ASI Interview Narrative GENERAL INFORMATION

JL is a 30-year-old white male, unmarried client. JL lives in Covington, KY, at 101 Main St. with his mother. They attend the local Catholic parish down the block most Sundays. He has lived there with his mother 3 months since his release from prison, where he served 10 months for parole violation (drug possession). He lives in the garage behind the house and does not share the main house with his mother. He has access in and out of the garage through the rear of the property. The garage is fixed up with a bathroom, kitchen, bed and TV and serves as a self-contained unit. JL was brought to Gateway by his older sister. JL is youthful in appearance though with a thin beard and semi-hollow cheeks. He appears to be adhering to standard hygiene. JL was not making a court-mandated appearance but rather arrived at the encouragement of his family and mainly his sister to get treatment.

SUBSTANCE USE

JL’s primary drugs of choice are heroin and opioids with fentanyl being used more frequently in recent months. JL last used 11/14/2018 and since his parole on 8/15/2018 he has been using consistently every week. JL is not currently employed and he uses about $100 to $200 per week using fentanyl and other opioids, and heroin on occasion. His income comes from selling drugs for a friend and also through odd jobs for his mother, who gives him a small allowance, and delivering food through DoorDash. JL has been using drugs since he was 15. He started smoking marijuana at that time and then began snorting heroin and has since moved to fentanyl.

JL consumes alcohol daily, drinking 1-2 beers per day and consuming 1-2 bottles of rum per week. JL has been drinking since he was 17. He has been arrested twice for driving under the influence of alcohol. He has been arrested thrice for drug use and possession. JL has a diagnosis of substance abuse, alcohol dependence and opioid dependence.

MEDICAL STATUS

JL has been hospitalized six times for drug use—thrice for heroin overdose, twice from fentanyl overdose, and once from alcohol-opiates car crash. His last hospitalization was two weeks ago and before that it was a month prior, one month following his release from a controlled environment (prison). JL does not have any chronic medical problems and is not taking any prescribed medication for depression or any other mental or physical health issues. He does not receive a pension for anything and has never held down a serious job for more than a few months at a time because of his drug addiction. He has a persistent cough but has not had it checked out by a medical professional and does not consider it important. JL has checked into substance abuse clinics five times in the past and each time has been court-mandated. JL last attended a 12-step program 2 years prior in May 2016 but only lasted in the program for one month.

EMPLOYMENT/SUPPORT STATUS

JL completed high school but never attended higher education. He completed high school via the technical vocation curriculum and focused on mechanics. He has worked side jobs fixing cars in the past but has never worked under a certified mechanic. His sister says that he is good with cars but JL does not express much confidence or enthusiasm in this skill and only shrugs his shoulders when it is mentioned, giving a faint smile.

JL is able to drive himself around using an old car that he fixed up and that allows him to make DoorDash deliveries. He says that he prefers this method of work because it gives him flexibility and the ability to work when he wants. If he has a hard night or long day or one of his friends needs him, he feels like he should be able to leave and go support them. His friends, however, all use drugs and he says he likes them as they are supportive and he feels he should be supportive of them as well.

His main friend is named Clarence and he is also his main drug supplier; and JL’s recent hospitalization two months ago was the result of an outing with this friend that started off as a show of support and ended up with JL passed out and unresponsive. His friend called the paramedics after leaving JL in a car and the paramedics...

His friend had been upset about his wife’s death from overdose. JL went to console him and together they got high.
His family does not like Clarence and does not want JL to visit or see or talk to Clarence anymore, but JL does not have any other friends. The sister of JL’s brother-in-law is also a recovering heroin addict and has shown support for JL in recent weeks, but a counselor advised the family against supporting such a relationship because, so the counselor said (so it was related) if the two of them who are struggling with their addictions were to blow up they would be worse off than they were before; the counselor said JL needs to overcome his addiction on his own before he enters into another relationship with a woman. The counselor was not certified or trained, it was revealed, but was rather a recovering drug addict himself, 12 years sober, who worked with the county in assisting families of drug addicts in the hospitals and getting them work. He offered to get JL a full-time job that would be 30 minutes from where he lived, but JL declined saying he did not want to drive that far to work every day.

JL was engaged to a girl when he was 24 but the relationship ended after a series of fights that culminated in the girl calling the police on JL one night when JL was drunk and the fight turned into a physical altercation. The ex-fiance obtained a restraining order against JL. He had one serious relationship following that and his sister and mother both thought he would marry this girl but JL began drinking again and another round of fights put an end to that relationship as well.

The family likes Sara, the recovering heroin addict who is the sister of JL’s brother-in-law (JL’s sister’s sister-in-law), but they feel that the “counselor” is right and that JL needs to face his addiction issues on his own. Thus, JL has a support network that is somewhat unstable and unreliable. The family is protective of JL but not entirely helpful. Their impulses are also contradictory: the mother enables JL by giving him a place to stay and an allowance and wants him to grow out of his ways but at the same time prevents him from entering into a serious relationship with Sara by telling Sara it would be best if she did not come around. At the same time the family wants JL to develop a better support group but does not know how to make this happen or how to get JL new friends.

PSYCHOLOGICAL / PSYCHIATRIC HISTORY

JL has not been treated for any trauma or for any psychiatric/psychological issues. He has been arrested twice for domestic disturbances—once when his fiancé called the police and once when his mother called the police following a threat of violence from JL when she refused to return his cell phone after his first hospitalization in October 2018 after his release from prison the month before.

JL has not been diagnosed with any type of depression or bi-polar disorder, though there may be an occasion to investigate his explosive rage, which seems to have become an issue for him in recent years. JL admits that he does not handle anger well which is why he tries to avoid people and situations that will make him angry. This is why, he says, he prefers his friends who are drug addicts—because they are relaxed and put him at ease. They do not challenge him or threaten him or make him feel uneasy about himself or his life. That is why he says he likes them—that and he enjoys using drugs.

FAMILY

JL is concerned about his health he says but he says he is not sure he wants to be sober because he has never been able to handle it and every time he tries he ends up getting angry with himself and his life and falling even harder than before. He says he wishes he could just plateau and stay even-keeled, not dropping any higher or lower, and just existing on this one plain—and that would be all right with him. He says he would not mind having a family but that providing for them would be a challenge as he cannot obtain work (though when work was offered him he turned it down), so there is a trace amount of denial in what he says with regard to his own situation. The truth…