Read The Following Case And Answer All Questions

Read The Following Case And Answer All Questionslaura Is a Hispanic W

Read the following case and answer all questions. Laura is a Hispanic woman in her late-forties. Laura is married and has two daughters aged 15 and 17. She works in the high-stress, high-powered world of corporate finance. Laura presents herself as a no nonsense business professional.

She has come to the clinic that you are presently working in as a social worker for an assessment because her husband and two teenage children are very concerned about her drinking. Her husband has insisted that she seek professional help. Laura tells you that although she promises herself that she will only have one or two glasses of wine per day, she routinely finds herself finishing the whole bottle and sometimes half or more of a second bottle. Laura reports that it seems to take more wine these days to help her feel relaxed at the end of a stressful day. She does not see this as a problem but she has missed a few important business meetings lately.

This has made her feel quite upset with herself and guilty because she has lied to her boss about the reason for her absences. About three years ago, Laura began to have trouble sleeping and the doctor prescribed the medication Xanax (an anti-anxiety drug and central nervous system depressant). Her father died about one year ago and her use of alcohol and Xanax has steadily increased since that time. She often takes five or six times the prescribed dose of Xanax. When her physician presented his concerns about the amount of Xanax she was taking on a regular basis she began to search for other physicians in order to obtain more prescriptions for Xanax.

She now takes Xanax during the day as well as at night when she is feeling stressed. /2021 Laura notices that her mind is quite fuzzy in the mornings and she cannot remember certain things from the evening before. Of major concern to her family is that she recently totaled her car in a crash on the way to work on a morning that she had a very bad hangover from drinking the night before. Laura states “I guess I am really lucky to have walked away unharmed”. Her children told her that they are beginning to feel embarrassed by her slurred speech and staggering gait in the evenings when they bring their friends home. Laura admits that she felt ashamed and guilty when her children told her that they felt embarrassed by her behavior.

Laura’s husband has told her that the car accident terrified him and he wants her to get help.

Paper For Above instruction

a) Initial Impressions of Laura

Laura presents as a high-functioning professional woman experiencing significant substance use issues that are affecting her health, safety, and family life. Her presentation suggests she is self-aware to some extent, recognizing her drinking and medication misuse, but may also be in denial about the severity of her condition or overwhelmed by stressors such as her father's death and occupational pressures. Her continued alcohol consumption and excessive Xanax use indicate a dependence pattern that is escalating, which is evidenced by her tolerance, neglect of prescribed dosages, and risky behaviors like drinking to the point of blackouts and experiencing a car crash. Her physical signs—slurred speech, staggering gait, and memory lapses—highlight the adverse effects of substance misuse. Her emotional state includes feelings of shame, guilt, and possibly denial, intertwined with a sense of helplessness or resignation due to her inability to control her substance use. Her professional demeanor and societal roles may mask her internal distress but also complicate her willingness to seek help actively.

b) Approach and Engagement of Laura with Ethical Considerations

Establishing rapport with Laura requires a compassionate, nonjudgmental approach that validates her experiences and concerns. Employing motivational interviewing techniques is appropriate to enhance her motivation for change, addressing ambivalence, and fostering self-efficacy. Active listening, empathetic understanding, and respecting her confidentiality and autonomy are critical within the boundaries of safety, especially given her risky behaviors and potential for harm. Ethical considerations include ensuring informed consent for assessments and treatment, maintaining confidentiality while balancing duty to warn if imminent danger (e.g., risk of driving under influence) exists, and respecting her cultural background by being sensitive to her Hispanic identity and any related cultural beliefs that influence her health behaviors. Collaborating with her to develop a treatment plan that aligns with her values and circumstances can promote engagement and adherence.

c) Assessment and DSM-5 Diagnosis with Rationale

The assessment indicates a substance use disorder characterized by problematic alcohol consumption and benzodiazepine misuse. According to DSM-5 criteria, Laura exhibits several signs of Severe Alcohol Use Disorder, including her inability to control drinking, neglect of responsibilities, continued use despite social and health problems, and physiological indications such as tolerance and withdrawal. Her Xanax use, especially taking multiple times the prescribed dose and using it to cope with stress, suggests Benzodiazepine Use Disorder, severe. Her escalating use, combined with risky behaviors like aging driving, memory impairment, and neglecting her health, supports these diagnoses. Comorbid mental health issues such as anxiety may be underlying factors but are exacerbated by substance dependence. Thus, the plausible diagnoses are:

• F10.2 Substance Use Disorder, Severe, Alcohol
• F13.2 Substance-Induced Disorder, Benzodiazepines

The rationale includes her pattern of escalation, physical and social consequences, and impaired functioning consistent with severe substance use disorders and substance-induced cognitive impairment.

d) Need for Medical Detoxification and Explanation

Given Laura’s history of high-dose Xanax use, recent memory impairments, and involvement in a motor vehicle accident while intoxicated, a referral for medical assessment is necessary. She exhibits signs of physiological dependence with potential for withdrawal symptoms such as seizures, agitation, and delirium, which can be life-threatening. Medical detoxification under supervision is recommended to safely manage withdrawal symptoms, prevent complications, and stabilize her medical condition. A comprehensive medical evaluation determines her physical health status and guides appropriate pharmacological or supportive interventions during detoxification. Engaging her in this process can reduce her risk of complications and lay a foundation for effective treatment of her substance use disorders.

e) Treatment Plan, Models, and Interventions

The treatment plan for Laura should be multidisciplinary, incorporating evidence-based interventions tailored to her needs. Initially, a medically supervised detoxification is essential to medically stabilize her. Following detox, she should engage in integrated addiction treatment that includes:

• Cognitive Behavioral Therapy (CBT): to address thought patterns contributing to substance use and develop coping strategies for stress and triggers.
• Motivational Enhancement Therapy (MET): to increase her motivation and resolve ambivalence toward abstinence and recovery.
• Medication-Assisted Treatment (MAT): considering pharmacotherapy to reduce cravings and prevent relapse, possibly including naltrexone or acamprosate for alcohol dependence.
• Family Therapy: to improve communication, restore trust, and involve her family in supporting her recovery.

Additional interventions include relapse prevention planning, life skills training, and addressing her mental health needs, including potential underlying depression or anxiety. Incorporating culturally sensitive practices to respect her Hispanic identity and incorporating community resources can enhance engagement and outcomes.

f) Family Involvement and Rationale

Family involvement is highly recommended in Laura’s treatment plan because her substance misuse significantly impacts her family dynamics and her loved ones' well-being. Engaging her family through family therapy can facilitate communication, educate them about addiction to reduce stigma, and empower them to support her recovery. Her children’s feelings of embarrassment and her husband's concern highlight the need for a family-centered approach to help rebuild trust, develop coping skills, and foster a supportive environment. Moreover, involving her family can alert them to potential safety issues, such as her risk of relapse or dangerous behaviors, and help create a comprehensive support system for sustainable recovery. Ethical considerations include obtaining her consent for family participation and ensuring confidentiality and emotional safety for all members.

References

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