TPC Journal V8, Issue 3- FULL ISSUE

The Professional Counselor | Volume 8, Issue 3 233 activities because of continuous pain. Because this debilitating injury occurred at home, Jason did not qualify for worker’s compensation benefits. He had surgery on his back and returned home with a prescription for narcotic pain medication. He did not comply with his doctor’s orders regarding physical therapy because as an hourly laborer, he could not afford any more time off work. Though the surgery did alleviate some of his pain initially, after a year it was clear that the operation did not fully repair his spine, and his pain again became unbearable. His doctor prescribed Percocet for him to take in the evenings when his pain was the worst, but over time, the medication became less effective. He visited a pain clinic near his apartment and received a prescription for OxyContin, which was stronger and long-acting. Jason noticed he felt less lonely and discouraged after taking the pills, which he began to do more often. Soon, Jason was not himself at work—making mistakes, forgetting things, and having conflicts with his supervisors. He was fired from his job. With no savings, outstanding medical bills, and being unable to work in his field, Jason returned home to live in a small house on his mother’s property. He applied for disability benefits and began receiving prescription opioids through a pain clinic in town. As his tolerance for opioids increased, he tried various strategies to avoid the horrific withdrawal symptoms he experienced when his supply of opiates ran out: crushing and snorting pills for a stronger effect, “borrowing” medication from family and friends, and buying additional pills from dealers. Nine months ago, the high street cost of pills led Jason to begin snorting heroin, which was cheaper, but more potent. Within 2 months, he began using heroin intravenously on a daily basis. Acquiring and using heroin became his primary endeavor, increasingly isolating him from his family and his group of lifelong friends. After showing up to church several times late and disheveled, Jason’s mother told him he was no longer welcome to join her in the family’s regular pew on Sundays. Last Friday, he met his ex-wife and younger son to attend his elder son’s first varsity football game as a family. In an effort to avoid becoming ill during the long game, Jason shot heroin in the parking lot and was visibly high when he entered the stadium. The evening ended with his ex-wife enraged, his younger son in tears, and his elder son saying he could not wait to go far away to college and never see Jason again. Two days ago, Jason’s mother found him unresponsive in his truck and called 911. EMTs administered naloxone (branded as Narcan), which restored his breathing after an accidental heroin/fentanyl overdose. He was taken to the hospital and referred to an outpatient community addiction and mental health clinic upon release. With no one in his family willing to pick him up from the hospital, and his mother saying she is unsure if she wants him to continue living on her property, Jason used a hospital bus pass to travel directly to a local substance abuse treatment facility. Treatment Planning Implications by Ecological Level: The Case of Jason Individual: Traditional treatment focus. Assuming a disease model of addiction, a counselor would view Jason’s opioid dependence as primary, chronic, progressive, and potentially fatal (Angres & Bettinardi-Angres, 2008). As such, many substance abuse professionals would advocate that Jason’s addiction is the primary presenting problem and must be addressed first, before tackling other concerns and challenges. A treatment plan including goals and objectives focused upon enhancing his ability to remain abstinent from opioids and all other mood-altering substances should be developed, implemented, and monitored from the outset of treatment. It is essential for Jason to reduce his isolation by developing a social network supportive of his recovery efforts. Specific objectives to meet this goal might include attending daily 12-step meetings for a minimum of 90 days, obtaining a sponsor who has a minimum of 5 years in recovery, and reestablishing relationships with non-using childhood friends.