Reference no: EM133589648

Case Study: You are a social worker in a detoxification unit of a hospital. Tony is a 38-year old male who is a resident in a transitional housing program. The previous week he was shooting heroin with a friend in the building when he turned blue and had difficulty breathing. The heroin had been laced with fentanyl. His friend started shouting, and another resident administered Narcan to him and called 911. He was taken to the hospital, where he was transferred to the detox unit where you work.

Tony has worked as a car mechanic since his teenage years. He has a high school diploma.

He enjoys car mechanic work and would one day like to have his own repair shop. However, heroin use has made this goal impossible to obtain. Tony met Leonora when he was 19. They ended up living together and they have two children. Their relationship began to became somewhat tense and strained. Furthermore, Tony never told Leonora that he was bisexual, and that he was having sex with men without her knowing it. Leonora checked Tony's cell phone surreptitiously one day and saw a text from a man telling Tony that he loved him. She quickly moved out of the apartment with the two children and moved to her mother's house in another part of the country.

Tony became overwhelmed by losing Leonora and his children, and became terribly distressed.

At work, when he was 27, a co-worker introduced him to Oxycontin pills, and he began taking them. They made him feel relaxed. Over the next three years, the number of pills he was taking each day steadily increased in order for him to feel the same effect. At the same time, it became harder and more expensive to obtain Oxycontin with new government regulations and he could no longer afford to buy it if he could find it. His dealer advised him to switch to heroin and snort it, which he did. Within a year, he had begun to shoot it. The amount he was shooting steadily increased over the next few years. At work, he would sometimes test drive the cars or work with machinery when he was high. Eventually, he was no longer able to work.

Tony's family was heavily involved with a church, and his brother, Al, spoke to the minister about Tony's addiction. The minister recommended a 60-day live-away Christian rehab program for Tony, and Al gave the information to Tony. Tony stated to his brother that he was going to get off of heroin on his own. However, he just could not stand the feelings of being "dope sick" when he attempted to wean off of the heroin. Eventually, Tony went to a detox, got off of heroin and went to the Christian rehab for two months. When he returned, he attended the church regularly with his family and attended Narcotics Anonymous (NA) meetings nearly every day. He obtained employment again. Eighteen months later, he ended up in a relationship with a man named Jay whom he met at an NA meeting. As the members of the church he attended and his family's attitudes were quite homophobic, he kept the relationship with Jay from his family and church peers. This created tension for him. Tony sustained a back injury while working and managed to have a physician give him a prescription for Percocet, which he started taking less for the pain, and more for the relaxation effects. He tried to keep taking the same dose each day, but found this to be impossible, and ended up taking more and more. He kept his Percocet use a secret from Jay, but soon Tony started snorting heroin again as he needed more of the Percocet and was not able to obtain it. Tony's family could see that he was getting high again, and turned their back on him. Jay convinced Tony to go to a detox and outpatient abstinence treatment at a substance abuse program that had LGBT groups. Tony became abstinent for six months. He ended up having sex outside of his relationship with Jay. Jay found out and ended the relationship, although remained friends with him. Tony was now very isolated without the relationship with Jay and his family rejecting him. He started using heroin again, and ended up being arrested when buying it.

As part of the deal in court, Tony agreed to go to long-term residential treatment. After being in the residential treatment program for 18 months and not relapsing while there, he began working as a mechanic again. He graduated from the program and found a small apartment for himself while working and attending NA meetings. However, after seven months, he began using heroin again, lost his job and apartment, and ended up in a shelter.

While at the shelter, he found out he was HIV positive. He was placed on HIV medications, which he takes as prescribed. Besides HIV, he is rather healthy. He tried to stop using heroin a number of times unsuccessfully, but he hates the "dope sick" feelings when he tries to stop. He also states he doesn't feel right when he is free of heroin, experiencing depression and sluggishness that does not seem to go away week after week. This gets him to use heroin again, which he always keeps thinking about and wanting.

Due to his HIV diagnosis, he was able to be referred to transitional housing where he currently resides in a small apartment. Many people in the transitional housing facility use substances, and there is drug dealing going on in the building. Tony wishes he could be heroin-free, so that he could go back to work and have a productive life again and a meaningful relationship with a woman or a man.

You are working to create a treatment plan for Tony for when he leaves the detox.

The first seven questions apply to Tony.

Question 1. What DSM-5 Diagnosis(es) would you choose for Tony? Be very specific, and include all specifiers for the substance use diagnosis(es). Explain which criteria he meets and why. (15)

Question 2. Identify several assessment tools that would be appropriate for use with Tony that would apply to Oxycontin, Percocet, and Heroin use. Discuss why they are appropriate. (5)

Question 3. Give one example of Post-Acute Withdrawal Syndrome (PAWS) described in the scenario. (3)

Question 4. a) How will the detox most likely withdraw Tony from heroin? b) If Tony had gone to the detox for alcohol use disorder, how would the detox withdraw him from alcohol? (7)

Question 5. In great detail, please describe possible treatment options now for Tony. Describe the pros and cons of different treatments (abstinence and specific medication-assisted treatments) for him based on his prior treatment experiences and his bio-psychosocial history.

Question 6. Give an example of "cross-tolerance" anywhere in Tony's history.

Question 7. How would you try to handle Tony's accidental use of fentanyl from a harm reduction approach when working with Tony?