Identify the Biological, Psychological, and Social variables impacting the client
Biopsychosocial #8
Case Vignette
Xavier is a divorced 32-year-old part-time landscaper who states that his life is in a downward spiral. He has been homeless for the past 6 months and lives in his car or at friends’ homes. For over one month, he had lived in a tent in the woods. After calling his parents, they had offered to pay for substance abuse treatment on the condition that they pay the treatment center directly.
Xavier stated he has had issues since he was 23 when he was working two jobs trying to take care of a new wife and young son. He injured his back and was not able to go back to work due to the pain. A friend offered him Percocet for the pain so he could feel better and get back to work. He stated his pain went away and his mood and energy improved. He felt good…and happy for the first time in his life.
Xavier continued to take the Percocet never taking more than one at a time, but he would take 4 per day for over a year. At age 26, he snorted half a bag of heroin. He stated he felt euphoric and like taking that first Percocet ten times. He later began using heroin intravenously in an effort to gain that euphoria again.
After that first experience with heroin, he began using more and more. In approximately 6 months, he was unemployed, separated from his family, and homeless. He was sleeping in his car or on the streets and using up to 30 bags a day.
Xavier reached out for help and enrolled in outpatient rehabilitation for opioid users, but he experienced intense cravings and relapsed multiple times. Cocaine was then added to the heroin injections, but he later returned back to just heroin. He has been admitted to approximately 10 detoxes and rehabs, and he has had multiple accidental overdoses. Xavier has also attempted Narcotics Anonymous (NA) meetings over a span of years.
In order to gain money for his habit, he would break into homes, steal from relatives, and write bad checks. Every penny would go to drugs. Xavier states he is lucky not to be in prison, but not so lucky as everyone hates him.
He moved to Martha’s Vineyard a year ago and took methadone with him, but the eventual withdrawals were fierce. He continued to use heroin and oxycodone when he could easily get them. Otherwise, he drank alcohol heavily. He also took Valium sporadically; however, he did not consider that to be an issue but more of a way to get through the day.
His landscaping boss is someone he had met at NA, and his boss made it clear that he would call when there was extra work needed but he would not actually expect him to show up until Xavier got clean. Xavier has held various odd jobs and has not seen his daughter in over 2 years.
Xavier appeared unkempt but generally cooperative. He was restless and urgently left the room at one point during the evaluation. When he returned, he stated that he was experiencing bouts of diarrhea. His pupils were enlarged, and his skin was remarkable for sweating and piloerection. He yawned several times and appeared irritable and unhappy. His arms and legs frequently twitched. He repeatedly blew his nose and appeared tearful. His speech was rapid, and he appeared impatient. He denied psychotic symptoms, suicidality, and homicidality. He stated he was hopeful that if get could get some Suboxone that he might be able to keep a job and get to be a real father.
Utilizing the information learned from this week’s chapter and reviewing the case examples in the text for practice, review the case below to:
a) Identify the Biological, Psychological, and Social variables impacting the client
b) Assess for Competence
Answer preview Identify the Biological, Psychological, and Social variables impacting the client
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