Case Study: Jennifer

You are performing an intake assessment at a community-based substance abuse treatment clinic. Jennifer is a 26 year-old cisgender biracial woman white American who completed college two years ago. She states that it took her six years to complete college because she "partied out" a couple of times and had to work her way back. In fact, the second time, her parents cut her off saying that they were not going to subsidize her drinking lifestyle any further and that she was on her own to complete college. She did. She was assessed by the college counseling center and told to go get "a lot more help than they had" but she never did because she did not want to quit. She had a DUI charge dismissed in college and once, a year and a half later, got a ride home by the police, but she was never really sure what for and hasn't wanted to go back and ask them, though she was terrified for a while waiting for something to come in the mail, like a summons, but it never did. "Even that", she says, "didn't make me stop drinking."

Jenny states has been pregnant twice, the second time very recently, and in both situations, she chose to terminated the pregnancy. She states that she feels like a horrible person because of the second pregnancy, having promised herself that she would never go through that again after the first one, but birth control makes her sick. Jenny also stated that she has a history of breast cancer in her family and taking additional hormones feels "risky" to her. When asked further about "feeling like a horrible person"this, she indicates that she has always been a very moral person, and that she felt she could forgive herself after the first abortionone, but having done this twice she feels like she's "going to hell", and that she "deserves" to. During the interview she says, "I sometimes wish I was dead. I don't see what the point of living is; I don't seem to be in control of anything."

She reports that she began drinking in the 9^th grade of high school, and felt from the start like it did something for her that it wasn't doing for other people. Some of her friends would party heavy, but soon after the onset of drinking, she just wanted to drink all the time. She stated somewhat casually, "I can drink a quart [of hard liquor] you know. I have to in order to be able to really feel it anymore." She controlled herself early on by restricting her drinking to specific periods of time and places. This was a strategy that worked well until college, when she would set benchmarks for herself, and, as she called it, "blow it." The first time that she withdrew from college she blamed it on being depressed after her abortion, which her parents blamed on her drinking lifestyle. She agrees that she would never have become pregnant then if she had not been drinking. The second time she withdrew from college she reports she had a whole semester of basically binge drinking and didn't go to any of her classes. Nonetheless, she "regained control of herself" for a while and completed school.

She has used cocaine in the past but stopped because she reportedly wound up "doing stupid stuff." When asked what stuff she said that she didn't want to talk about it. When asked if it included other drugs, she indicated she had also snorted heroin a couple of times because it was powdered just like coke, but she would never shoot anything- and it was not a habit - either of them. She has tried "most of the pills" but didn't like them. Alcohol was more reliable. She states she loves pot but never gets anything done when she smokes so she only does it sometimes. She tried meth but hated it - not relaxing at all. She is irritated that you are asking about all this stuff she does not have a problem with. "It is alcohol", she says, "just alcohol". She used to go out drinking with friends but most of them are "pissed at her" and it is cheaper to just drink at home alone now.

Her college degree was in biology and she is currently employed by a high-technology company doing what she describes as "lab rat" work and she really likes it. She prepares slides and specimens and enjoys the company. She was dating one of the lead researchers, but he just dumped her to get back together with his wife. She stated that, "He was the father for the second kid." Jenny reports that after this break up and the resulting abortion, she started drinking really heavily, ("more than a quart?" you ask; "way more" she says) and missed work for several days - again. Unable to get her nerves together for work, she states that she would drink just a little in the morning before going in to stop shaking and to make her head stop hurting so bad. One month ago, she briefly tried to stop drinking, but she "freaked out" and woke up much later on the floor. She is not sure, but she might have had a seizure. Recently, one of her coworkers said that she smelled like alcohol and that she was going to tell the boss. She lied and said she had spilled some formaldehyde and now feels wicked guilty about lying about drinking - on top of the abortions. She feels like people at work are looking at her, like they know everything now. She quit another a previous job over a year ago because she thought she was going to get caught. This recentent "threat" from her co-worker terrified her enough that she is coming to you, voluntarily. She states, "It's piling up. My life's a mess and I can't go on like this. I have abortions, the cops drive me home, I'm losing my job. This isn't me; it has to stop. This has to end and I will find a way to end it if you can't do something." When asked what she would be willing to do for treatment she said, "My insurance will cover it if I have to go away and then they can't fire me at work because of ADA. Or I could take FMLA", but I'd rather they didn't know about it." She states she will do anything to get her drinking under control, but she does not want to take "those pills."

Questions

Complete the ASAM assessment

• using the resources and example provided. Address all Dimensions 1-6 as they pertain to Jennifer.
• Discuss any pertinent information that is helpful to counselors who might be working with Jennifer going forward.
• Are there any other diagnoses, concerns, risks, or other factors to consider?
• What additional information did you wish you had when completing this assessment?
• What level of care would you recommend for Jennifer? Explain.