Case Study 3
(Identifying information has been changed in order to maintain confidentiality.)
Identified Client : Katie is a 35 year old woman, wife, mother of 2 young children, daughter, and rising professional.
Drug of Choice: Prescription Drugs. Mostly pain medication and soma (muscle relaxant).
Initial Contact: Lewis (husband) called to discuss the possibility of doing an Intervention with his wife, Katie. He believed she had relapsed back into using pain meds about 4 months previously. All the signs of the previous addiction were coming back. "I've had it. I'm not going to go through this again." We scheduled an appointment and agreed to meet and discuss whether or not Intervention was the right option at this time. Lewis said he had been talking with Katie's dad who lived across the country and that he was very concerned and asked if he could call me as well. We set up a time to meet again the following day.
Substance Abuse History: Katie had been to a residential treatment center 3 years before. The reason for her admission at that time was that she was abusing pain medication. She spent 4 weeks there and appeared to benefit from the program. She did not do any kind of follow-up. She did not attend any counseling or self-help (AA/NA meetings). She felt that she had gotten the pain med abuse under control and behind her. She didn't care to go to the meetings because they reminded her of a low point in her life. Her husband did not attend the family program offered at the treatment center and agreed with Katie that they could put this unfortunate incident behind them and move on with their lives.
Katie initially began taking pain meds because of a low back pain she experienced in a car accident while in her mid-20's. She took the medication as prescribed at the time but remembered how wonderful it made her feel about her whole life. Over the next several years there were times she had reason to visit her doctor about one thing or the other and usually was able to walk out of the doctor's office with a prescription for some pain pills. As Katie's life became more complicated with marriage, a child, her career taking off, and the day to day pressures of life, Katie looked for ways to make herself feel better. She began to seek out pain pills from friend, family, co-workers. If someone she knew had injured themselves in some way she was quick to inquire whether or not the doctor had given them any pills.
When Katie found out how to get pain pills through the Internet, her abuse turned to addiction in a short time. Things started moving quickly. Pain pills can be very expensive over the internet. Lewis became aware of the situation because of the financial stress on the family budget. He talked with her about this. She claimed she was only getting vitimaim. Then he talked with her parents. The parents decided to come for a visit and see what help they might be able to offer.
When the parents arrived, they along with Lewis sat down with Katie and expressed their concerns and worries. Katie after some time admitted that she in fact was buying pills over the internet and had also been seeing several doctors in her community for more pain pills. The family wanted her to enter a treatment program. She agreed and did so. That was 3 years ago.
Over the past several months, Katie's pain pill seeking behaviors have returned. Lewis has contacted me. Frustrated and ready to end the marriage, he says that if this doesn't stop immediately he is out of there.
Katie and Lewis had their second child about 6-months ago. Within the past 3 months, Lewis has had an accident at work were he ended up with a torn Achilles tendon and is off work and must use crutches to get around. Lewis has become the at home parent taking care of the children while Katie goes off to work. Lewis and Katie are also in the middle of a major home improvement project which Lewis is doing himself. The stress is high. The other day while Lewis was home tending to the family and remodel the FedEx truck delivered a package for Katie. Lewis had to sign for it. It felt like a bottle of pills to Lewis. He opened it. It was a bottle of 100 Vicodan (pain pills). Lewis was beside himself. He later told me that he had found evidence of FedEx deliveries several times during the past few months.Thus the call to me.
Katie's Father called me later that day and recounted the previous history of the family meeting they had 3 years ago. He was very concerned that Katie was headed in this direction. He knew that Lewis was not a man to make idle threats. He would take the children and leave. He was scared that Katie might get worse and end up loosing her marriage, her children, possibly her job, and then what? Her life? He was making plans to come out as soon as possible. He wanted to know what he could do.
A meeting was scheduled for Lewis to come an talk with me further and discuss intervention and treatment options.
Office Meeting: When Lewis arrived at the office he brought Katie with him. He stated he had talked with her and told her that if she didn't get help that he would not continue this way. The Father had also talked with her over the phone before this meeting and shared his concerns.
During the course of the meeting Lewis voiced his concerns again. Katie cried a low kind of little girl cry/wine and said she had stopped doing that and in fact hadn't had any pain medication for over a week now. The notion of going into rehab was presented. Katie did not want to go back into treatment. "I can do this on my own, give me a chance to prove it to you. I can, let me try." It was also suggested that perhaps Katie could benefit from going back into rehab program for a short stay of a week or 10-days to a relapse prevention kind of protocol. She wined and cried and got her way. Katie said she would do whatever it took so that she wouldn't have to leave her children and her home. Lewis was unable to hold firm on Katie going into rehab. You'll remember that he is now with his leg from the knee down in a cast, on crutches, and remodeling the home, plus taking care of the children. For whatever reasons, Lewis and Katie worked out an alternative plan. This plan consisted of her going to counseling one time per week. Remain abstinent and if any further use occurred then she would agree to a full course of at least one month of treatment in the program she had attended before.
I explained my concerns for this plan. It did not sound like a plan for success and I worried it would be a setup for failure. At any rate this was their choice and we scheduled a meeting for Katie and one for couples a few days later.
Outcome thus far: Katie kept her individual session with me a few days later. She said she had remained clean and hadn't used any pills. Also claimed to not be experiencing any withdrawal or detox symptoms. "I feel fine, I really don't need any kind of treatment" said Katie. "Why do you suppose you ended up at this place again in your life Katie?" I asked, "Oh I just get too stressed. I'll be OK" she claimed. We met later in the week as a couple. They argued about money and whose suppose to watch the kids. Very little was talked about her substance abuse. Katie was a no call, no show for her second individual session. I haven't heard from them in a couple of weeks. The prognosis is poor. I say that because I believe Katie is in need of treatment for her addiction to pain meds. Nothing was resolved in the brief therapy we did. Lewis seemed to change his mind from the concrete thinking of "Katie better get help or we're done". This could be for multiple reasons. Really nothing has changed. For someone who in the past had a significant pain pill abuse problem and then to relapse. Get basically no treatment and really sort of sweep it under the rug; this is going to be a problem again. Hopefully she, actually they, will get help then. And hopefully they won't have to experience a major consequence because of her using.
Addiction is a disease. It is a progressive disease. It gets worse and worse. What they say in AA is left untreated; they're only three possible outcomes: jails, institutions, and death.
Comment: Pain meds and other prescription drug abuse is epidemic in our country. More and more people are addicted to these drugs everyday. They are easy to come by and difficult to separate from. If you know someone who is experiencing a prescription drug abuse problem there is help available. Intervention Works!