Case Study
Patient Demographic: Client Age: 54 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Multiracial Relationship Status: Divorced Counseling Setting: Local Government Mental Health Agency Type of Counseling: Individual Presenting Problem: Opioid Use Diagnosis: Opioid Use Disorder, Severe (F11.20), Homelessness (Z59.0)
Mental Status Exam: Mental Status Exam: The client has not maintained hygiene, as evidenced by him not smelling clean and wearing clothes that are visibly dirty. He appears to have bilateral tremors in his hands. The client is oriented to person, place, situation, and time. The client appears malnourished because he is very thin and f
Presenting Problem: You are a mental health counselor working at a local government mental health agency, specializing in substance use counseling. An individual came in today to become a client for mental health case management and was encouraged to meet with a counselor to begin receiving therapy. The 54-year-old male client is currently living in a tent in the woods behind a local grocery store and reports that he lost his job a year ago following a divorce from his wife of 26 years. The client stated that about 3 years ago he had a back injury and following surgery was prescribed oxycodone. The client continued that he had difficulty stopping his use of the medication when the prescription ran out and connected with a friend to get fentanyl. He reports that he spends a lot of time on a street corner asking for money to get fentanyl and that he cannot seem to go a day without it. The client feels that he cannot sleep or function without the use of fentanyl and that this has affected his housing, marriage, employment, and social life. He acknowledges that fentanyl has negatively affected his life and that he is not sure if he wants to stop using it because he knows it would be hard to deal with life without it.
Other Contexts: rail. Family History: The client got divorced about 1 year ago. He states that his wife left him because he lost his job and because of his fentanyl use. The client has two children that are 18 and 22 years old. The client no longer has contact with his ex-wife or children. The client reports no known mental health history or substance use history in his family

(A): Provide a referral for another counselor who specializes in opioid addiction counseling.
(B): Refer the client to a Narcotics Anonymous group.
(C): Pursue further education on opioid addiction counseling.
(D): Use motivational interviewing techniques because these are effective with substance use disorders.

Correct Answer: Provide a referral for another counselor who specializes in opioid addiction counseling.
Explanation: If a counselor does not have experience and education in providing counseling for certain diagnoses, then it is most ethical to refer the client to another counselor that specializes in that diagnosis (ACA Governing Council, 2014). It is also important to seek education on certain diagnoses prior to providing services (ACA Governing Council, 2014), although a referral would be more indicated in this scenario. Motivational interviewing is commonly viewed as beneficial for substance use disorders, but if the counselor is not competent in counseling these populations, then this would not be appropriate. Support groups can be helpful in working through a substance use disorder, but they are not a clinical service that can treat substance use disorders. Therefore, the correct answer is (B)
Competency: professional practice and ethics