Case Study Vignette

A 42-year-old homeless man, Wan DeRer, with a long history of severe alcohol dependency is being treated at a drug abuse treatment program. His family history reveals that he and his siblings were severely neglected and punished physically and emotionally as children. Both parents passed away long ago. When family issues are raised during individual counseling sessions, he shrugs them off and avoids commenting on the issues raised.

At one time, the client was a highly paid welder and is very proud of his craft. He still gets occasional jobs through his union hall because of his skills and often gets quickly promoted and given more responsibility. After a couple of months on the job, he goes off on another bender of drinking.

He has been coming to the treatment program for several months and sometimes remains sober for several weeks. Despite the program’s best efforts, he continues to relapse. It is not unusual for him to come to group under the influence. On most occasions, he simply smells of alcohol and engages in limited dialogue. At other times, he is severely drunk and comes to treatment activities tearful, repentant, and pleading for help. The clinical staff sets limits and allows him to attend group only when he is sober and able to take part in the process.

Last month, the client was twice found passed out in the alley next to the treatment center. Police and the Emergency Medical Team took him to the county hospital on these occasions. For several months, the clinical staff tried, unsuccessfully, to get the client into an inpatient residential program, or inpatient hospital detoxification program. He either refuses to go because “he has to maintain his standing at the Union hall to pay for his tools in storage” or he does not show up for the appointments made for him at the programs.

He has been a frustrating client to work with. First, he agrees to go into a detoxification, residential or hospital program and then he ducks out at the last minute with a lame excuse for why it would not work for him.

The only positive is his connection to the program. Despite numerous, relapses he continues to come back asking for help.

Reflections in Preparation for Case Studies

The above Case Study presents a disruptive, chronic relapsing client who challenges the compassion of program staff. Before responding to the assessment questions below, review the How to Approach a Case Study and Case Study Instructions and Template documents for detailed instructions pertaining to the assignment.

Identify the following information in your review of the above case study.

• What evidence, if any, is there that the client in this case study has alcohol dependency?
• Did this client’s family and social history contribute to the development of his alcohol use disorder?
• Consider the impact that the chronic relapsing behavior is having on both staff and other clients in the program. Would there be valid cause to discharge the client from treatment?
• What considerations favor retaining the client in treatment and under what conditions should treatment continue?
• Prioritize the clinical interventions that need to occur with this client.