Week 4 Discussion

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Week 4 Case Studies

Please select one of the following case studies to support your Application Assignment this week.

Marisa (Young Adult) Marisa is an 18-year-old lesbian-identified female of Hispanic American heritage. She has been referred to you by her college advisor following a consultation about her academic struggles and noticeable weight loss since earlier in the school year. In your first meeting with Marisa, she appears anxious and hesitant to discuss her challenges, repeatedly telling you, “My problems are no different from anyone else’s.” Marisa does admit that she has felt out of place at school, and feels pressured to fit in with “all of the pretty, rich girls;” she is also hoping to pledge a sorority before the end of the year. Marisa was raised by a single mother in a middle-class neighborhood, and she had little contact with her biological father during childhood. Her mother was married briefly to a man Marisa describes as a “fat, selfish jerk,” and their divorce was contentious. Marisa describes her mother as a “strong, beautiful role model” and states that she misses her mother very much. She admits that her mother was a very restrictive parent, and that Marisa had very little freedom growing up. Her mother was also somewhat critical and controlling, though Marisa quickly rationalizes those behaviors by saying “she just worried about me a lot.” Marisa also shares that her biggest fear at school is letting her mother down—her mother has repeatedly stressed the need for Marisa to focus on rushing a sorority, and being sure not to “fall victim to the Freshman 15.” As Marisa slowly opens up, she admits to you that she has been using cocaine “occasionally,” which she easily gets from her roommate. She emphatically denies that she has a “problem,” although does admit that she sometimes uses cocaine several days in a row when she needs to stay awake to study or to work her part-time job. Marisa also likes that cocaine controls her appetite, and she acknowledges that she’s lost a significant amount of weight (approximately 20 pounds) since the beginning of the school year. She adds, however, that “everyone tells me how good I look.” Sharon (Middle Adult) Sharon is a 32-year-old heterosexual-identified female of mixed Cherokee and Euro- American heritage. She is being referred to you at the suggestion of her lawyer, following the second charge of driving while intoxicated (DWI) in 6 months. During your intake interview with Sharon, she identifies that her drinking feels “out of control.” Sharon states that she has moved with her company four times in the past 3 years. She has never been married and identifies feeling "very lonely" and having a strong desire to make friends and to date. She states that she feels socially awkward about meeting men and “dating scenes,” and that the only place she meets people is in her local sports bar. An avid fan of her home sports teams, Sharon states, “the only

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place I ever get to watch them is at Willy’s Pub.” She identifies a strong camaraderie with the other sports fans at Willy’s, many of whom are from Sharon’s hometown. Both incidents in which Sharon was charged with DWI occurred after leaving Willy’s Pub. She states to you, “I do get pretty smashed sometimes when I'm there.” While Sharon does acknowledge a desire to quit drinking, she is insistent that she does not want to give up going to Willy’s Pub: “I see people who know my neighborhood, who love my teams, and, of course, I see my teams. No way am I giving any of that up. That would mean staying at home with nothing to do.”

Alan (Older Adult) Alan is a 70-year-old heterosexual-identified male of African American heritage. He is a recent widower, having just recently lost his wife to cancer. Alan and his wife were married for 48 years; he has four children and nine grandchildren, all of whom live in other states. Alan was referred to you by his primary care physician, who expressed concerns following Alan’s requests for pain medication refills in a very short period of time. The physician also shared that Alan had tried to get the office physician assistant to write him a prescription separately in addition to that requested directly from the doctor. Alan’s medical history includes high blood pressure and diabetes; in the past, he has also been on pain medications for extended periods of time due to a back injury. Alan maintains that the surgeries did little to help the problems, and reports, “I’m always in pain.” Alan acknowledges that he “might sometimes take more Vicodin that (he) should,” though he quickly rationalizes his drug use and changes the subject. He also shares that he is lonely much of the time, and that since the loss of his wife, he feels little motivation to even visit his children. When Alan speaks of his life, he generally focuses on past memories in a wistful, melancholy manner, and presents with a sad affect. Alan becomes somewhat defensive and agitated when pressed to recognize he is misusing the medication, and that there may be substantial health risks. Further, he dismisses your concerns by saying, “So what if it’s dangerous? Who would miss me anyway?”