Reference no: EM133487097
Case Study - Nicole
Nicole is a very successful business woman in the high-stress high-powered world of corporate finance. She has been referred to you by the company's Employment Assistance Program (EAP). Nicole is 35-years-of-age and presents herself as a no nonsense business professional, who lives alone. She is frank and honest about the events that have brought her to this position.
Nicole says that although she tells herself that she will only have one or two glasses of wine with dinner, she usually finishes the whole bottle.
"About five years ago I started having trouble sleeping and started to take a tranquiliser (5 mg Valium) I normally take one or two pills, two to four times a week to help me sleep through the entire night."
In the morning Nicole drinks at least 3 to 4 cups of coffee daily, even on the weekends. She noticed that her sleeping problems developed around the same time her Dad died. He was only in his early 50's and they were very close. His death hit her hard and she says she wanted to give in to a big depression but she fought it and lost herself in her work.
Nicole makes it a point to work out at least three times a week in the morning before going to work. In addition to the medications already mentioned, Nicole is also prescribed Xanax, as needed, for panic attacks, and diet pills (amphetamine congeners) to control her weight, a problem she had since she was a child. Over the last year she has become more reclusive. She can barely make it to business dinners and after-work functions. Lately she has noticed that she has been steadily increasing her use of wine.
"More often than not I finish off the bottle before going to bed. I just can't seem to stop. A lot of times I will come home and tell myself that I'll only have one glass of wine and no more but by the time I go to bed, the bottle is empty and I'm deciding whether I should open another or not. I never used to drink to excess or take anti-anxiety medication before. Now I can't seem to stop drinking or taking these downers at social events. I can't seem to control when I take them and things are happening that I'm not too happy about. Of course the alcohol adds to my weight problem which then causes me to take more of my Redux. Then I have to increase my Xanax to calm my nerves and also take my Valium to make sure I get a full night's sleep. It has become a very vicious circle."
According to Nicole, last week she reached a crisis point. She had to meet the firm's top client at a business luncheon, but could not get out of bed that morning. It took all her willpower to finally get up and get dressed, which made her 20 minutes late.
Nicole was so nervous and sick she had to excuse herself in the middle of her presentation. In the bathroom she took another Xanax to calm her nerves. Then at the luncheon she could not stop herself from ordering several glasses of wine and had to be assisted to her car after the meeting.
"My client spoke to my boss and then cancelled his account with me. The next day I met with my boss and he recommended (ordered) I make an appointment with our EAP rep or be terminated. I'm really scared. Work is all I have. I can't afford to blow it."
Questions
1. What would your initial assessment of Nicole be?
2. What would you say Nicole's main drug of choice is and do you think she will need to be placed in a detoxification program to address this problem?
3. Given Nicole's emotional situation and the medications she is taking, what if any dangers do you need to be aware of?
4. Based on the information Nicole has given you, who would you need to contact to advise them of Nicole's situation and what would you need from Nicole to make these contacts?
5. If Nicole's boss calls your office to find out how Nicole is doing, how would you respond to his inquiry? What are his rights to know if Nicole did keep her appointment with you?
6. What possible dual diagnosis issue(s) might Nicole have and how would you confirm this possibility?