Case Management Plan for Janice Jones
Janice has cut herself off from all her friends and relies heavily on her daughter Dorothy to handle her daily affairs. She explains that she needs a drink just to get out of bed and another before she eats breakfast that her daughter comes over every morning and prepares. If it weren’t for Dorothy she probably wouldn’t eat. Just to get through the day she must drink and the day she was arrested was after Dorothy and she had spent the morning doing her weekly grocery shopping. Janice explains that since her divorce she has been terminated from her position as a paralegal; for missing too many days of work.
She is living off the alimony she receives from her ex-husband who is an airline pilot. You explain to Janice that she must stop drinking before there can progress with her personal issues. Janice hesitantly expresses she is ready to stop drinking. After a complete compilation of Janice’s social history you have tentatively diagnosed her with the following disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) retrieved.
Dependent Personality Disorder Axis IV- Recent Divorce/Unemployment Axis V- 60 Since Janice has agreed to stop drinking you realize that you have a potential crisis situation. According to About. Com Alcoholism “When a heavy or frequent drinker suddenly decides to quit “cold turkey” they will experience some physical withdrawal symptoms which can range from mildly annoying to severe and even life-threatening” retrieved 5/1/2012. Janice has admitted to being a daily heavy user of alcohol for a little over six months.
You have noticed that she appears to have some shaking of her hands which could be the beginning of Delirium Tremors (DT’s). You decide to ask her to go to the local hospital which has a specific unit for alcohol and substance withdrawal. She agrees and you take her to the hospital where she is immendialtly admitted and given Valium to ease the withdrawal symptoms she has already begun to show. The nurse explains that you have done the right thing and that Janice will remain hospitalized for the next 7 to 10 days. She advises there be no contact for the first five days.
That by then her head will of cleared and she will have passed through the worst of the withdrawals. You ask Janice if you would like her to visit and possibly get started on her treatment plan so she has a plan of action upon her release. She reluctantly agrees. You return to see Janice on day 5 of her treatment to discuss her treatment plan. According to Summers Janice is in the 3rd stage of recovery “developing a treatment plan” (2009 p330). However after you speak with her you quickly realize that she is not in stage 3 but stage 2 “contemplation” (Summers 2009 p330).
Janice complains that she just doesn’t know if she’s ready. That ever since she stopped drinking she has all these emotions that she feels she is not ready to deal with. The nurse informs you that she spends hours in her room crying and refuses to engage in any of the programing designed to prepare her for her release. This is what Summers defines as “Ambivalence” a normal and expected response. Summers continues to explain “that collaboration and good listening skills are very important at this stage” (2009 p330). Janice talks a lot about her daughter Dorothy who has yet to come visit.
You take this as a prime opportunity to possibly get Dorothy involved in the treatment. You ask her if it would be alright for you to contact Dorothy and discuss her recovery plans. Janice agrees. You put together the appropriate release forms giving her authority to discuss with her daughter how she can be an intricate part of Janice’s treatment. She signs the forms and you express your interest in picking her up in 3 days to get started on her treatment plan so there is no question about what is expected of her. Janice agrees.
The next day you meet with Janice’s daughter Dorothy who expresses her concern about her mother’s dependence on her since the separation and subsequent divorce. Dorothy explains how her mother’s every waking moment has been spent consuming alcohol and that she cannot go on living like this. You comfort her by explaining how you had diagnosed Janice with Dependent Personality Disorder and how important it is for her to be supportive of her mother as they work through these issues. Dorothy and you put together a tentative plan detailing her role in her mother’s recovery.
Upon Janice’s release you are there as planned and take her back to your office to put together her treatment plan and you encourage her to embrace her new beginning as a productive, vibrant, individual living in recovery not only free of her alcoholism but her new role as a single women too. The first question you ask Janice is what she wants to see happen in her recovery. She confidently replies, “remain sober first of all. ” Janice goes on to say before her husband left her she was lucky to drink one maybe two drinks a week.
You suggest she begin attending Alcoholic Anonymous (AA) meetings. You explain how AA has helped millions to recover from alcoholism and that you feel this would be a great start for her. She can get a sponsor and begin working the 12 steps. Together you decide this will be one of Janice’s first goals to attend AA meetings at least four times a week, get a sponsor and remain sober all while working the 12step program of AA. You write this as one of Janice’s first goals. Janice expresses her concern over the DUI ticket and her suspended license.
You calm her by explaining that she will most likely be given driving privileges once the charge is disposed of. You tell her that you will set her up with GCBH’s lawyer who will take over her defense if she so desires. Janice agrees and this becomes another goal to apply for driving privileges, dispose of legal matters and serve out any fines or sanctions. You explain to Janice how you are concerned with her depression, crying spells and dependence on other. Janice expresses how she just feels totally lost without her husband and can’t picture her life without him.
You ask if she is having any suicidal houghts. After a brief pause she shyly admits to them when she was drinking but since she is sober she no longer is feeling that way. You express your concerns and suggest seeing a psychiatrist for the depression. You ask if she would be against medication for her symptoms, reluctantly she says no. Having determined this as goal number three you move on to her dependence on others and her need to come to terms with her divorce. GCBH has an excellent staff of Psychological Therapists and you feel that Janice would benefit greatly from their services. Janice agrees and you move on to employment.
Janice quickly jumps in and says adamantly she is not ready to return to work. She goes on to explain that she receives more than enough money from her husband’s alimony payments and feels time better spent focusing on her. You agree and move on. Finally, you express you concern over her lack of social relationships. Dorothy explained that all your friends either abandoned you and stuck with your husband or have avoided you because of your drinking. Janice shook her head and said her friends tried so hard to be there for her but she shoved them out as she wallowed in her alcoholism.
I suggest she discuss this in her therapy sessions and that her goal will be to begin making amends to these friends according to the 12 step program. Janice and you have gone over a lot of information. You’ve set short term and long term goals and you definitely have put together a workable treatment plan for the next few months. You express your gratitude for Janice getting serious about her treatment plan and inform her you will arrange all her appointments and be in contact with her soon. You set an appointment to see her again in one week which concludes your meeting.