PSYC 305
CASE S A P TTUDY SSESSMENT APER OPICS
1. Patricia
(Please note this case history deals with , , alcohol abuse lawsuits surgery, and family dynamics.
If any of those issues are emotional triggers for you, please choose another case to explore.)
Patricia is a 65-year-old white woman, married for 42 years to Rob, an accountant. They have five
grown children and 12 grandchildren. She taught elementary school for 38 years and has not worked
since retiring 5 years ago. Her mother suffered with hypertension and died of a stroke 10 years ago at
age 81. Her father died after a heart attack more than 30 years ago at age 55. She has two younger
sisters, aged 61 and 59 years old, who are basically in good health.
She had an appendectomy at age 28, and a cholecystectomy at age 55, one month after her mother
died. She sees her family doctor for control of asthma and high blood pressure. The same family
doctor has treated the patient for nearly 15 years.
Patricia has been drinking, sometimes to excess, for several years. Her drinking began in the early
1990s after she was involved in a lawsuit initiated by a parent of one of her pupils. Although the
school backed her, and the case was eventually resolved in her favor, she remembers the two-year
period as one of constant fear and uncertainty. She recalls subsequently experiencing blackout
spells. On three separate occasions, she was hospitalized for detoxification, and brief periods of
sobriety followed. She would vow not to drink and would be sober for a few months after being in the
hospital, but then she would start to drink again.
Recently Rob and their eldest daughter called the family doctor to request time to “talk about mother.”
He related that his wife had resumed daily drinking (about one pint of vodka) three months ago. She
sometimes slurs her words. Their daughter has become fearful of leaving the grandchildren with her
mother. When they spoke with her, she denied “heavy drinking” and said they made “more of the
problem than there was.”
When Patricia came to the center, she validated the history of her alcohol habit, as presented by her
primary care physician. She added her several brief attempts to attend Alcoholics Anonymous (AA)
meetings, until about a year earlier when she quit attending because she “was bored.” She describes
her husband as a “workaholic who is domineering and often makes me feel defensive.” She admitted
to drinking daily for the past three months. She has slept poorly for six months, which she attributed
to “bronchitis and a chronic cough.” Her energy, appetite, and weight were all stable. She denies
being depressed or anxious. She reports that she recently drank very little while they were away from
home for a week-long vacation.
Patricia and Rob attend a local Presbyterian church regularly. They have friends there and serve on
various committees. When asked about her spiritual condition, Patricia indicated that she saw
nothing wrong with her drinking since Jesus drank wine.
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Patricia is neatly-dressed, cooperative, and appropriately behaved. Her mood is stable, and her affect
was full in range. She does not see a need for therapy, but has agreed to counseling because her
daughter is threatening to not let her see her grandchildren if she does not get help.
2. Angela
(Please note this case history deals with , , , , and alcohol use sexual abuse rape crack cocaine use
family of origin dynamics. If any of those issues are emotional triggers for you,
please choose another case to explore.)
Angela is a 32-year-old Hispanic female. She is divorced and employed as an administrative
assistant at a local human services program. She drinks alcohol and uses cocaine (crack). She lives
with her 11-year-old daughter, Katie, in an apartment near her job. Although she makes a relatively
low salary, Angela has managed to support herself and her daughter without financial support from
Katie's father. Angela was married briefly to Katie's father when she was 20, but she left him after he
became physically and sexually abusive toward her. He also was an alcoholic. She had almost no
contact with him for many years. Her mother is a strong support for Angela and Katie. Angela reports
growing up in a "normal family" and states that her childhood was "good" despite her father's
occasional drinking binges, which she says were related to him celebrating a special account he had
landed (he was in advertising), and her mother's "occasional bad depressions." She is the youngest
of five children and the only girl.
Angela describes having little pleasure in life and feeling tired and "dragging" all of the time. She says
her difficulty in standing up for herself with her boss at work is a constant stressor.
She has had periods of sobriety in her recent past. Her most recent stretch was more than six
months with no drugs or alcohol. After that, she started having a harder time getting up each day, and
began to drink daily. She started experiencing bouts of feeling worthless, sad, guilty, hopeless, and
very anxious. Her sleep problems increased, she began having nightmares, and she lost her appetite.
After a month of this, she saw friends and family less often, instead stayed home and watched TV.
She started her crack use again one night after her boss got very upset with her not finishing
something on time. She went to a local bar after work that day and hooked up with a guy she met
there to get crack. In accompanying him to a local dealer's house to get some crack, she was raped
by several men. Angela did not return home that night (Katie was at a friend's sleepover party) and
did not show up for work the next day. She does not recall where she was the rest of that night.
However, shortly after that, she came to the center for help.
Angela reports that she began drinking around the age of 13 and it became progressively worse over
the years, although she did not begin to see it as a problem until after she began using crack, at
around age 28. She says her depression got much worse after she began using crack.
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Angela reports having had gynecological problems during her 20s, resulting in a hysterectomy at age
27. When asked if she was ever physically or sexually abused as a child, she says no; however, she
confesses (with some difficulty) that when she was 11, she had an affair with her 35-year-old uncle
(father's brother-in-law).
Angela does not attend church at all, although she was faithful to Sunday school as a child. She says
she sometimes prays, but has not lately since she does not believe God listens to her. She says she
feels hopeless about her ability to put her life together and stay sober. Of her recent rape, she says
that she "only got what she deserved" for being in the wrong place with the wrong people at the
wrong time. Angela speculates that maybe she is an unfit mother and should give up custody of her
daughter. While Katie is currently staying with Angela's mother, Angela is concerned that her ex-
husband will try to get custody of Katie if he hears that she is in the hospital for alcohol and drug
treatment. He has been in recovery himself for two years and began demanding to see Katie again
about two months ago.
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3. Marco
(Please note this case history deals with , , and . alcohol abuse death of a spouse family dynamics
If any of those issues are emotional triggers for you, please choose another case to explore.)
Marco is a 74-year old Italian-American man, living alone in an apartment complex for older self-
sufficient adults. He came to the center that is associated with the housing units. Marco and his wife,
Marie, owned and operated a small, local grocery for 44 years (they came to the US from Italy when
they were newlyweds at age 19). They sold the business to their son Frank when Marco turned 70.
The plan was to enjoy travel and retired life together. However, shortly after retiring, Marie was
diagnosed with an aggressive leukemia, and she died within four months. Marco has been living
alone for over three years. Because Marco and Marie spent most of their time working and involved
with family activities, there are few close friends in his life. Frank's family has Marco to dinner every
Sunday, but has little time during the week because of competing demands. Marco’s other children
include a daughter living in another state who calls daily (but seldom visits because of the cost); a
daughter oversees in military service, and a son with Down Syndrome who lives in a group home an
hour away.
Marco says he spends most of his days in front of the TV. She still gets up at 7:00 each morning and
shaves and showers, but he doesn’t know why. He says, “I don’t have anyone to look good for.”
Marco indicates he was a "hard drinker" during his 20s and 30s, when he developed stomach
problems and high blood pressure. At that point, he limited his use of alcohol to his Friday night poker
club and to Sunday dinner with the family. Since Marie's death, he has regularly consumed three or
four drinks a day. He says it alleviates some of the pain, stress, and loneliness. It also helps him
sleep. He went to the local health clinic because his hypertension and gastritis have become
unmanageable. When you ask Marco how he is doing, he says, "Oh, I guess I'm okay for an old
widower. I don't think it really Danteers how I feel or what I do anymore at my age."
Marco reports that he and his wife were faithful to the Catholic Church all of their married life. Even
now, he attends mass weekly and goes to confession regularly.
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4. Emily
(Please note this case history deals with and . If either of those issues are alcohol abuse adoption
emotional triggers for you, please choose another case to explore.)
Emily is a 28-year-old Asian female accountant who grew up in Texas and started binge drinking as a
teenager. She says, "I started putting liquor into bottles of soda at 13 years old. My friends and I
would go to local bars or drink at our houses. I made friends with some older boys in my area and a
group of us would spend our weekends hanging out at their houses and drinking from their parents’
supplies. I think the first time I was actually drunk was when I was 14. By that age, I was able to go
out clubbing and not get carded - so I was drinking heavily and regularly every weekend It's much .
stricter these days than it was 10 years ago."
Emily says peer pressure was not part of her starting to drink, but that she may have encouraged
others to try alcohol. She says her childhood was good. She was adopted from Korea by a family
who were unable to have biological children. She went to a good school with strict discipline. Emily
states she was always a bit rebellious. She says, “I liked to be a leader. I was one of the first girls in
my class to date older boys and drink. I liked feeling like I was ahead of all the others.”
Emily says by the time she was 18, drinking was natural to her, and she was able to tolerate a
substantial quantity of alcohol without getting too drunk or sick. She says her social life continues to
revolve around alcohol.
On an average night, Emily will drink a bottle of wine before going out. This will be followed by four or
five cocktails and several shots or a second bottle of wine while she is out. She often loses track of
how much she drinks. Emily says she is lucky that she has never had to go to the hospital for her
excessive drinking, but she thinks alcohol is beginning to have a harmful effect on other aspects of
her life. Sometimes she has difficulty going to work the next day, and at least a couple of times has
called in sick.
She says there seems to be more chaos in her life. She frequently gets in fights with her friends and
boyfriend, but cannot remember why. She often loses her phone or keys when she is out.
Sometimes she passes out and wakes up not knowing how she got home. She says more than once
she has awakened in a place that she does not recognize. These recent incidents have frightened
her. Emily says she needs to stop her destructive habits, but she is not sure she needs to completely
quit drinking.
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5. Shanita
(Please note this case history deals with prostitution, sexual abuse, pregnancy, alcohol abuse,
and If any of those issues are emotional triggers for you, please choose another case toheroin use.
explore.)
Shanita has come by the free “drop-in” counseling clinic where you work to get some information and
advice. Shanita is a 22-year-old black woman who has been living with her boyfriend, Dante, for the
past five years. She and Dante have been using heroin for as many years. When Shanita was 10
years old, her father, whom she says was a very heavy drinker, left her mom and the kids, and never
came back. At 14, she started drinking and smoking marijuana. At 16, she had dropped out of high
school and at 17, she moved in with Dante. He introduced her to heroin. She reports using about one
half gram of heroin per day just to be able to function and feel comfortable. Dante does not work. In
order to pay for the heroin and pay the rent on their apartment, she works the streets at night. She
usually drinks four or five beers each night before going out to work. If she cannot score enough
heroin, she will try to score either some Valium or Klonopin to “tide me over until I can get some
heroin”. She says she has tried cocaine but, “I really didn’t care for the high all that much.”
Shanita says that the alcohol and heroin help to calm her nerves and get her through the night. She
and Dante are not having sex all that much. When they do make love, he never wears a condom. He
says that is what makes him different from her “customers” “Which is true because I won’t work
without a condom.” Lately she is having physical symptoms to cause her to think she is pregnant. She
says she knows it is Dante’s baby. However, she is not sure she can stop using opioids or quit work to
have the baby even though Dante wants her to keep it. She is confused about what she should do
and is her asking for help to make some decisions. Her friend who works with her at night told her not
to stop using dope if she is pregnant “Because it’s worse for the baby than to keep using.” “I just don’t
know what I should do?”
When Shanita was a child, she went to Sunday school regularly, but she stopped going to church
when she started middle school. She says none of her friends went, so she did not see the need to
go either. She says she believes there is a God, but is not sure He cares about her or even knows
who she is.
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6. Grace
(Please note this case history deals with , , and heroin use expulsion from high school family
dynamics. If any of those issues are emotional triggers for you, please choose another case to
explore.)
For most of Grace’s 19 years of life, she was a “normal kid” who swam on the school swim team and
looked forward to trips to the zoo with her mother. She is white and the youngest of four sisters.
Grace enjoyed art and French class, and her classmates at the high school she attended. Drugs and
alcohol had never been a problem. “I didn’t drink, smoke pot or anything,” she says. However,
Grace’s boyfriend was another story.
“My boyfriend was into heroin,” she says. Though she was tempted to try it, she never did. Then a
couple of years ago, he jabbed her with a heroin-filled syringe as she walked by. Grace was shocked
– at first – then grew to need the drug.
It was not long before Grace became addicted. “I’d use once every couple of weeks,” she says. “But
then it progressed…and I was doing it every day.”
She was also stealing money from her parents to buy drugs. The combination of lying, stealing, and
addiction led to a breakdown. “I was going through counseling and I told my therapist about all the
lying and using behind my parents back,” she says. Grace told her parents about her drug use and
tried hard to quit. However, she could not.
Within a few months, Grace had returned to a daily habit and along with an acquaintance, brought
drugs and needles with her for a three-day senior retreat. Members of the school staff discovered
their plans and called Grace’s parents to come and pick her up. Just two months shy of graduating,
Grace was expelled from high school.
She was given a job at her father’s business to keep her busy while her parents looked for ways to
help their daughter. She says she stays clean for a few weeks at a time, but then the craving gets the
best of her and she begins using again.
Grace’s parents are strong Christians and want to help their daughter, but are somewhat unsure of
how to do so. Grace went to church as a child and continues to go most Sundays, but does not
believe it helps with her addiction issues.
Grace continues to struggle with her addiction. “I relapsed during the school year,” she says.
Throughout the last few months, Grace has experienced several relapses, the worst coming over the
Christmas holiday. “Normally when I relapse I use once or twice,” Grace says. This time she used
every day.
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Grace has currently been sober for 90 days, but she says she feels herself slipping. She wants to
finish high school or get her GED, but she has difficulty staying on task.
7. Ryan
(Please note this case history deals with , and alcohol marriage conflict, family of origin
dynamics. If any of those issues are emotional triggers for you, please choose another case to
explore.)
Ryan is a 45-year-old white male who is a safety expert for the Department of Transportation. He
began his career as a mechanic in the US Army. About five years ago, he moved into his current job.
He sometimes feels out of place as a “white-collar” executive. He and his wife, Diane (a physician’s
assistant) have been married 18 years and have three children. They have a very comfortable life,
financially. Ryan has been coming to individual counseling for several months for help with his anxiety
and anger. He and Diane are also seeing a therapist for marriage therapy.
Ryan admits to drinking alcohol every day. His wife knows he drinks, but he says she has no idea
how much he drinks. It is easy to smell alcohol on his breath when he comes to each session. He
says he does not drink during the day when he is working, but stops on his way home or before
coming to counseling to get beer, vodka, or wine. He says he is not particular about what the drink is.
He just likes the taste and how it makes him feel. When he and his wife go out for an evening, he
may have “a couple of beers,” but he does not drink to excess. However, he admits to keeping
bottles of liquor in his garage and other places around the house. He likes to cook, but says he
always wants to drink wine as he is cooking. He says he tries to do a lot of the cleaning and cooking
at home to make it easier for Diane.
Ryan grew up with both of his parents in the home. He has a younger brother and sister. His mother
has always suffered from depression and anxiety. He says his father was always taking care of his
mother, and the household revolved around keeping his mother happy. He says it is still like that and
has recently stopped talking to his mother after a heated family argument at Thanksgiving. He grew
up going to church, but says it was not a big part of his life. He does not believe in God or has any
regard for spiritual Danteers now.
Although he says he does not want to stop drinking completely, Ryan acknowledges that he should
“cut down.” He says he has been able to cut down in the past and even stopped for a few months, but
now he is drinking more each day than he ever has. He says he knows it is not good for his body.
He is starting to have some heart problems and is seeing a cardiologist. He also is medicated for
high blood pressure. Ryan works out at least three times a week. How he looks is important to him.
The weight gain with the increased alcohol intake bothers him.
Ryan’s wife wants him to stop drinking and has told him she will not continue in the marriage if he
continues to drink. Ryan says if she knew how much he really drinks, she would have already left
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him. He loves his wife and does not want a divorce, but Ryan says there are a lot more problems in
the marriage than just his drinking.
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8. Hallie
(Please note this case history deals with , alcohol marriage conflict, cocaine use, heroin use, and
family of origin dynamics. If any of those issues are emotional triggers for you, please choose
another case to explore.)
Hallie is a 40-year-old white female who is currently unemployed. She has a degree in social work
but has not had a job for more than five years. Hallie is married, but she and her husband Charlie are
not together. He insisted she leave the house when her alcohol and drug use became her priority.
Hallie and Charlie have an 11-year-old son, Hunter, who currently lives at home with his father. Hallie
says Charlie is “hypocritical” since he has used drugs, too, for almost as long as she has.
Hallie is living with her mother because she has nowhere else to go. She has been to rehab four
different times with the most recent being about a year ago. After she was released, Hallie started
using crack cocaine again within two weeks. She says she has rarely been clean for more than 30
days at a time (except when she is in rehab) since she started using about eight years ago.
During Hallie’s most recent rehab stay, she says she was in a special program where doctors, nurses,
and therapists were with her day and night, speaking to her all the time, never allowing her to fully
rest. She says they instructed her all the time about everything she was supposed to do or not do and
specifically how she was to perform every task. They only spoke to her; never to the people with her.
She was the only person who could see or hear them. After she got out of the hospital, she didn’t see
the program people as much, but they sometimes still come and talk to her.
Hallie is using cocaine occasionally now, but not as much as she was because her resources are
limited. She says that about six years ago, her grandmother died and left her a substantial sum of
money, but it is all gone now. She used most of it for drugs.
She would like to stop using drugs and drinking but does not believe she can do so. Hallie says she
has tried to quit so many times and has been unable to stay clean. However, she misses Charlie and
Hunter and would like to be able to move back home so they could be a family again.
Hallie’s mother is with her at the center today, but it is apparent that she is “worn out” with taking care
of Hallie and trying to help her. In a private moment with you, she said, “I’m too old to still be taking
care of my daughter, but what else can I do?”
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9. Charlie
(Please note this case history deals with , , and . If any substance abuse stealing family dynamics
of those issues are emotional triggers for you, please choose another case to explore.)
Charlie is a white male, 45-years old. He works as a union tradesman in an auto parts plant. He is
married to Amy, an office worker. They have been married for 23 years, and were high school
sweethearts. They have two children (Hannah, 16 and Bradley, 13).
Charlie’s substance abuse began about 15 years ago when he had an accident at work where he
injured his back. He had surgery to repair it and was given oxycontin for the pain before and after
surgery. He says the pills helped with the pain and he was able to function. After he healed from the
surgery, he found that stopping the pills made him ill physically, but he also would fall into depression
when he tried to stop.
On two different occasions in the past 10 years, Charlie has been to a residential treatment center.
He was able to go through detox and stop using for a while, but he says the “feeling of dread” that he
has when is without the substance is overwhelming. He says, “I don’t think I want to live if the rest of
my life feels like this.”
At times in the last 15 years, Charlie has been able to get a doctor to prescribe pills for him, but they
never last long enough. In recent years, with restrictions being increased, it has been more and more
difficult for him to obtain pills legally.
Charlie’s parents were divorced when he was young, and his mother remarried. He has maintained a
relationship with both his parents. Both his mother and father struggle with opioid addiction and have
given pills to Charlie when he “needs” them. He says his dad always seems to have an abundance of
pills, even selling them to others for extra money.
Charlie’s wife, Amy, is becoming more frustrated with Charlie’s need for drugs. She recognizes that
he is spending a substantial amount of the family budget on pills. While together they make enough
money to support the family, the drugs are expensive and take away from the things they would like
to do as a family.
Amy is threatening to leave Charlie if he does not get help. While Charlie admits the marriage has
not been good for several years, he says, “I don’t want to live away from my kids.” He is willing to
seek help but says he doesn’t think anything will work. He has been to residential rehab twice and
gotten clean, but always goes back to using because he cannot stand the feeling of dread and doom
that overwhelms him when he is clean.
Charlie says that when he does not have pills to take, he spends a lot of his time and energy trying to
find a source of opioids. When he has pills to “get him through,” he is constantly worrying about what
will happen when he runs out.
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Charlie expresses that he wants to get help, but is not hopeful that anything will work for him. He
thinks he has tried every option without success. He seems to be resigned to continuing to live his
life in the current pattern.
Charlie grew up in the Church of Christ and continues to attend regularly with Amy and the kids. He
says he is a Christian and reads his bible and prays daily. He has prayed for deliverance thousands
of times, but doesn’t feel like God has answered. He wants to be free of his need for the pills, but so
far, nothing has worked for him long-term. Charlie says, “I don’t have much hope of anything
changing.”
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10, Christina
(Please note this case history deals with , , , and .alcohol abuse gambling stealing family dynamics
If any of those issues are emotional triggers for you, please choose another case to explore.)
Christina is a white female, 45-years old, and a stay-at-home wife and mother. She has been married
for 25 years to Dan, a plumber, with two daughters (23 and 20 years old) and one son (11 years old).
Christina’s gambling began about 7 years ago. She began to go out with her friends to horse races
and bet small amounts. She never won very much but remembers that she had a good time. Her
husband did not know that she went to the races, but she dreamed of hitting it big and giving him a
nice surprise. She never lost control with this kind of betting. Later, she began buying lottery tickets.
She spent about $20 weekly and continues to do so.
Christina began to lose control playing slot machines about six years ago. While waiting for a friend at
a coffee shop, she saw a man win a prize playing on a slot machine. Since then, she started
spending the change from the price of coffee on the slots. She became increasingly hooked and
spent more and more time playing. As a result, she began to drift away from her friends, preferring to
be by herself to feel more at ease. At first, she played in her hometown, but then she began to go to
the track and casino in a nearby town, so neighbors and people who knew her would not see her.
Christina grew up in the Catholic Church, but has not gone to mass for many years. When she
married Dan, it was not in the church, and she has rarely attended since. She did not take her
children to church, and they did not attend on their own. One daughter, Emma (the 23-year-old), has
started attending a large non-denominational church in their town. She has invited Christina, but so
far, she has not attended.
Christina continues to play the lottery and slot machines (spending about $175 in total). She goes
about three times a week to the track and casino in the next town—never anywhere else—and
spends $50-60 each time, although one time she lost $270. When she wins money, she does not
leave the gambling area, but, instead, continues gambling until she loses everything. She only allows
for $5, which she keeps in a separate pocket, for the bus trip back home.
Christina feels depressed and ashamed because she is forced to lie. When she gets back home, she
usually finds people from her town on the bus and she no longer can think up an excuse for making
the trips. When she arrives back in her town, old friends are usually at a coffee shop near the bus
stop, and when she is with them, she has to think up new excuses. She is totally despaired, can no
longer take it, and thinks nobody believes her anymore. When she is very down, she often drinks too
much, “to forget it all.” At home, the situation is not any better. She is very nervous and has difficulty
sleeping. When she gets home, she does not like talking nor does she feel like doing any housework.
Nobody in her family knows anything about her gambling, although she does think they suspect
something.
On one occasion, she commented to them that she had a problem but did not dare tell them the truth.
She has let the house run down and even her personal appearance. Her daughters confront her
because it is not possible to talk to her, and Dan, who until recently has not worried about money at
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home, has begun to ask her to account for her spending. Christina is very desperate because she
has spent all of her savings. Her gambling has added up to become a $1,500 debt from a small
personal loan that she can no longer meet. She has never stolen, but on some occasions has begun
to go through the drawers in her daughters’ rooms searching for money to use for gambling. Every
night when she goes to bed, she thinks that she is not going to gamble the next day; however, she
cannot help it. Her thoughts about gambling are continuous. The relationship with her husband is
worsening. They have not had sexual relations for two months, because she feels incapable, and he
has lost interest. Christina insists that if Dan were to find out, he would file for divorce. She has come
to the therapist’s office ready to do anything she can to quit gambling because she can no longer
cope with the situation she finds herself in, and she feels she is incapable of controlling it by herself.
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