Reference no: EM133820380

Case: You have a patient who is a new referral to you from the court system for substance abuse issues. This patient is a 32-year-old man who has a history of heroin abuse and bipolar II disorder. He began using heroin at age 19 and has been clean for the past 6 months.

He tells you that he was diagnosed with attention deficit hyperactivity disorder (ADHD) at age 11 and was prescribed Adderall. His drug use began at age 13 with smoking marijuana with friends and escalated from there. He was diagnosed with bipolar II disorder in his 20s but has never been hospitalized. His current medications include Suboxone 8 mg, risperidone 1 mg BID, Lamictal 200 mg daily, and Klonopin 1 mg TID PRN anxiety. Hire writer now!

He meets with you and tells you he is committed to his sobriety and reports he is having a hard time at work. His attention and focus are poor, and he is at risk of losing, "the only job I could get after getting out of jail. I need this job because my fiancée has cancer and I have to support her three kids." He tells you he was a patient at your clinic 10 years ago and was treated with Adderall by the psychiatrist at the time (during a period of sobriety). Once he relapsed, he stopped coming to the clinic and spiraled from there.

He tells you he was on Adderall IR 30 mg TID. He works 12-hour shifts and "needs to get through his shift" so he can provide for his family. He tells you he is not currently taking his Suboxone but does have it in case he has a craving for heroin.

Use the information above to address the following:

Given his substance abuse history, would you prescribe this patient Adderall IR?

Give an alternative treatment option. Why would this be a better option?

What dose would you use?

What steps can be taken to show adherence and prevent diversion?