Johnny Walker is a thirty-year-old male that was referred by his primary care physician for chronic alcohol and prescription drug use. He has doubled the amount of pain pills over the five-year span of using them to treat his back pain. His professional life is a major stress producer in his life, he is under constant pressure to perform and meet his sales quota each month.
Johnny Walker is a thirty-year-old male that was referred by his primary care physician for chronic alcohol and prescription drug use. He has doubled the amount of pain pills over the five-year span of using them to treat his back pain. His professional life is a major stress producer in his life, he is under constant pressure to perform and meet his sales quota each month.
Johnny Walker is a thirty-year-old male that was referred by his primary care physician for chronic alcohol and prescription drug use. He has doubled the amount of pain pills over the five-year span of using them to treat his back pain. His professional life is a major stress producer in his life, he is under constant pressure to perform and meet his sales quota each month.
2 Demographic Information Name: Johnny Walker* DOB: 09/05/1985 Residence: Oscoda, Michigan Age: 30 Intake Clinician: Bryan Blattert Sex: Male Date of Interview: 06/14/2016 Ethnicity: Caucasian Presenting problem Johnny Walker is a thirty-year-old male that was referred by his primary care physician for chronic alcohol and prescription drug use. Mr. Walker lives with his wife of five years and their four-year-old son. Mr. Walker has been prescribed opiates for the last five years. He has steadily increased the consumption of opiates and alcohol over the past two years. Mr. Walker has developed a dependency on alcohol and pain killers and it is beginning to effect his personal and professional relationships. He has doubled the amount of pain pills over the five-year span of using them to treat his back pain. Mr. Walker has also added alcohol into his daily life and consumes approximately 750ml of whiskey each day. He has been cited on several occasions by family and co-workers as too intoxicated to function, leaving him unable to complete the necessary tasks needed to maintain a professional and personal life. Mr. Walker is aware of his dependency on alcohol and pain killers, he brought the issue to attention with his primary care physician. He admits to using alcohol and pain killers to relieve the stress caused by life. Mr. Walker points to several different things that are stress triggers in his life, and are reasons he turns to alcohol and drugs. His professional life is a major stress producer in his life. He is under constant pressure to perform and meet his sales quota each month. Issues in his professional life are beginning to impact his personal life as well. Mr. Walker is having relationship trouble in his marriage, and is also experiencing trouble maintaining a normal relationship with his son. Mr. Walkers interactions with his family are creating tension in the
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3 household. Mr. Walker uses alcohol and pain killers to relax after a long day at work, leaving him unable to function as the father and husband his family needs him to. Family of Origin History Mr. Walkers mother was 21, and his father was 23 at the time of his birth. The couple had been married for a year at the time of his birth. His mother is now 51 and his father 53, and still happily married with no major issues reported. Both parents are in great health and take minimal medications to treat cholesterol and blood pressure. His mother is a high-school graduate and his father holds a bachelor in social work degree from Michigan State University. Mr. Walker has two siblings, one brother and one sister. His brother named Jim is 26 and his sister named Jenny is 28. Jim works as a concrete finisher; he is in great health and exercises on a regular basis. Jenny works as a hair dresser and is in great health with no medical issues. The pregnancies of all three children were planned. All three children remain in contact with each other and speak at least once a week. The family still gets together at least twice a month for dinner on Sundays. Mr. Walker was brought up in a typical white, middle-class family like any other ordinary American family. He had an active and fun childhood, visiting many places on vacation as a family unit. Family holidays and celebrations were held at his house. The family had a fairly uneventful life when it came to tragedy and struggles. The loss of Mr. Walkers grandmother was the first and only death he has experienced so far in life.
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4 Developmental History Mr. Walker weighed 10lbs, 5 ounces at the time of his birth. His mother had an unremarkable full-term pregnancy with a vaginal delivery. Mr. Walker was breast fed until he was two years old. He started walking around eighteen months old, and started talking around twenty-eight months. He was fully toilet trained by four years of age. Health History Mr. Walker is in great health. He experienced no complications when he was born and continues to remain that way. During his childhood, he experienced two separate events where he broke bones. When he was eight, he broke his left arm when he fell off of his bicycle. The injury required surgical repair and healed with no complications. When he was twelve he broke his foot when he fell while climbing a tree. He has no long term deficits from either injury. There are no family illnesses that are present to report. Relationship/Sexual History Mr. Walker had a normal childhood growing up and had many friends. He was active in school sports and was liked by almost everyone he came in contact with. He is still in contact with many of the same people he grew up with. He started dating in middle school. He is heterosexual and the first time he had sex was during his freshmen year of high school. He reported that he enjoyed the experience and still enjoys sex now. He reports no major issues in his sex life. He has always used protection when having sex, other than when him and his wife were trying to get pregnant, which is when their son was conceived. Mr. Walker contracted HPV when he was a teenager but has no complications from the virus. He has had ten sexual partners to date.
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Family of Creation/ Current Relationship History
Mr. Walker had several short-term relationships before he met his wife of five years. He was twenty-five when he married his wife, she was also twenty-five at the time. The married couple has a four-year-old named Red. Mr. Walker and his wifes relationship is suffering due to his substance abuse problem, they report no other issues that are unrelated to his problem with alcohol and pain killers. Mr. Walker seems to lack when it comes to connecting and interacting with his son. He seems to have a general disinterest towards his wife and his son while at home. His wife complains about him not having a good father-son relationship. Mr. Walker holds a bachelor degree from an accredited university. His wife has completed a certificate program and an associates degree from a local community college. His wifes gestation period was healthy and unremarkable, with no complications reported at birth. Conception of their child was planned and something they had openly discussed since early on in the relationship. The two report that there has never been an issue with violence or abuse in their home or in their relationship. Substance Use/Abuse History Mr. Walker was first prescribed pain medication five years ago for his back pain. He was twenty-five when he began taking pain meds and has increased his usage over time, he admits to abusing alcohol and pain killers now. He uses both substances to cope with stress and would like help to get his dependency under control. This is the first time he is seeking counseling for his dependency, he only reports issues with alcohol and pain killers.
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Mental Health History
Mr. Walker has never seen a counselor before, this will be his first time attempting to treat his dependency. He came into the local behavioral medicine clinic to seek treatment; he was referred by his primary care physician. Military History Mr. Walker always had an interest in joining the United States Marine Corps after high school but was talked out of it by family and his girlfriend at the time. Financial History Mr. Walker comes from a middle-class Caucasian family. His mother became a stat-athome housewife once he was born and never returned to formal employment. His father works for a local nonprofit, and recently became director of the organization. The family always had a financially stable life; they were able to take vacations and own a cottage up north along with being able to afford the accessories in life that they desired. Mr. Walker and his family are financially stable due to his career. He is able to support the familys needs but feel a great deal of stress because he is the sole provider. Mr. Walker and his wife decided she should leave work and stay at home once their child was born. Legal History
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7 Mr. Walker has two prior arrests and convictions. He received a minor in possession of alcohol ticket when he was a senior in high school on spring break. He also was arrested for driving under the influence when he was twenty-two. Mr. Walker was sentenced to ten hours community service for his minor in possession offense; he was sentenced to pay fines, complete thirty hours of community service, and have a restricted driving license for three months as a result of his driving under the influence offense. Immigration Issues Mr. Walker is a United States citizen, he was legally born and raised in the U.S.A. There are no immigration issues with Mr. Walker. Treatment Plan Goal One: Mr. Walker will stop abusing alcohol and pain killers. Objective A: Mr. Walker will learn techniques to cope with his stress and addiction. 1. Mr. Walker will attend Alcoholics Anonymous and Narcotics Anonymous meetings once a week each for eight weeks. 2. Mr. Walker will purchase the book A Complete Self-Help Guide and read before the beginning of the fourth session of counseling. Objective B: Mr. Walker will explore alternatives for stress relief and pain relief. 1. Mr. Walker will see his primary care physician before beginning of the next counseling session to discuss alternative medication and physical therapy. 2. Mr. Walker will work with attend physical therapy for his back issues, pending approval by primary care physician. Goal Two: Mr. Walker will improve his relationship with his wife and son. Objective A: Mr. Walker will improve communication with his wife and son. 1. Mr. Walker will make fifteen attempts per week to communicate with his wife and son. 2. Mr. Walker will attend therapy for twelve weeks, taking the techniques learned and applying them to his professional and personal relationships.
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8 Objective B: Mr. Walker will learn how to be more affectionate with his wife and son. 1. Mr. Walker will purchase and read the book Five Love Languages before the beginning of the third week of counseling. 2. Mr. Walker will attend two family counseling sessions per week for four weeks.
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9 Contract for Treatment Plan Client Name: Johnny Walker 1. Description of the Problem: Mr. Walker is suffering from an addiction to alcohol and pain killers. Mr. Walker has increasingly abused pain killers for the last five years and it is taking its toll on his professional and personal relationships. Mr. Walker struggles with being a father and in his marriage. His communication with his wife has shut down and lacks the normal father-son connection with his four-year-old son. Both relationships are experiencing difficulties and are in poor health. 2. Primary Goals: Help Mr. Walker become sober and achieve sobriety permanently. Also, improve Mr. Walkers relationship with his son and his wife. 3. We, the undersigned, agree to the objectives in the following plan: A. Mr. Walker will learn techniques to cope with addiction. B. Mr. Walker will explore alternatives for pain relief and stress relief. A. Mr. Walker will improve communication with his wife and his son. B. Mr. Walker will learn how to be more affectionate with his family. _Johnny Walker__________ (Signature of Client) _6/16/16_____________ (Date)
_Bryan Blattert________ (Signature of Worker) _6/16/16_____________ (Date)
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10 Description of Interventions Mr. Walker will receive behavioral counseling for his alcohol dependency. Studies have shown good-quality brief behavioral counseling interventions to be very effective, reducing risky and harmful alcohol use (Whitlock, E. P., Polen, M. R., Green, C. A., Orleans, T., & Klein, J., 2004, pp. 554). Mr. Walker will need a higher frequency of counseling sessions in the beginning and they will remain that way until he displays positive outcomes. Once he is able to control his drug and alcohol dependencies, we can switch to a less demanding schedule of sessions. Steady contact interventions are proven to be most effective. According Whitlock, E. Et al. (2004), participants in a behavioral counseling study achieved safe or recommended drinking levels (pp. 563). Behavioral counseling is effective and I believe this will be a tool that will work for Mr. Walker. Mr. Walker will need treatment for his opiate dependency, which can be very difficult to overcome. Drugs cravings are increased by a state of negative moods (Pollack, M. H., Penava, S. A., Bolton, E., Worthington, John J., I.,II, & al, e., 2002, pp. 312). It is important that we focus counseling sessions on what triggers a negative mood for Mr. Walker as well as the environments that make him want to use. By treating these two areas, I hope to greatly reduce his risk factors associated with drug and alcohol use. Cognitive behavioral therapy has shown to be effective in reducing environmental conditions that cause cravings for opiate users (Pollack, M., et al , 2002, pp. 215). Drug and alcohol dependency is common among people feeling stressed, also those who suffer from chronic pain. By treating his addictive habits, stress, and providing chronic pain relief alternatives I hope to rebuild Mr. Walkers relationships with his loved ones.
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11 The use of medicinal cannabis is something Mr. Walkers primary care physician mentioned to him for his stress as well as back pain. Treating his back pain with cannabis is a much safer and healthier alternative than using prescription opiates. While doing so, he will be effectively treating his stressful triggers. Hyman, S. M., PhD., & Sinha, R., PhD.,2009, pp. 400). Cannabis receives a lot of negative attention, and its illicit use is widespread in the United States. With the rise in medical marijuana we have seen in recent times, use among teens and young adults is rising as well. Medical Marijuana is a very effective tool for treating chronic pain which often people are prescribed opiates for. Cannabis, when ingested directly affects the bodys stress arousal system (Hyman, S. M., PhD., & Sinha, R., PhD., 2009, pp. 400). Treating the chronic pain Mr. Walker feels with an alternative to opiates will allow him to still have pain relief without taking such an addictive medication. By treating his back pain and stress with medical cannabis, and treating his alcohol and drug dependencies with counseling, Mr. Walkers relationships should start to strengthen. Theory of Interventions Stress is conceptualized as a relationship between a person and his or her environment that exceeds the individuals coping resources, potentially endangering the persons well-being (Hyman, S. M., PhD., & Sinha, R., PhD. (2009). Ecological perspective uses a person-inenvironment perspective. Mr. Walkers environment is causing him stress that is unable to cope with. By working with Mr. Walker, I hope to offer him constructive ways to cope with his stress triggers so he will not have to use alcohol and opiates. According to Pollack, M. H., Penava, S. A., Bolton, E., Worthington,John J., I.,II, & al, e. (2002), distinctive environments associated with drug effects can elicit the cravings of an opiate user (pp. 335). Returning Mr. Walker to a positive mood can have a major impact with how he views the environments that he is in.
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12 Regaining a bit of control when it comes to his professional and personal life will likely reduce his stress triggers, therefore changing his environment to one that will lessen his cravings to use. According to Wakefield (1996), the ecological perspective insights into human capacities for adaption and into environmental factors necessary for normal human growth have a fundamental place among the domain-specific theories that form social works knowledge base. (pp.476). This theory allows us to do an analysis to determine what is necessary for a person to meet their basic needs. By addressing Mr. Walkers basic needs I hope to lessen his stress and increase his coping skills. The systems theory analyzes the complexities of human behavior, and how systems interact in a persons life (Sallach, David L, 1972, pp. 56). The systems in Mr. Walkers life are stressed due to his inability to cope with stress in a constructive way. His drug and alcohol dependencies has taken a toll on his family system, taxing his marriage and his relationship with his four-year-old son. As Mr. Walker receives treatment for his condition, I believe his systems will become less taxed by him and less taxing on him. Right now there is a major imbalance with the systems in Mr. Walkers life. Value and Ethical Dilemmas Related to Service Delivery When working with clients who are battling drug and alcohol dependencies, it can be difficult to counsel them for long periods of time if there is no change. According to the National Association of Social Workers Code of Ethics (2008), the importance of human relationships is a strong social work value; social workers use relationships among people as a vehicle for change. If I fail to reconnect Mr. Walker with his family by strengthening their relationships, it may be difficult to create change for him and get him sober. I know relationships with loved ones can
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13 help people change their negative habits. This would be my first tool to use to help Mr. Walker, if it does not work then treatment interventions will need to be more in depth and structured. According to the National Association of Social Workers Code of Ethics (2008), section 1.01 Commitment to Clients states that it is the social workers primary responsibility to promote the well-being of clients. Regardless of Mr. Walkers outcomes, I will have to keep delivering the highest level of service interventions that I can. This can be challenging with dealing with drug and alcohol dependencies, often it takes a long time and a lot of different treatments to be effective. Some may never be cured of their battle with drugs and alcohol, and that can be taxing on the social worker. I will be aware of these values and ethical dilemmas, in order to ensure that I am providing the highest level of service to Mr. Walker that is possible. Regardless of the outcomes from treatment, I will continue to serve him until he is able to gain control of his dependencies and strengthen his relationships with his family. Mr. Walker may always need to come in for regular counseling, but not as frequent as he needs when he is actively using. Conclusion The case of Mr. Walker is a challenging one, and has been spiraling out of control for several years now. It may take years to fix the damage that has been done but I believe he is willing to do the work that is necessary to gain control of his drug and alcohol dependencies. By providing counseling for Mr. Walkers drug and alcohol use and offering alternatives to stress and treating chronic pain I believe Mr. Walker will gain control of his personal and profession life. As he gains control from these interventions, his personal relationships will strengthen to provide his long term success and support.
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14 References Code of Ethics- National Association of Social Workers. (2008). Retrieved June 17, 2016, from https://www.socialworkers.org/pubs/code/code.asp Hyman, S. M., PhD., & Sinha, R., PhD. (2009). Stress-related factors in cannabis use and misuse: Implications for prevention and treatment. Journal of Substance Abuse Treatment, 36(4), 400. Retrieved from http://search.proquest.com.proxy.lib.wayne.edu/docview/217322330?accountid=14925 Pollack, M. H., Penava, S. A., Bolton, E., Worthington,John J., I.,II, & al, e. (2002). A novel cognitive-behavioral approach for treatment-resistant drug dependence.Journal of Substance Abuse Treatment, 23(4), 335-342. Retrieved from http://search.proquest.com.proxy.lib.wayne.edu/docview/217314651?accountid=14925 Sallach, David L. "Systems Analysis and Sociological Theory." Sociological Focus 5.3 (1972): 54-60. ProQuest. Web. 17 June 2016. Wakefield, Jerome C. "Does Social Work Need the Ecological Perspective? Reply to Alex Gitterman." Social Service Review 70.3 (1996): 476-81. ProQuest. Web. 17 June 2016 Walker, J*. (2016, June). Personal interview conducted by B. Blattert. Oscoda, MI. Whitlock, E. P., Polen, M. R., Green, C. A., Orleans, T., & Klein, J. (2004). Behavioral counseling interventions in primary care to reduce Risky/Harmful alcohol use by adults: A summary of the evidence for the U.S. preventive services task force.Annals of Internal Medicine, 140(7), 557-68. Retrieved from http://search.proquest.com.proxy.lib.wayne.edu/docview/222194615?accountid=14925