Psychology Case study: Tommy

Case : Tommy

Tommy is a 45-year old Caucasian male who ruptured a disc in his back while at work over five years ago. After failing to improve through physical rehabilitation, Tommy received a spinal fusion surgery which joined two of his vertebrae together. After Tommy’s injury he received a prescription for a acetaminophen/hydrocodone at 300 mg/5 mg. However. Tommy indicated that his pain levels continued to escalate. His prescription was increased to 300 mg/7.5 mg after 6 months. Post surgery, Tommy continued to complain of escalating pain and his prescription was increased to 300mg/10mg.

At one year post surgery, Tommy continued to request increases in his prescription and his physician determined that Tommy had developed an opioid dependence. The physician refused to increase the prescription and referred Tommy to a substance abuse provider. Instead of seeking help, Tommy began to look for ways to supplement his prescription. He discovered that he was able to purchase heroin and that the injections provided him with pain relief. Tommy began with 300 mcg dosages of heroin injected into his body but quickly increased the dosages and his dependence upon the drug.

Eventually Tommy became homeless and was arrested for breaking and entering. He has been referred to you for a mandated substance abuse assessment from the courts. Tommy has been living in a shelter. He reported using heroin three times per day and that his last injection was 12 hours ago.

Questions

• What would be your initial diagnostic impression of this case?

• What risk factors and behaviors are present in this case?

• What individual and family interventions might need to be considered?

• What type(s) of treatment settings and strategies may be needed?

• What cultural, ethnic, or special population factors may play a role in treatment planning?

• Assuming Tommy has a substance-use disorder, what specific challenges may need to be addressed to maintain her recovery to avoid relapse?

• What specific roles could or should healthcare providers, businesses, schools, and organizations play in Tommy’s assessment, intervention, and treatment study?

• What specific client advocacy, current public policy discussions, or ethical or legal issues may be related to this case study?