ASI Interview Narrative: Opioid and Polysubstance Abuse Case Study

General Information and Background

The client is a 30-year-old white male who is unmarried and lives in Covington, KY, with his mother. They attend the local Catholic parish most Sundays. He has lived with his mother for three months following his release from prison, where he served ten 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 fitted with a bathroom, kitchen, bed, and television and serves as a self-contained unit. The client was brought to Gateway by his older sister. He is youthful in appearance, with a thin beard and semi-hollow cheeks, and appears to be adhering to standard hygiene. The client was not making a court-mandated appearance but arrived at the encouragement of his family — primarily his sister — to seek treatment.

Substance Use and Medical Status

The client's primary drugs of choice are heroin and opioids, with fentanyl being used more frequently in recent months. He last used on November 14, 2018, and since his parole on August 15, 2018, he has been using consistently every week. He is not currently employed and spends approximately $100 to $200 per week on fentanyl and other opioids, with heroin used on occasion. His income comes from selling drugs for a friend, performing odd jobs for his mother (who gives him a small allowance), and delivering food through DoorDash. The client has been using drugs since he was 15 years old, beginning with marijuana, then progressing to snorting heroin, and eventually transitioning to fentanyl.

The client consumes alcohol daily, drinking one to two beers per day and one to two bottles of rum per week. He has been drinking since he was 17. He has been arrested twice for driving under the influence of alcohol and three times for drug use and possession. He carries a diagnosis of substance abuse, alcohol dependence, and opioid dependence.

The client has been hospitalized six times for drug use: three times for heroin overdose, twice for fentanyl overdose, and once following an alcohol-opiates car crash. His last hospitalization was two weeks prior to this assessment, and before that, one month prior — approximately one month after his release from prison. He does not have any chronic medical problems and is not taking any prescribed medication for depression or any other mental or physical health condition. He does not receive a pension and has never held down a serious job for more than a few months at a time due to his drug addiction. He has a persistent cough but has not had it evaluated by a medical professional and does not consider it important. The client has checked into substance abuse clinics five times in the past, each time as a court mandate. He last attended a 12-step program two years prior, in May 2016, but lasted only one month in the program.

Employment, Support, and Social Relationships

The client completed high school through a technical vocational curriculum focused on mechanics. He has worked side jobs repairing cars in the past but has never worked under a certified mechanic. His sister says he is skilled with cars, but the client does not express confidence or enthusiasm about this and only shrugs when it is mentioned, offering a faint smile.

The client is able to drive himself around using a car he fixed up, which allows him to make DoorDash deliveries. He says he prefers this type of work because it gives him flexibility and the ability to work on his own schedule. If he has a hard night or a friend needs him, he feels he should be able to leave and go offer support. However, all of his friends use drugs, and he says he likes them because they are supportive and he feels he should be supportive of them in return.

His main friend, Clarence, is also his primary drug supplier. The client's most recent hospitalization two months ago resulted from an outing with this friend that began as a show of support and ended with the client passed out and unresponsive. His friend called the paramedics after leaving him in a car, and the paramedics saved his life. Clarence had been upset about his wife's death from an overdose, and the client went to console him; together they got high.

The client's family does not like Clarence and does not want him to visit, see, or communicate with Clarence anymore, but the client has no other friends. The sister of the client's brother-in-law is a recovering heroin addict who has shown support for the client in recent weeks. However, an informal counselor advised the family against encouraging this relationship, suggesting that if the two individuals — both struggling with addiction — were to relapse together, they would be worse off than before. The counselor stated the client needs to overcome his addiction on his own before entering a relationship with a woman. It was later revealed that this counselor was not certified or trained, but was himself a recovering drug addict with twelve years of sobriety who worked with the county assisting families of drug addicts and helping them find employment. He offered to get the client a full-time job thirty minutes from where he lived, but the client declined, saying he did not want to drive that far to work each day.

The client was engaged at age 24, but the relationship ended after a series of fights that culminated in his fiancée calling the police during a physical altercation. The ex-fiancée obtained a restraining order against him. He had one serious relationship after that, and both his sister and mother believed he would marry this woman, but the client began drinking again and another cycle of conflict ended that relationship as well.

The family likes Sara — the recovering heroin addict who is the sister of the client's brother-in-law — but feels that the informal counselor's advice is correct: the client needs to face his addiction issues on his own. As a result, the client's support network is unstable and unreliable. The family is protective but not entirely helpful, and their impulses are contradictory. The mother enables the client by providing a place to stay and a small allowance while simultaneously hoping he will grow out of his habits; at the same time, she prevents Sara from coming around. The family wants the client to develop a better support group but does not know how to facilitate this or how to help him build new friendships.