Reference no: EM133987315

Presenting Problem: Client presents as a 21 year old single Caucasian male who was referred to the case management program by his probation officer because "I smoke chronic (marijuana) and was snorting powder". Client reports he is motivated for treatment and to stop using substances because he does not want to go to prison. Client's probation officer reports that the client has consistently tested positive for marijuana since being placed on probation three months ago. The client's probation officer also reports that he has tested positive twice for cocaine in the three months he has been on probation. A breathalyzer on January 1st also showed that he was positive for alcohol use. History of Present Problem: Client reports he began drinking alcohol at the age of 9 and by the age of 18 was drinking every weekend- a fifth of liquor. Client reports he currently drinks two to three days a week, usually on the weekends- a couple of 40 ounce beers or a fifth of liquor. He reports he last drank on 12/31. Client reports he first smoked marijuana at the age of 11 and by the age of 13 was smoking two blunts a day of marijuana. Client reports this is his current amount of use and that his last use of marijuana was 12/31- two blunts. Client reports his first use of cocaine was at the age of 16 and by 19 he would use two to three times a week-approximately 2 grams of powder each time. Again, he reports this is his current amount of use of cocaine. Client reports his last use of cocaine was 12/31. Client has been incarcerated since 1/1 on the probation violation of testing positive for cocaine, marijuana, and alcohol. It is because of his incarceration that he has not used any substances and he was brought straight to the case management program from jail by his probation officer. Client reports that he likes to drink alcohol and will use cocaine when it is available but that his substance of choice is marijuana. Client reports that he has tried a few times to stop using marijuana due to being on probation but that he would crave the drug and felt very irritable when not using marijuana. He reports that when he stops using cocaine and alcohol that he has not noticed any ill effects. When not using marijuana the client also reported an inability to sleep, having severe nightmares when he did sleep, experiencing horrific headaches, and a significant amount of anxiety. Client reports that he does work from 8am - 4 pm but the remainder of his day is spent getting high and that he smokes marijuana as soon as he wakes up in the morning to get his day started. He will also smoke on his lunch hour and then as soon as he gets off work and for the remainder of the day until he goes to sleep around midnight. Social and Family History: Client reports being raised by his parents and that he had a "good" home-life but that his parents didn't buy him what he wanted. He reports that they bought him "no name brand stuff" and he wanted name brand items. Client reports he has one sister and that he is the youngest. Client did not report any abuse in his childhood. Client reports that he left school after the 8th grade because he wanted material items and could not get them by staying in school. He reports that he left school and began selling drugs to earn money. Client reports that while in school he was made fun of for stammering and stuttering. Client reports that as an adolescent he was involved in excessive fighting and gang activity and that this has continued into adulthood. Client reports that two years ago he even planned to commit homicide because one of his good friends was killed but did not carry it out because he did not want to go to prison. Client reports that he has engaged in cruelty to animals. Client reports that as an adolescent he was diagnosed with Conduct Disorder. Present Life Situation: Client reports that he is currently employed at ABC Paving. Client reports that this is the only job he has ever had and is only working at this job because it is a condition of his probation. Client reports that he is concerned about losing this job due to his jail time as having a job is a condition of his probation. Client also reports that he is concerned about losing his job because he has smoked marijuana while at work and is concerned that his supervisor may be aware of this. Client reported that he has used heavy machinery after smoking marijuana. Client reports that he is currently single and has never been married. Client reports he has a son who is 5 years old but that he hasn't seen him since the child was 2 years old. Client reports that he does want to know his son but that the child's mother will not allow him to see his son because of his drug use. Client reported some irritability in his daily activities but reports that he believes this comes from not being able to smoke marijuana. Client is currently on intensive probation for Possession of a Stolen Automobile. Client has pending charges of Discharging a Firearm into an Occupied Dwelling and previous convictions of Possession with Intent to Manufacture, Sell, and Distribute Cocaine. Client reports that he knows his freedom is in jeopardy because of his continued substance use. Medical History and Mental Status Exam: Client reports no current medical problems but does report being shot twice previously and stabbed once. Client reports he was hospitalized for the gunshots but not for the stabbing. He reports that these occurred during gang-related activities. Client was oriented times three (oriented to person, place, and time) was determined by a mental status examination. Client's appearance was appropriate for the situation, his attitude was cooperative, his affect was normal, and his thought process appeared within the normal range. Client's thought processes appeared to be free of any delusions and to be based in reality. He reports no current suicidal or homicidal ideations and denied any hallucinations. The client appears to be of average intelligence for his age and education level. Client reports that the only prior counseling he has received was at a State Mental Hospital at the age of 15 where he was sent after fighting the police. This is when the client received the prior diagnosis of Conduct Disorder. Based on the case study above, and as part of a relapse prevention plan, i. Explore the lifestyle changes that will assist this client in avoiding relapse ii. Include a discussion on an individualized self-care plan for this client.