Psychology Homework

Addiction Case Conceptualization Template

[MUSIC PLAYING] CYNDI BRIGGS: Well Magda, it's so nice to see you again. Thank you for coming back. How are you doing? MAGDA: I'm doing the best that I can. CYNDI BRIGGS: Right. I know there's a lot going on. And I really look forward to delving in a little bit more deeply with you today. I think today's session will be helpful for you. And we're going to build on some of the information that we talked about during our screening time the last time we met. Today, we're going to be doing what's called a biopsychosocial spiritual assessment. And so we're going to look at all these different areas of your life. And I'm going to ask you a whole bunch more questions. And so some of it may feel a little repetitive or a little bit tedious. But the goal today is just to really get as clear a picture as possible before we start making decisions about what happens next. So does that make sense, and do you feel ready to get started? MAGDA: I guess so. Bring it on. [CHUCKLE] CYNDI BRIGGS: Yeah, yeah, this is all a little nerve wracking, isn't it? MAGDA: A little bit, yeah. I just never had to do something like this before. CYNDI BRIGGS: Yeah, it feels it feels pretty strange. So we'll both just take a really deep breath and just dive in together. And of course, any time that you have questions for me, you are more than welcome to ask. Or if you want to take a pause or anything, you're in control here. So if it's OK, I'll go ahead and get started. We're going to start with looking at your overall substance use. You mentioned last time that you do use alcohol. Can you talk a little bit more about how much alcohol you're using? MAGDA: I mean, I don't drink often usually, on the weekends, a typical glass of wine. CYNDI BRIGGS: OK, so just one glass, is that pretty standard? MAGDA: Yeah, I mean, like if I have company, one or two. CYNDI BRIGGS: OK, so one or two glasses, and what about during the week? MAGDA: Usually during the weekends, I'm at a bar. During the week, then I'll maybe go out and have a Margarita or something. CYNDI BRIGGS: OK, so you might have a Margarita, a glass of wine or two. And that's pretty standard for you. MAGDA: Yeah, a Margarita or just wine, usually wine. CYNDI BRIGGS: OK, sounds good. So you have a preference. And that's kind of that one to two glasses of wine is sort of the norm for you. MAGDA: Yes. CYNDI BRIGGS: OK, so shifting gears a little bit, what about cannabis, marijuana? Have you ever used that, or is that something that's a part of your life? MAGDA: Oh, no, I haven't. I've never used that before. CYNDI BRIGGS: OK, now I'm going to start asking about some a little bit harder drugs. And so I just wanted to kind of let we're going to shift gears a little bit. So just let me know if any of these things have been a part of your life either now or in the past. So what about cocaine use? MAGDA: No, no, I have never used cocaine before. CYNDI BRIGGS: OK, gotcha. What about stimulant use like speed, amphetamines, anything like that? MAGDA: I mean, I don't even really know what speed is. But no, I haven't had that. I've never used any drugs except for what we're going to talk about today. CYNDI BRIGGS: Right, gotcha, gotcha. I know all of this feels very overwhelming, especially if drug use aside from prescription medication has never been a big part of your life. I'm going to go through and ask about a couple more just to be clear. Sometimes for some people, they've maybe been prescribed something in the past, or there's been some experimental use when they were much younger that maybe flew off the radar. So I'm just going to check about a couple of other things, and then we'll move on. And so no speed or amphetamines. What about things like inhalants? So this is often younger people do this, like sniffing gas or paint or glue. MAGDA: No. CYNDI BRIGGS: Hallucinogens, like LSD or PCP? MAGDA: No, I have not done something like that before. CYNDI BRIGGS: OK. So this next one on the list is opioids like OxyContin. And that is something that you've used. MAGDA: Well yes, that's why I'm here right now. CYNDI BRIGGS: The OxyContin. MAGDA: Yeah. CYNDI BRIGGS: Gotcha. Any other opioid use, such as heroin or narcotics? MAGDA: No, no. CYNDI BRIGGS: Gotcha. So let's go back to that OxyContin. You talked a little bit during our screening about your accident. Can you talk just clarify a little bit about how the OxyContin use began and sort of just a general sense of how long you've been using that? MAGDA: Well, about two years ago, I was injured. I had a back injury while carrying a patient because I'm a nurse. And I was prescribed OxyContin for about a year. But about six months ago, the doctor canceled my subscription, sorry, not my subscription, my prescription. Sorry, I'm a little bit nervous. And yet I just had to find other ways of having it CYNDI BRIGGS: OK, gotcha. And so what I'm hearing is there's a couple of things going on. You've talked about this accident. But also you've had back injuries in the past. So there have been multiple instances where OxyContin is really kind of come to the rescue for you where that's the pain gets to be so much, that that's the one thing that really helps you. And you mentioned that you've tried different ways of getting your OxyContin. Can you talk a little bit more about that? What are some of those ways? MAGDA: Well, I know someone who can get that for me. And I do my best not to overstep. I mean, I know that it's not-- I know that's not necessarily legal. It's just been really hard for me lately. CYNDI BRIGGS: Yeah, yeah, I hear that. You've kind of had thing upon thing over the past few years. And it makes it really difficult to let go of some of that OxyContin use. MAGDA: Yeah, I mean it's hard to wean myself off of that because the pain keeps coming back. CYNDI BRIGGS: I hear you. I can hear the exhaustion when you take that deep breath, and you sigh, it's just exhausting. And trust me when I say this. You are not alone. This is a struggle for so many people right now. OxyContin is a highly addictive drug. Unfortunately, it works really well, which is why people are prescribed it in the first place and also why it's so hard to stop using it and cut back on use. And so what you're dealing with here is really common among people who struggle with chronic pain and find themselves using opioids or OxyContin to a point that really makes it difficult to stop. MAGDA: Yeah. Yeah. CYNDI BRIGGS: Yeah. You're definitely not alone. So let's put that over here to the side for just a second. There are a few more questions kind of other drug use. I just want to make sure we explore all the possible avenues real quickly. So the next one is Valium or phenobarbital. Have you ever been prescribed those or use those? MAGDA: No. CYNDI BRIGGS: OK, the next one is steroids or cough syrups that include steroids, any of that use? MAGDA: Oh, no. I mean, I've had cough syrup before and had steroids when I had poison Ivy a while ago. But I don't normally use that. CYNDI BRIGGS: OK, gotcha. That was like a one time thing. OK, and then what about smoking or chewing tobacco? MAGDA: No, I have never smoked. CYNDI BRIGGS: OK. Have you ever injected drugs using needles? Has that ever been a part of your life? MAGDA: Never. CYNDI BRIGGS: OK, that's actually a really good news. That can be a real-- that can be really challenging for folks from a medical perspective. So that's very helpful to know. And it sounds like it's definitely not your thing. MAGDA: No, yeah, fortunately, not my thing. CYNDI BRIGGS: So intravenous use is one way to use drugs. What about snorting drugs, so in other words, inhaling them? Has that ever been a part of your life. MAGDA: Oh, never, no. CYNDI BRIGGS: OK, so I feel like we've really honed in on OxyContin is kind of the main problem. I think you were aware of that. And it certainly seemed to be going in that direction from our screening. So let's explore this a little bit more. What I'd like to talk to you about now are what are called triggers. And so these are the things that kind of make you want to use or feel like it's almost like an itch that you have to scratch when you get this feeling. So for some people, triggers are things that happen in their life. It might be a smell. It might be an experience. It might be a memory. What kind of things are triggers for you? As you've been trying to get off the OxyContin a little bit, what kind of things, what kind of triggers make it difficult for you to cut down or stop using the OxyContin? MAGDA: I guess, I don't know. It's just like always popping into my head. And I guess maybe when well, obviously when I'm feeling pain. And my initial reaction is OK I'm having back pain. Take some OxyContin. And I take it every four hours, 40 milligrams. And yeah. CYNDI BRIGGS: OK. MAGDA: Sorry, four hours, I was, sorry. CYNDI BRIGGS: OK it can get confusing. I think whenever we start talking about medical stuff, it's like a lot of numbers and amounts flying around. And it can definitely get confusing. But it sounds like you're describing it's popping in your head a lot. It's something that's sort of on your mind. And you're really aware of that next time you get to take your dose, that that's really prominent for you and that this pain is what got you started in the first place. So is that pain still there for you? MAGDA: Yeah, yeah the pain is still there. My physical therapy is just not helping. And my recovery from my car accident is just taking so long. And sometimes, when I feel nauseous if I don't have it after four hours, I start to feel my back pain again. And I start to feel nauseous like really, really sick. And I don't know. It just, it helps alleviate that. It makes me feel I don't know, everything is much more euphoric. And I can just forget about all this struggle for a while. I don't know. CYNDI BRIGGS: Yeah. Well, it makes sense to me that you're keeping your eye on the clock if you're starting to feel nausea, which is a really unpleasant side effect. And then also, you're talking about how that OxyContin really kind of brings you up a little bit. It helps you, you use the word euphoric. It helps you just feel better. So those are both really reinforcing things that would make you want to use. Are there any other things that make you want to use besides the things you've already described? MAGDA: I guess just like conflict in general if in fighting with my husband or even if we don't fight, but I'm feeling the tension around everything that's not great with us. I don't know. I just, it helps makes things not a sucky as they already are. CYNDI BRIGGS: Gotcha. Yeah, yeah. It makes it feel more manageable for a little while. It takes that edge off. MAGDA: Yeah, I guess so and exactly. It does kind of just help take the edge off. It really does. CYNDI BRIGGS: OK so with all the stress it sounds like you've been experiencing, especially the past couple of years with the injury and then the car accident and then the conflict with your husband, all of those things get together could really create a lot of disruption for anybody. So one thing I always like to check with my clients is if you've ever had moments of thinking about harming yourself, such as suicidal thoughts, any kind of self harm, anything like that that's concerning you. MAGDA: I mean, I don't-- I mean, I've had days where I'm depressed, but no, never planning anything. CYNDI BRIGGS: OK, so some sense of depression, feeling down, but no active thoughts of hurting yourself or killing yourself at this point. MAGDA: No, no. CYNDI BRIGGS: OK, so another piece is sometimes people want to engage in self harm like cutting themselves without actually being suicidal. Has that ever been an issue for you? MAGDA: I mean, it's not the standard like cutting or burning. But sometimes, I just want to slam something down. And it's not really harming myself, but I'm just angry. CYNDI BRIGGS: Yeah, OK. MAGDA: I don't know. CYNDI BRIGGS: Yeah, yeah. So no thoughts of cutting or burning yourself with cigarettes or anything like that. MAGDA: No, I mean, I don't smoke, so no. CYNDI BRIGGS: OK, but you get that feeling like you want to just slam something down like you get so much energy and maybe some frustration that you just want to throw something. Have you ever thought about throwing something at a person? Has that ever been directed towards someone else? MAGDA: I mean, I've definitely wanted to throw a book that's next to me at my husband when he's yelling at me. But I've never premeditated any malicious or violent actions. So it's not really, no. CYNDI BRIGGS: OK, so you have that frustration that you wish you had an outlet, but you don't have sort of serious thoughts about doing real harm to anyone else. MAGDA: No, I mean, thoughts are thoughts. But I've never contemplated them or like I said, premeditated anything, so no. CYNDI BRIGGS: OK I'm going to switch gears just a little. You mentioned sort of with the conflict with your husband, and sometimes when he's yelling, and you're arguing, you just get really frustrated. And so what I'm wondering is if you've ever had any concerns about someone else harming you like if you're feeling safe at home, if you're feeling like your own well-being may be in danger because of someone else. Any concerns there? MAGDA: Someone else harming me like paranoia? CYNDI BRIGGS: No I mean, that's certainly important to consider, but not necessarily paranoia, more like a legitimate concern, like are you worried at all that someone else might cause you harm, be it your husband, any abuse in the home, anything like that? MAGDA: I mean, no. I've never actually thought that anyone is going to cause me harm like actually going to cause me harm. I mean, sometimes when my husband and I fight, he can be a little bit scary. But he's never said anything that he's going to hurt me. And he's never threatened me, and I've never been threatened by him or anyone in my family, so no, no. CYNDI BRIGGS: Thank you for that. I know this is really sensitive and can be tough to talk about. I appreciate your honesty. Are there any weapons in your home like a handgun or anything like that might be of concern? MAGDA: Oh, no, absolutely not. CYNDI BRIGGS: So no guns, any other kinds of weapons? MAGDA: I mean, we have kitchen knives. That's about it. CYNDI BRIGGS: OK. Have you ever felt threatened by someone with a knife, or have those ever felt threatening to you in any way? MAGDA: No, they haven't. And no, I have not. CYNDI BRIGGS: OK. Thank you again for being so honest about all that. I know these questions can be tough, and these conversations can be hard. My primary goal is just to make sure that you're safe and you feel like you're in the best environment to heal, to recover, and to start to feel better from all of this. MAGDA: That's good. So I mean, is this going-- are you diagnosing me already? CYNDI BRIGGS: Well, I've asked a lot of questions. And again, I appreciate you taking the time to answer them and to be so honest about it. What we want to do is take all of this information and put it together with the screening results that we did in our last session and come up with a plan. And so the goal here is to really get a strong sense of things so that we can build a scaffold so that you're able to begin to make steps to feeling better, to making the changes that you want to make, and to start feeling a bit more in control in your life so that your physical well-being improves, your relationships improve, and just overall you're feeling better. And to getting off the OxyContin, and so that you feel that that's not so much of a control in your life, but also that you feel comfortable and that you're not in pain anymore. So that's what I'm thinking. How does all of that sound? MAGDA: That sounds great. Yeah. CYNDI BRIGGS: OK, OK, great. So let's take what you've told me and work together to come up with a plan that works for you and to get you in a little bit of a better place. MAGDA: OK, I just, sorry I just wanted to make sure I understood what the next steps were. CYNDI BRIGGS: No, absolutely. This is really important. You're asking really good questions. And it's really important that you feel comfortable with everything we're talking about and that it seems like it makes sense for you. How would you feel about making another appointment and coming back, and we can talk a bit more? MAGDA: Yeah, I mean that sounds fine by me. Hopefully, we can find a solution for this. CYNDI BRIGGS: Yeah, I hope so, too. And I think everything what I'm hearing so far is that you are a very self aware person. You have some really good supports in place. You're engaged with your medical community with your doctor. You have a husband who has been paying attention, is concerned about you. You've got overall, your lifestyle sounds like it's pretty healthy. And you're here. You're motivated. You're making some decisions about your well-being. So I feel like the solutions are out there. I feel like the solutions are in here. The fixes may not always be easy. There may be challenges ahead. But I do feel that we can set up a framework for you that can really support you. MAGDA: I really appreciate that. And I'm definitely ready for this. CYNDI BRIGGS: Yeah, I hear that. All right so how about we schedule an appointment for next week? MAGDA: OK, yeah. That sounds great. CYNDI BRIGGS: That sounds great. And then what we'll do is get together, and we'll start putting that framework in place for you to start feeling better. MAGDA: OK. I appreciate that so much. Thank you. CYNDI BRIGGS: For sure. Yeah, my pleasure. I'll see you next week. MAGDA: OK, bye bye. [MUSIC PLAYING]