2015 Final Case Studies Asam Fundamentals Final Updated

CASE STUDIES
CASE STUDIES
BOOKLET
April 23, 2015
8:00 am 5:30 pm
Governor's Ballroom D-E, Fourth Floor
American Society of Addiction Medicine
4601 N. Park Avenue, Upper Arcade #101, Chevy Chase, MD 20815

Phone: 301-656-3920 | Fax: 301-656-3815 | Email: email@asam.org
Copyright 2015 ASAM
MEET OUR PATIENTS

The following pages contain the profiles of two patients, Sam and Pat. These cases will unfold
throughout several sessions, and comprise the foundation for role-plays. The names can apply
to either male or female participants, but once a role is initially assigned, the participant will
continue in the same role throughout each session. A third patient, Jesse, will be introduced at a
later point in this course.
The case studies booklet is divided into six sections according to patient and gender. Refer to
the tabs to find the appropriate patient and gender for each of the table exercises.
Note: shaded areas in table indicate information has been previously provided in the case
study.
April 23, 2015
April 23, 2015
SAM - FEMALE
April 23, 2015
April 23, 2015
SAM
Session 1
ID
Housing
Education
Occupation
Reason for visit
Other
Med/Sx Hx
Fam Hx
April 23, 2015
Sam is 20 years old single female; boyfriend- 2 years

Lives with partner 1 year
Community college
Service agent- car rental company
Wants a sleeping pill
Patient relatively new to your practice
Nil significant
Father: alcohol problem
Mother: uses pills for her nerves sometimes to excess
1 younger brother: age 15. Healthy
SAM, CONTINUING CASE STUDY

Session 3
ID
Housing
Education
Occupation
Reason for visit
Brief hx
Alcohol use Prior to

DUI
Since DUI
Other
Med/Sx Hx
Fam Hx
April 23, 2015

Community college
Poor sleep x 3 months after charged with DUI (driving under the
influence). Feels nervous and shaky in the morning, doesnt
want to leave the house
Court 1 week prior to visit
2 glasses of wine at lunch, 3 - 4 at dinner and 1 or 2 of brandy or
mixed drinks during the evening
50% reduction; doesnt help sleep.
Shakes in the morning are reduced slightly since cutting back
Nil significant
ADDITIONAL INFORMATION FOR SESSION 3 CLINICAL SKILLS PRACTICE

Screening
AUDIT
(See page 8)
AUDIT Score: 17
POINTS FOR THE FOLLOWING:
1) How often do you have a drink having alcohol? (4 or more
times per week = 4 points)
2) How many drinks containing alcohol do you have on a typical
day when you are drinking? (3 or 4 = 1 point)
3) How often did you have 5 or more drinks on one occasion?
(Monthly = 2 points)
4) How often during the last year have you found that you were
not able to stop drinking once you had started? (Less than
monthly = 1 point)
5) How often during the last year have you failed to do what
was normally expected of you because of drinking? (Less
than monthly = 1 point)
6) How often during the last year have you needed a first drink
in the morning to get yourself going after a heavy drinking
session? (Less than monthly = 1 point)
7) How often during the last year have you had a feeling of guilt
or remorse after drinking? (Monthly = 2 points)
8) How often during the last year have you been unable to
remember what happened the night before because of your
drinking? (Less than monthly = 1 point)
9) Have you or someone else been injured because of your
drinking? (No = 0 points)
10) Has a relative, friend doctor, or other health care worker
been concerned about your drinking or suggested you cut
down? (Yes, during the last year = 4 points)
Screening DAST- 10
(See pages 9 10)
DAST-10 Score: 0
YES TO THE FOLLOWING:
3) Are you always able to stop using drugs when you
want to? (0 points)
Practice single
screening
questions.
(See page 11)
Sam will be positive for the single question alcohol screen and
tobacco products screen
Sam will be negative for the single question prescription drug

screen and illegal drugs screen.
April 23, 2015
April 23, 2015
April 23, 2015
April 23, 2015
10
April 23, 2015
11

Session 4
ID
Housing
Education
Occupation
Reason for visit
Brief hx

DUI
Since DUI
Med/Sx Hx
Fam Hx
Single Alcohol
Screening Question
score
Single Tobacco
Screening Question
score
Screening AUDIT
Single Prescription
Drug Screening
Question score
Single Prescription
Drug Screening
Question score
BI practice
(See Pages 13 14)
April 23, 2015

Community college
Poor sleep x 3 months after charged with DUI. Feels nervous and
shaky in the morning, doesnt want to leave the house
2 glasses of wine at lunch, 3 - 4 at dinner and 1 or 2 of brandy or
mixed drinks during the evening
Nil significant
Father: alcohol problem left home when she was 10- no contact
Mother: uses pills for her nerves sometimes to excess- not much
contact
Positive (Monthly - 25 times)
Positive (Daily or Almost Daily - 20 cigarettes per day)
AUDIT Score: 17
Negative (never - 0 times)
Use the SBIRT ref sheet to conduct a BI
12
April 23, 2015
13
April 23, 2015
14

Session 6
Housing
Education
Occupation
Reason for visit

Brief hx
ID
Finances
Alcohol Use
frequency and
pattern
Amount
Tobacco
Other drug use
Med/Sx Hx
April 23, 2015
Sam is now 35 years old, single female

boyfriend- left because of drinking
Sharing apartment with friend
Community college
Fired from job 2 years ago. Poor attendance- hangovers.
Unemployed
Feeling depressed
Sad off and on 2 months; mild anhedonia; fitful sleep, appetite
normal, weight gain of 10 pounds over 2 years, low energy, poor
concentration, guilt but mainly over drinking and losses due to
drinking; Not suicidal Not homicidal. You smell alcohol on patients
breath. Had cut down drinking to guidelines at last intervention but
began drinking daily once the relationship broke up. Didnt want to
get to this state but had noticed increased drinking prior to
breakup. Was confident that it wouldnt escalate to the current
amount
Had tried to quit on her own but only lasts a few days after
discharge from detox x 3 admissions.
Has given up playing sports
All money goes to buy alcohol; in debt and panhandles to support
self
Drinks daily from morning to night (within an hour of waking).
Gets very shaky if doesnt drink by noon and craves alcohol all
the time especially when friends are drinking with her
Drinks 8 tall boys plus mickey of rye.
20 cpd (cigarettes per day) with first cigarette within 5 minutes of
waking
Cocaine: tried crack x1 didnt like it. Caused rapid heart rate. No
other stimulant
Opioids: none
Benzodiazepines: will use 6 mg clonazepam whenever available.
Helps anxiety uses 2-3 x per month
Marijuana: Smokes 1 joint per day with friends.
Denies other drugs
Had an upper GI bleed 8 months ago- ER. Admission 2 days.
Hypertensive and had recurrent diarrhea and insomnia. All tests
normal except elevated LFTs consistent with alcoholic hepatitis.
was advised to stop but couldnt maintain abstinence
Has had recurrent blackouts
No withdrawal seizures
15
Fam Hx
Father: alcohol problem left home when she was 10- no contact
contact
TASK: Describe a
treatment plan for
this patient
Use the two worksheets ASAM Patient Placement Criteria

Worksheet and the Case Study Treatment Plan
Template in the Agenda Book to place the patient and form a
treatment plan (Pages 32 - 33 in Agenda Book)
Assess motivation
for treatment
Readiness 8/10
Wants to, needs to, has reasons to; knows how to cut down but
not stop completely
Ready to stop
Not ready to stop
Developing a Treatment Plan

Treatment plan considerations:
Co-morbid substance use, psychiatric, medical, and social problems impact the treatment
plan
The patients readiness frames the treatment plan
Resources available in your practice setting
UDT as an assessment tool
Non-pharmacological treatment options
Harm reduction optimizing safety
Medication
Need for withdrawal management
Family and social supports
April 23, 2015
16

Session 7
ID
Reason for visit
Physical
Labs
Tobacco
Sam is still a 35 year old single female

Diagnosed with a severe alcohol use disorder
Expresses motivation to stop using alcohol.
No evidence of alcohol withdrawal at the moment; a strong odor of
alcohol on breath
No withdrawal
AST >ALT 2x
bili normal. Hb N
MCV elevated
Urine tox: positive alcohol, neg THC
Urine HCG neg
waking
Discussion Questions for Sams Case

1. How would you assess Sams risk for withdrawal symptoms?
2. If you decide that Sam is at significant risk of alcohol withdrawal syndrome, where and how
would you treat the alcohol withdrawal?
3. Once Sam has withdrawn from alcohol, what treatment settings would be appropriate for
Sam?
4. What treatment modalities would you offer Sam for Alcohol Use Disorder?
5. How about for Tobacco Use Disorder?
6. What are your treatment targets, and what duration would you recommend for the
treatment?
7. Would you advise Sam to engage in treatment for one SUD or the other (alcohol or tobacco)
first, or to address both simultaneously?
April 23, 2015
17
April 23, 2015
18
PAT - FEMALE
April 23, 2015
19
April 23, 2015
20
PAT
Session 1
ID
Housing
Education
Occupation
Reason for visit
Other
Med/Sx Hx
Fam Hx
April 23, 2015
Pat, 25 year old single female; boyfriend- casual relationship; 1 year

Lives with boyfriend
Masters in biochemistry
RA in a molecular lab
Hurt R shoulder playing hockey
Otherwise healthy
Father: well
Mother: depression on meds
2 younger sisters: age 19, 15. Healthy
No substance use problems
21
PAT, CONTINUING CASE STUDY

Session 3
ID
Housing
Education
Occupation
Reason for visit
Other
Med/Sx Hx
Fam Hx
Diagnosis and
Management
Other meds
Pat, 25 year old single female; boyfriend- casual relationship 1 year

URI
Otherwise healthy
Father: well
Viral URI; reassurance and symptomatic treatment
Hydrocodone tid for R shoulder pain following recreational injury;

prescribed by sports medicine doctor

Screening
DAST-10
(See pages 23 24)
DAST-10 Score: 2
1) Have you used drugs other than those required for medical
reasons? (1 point)
want to? (0 points)
5) Do you ever feel bad or guilty about your drug use?
(1 point)
Screening AUDIT
(See page 25)
AUDIT Score: 2
1) How often do you have a drink containing alcohol?
(Monthly or less = 1 point)
3) How often do you have 5 or more drinks on one
occasion? (Less than monthly = 1 point)
Practice single
screening
questions.
(See page 26)
Pat will be positive for the single question prescription drug screen
and tobacco products screen
Pat will be negative for the single question alcohol screen and
illegal drugs screen.
April 23, 2015
22
April 23, 2015
23
April 23, 2015
24
April 23, 2015
25
April 23, 2015
26

Session 4
ID
Housing
Education
Occupation
Reason for visit
Other
Med/Sx Hx
Fam Hx
Diagnosis and
Management
Other meds
Alcohol
consumption
Medication use
Single alcohol
screening question
score
Single tobacco
screening question
score
AUDIT
Single drug
screening question
score
DAST-10 Score
Instructions
(See page 28)
April 23, 2015
Pat, 25 year old single female; boyfriend- casual relationship 1 year

Masters in Biochemistry
URI
Otherwise healthy
Father: well

drink wine 1 glass with friends on Saturday or Sunday once or twice
a month when entertaining or when out with friends
Prn for pain; recently had the meds on an empty stomach with a 2
glasses of wine- got a nice feeling.
Her friends told her about it
Negative (Never)
Positive (Daily almost daily - She smokes half pack/10 cigarettes

per day)
AUDIT Score: 2
Positive (Weekly - 3 times)
DAST-10 Score: 2
Use the provided card to conduct a BI
27
April 23, 2015
28
JESSE - FEMALE
April 23, 2015
29
April 23, 2015
30
JESSENEW CASE STUDY

Session 6
Housing
Education
Occupation
Reason for visit
Brief hx
Withdrawal
Tolerance
Cravings
Amount used
Duration
Time spent
Finances
Role issues
Relationships
affected
Use in hazardous
situations
Use despite harm
Alcohol use
frequency and
pattern
Tobacco
Other drug use
Med/Sx Hx
Fam Hx
ID
April 23, 2015
Jesse, 35 year old divorced, 2 kids 10 and 8

no custody but can visit
Lives in a one bed room apartment
Masters in Business Administration
Office administrative supervisor, legal firm
I want help for my addiction to pain pills
Had started using acetaminophen/ oxycodone (325mg/5mg) as a
teenager recreationally; was raped during first year university;
increased her use to sustained release oxycodone after the birth of
her second child- mild postpartum depression but flash backs to the
rape was most troublesome. Increased to daily use of 160-320mg
per day; When new tamper resistant sustained release oxycodone
came on the market, she switched to hydrocodone; No street
heroin.
Currently uses daily, crushes and snorts. No IDU
Gets sniffly, stomach aches, diarrhea and gooseflesh two days after
stopping or running out
Can work with increased energy after taking 320mg per day. Liked
the energy it provided. Doesnt find she gets high anymore
Every day especially when she has money
Always runs out. Has tried to ration but uses all the meds up in one
go
Never thought use would be going on for this long
At least 3 to 4 times a week tries to score; double doctor; buy on the
streets- find dealers. Once uses, unable to function at times for half
a day- goes to sleep
On social assistance; all $ go for drugs. High debt
Couldnt work or parent
Estranged from ex-partner; parents and children. Not many friends
left except those who are also addicted
Uses and drives;
Loss of custody partly due to drug use; one OD 2 years agoadvised to stop but relapsed post discharge from hospital
Occasional- 1-2 standard drinks every 10 -20 days. Drinks a mickey
of vodka if short on pills
Smokes 25 cpd. First cig within 5 minute of waking
Occasional crack use- last use 1 month ago. Smokes with friends.
Doesnt like it
Nil significant
Parents both Heroin users but were maintained on methadone for 5
years. Doing well functioning
31
TASK: Describe a
treatment plan for
this patient

treatment plan (Pages 32 33 in Agenda Book)
Assess motivation
for treatment
Ready to stop
Not ready to stop
Readiness 10/10

plan
Medication
April 23, 2015
32
JESSECONTINUING CASE STUDY

Session 7
ID
Reason for visit
Physical
Labs
Psychosocial
treatment
Tobacco
Jesse, 35 year old divorced female,

2 kids -10 and 8- no custody but can visit
Wants to explore pharmacotherapeutic options for opioid use
disorder.
Evidence of mild opioid withdrawal
No track marks
HCV pos
HIV neg
HBV negative
LFTs Normal. Rest Normal.
HCG neg
Nil in the past.
Doesnt believe in NA or AA.
Discussion Questions for Jesses Case

1. Jesse is interested in pharmacotherapy for opioid use disorder (OUD). What options would
you explore with him/her? Note that Information about each of these agents is in the last
page of your guide for this session, as well as in the Agenda Book for this session.
2. Depending on Jesses choice of medication options s/he may need to undergo opioid
withdrawal. What are your options for managing his/her withdrawal, and how do they relate
to the choice of ongoing pharmacotherapy?
3. What treatment settings would be appropriate for Jesse, and how would you decide?
4. Jesse has stated that s/he is not interested in Narcotics Anonymous. How would you
respond? What other types of Peer Support are available? What types of
counseling/psychotherapy are effective?
5. What types of harm reduction and health care maintenance interventions would be
appropriate?
6. How about treatment for Tobacco Use Disorder? Note that Information about each of these
agents is in the last page of this session in your guide, as well as in the Agenda Book for
this session.
treatment?
8. Would you advise Jesse to engage in treatment for one SUD or the other (opiods or
tobacco) first, or to address both simultaneously?
April 23, 2015
33
April 23, 2015
34
SAM - MALE
April 23, 2015
35
April 23, 2015
36
SAM
Session 1
ID
Sam is 20 year old male; girlfriend- 2 year
Housing
Education
Occupation
Reason for visit
Other
Med/Sx Hx
Fam Hx

Community college
Nil significant
April 23, 2015
37

Session 3
ID
Housing
Education
Occupation
Reason for visit
Brief hx

DUI
Since DUI
Other
Med/Sx Hx
Fam Hx
April 23, 2015

Community college
Poor sleep x 3 months after charged with DUI (driving under the
influence)
2 beers at lunch, 3 - 4 at dinner and 1 or 2 of rye or mixed drinks
during the evening
Nil significant
38
Screening
AUDIT
(See page 40)
AUDIT Score: 17
1) How often do you have a drink having alcohol?
(4 or more times per week = 4 points)
2) How many drinks containing alcohol do you have on a
typical day when you are drinking? (3 or 4 = 1 point)
3) How often did you have 5 or more drinks on one
occasion? (Monthly = 2 points)
4) How often during the last year have you found that you
were not able to stop drinking once you had started?
(Less than monthly = 1 point)
5) How often during the last year have you failed to do
what was normally expected of you because of
drinking? (Less than monthly = 1 point)
6) How often during the last year have you needed a first
drink in the morning to get yourself going after a heavy
drinking session? (Less than monthly = 1 point)
7) How often during the last year have you had a feeling
of guilt or remorse after drinking? (Monthly = 2 points)
8) How often during the last year have you been unable
to remember what happened the night before because
of your dinking? (Less than monthly = 1 point)
9) Have you or someone else been injured because of
your drinking? (No = 0 points)
10) Has a relative, friend doctor, or other health care
worker been concerned about your drinking or
suggested you cut down? (Yes, during the last year =
4 points)
Screening DAST- 10
(See pages 41 42)
DAST-10 Score: 0
want to? (0 points)
Practice single
screening
questions.
(See page 43)
Sam will be positive for the single question alcohol screen and
tobacco products screen
Sam will be negative for the single question prescription drug

screen and illegal drugs screen.
April 23, 2015
39
April 23, 2015
40
April 23, 2015
41
April 23, 2015
42
April 23, 2015
43

Session 4
ID
Housing
Education
Occupation
Reason for visit
Brief hx
DUI
Since DUI
Med/Sx Hx
Fam Hx
Single Alcohol
Screening Question
score
Single Tobacco
Screening Question
score
Audit Score
Single Prescription
Drug Screening
Question score
Single Illegal Drug
Screening Question
score
BI practice
(See pages 45 46)
April 23, 2015

Community college
Poor sleep x 3 months after charged with DUI
court 1 week prior to visit
2 beers at lunch, 3 - 4 at dinner and 1 or 2 of rye or mixed drinks
during the evening
Nil significant
Positive (25 times)
Positive (Daily or Almost Daily - 20 cigarettes per day)
AUDIT Score: 17
Use the SBIRT ref sheet to conduct a BI
44
April 23, 2015
45
April 23, 2015
46

Session 6
Housing
Education
Occupation
Reason for visit

Brief hx
ID
Finances
Alcohol Use
frequency and
pattern
Amount
Tobacco
Other drug use
Med/Sx Hx
April 23, 2015
Sam is now 35 year old, single male

Girlfriend- left because of drinking. Now alone
Sharing apartment with friend
Community college
Fired from job 2 years ago. Poor attendance, hangovers,
Unemployed
Feeling depressed
Sad off and on 2 months; mild anhedonia; fitful sleep, appetite
normal, weight gain of 10 pounds over 2 years, low energy, poor
concentration, guilt but mainly over drinking and losses due to
drinking; Not suicidal Not homicidal. You smell alcohol on patients
breath. Had cut down drinking to guidelines at last intervention but
began drinking daily once the relationship broke up. Didnt want to
get to this state but had noticed increased drinking prior to breakup.
Was confident that it wouldnt escalate to the current amount
Had tried to quit on his own but only lasts a few days after
discharge from detox x 3 admissions.
Has given up playing sports
All money goes to buy alcohol; in debt and panhandles to support
self
Drinks daily from morning to night (within an hour of waking)
Gets very shaky if doesnt drink by noon and craves alcohol all the
time especially when friends are drinking with him
Drinks 8 tall boys plus mickey of rye.
waking
Cocaine: tried crack x1 didnt like it. Caused rapid heart rate. No
other stimulant
Opioids: none
Benzodiazepines: will use 6 mg clonazepam whenever available.
Helps anxiety. Uses 2-3 x per month
Marijuana: Smokes 1 joint per day with friends.
Denies other drugs
Had an upper GI bleed 8 months ago- ER. Admission 2 days.
Hypertensive and had recurrent diarrhea and insomnia. All tests
normal except elevated LFTs consistent with alcoholic hepatitis.
was advised to stop but couldnt maintain abstinence
Has had recurrent blackouts
No withdrawal seizures
47
Fam Hx
Father: alcohol problem left home when he was 10- no contact

contact
TASK: Describe a
treatment plan for
this patient

Assess motivation
for treatment
Readiness 8/10
Wants to, needs to, has reasons to; knows how to cut down but not
stop completely
Ready to stop
Not ready to stop

plan
Medication
April 23, 2015
48

Session 7
ID
Reason for visit
Physical
Labs
Tobacco
Sam is still 35 year old single male

Diagnosed with a severe alcohol use disorder
Expresses motivation to stop using alcohol.
No evidence of alcohol withdrawal at the moment
Odor of alcohol on breath
No withdrawal
AST >ALT 2x
bili normal. Hb N
MCV elevated.
Urine tox: positive alcohol, neg THC
waking
Discussion Questions for Sams Case

8. How would you assess Sams risk for withdrawal symptoms?
9. If you decide that Sam is at significant risk of alcohol withdrawal syndrome, where and how
would you treat the alcohol withdrawal?
10. Once Sam has withdrawn from alcohol, what treatment settings would be appropriate for
Sam?
11. What treatment modalities would you offer Sam for Alcohol Use Disorder?
12. How about for Tobacco Use Disorder?
treatment?
14. Would you advise Sam to engage in treatment for one SUD or the other (alcohol or tobacco)
first, or to address both simultaneously?
April 23, 2015
49
April 23, 2015
50
PAT - MALE
April 23, 2015
51
April 23, 2015
52
PAT
Session 1
ID
Housing
Education
Occupation
Reason for visit
Other
Med/Sx Hx
Fam Hx
April 23, 2015
Pat, 25 year old single male; boyfriend- casual relationship; 1 year

Lives with boyfriend (not a typo)
Hurt R shoulder playing hockey
Otherwise healthy
Father: well
53

Session 3
ID
Housing
Education
Occupation
Reason for visit
Other
Med/Sx Hx
Fam Hx
Diagnosis and
Management
Other meds
Pat, 25 year old single male; boyfriend- casual relationship 1 year

URI
Otherwise healthy
Father: well


Screening
DAST-10
(See pages 55 56)
DAST-10 Score: 2
2) Have you used drugs other than those required for medical
reasons? (1 point)
want to? (0 points)
5) Do you ever feel bad or guilty about your drug use?
(1 point)
Screening AUDIT
(See page 57)
AUDIT Score: 2
1) How often do you have a drink containing alcohol?
(Monthly or less = 1 point)
3) How often do you have 5 or more drinks on one
occasion? (Less than monthly = 1 point)
Practice single
screening
questions.
(See page 58)
Pat will be positive for the single question prescription drug screen
and tobacco products screen
Pat will be negative for the single question alcohol screen and
illegal drugs screen.
April 23, 2015
54
April 23, 2015
55
April 23, 2015
56
April 23, 2015
57
April 23, 2015
58

Session 4
ID
Housing
Education
Occupation
Reason for visit
Other
Med/Sx Hx
Fam Hx
Diagnosis and
Management
Other meds
Alcohol
consumption
Medication use
Single alcohol
screening question
score
Single tobacco
screening question
score
AUDIT
Single prescription
drug screening
question score
Single illegal drug
screening question
score
DAST-10 Score
Instructions
(See page 60)
April 23, 2015
Pat, 25 year old single male; boyfriend- casual relationship 1 year

Masters in Biochemistry
URI
Otherwise healthy
Father: well

drink 2 to 3 twelve ounce beers with friends on Saturday or Sunday
once or twice a month while watching sports events on TV
Prn for pain; recently had the meds on an empty stomach with a few
beers- got a nice feeling
His friends told him about it
Negative (Never)
Daily almost daily (He smokes 1/2 pack 10 cigarettes per day)
AUDIT Score: 3
Positive (Weekly - 3 times)
Negative (Never)
DAST-10 Score: 2
Use the provided card to conduct a BI
59
April 23, 2015
60
JESSE - MALE
April 23, 2015
61
April 23, 2015
62
JESSENEW CASE STUDY

Session 6
Housing
Education
Occupation
Reason for visit
Brief hx
Withdrawal
Tolerance
Cravings
Amount used
Duration
Time spent
Finances
Role issues
Relationships
affected
Use in hazardous
situations
Use despite harm
Alcohol use
frequency and
pattern
Tobacco
Other drug use
Med/Sx Hx
Fam Hx
ID
April 23, 2015
Jesse, 35 year old divorced, 2 kids 10 and 8

No custody
Lives in a one bed room apartment
Masters in Business Administration
Office administrative supervisor, legal firm
I want help for my addiction to pain pills
Had started using acetaminophen/ oxycodone (325mg/5mg) as a
teenager recreationally; was physically assaulted during first year
university; increased his use to sustained release oxycodone after
work place related fall. Increased to daily use of 160-320mg per
day; When new tamper resistant sustained release oxycodone
came on the market, he switched to hydrocodone; No street heroin.
Currently uses daily, crushes and snorts. No IDU
Gets sniffly, stomach aches, diarrhea and gooseflesh two days after
stopping or running out
Can work with increased energy after taking 320mg per day. Liked
the energy it provided. Doesnt find he gets high anymore
Every day especially when he has money
Always runs out. Has tried to ration but uses all the meds up in one
go
Never thought use would be going on for this long
At least 3 to 4 times a week tries to score; double doctor; buy on the
streets- find dealers. Once uses, unable to function at times for half
a day- goes to sleep
On social assistance; all $ go for drugs. High debt
Couldnt work or parent
Estranged from ex-partner; parents and children. Not many friends
left except those who are also addicted
Uses and drives;
Loss of custody partly due to drug use; one OD 2 years agoadvised to stop but relapsed post discharge from hospital
Occasional- 1-2 standard drinks every 10 -20 days. Drinks a mickey
of vodka if short on pills
Occasional crack use- last use 1 month ago. Smokes with friends.
Doesnt like it
Nil significant
Parents both Heroin users but were maintained on methadone for 5
years. Doing well functioning
63
TASK: Describe a
treatment plan for
this patient

Assess motivation
for treatment
Ready to stop
Not ready to stop
Readiness 10/10

plan
Medication
April 23, 2015
64
JESSECONTINUING CASE STUDY

Session 7
ID
Reason for visit
Physical
Labs
Psychosocial
treatment
Tobacco
Jesse, 35 year old divorced male

2 kids- 10 and 8 - no custody but can visit
Wants to explore pharmacotherapeutic options for opioid use
disorder
Evidence of mild opioid withdrawal; no track marks
HCV pos
HIV neg
HBV negative
LFTs Normal. Rest Normal
Nil in the past.
Doesnt believe in NA or AA.
Discussion Questions for Jesses Case

9. Jesse is interested in pharmacotherapy for opioid use disorder (OUD). What options would
you explore with him/her? Note that Information about each of these agents is in the last
page of your guide for this session, as well as in the Agenda Book for this session.
10. Depending on Jesses choice of medication options s/he may need to undergo opioid
withdrawal. What are your options for managing his/her withdrawal, and how do they relate
to the choice of ongoing pharmacotherapy?
11. What treatment settings would be appropriate for Jesse, and how would you decide?
12. Jesse has stated that s/he is not interested in Narcotics Anonymous. How would you
respond? What other types of Peer Support are available? What types of
counseling/psychotherapy are effective?
13. What types of harm reduction and health care maintenance interventions would be
appropriate?
14. How about treatment for Tobacco Use Disorder? Note that Information about each of these
agents is in the last page of this session in your guide, as well as in the Agenda Book for
this session.
treatment?
16. Would you advise Jesse to engage in treatment for one SUD or the other (opiods or
tobacco) first, or to address both simultaneously?
April 23, 2015
65
American Society of Addiction Medicine
4601 N. Park Avenue, Upper Arcade #101, Chevy Chase, MD 20815

Phone: 301-656-3920 | Fax: 301-656-3815 | Email: email@asam.org
Copyright 2015 ASAM

2015 Final Case Studies Asam Fundamentals Final Updated

Enviado por

Dados do documento

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

2015 Final Case Studies Asam Fundamentals Final Updated

Enviado por

Direitos autorais:

Formatos disponíveis

CASE STUDIES

American Society of Addiction Medicine

4601 N. Park Avenue, Upper Arcade #101, Chevy Chase, MD 20815

MEET OUR PATIENTS

April 23, 2015

April 23, 2015

April 23, 2015

April 23, 2015

April 23, 2015

Sam is 20 years old single female; boyfriend- 2 years

SAM, CONTINUING CASE STUDY

Alcohol use Prior to

April 23, 2015

Sam is 20 years old single female; boyfriend- 2 years

ADDITIONAL INFORMATION FOR SESSION 3 CLINICAL SKILLS PRACTICE

Sam will be negative for the single question prescription drug

April 23, 2015

April 23, 2015

April 23, 2015

April 23, 2015

April 23, 2015

SAM, CONTINUING CASE STUDY

Alcohol use Prior to

April 23, 2015

Sam is 20 years old single female; boyfriend- 2 years

Positive (Daily or Almost Daily - 20 cigarettes per day)

Negative (never - 0 times)

Negative (never - 0 times)

Use the SBIRT ref sheet to conduct a BI

April 23, 2015

April 23, 2015

SAM, CONTINUING CASE STUDY

Reason for visit

Other drug use

April 23, 2015

Sam is now 35 years old, single female

Use the two worksheets ASAM Patient Placement Criteria

Developing a Treatment Plan

April 23, 2015

SAM, CONTINUING CASE STUDY

Sam is still a 35 year old single female

Discussion Questions for Sams Case

April 23, 2015

April 23, 2015

April 23, 2015

April 23, 2015

April 23, 2015

Pat, 25 year old single female; boyfriend- casual relationship; 1 year

PAT, CONTINUING CASE STUDY

Pat, 25 year old single female; boyfriend- casual relationship 1 year

Hydrocodone tid for R shoulder pain following recreational injury;

ADDITIONAL INFORMATION FOR SESSION 3 CLINICAL SKILLS PRACTICE

April 23, 2015

April 23, 2015

April 23, 2015

April 23, 2015

April 23, 2015

PAT, CONTINUING CASE STUDY

April 23, 2015

Pat, 25 year old single female; boyfriend- casual relationship 1 year

Hydrocodone tid for R shoulder pain following recreational injury;

Positive (Daily almost daily - She smokes half pack/10 cigarettes

April 23, 2015

April 23, 2015