One of the best ways to learn is by using a dramatic experience, followed by reflective analysis. Case studies are designed to help counselors examine situations carefully, make initial assessments, and formulate hypothetical treatment plans. Case studies provide an appreciation of the complexity of assessment, diagnosis, and treatment. It is a way to determine if the knowledge and skills the students are studying can be applied in a hypothetical case setting.
The cases themselves are composites of actual client cases or events. All the names of the actual cases have been changed, and only first names are used. Any relationship to actual people or events is purely coincidental.
Read the case studies individually and then discuss your reactions and interpretations with your Learning Team members.
Keys to Reading and Analyzing Case Studies
- Read and interpret only the given information. Do not make up information not found in the case study text. If the case states someone is drinking alcohol, do not imply they are also doing cocaine if it has not been mentioned elsewhere.
- Use only the given information. If you think a question was not asked, you can say, “I would want to ask him or her,” but do not fill in their answer.
- Realize there may be no definitive or correct answer, but there may be some responses that are more appropriate than others based on the limited information provided.
- Think of the person in each case as a real client sitting in front of you asking for help, and approach the case from several levels. View each case from the different course-related etiological perspectives you have been studying and consider the different clinical issues that might be involved.
- Think about other resources and referrals this person and his or her family members might require.
- Determine if there are other risk factors or other information that could be dangerous to the client, family members, or others.
- Remember that an initial diagnosis or assessment and treatment plan can only be based on what is presented and determined at any given time and may likely need to be revised over time.
Case Studies
Case 1: Alan
Alan is a 25-year-old African American Army veteran who is introducing himself to you at the Veterans Hospital. He has been back home for 3 months after returning from his second 1-year tour of duty in Iraq, where he was in an infantry company in charge of maintaining security for local citizens. Alan was wounded in an explosion, and his lower right leg was amputated. He is awaiting final disability designation and benefits, and is getting increasingly frustrated. Alan is proud of his service, but finds it hard to show his feelings to others. He reports pain and PTSD symptoms, including nightmares, flashbacks, irritability, and anger. He is on prescription pain medication and antidepressants. Alan reports he is drinking more “as needed.” He is married and living with his wife of 3 years and their 2-year-old son. He reports his wife “doesn’t understand the pain I am in physically or psychologically.” Alan is not working and is worried about how he will provide for his family.
Questions
- What would be your initial diagnostic impression of this case?
- What risk factors and behaviors are present in this case?
- What individual and family interventions might need to be considered?
- What type(s) of treatment settings and strategies may be needed?
- What cultural, ethnic, or special population factors may play a role in Alan’s treatment planning?
- Assuming Alan has a diagnosable substance-use disorder, what specific challenges may need to be addressed to maintain recovery and avoid relapse?
- What specific roles could or should healthcare providers, businesses, schools, and organizations play in Alan’s assessment, intervention, and treatment?
- What specific client advocacy, current public policy discussions, or ethical or legal issues may be related to this case study?
Case 3: Tommy
Tommy is a 45-year old Caucasian male who ruptured a disc in his back while at work over five years ago. After failing to improve through physical rehabilitation, Tommy received a spinal fusion surgery which joined two of his vertebrae together. After Tommy’s injury he received a prescription for a acetaminophen/hydrocodone at 300 mg/5 mg. However. Tommy indicated that his pain levels continued to escalate. His prescription was increased to 300 mg/7.5 mg after 6 months. Post surgery, Tommy continued to complain of escalating pain and his prescription was increased to 300mg/10mg.
At one year post surgery, Tommy continued to request increases in his prescription and his physician determined that Tommy had developed an opioid dependence. The physician refused to increase the prescription and referred Tommy to a substance abuse provider. Instead of seeking help, Tommy began to look for ways to supplement his prescription. He discovered that he was able to purchase heroin and that the injections provided him with pain relief. Tommy began with 300 mcg dosages of heroin injected into his body but quickly increased the dosages and his dependence upon the drug.
Eventually Tommy became homeless and was arrested for breaking and entering. He has been referred to you for a mandated substance abuse assessment from the courts. Tommy has been living in a shelter. He reported using heroin three times per day and that his last injection was 12 hours ago.
Questions
- What would be your initial diagnostic impression of this case?
- What risk factors and behaviors are present in this case?
- What individual and family interventions might need to be considered?
- What type(s) of treatment settings and strategies may be needed?
- What cultural, ethnic, or special population factors may play a role in treatment planning?
- Assuming Tommy has a substance-use disorder, what specific challenges may need to be addressed to maintain her recovery to avoid relapse?
- What specific roles could or should healthcare providers, businesses, schools, and organizations play in Tommy’s assessment, intervention, and treatment study?
- What specific client advocacy, current public policy discussions, or ethical or legal issues may be related to this case study?
Case 4: James
James is a 28-year-old Native American who has been referred to you for a mandated substance abuse assessment from the courts. He was arrested for the manufacturing and sale of methamphetamine, and is awaiting sentencing in the county jail. James works as a laborer at the Native American-owned casino, but lives off the reservation. He is very uncooperative and suspicious. James says he drinks, but does not use meth and reports he was “set up by some rednecks who hate Indians.” His court records indicate 2 arrests for drinking and driving and 3 investigations, but no convictions for domestic violence. James lives with a woman and her two young children. He also has three children of his own, ages 5, 8, and 10, from 2 women he rarely sees, although he says he does care about them.
Questions
- What would be your initial diagnostic impression of this case?
- What risk factors and behaviors are present in this case?
- What individual and family interventions might need to be considered?
- What type(s) of treatment settings and strategies may be needed?
- What cultural, ethnic, or special population factors may play a role in James’ treatment planning?
- Assuming James has a substance-use disorder, what specific challenges may need to be addressed to maintain his recovery to avoid relapse?
- What specific roles could or should healthcare providers, businesses, schools, and organizations play in James’ assessment, intervention, and treatment?
- What specific client advocacy, current public policy discussions, or ethical or legal issues may be related to this case study?
Case 5: Jose
Jose, a 45-year-old Mexican man referred to you by his minister, was recently arrested for possession and distribution of cocaine and marijuana. Jose presents himself as remorseful, embarrassed, and scared. He has no legal immigration status and little money. He was let go by the landscape company he was working for 6 months ago when there was no work. Jose admits he used pot and cocaine when he was working. Jose was later arrested after he agreed to help a friend of a friend set up a deal to make some money. He is married and has 3 children, ages 18 to 25, who are in the area but do not live with him. His wife is very religious and involved with the church, and Jose agreed to talk to the priest and do whatever he recommended. He is fearful of going to prison and being deported.
Questions
- What would be your initial diagnostic impression of this case?
- What risk factors and behaviors are present in this case?
- What individual and family interventions might need to be considered?
- What type(s) of treatment settings and strategies may be needed?
- What cultural, ethnic, or special population factors may play a role in Jose’s treatment planning?
- Assuming Jose has a substance-use disorder, what specific challenges may need to be addressed to maintain his recovery to avoid relapse?
- What specific roles could or should healthcare providers, businesses, schools, and organizations play in Jose’s assessment, intervention, and treatment?
