Suzanne has come by the free “drop-in” counseling clinic where you work to get some information and advice

Case Study number 1: Suzanne S.

Suzanne has come by the free “drop-in” counseling clinic where you work to get some information and advice. Suzanne is a 22-year-old single woman who has been living with her boyfriend Jack in Manhattan’s lower east side for the last four years. She and Jack have been heroin addicts for as many years.

When Suzanne was 10 years old, her father, whom she says was a very heavy drinker, left her mom and the kids and never came back. At 14 she started drinking and smoking marijuana. At 16 she had dropped out of high school and at 18 she moved in with Jack. He introduced her to heroin. She reports using about a 1/2 gram of heroin per day just to be able to function and feel comfortable. In order to pay for the heroin and pay the rent on their apartment, Jack doesn’t work, instead, she works the streets at night. She usually drinks four or five beers each night before going out to work. If she can’t score enough heroin, she will try to score either some Valium? or Klonopin? to “tide me over until I can get some ‘horse'”. She says she has tried cocaine but, “I really didn’t care for the high all that much.”
Suzanne tells you that the alcohol and heroin help to calm her nerves and get her through the night. She and Jack are not having sex all that much. When they do make love he never wears a condom. He says that’s what makes him different from her “john’s” “Which is true because I won’t work without a condom.”

Lately she has noticed that her breasts have become swollen and more tender. She also hasn’t had her period in the last 12 weeks. She is pretty sure she is pregnant and knows it’s her boyfriend’s baby. However, she’s not sure she can stop using dope or work to have the baby even though Jack wants her to keep it. She really confused at what she should do and is her asking for you to help her make some decisions. Her friend who works with her at night told her not to stop using dope if she is pregnant “Because it’s worse for the baby than to keep using.”. “I just don’t know what I should do?”
Questions-Suzanne 1. What drug(s) does Suzanne seem to be most addicted to?

2. Of the drugs she is abusing, which one(s) pose more of a danger to withdraw from? Why?

3. What dangers do you see as you read this case? What are the dangers for Suzanne? What are the dangers for the baby?

4. What treatment options would you offer Suzanne and why?

5. What referrals would you give to her and in what order?

6. Is her girlfriend correct in her advice for Suzanne not to stop her heroin use if she is pregnant? If she is, why?

7. What legal issues are more than likely to present themselves in this case if she decides to keep the child?

8. Do you see any “transference or counter-transference” issues that could affect your judgment in handling this case? Please explain?

Case Study number 2: Lloyd

Lloyd is a 23-year old single male who chose to move to Dallas, Texas instead of going to college. He has been working as a plumber’s assistant for the last couple of years and will soon get his union membership. “Then I could bid on city jobs and make a very comfortable living.” As it is, he makes pretty good money when jobs are around. During lean times he works on cars and motorcycles on the side. He reports an active social life with his friends and all of them do some type of drug or another. Last year Lloyd tested positive for HIV. He’s not really sure how he got it. He is always very careful about his needles “so someone must have spiked the dope.” He doesn’t want to go into it but he was really “pissed off and angry” when he got the news. He tells you; HIV is clearly a Republican plot to wipe out the Liberal Democrats. Since he works as an independent contractor, he has no insurance. “And I sure as can’t get insurance today with my HIV status.”

Consequently, paying for his medication that his doctor has prescribed has been sporadic at best. He has prescriptions for AZT and protease inhibitors but he has not been able to take them consistently because they are too expensive. “Either way you look at it I’m screwed.”
Lloyd prefers to do “speedballs” when he can score those drugs. He loves the rush and even boasts that he can get a full count (1 gram) that’s at least a “……’ten hitter’ for a C note”. Most “bumpers” on the street will have to pay twice as much for half the quality.”
Lloyd says he doesn’t do any other drugs but has tried them all. Occasionally he will drink some Scotch but lately his stomach has been really giving him trouble. Sometimes it will feel like multiple stab wounds in my gut that go on for hours. It really has me scared. He’s seen his doctor and she prescribed some Demerol? and an antacid. He’s pretty sure it’s related to his HIV. Lloyd tells you quite frankly that when he gets too bad and too sick from the AIDS he’ll take himself out. “Hey, I think of suicide from time to time. If it gets really bad? I mean the AIDS thing? and life get too unbearable, I know I don’t have to take it”.
Questions-Lloyd

1. Lloyd states that he “prefers to do “speedballs.” Based on your readings, please describe what a “speedball” is?

2. Based on the information Lloyd has given you, what would your initial assessment be?

3. What would your recommendation for treatment and medical intervention be for Lloyd based on your assessment?

4. What pharmacological interventions would you suggest Lloyd look into regarding both his medical condition and his drug history?

5. Lloyd uses a number of street terms you may not be familiar with. How would you handle a client like Lloyd who uses street terms you may not recognize or understand? Why do you think Lloyd is using these terms?

6. What possible transference issue that might be connected to Lloyd’s use of street terms? What possible Countertransference issues might his use of these terms bring up for the counselor?

7. What do you think about Lloyd’s statements of suicide? How would you handle this issue with Lloyd?