Continuum of Care for Patients with Issues with Medication Abuse

Instructions:
Please respond to each of the following questions regarding the clinical vignette below. Please incorporate some of the attached course material. **No cover page needed.
Questions:
1. Based on the information in the clinical scenario below, what was the level of care used for Katie’s original treatment three years ago?
2. Based on the information in the clinical scenario below, using the Continuum of Care, what level of care would you assign to Katie’s current treatment? Why?
3. NOT including the relapse stage in the stages of change model by Prochaska and DiClemente, what stage is Katie currently in? Why?
4. What stressors can you identify that have impacted Katie’s relapse?
5. Based on this clinical vignette, what information is provided that demonstrates the importance of understanding and treating addiction from a relational perspective (relational perspective meaning the mental health professional will work with and consider factors other than just Katie)?
Clinical Vignette:
Katie had been to a residential treatment center 3 years ago. 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 participate in any form of follow-up treatment. She also did not attend any counseling or self-help (AA/NA meetings). She felt that she had gotten the pain medicine abuse under control and behind her. Katie reported that she did not care to go to the meetings because they reminded her of a low point in her life. Her husband Lewis 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 medicines 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 friends, family, and 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 quickly turned to addiction. 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 vitamins. 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 prescription pain 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 a mental health professional. Frustrated and ready to end the marriage, he says that if this doesn't stop immediately he is done with the marriage.
During the first session, the following information is reported: Katie and Lewis had their second child about 6-months ago. Within the past 3 months, Lewis has had an accident at work where 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 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 Vicodin (pain pills). Lewis was beside himself. He later told the mental health professional that he had found evidence of FedEx deliveries several times during the past few months. This was the initiating factor for the call to the mental health professional.
Katie's Father called the mental health professional 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 the same 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 losing 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.