Medical Case Study Martha

Drug History and Current Pattern of Use: Martha has a history of alcohol use disorder. Client has stated she has eight to twelve drinks a day, never having fewer than five drinks.
Substance Abuse Treatment History: The client has no history of substance abuse treatment.
Medical History and Current Status: Doctors have reported Martha has impacted liver function and is developing cirrhosis of the liver. Aside from substance-related health impairments Martha is in good health and appears to have no other physical health issues or ailments.
Family History and Current Relationships: Martha was born into a two-parent household located in an affluent New York suburb. Her father was a successful academic and university administrator. Her biological
mother was a housewife who participated in a number of social activities. Martha was their only child. The client describes her early childhood as safe and secure. Martha’s mother died when she was six years old. Martha reports her father then married an extremely wealthy woman who was significantly older. Although they lived very well the client describes that her father’s new wife never loved or cared for her. Although her father was very busy with his academic career Martha’s relationship with her father was maintained. Martha holds her father and his opinions in high regard to this day. The client disclosed she feels guilty complaining about her childhood because she was well taken care and “had all the things a kid needs” during her upbringing. However, at times she felt like an unwanted nuisance in the new marriage because her stepmother was cold and unkind. In her late teens Martha eloped with a man who her father did not find suitable due to his social class so the marriage was annulled. Initially her current husband George seemed like an ideal husband. A scholar of history he seemed to have the background and interests to make a good match with Martha. Additionally, early in their marriage, he was being considered for university president when Martha’s father stepped down from the position. Something that Martha was very excited about. However, over time it has been revealed that George does not really want to fight his way to the top of the academic hierarchy. Although George says he is content with his current position his actions have been interpreted by some as a lack of drive to achieve success. Martha’s father no longer sees George as a suitable replacement as president of the university. These unfulfilled expectations and mismatch of goals have caused a great deal of tension between Martha and George, as well as between Martha and her father. Martha believes her drinking has exacerbated the disconnect between her and her father stating he is now “cold and reserved.” The client reported that her husband believes her father does not care "whether she lives or dies." The withdrawal of such an influential figure combined with the fact that George’s academic career has not gone anywhere has left Martha bitter, hurt and disillusioned. Although she has turned to alcohol instead of George’s support she does acknowledge that George loves her. She went on to say that George "has made the hideous, the hurting, the insulting mistake of loving me and must be punished for it" suggesting Martha has some feelings of ambivalence toward being loved and cared for. She perhaps resents George for his feelings toward her.
Positive Support Systems: Martha’s primary support is her husband George. It appears that although supportive George has traditionally enabled Martha’s use and that George may also have a substance use disorder. Moving forward it will be beneficial to speak with George and if he is open to supporting Martha in abstinence to provide him with information about alcoholism and recovery. The client also indicated that in the past, her father has been more willing to spend time with her after stretches of abstinence. If Martha is willing to attempt abstinence her father may emerge as an additional source of support.
Crime and Delinquency: Martha does not have a criminal history.
Education: Martha’s level of educational attainment is junior college.
Employment: Martha is a homemaker.
Readiness for Treatment: Martha is in denial of her drinking problem. Although the trip to the hospital for acute alcohol poisoning has caused her to “want to cut back” on her drinking, I would classify her as in the precontemplation stage of addressing her substance use disorder.
Resources: Martha and her husband are in great financial standing leading the household to being monetarily supportive of Martha’s treatment.
Mental Status Exam: The patient is well groomed and appeared to be her stated age.
There is no clinical evidence of psychomotor disturbance. The client maintained adequate eye contact. The client has been prescribed Benzodiazepines to combat her symptoms of withdrawal. Although there was some slowed speech and the occasional slurred word her speech was coherent, spontaneous and appropriate with normal rate, volume and rhythm. She described her mood as “blue.” Objectively her mood was a combination of sad, ashamed and distracted. Her affect is full range, appropriate, with spontaneous emotional reactivity. There were no clinical features of psychotic illness. Her behavior is appropriate for a person who is in a hospital being treated for acute alcohol poisoning and withdrawal. Her memory for recent and remote events is intact, yet recent memories are slightly “hazy” at times. She is well oriented to place, time and person. Her concentration and attention were both adequate, although at times she did trail off and lose track during our conversation. She was able to add and subtract figures without difficulty. Her level of intelligence and fund of general knowledge is within the normal range. Her level of personal hygiene is adequate. She was able to communicate clearly and was able to achieve goal directed ideas without difficulty. She denied any current suicidal or homicidal ideation. Client disclosed ideations of “It all being just too much,” frustration with treatment and
desire to go home. I was able to maintain adequate rapport with her throughout the interview and she was able to follow directions. She denied any current auditory or visual hallucinations. However, in the night prior to being prescribed Benzodiazepines she said she could feel insects crawling on her skin, claims she saw bats on the upper parts of a few walls and mice in some corners of the hospital. These appear to have been withdrawal related hallucinations that were mitigated by Benzodiazepines. The client has poor insight into the nature of her condition.
Treatment Plan:
Due to Martha’s level of dependence a medical detoxification will be necessary.
It is my professional opinion that she should remain on site for at least eight days. During this time I will continue to build a report with Martha by talking with her about her life. This will enable me to gain insight into what her life has been like. During our sessions I will utilize basic counseling skills by listening attentively, using reflective statements and expressing empathy when appropriate. Additionally I will identify Martha’s strengths as well as sources of support and help Martha relate her experience to the here and now. It is my hope that this client-centered approach will help foster trust in our relationship. If the client is willing I would like for her to begin attending group meetings tomorrow. If she is not open to attending the Alcoholics Anonymous (AA) meetings the organization brings to the facility I will see if she is open to attending our in house group psychoeducational classes. These would enable her to learn about substance use, its consequences, symptoms of withdrawal, coping strategies and relapse prevention. My first impression about Martha is that she values her autonomy so in individual treatment, it will be important to work collaboratively with her. Group will provide her with a base of information and I will focus on evoking change through motivational interviewing. Although it appears Martha has attempted to reduce her drinking at times it does not
sound like she has contemplated an attempt to abstain from alcohol. Although I see her as in the precontemplative stage of change it will be necessary to further explore her readiness for change. When speaking about attempts at reducing her intake Martha did display preparatory change talk speaking about what it would be like “if she could cut back” and that she “wished she was able to drink even less than 5 drinks a day. Martha explained that on days she had fewer than 5 drinks her hands shook uncontrollably dissuading her from additional attempts of reducing her intake. Having asked first if she would like to create a plan, I have already begun setting harm reduction goals with the client. Given her history I do not believe Martha is an ideal candidate for harm reduction. She might benefit additionally from abstinence, however, it is unclear if she will be receptive to the suggestion. Although she has been permissive to suggestion generally abstinence may sound like an excessive measure. It is my hope that the group psychoeducation classes will begin to build a base of knowledge that will lead to additional insight and perhaps the contemplation of a greater level of change. If this occurs I will set new goals with Martha, explore any ambivalence she is experiencing toward changing, attempt to identify additional sources of support and elicit Martha’s strengths. Assuming she is attending group I will ask her what strategies have worked for other members attempting a similar change. It is during this stage that a sober support network like AA would be beneficial. Attending the in house group that focuses on practical skills training and relapse prevention would also be useful during this key time. Whether Martha exits the facility as soon as she is medically able or after long-term treatment my recommendation will include attending a like-minded support group. The selection of the group will depend on the level of change she is contemplating or committed to at that time. If she is interested the harm reduction model I will recommend Moderation Management, or abstinence focused groups like SMART Recovery or Alcoholics Anonymous.