Case Study
Patient Demographic: Client Age: 45 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced, single Counseling Setting: Private practice Type of Counseling: Individual counseling Presenting Problem: The client is experiencing difficulty in functioning in all areas of his life due to inhalant use. Diagnosis: Inhalant use disorder, severe (F18.20)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client does not appear to be under the influence of inhalants because he does not display any symptoms of use. The client is friendly and engaged in the ses
Presenting Problem: You are a licensed counselor working in a private practice. You specialize in substance use disorders. The client comes into the session, is very friendly, and states that although his sessions are court ordered, he wants to get help with his inhalant use. The client spent the first half of the session explaining what happened to lead to him getting his third charge of driving under the influence of inhalants. The client says that he had twin sons 13 years ago and they both were in the ICU; one of his sons died after about a month. The client began drinking alcohol to excess daily for about 6 months, which then transitioned to inhalant use. The client says that he uses contact cement, model glue, paint, and permanent markers to become intoxicated. The client identified the following symptoms of inhalant use disorder: increase in frequency and amount of use over the past 5 years, several failed attempts at cessation of inhalant use, craving inhalants throughout every day, losing several jobs because of his inability to get to work on time due to inhalant use, use that has affected his ability to have visits with his children and maintain employment, use that increases the risk of harm to himself and others such as driving under the influence, increased tolerance, and continued use even when he knows it is negatively affecting his life. The client wants to become sober, improve his relationship with his children, and maintain employment.
Other Contexts: You meet with the client after he requested an emergency appointment. The client says that he had a supervised visit with his children and he had used inhalants prior to the visit because he was anxious. The supervisor noted the intoxication and ended the visit early. The client says that this was 3 days ago and that he has used inhalants several times daily since the visitation. Due to his intoxication at the visit, all future visits have been canceled until the next hearing in court regarding visitations. The client says that he has been very depressed and that is why he is using inhalants. During the session, the client asks if he can go to the lobby to get water and you tell him that this is fine. The client returns, sits down, and appears listless because he is not displaying any emotion and has a very flat affect. You suspect that he is now intoxicated.  Following this session, you determine that the client is not benefiting from therapy with you because he has used inhalants since at least your third week of sessions and almost daily since then

Question: Following this session, you determine that the client is not benefiting from therapy with you because he has used inhalants since at least your third week of sessions and almost daily since then. Which of the following would be the most appropriate intervention for this client based on his recent inhalant use?
(A): Case management from a local government agency
(B): Psychiatric hospitalization
(C): Referral to another counselor
(D): Inpatient drug rehabilitation

Correct Answer: Inpatient drug rehabilitation
Explanation: The client continues to use inhalants regularly despite counseling, and it is causing harm to his relationships and putting him and others at risk of harm. An inpatient drug rehabilitation facility might be a more appropriate level of care. A referral to another counselor would likely produce the same results because the counselor can only provide counseling twice weekly and cannot monitor or support him between sessions as well as an inpatient facility could. Psychiatric hospitalization may be helpful to stabilize the client quickly, but it would not provide the therapeutic level of support that the client needs to reestablish and maintain sobriety. Case management might be helpful; however, case management connects the client to services and supports functioning and this takes some time to set up and provide the funded services. The client needs more immediate support to keep him from causing further harm to his relationships and to decrease the risk that the client might pose to himself and others. Therefore, the correct answer is (C)
Competency: treatment planning