11:10 >> Yeah.

00:11:10 >> Yeah, I'm trying to cut back.

00:11:15 Two packs a day.

00:11:15 >> Ritalin, Dexedrine?

00:11:20 >> Oh, stimulants?

00:11:20 >> Right

00:11:20 >> Oh, yeah. Not a lot.

00:11:25 Like hardly ever.

00:11:25 I mean, if Zano and I are down for whatever reason,

00:11:30 or sluggish from smoking pot,

00:11:35 or just like if I need to get back up again.

00:11:35 Yeah, Adderall, just 20 helps.

00:11:40 >> Do you ever take prescription medications

00:11:40 that are not prescribed for you?

00:11:45 >> Well, are you kidding me?

00:11:45 Why would I do that?

00:11:50 I told you I don't like medications in the first place.

00:11:50 >> Klonopin, Ativan, Xanax?

00:11:55 >> Those?

00:11:55 >> Yeah.

00:12:00 >> Yeah, if my anxiety is acting up,

00:12:05 if my meditation isn't working?

00:12:10 Yeah, a couple Xana bars,

00:12:10 but not a lot.

00:12:10 >> How often would you estimate that is?

00:12:15 >> I don't know.

00:12:20 Two? I don't know.

00:12:20 I need like a freaking calendar to keep up with

00:12:25 all your questions, Doc, God.

00:12:25 >> So in the past,

00:12:30 who prescribed the oxycodone for you?

00:12:30 >> No one yet. Zano he

00:12:35 takes them because he's got shoulder and back problems,

00:12:40 and I tried one and it really works.

00:12:45 To be honest it works fantastic.

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