Case Study – Mike Mike is a 43-year-old, single male. Having never been married, he lives with his mother and receives Social Security’s Supplemental Security Income (SSI) benefits. He graduated from high school and has had a few odd jobs doing construction and yard work; however, he has not worked in 15 years. He reports he began drinking a couple of alcoholic beverages twice a week when he was 9 years old and began drinking heavily beginning at the age of 14. He states that he has not been sober for more than a couple of months at a time throughout his life, and these months of sobriety “have been few and far between.” Mike states he spends his days drinking and panhandling for money so that he can buy more alcohol. He states he wakes up during the night and has to drink to “stop the hakes” (i.e., delirium tremens). He admits that drinking consumes his life but states he “does not really see it as a big problem.” He reports that his mother has been increasingly concerned about him. Mike has been arrested 47 times so far this year for public drunkenness, which is a significant increase from his previous arrest record of once or twice per year for public drunkenness. When the police finally put him in jail, he could not understand why he was being incarcerated. The medical staff at the prison helped Mike detox from alcohol and helped him get stabilized on medication. He spent 4 months in jail; the prison staff reports that Mike had some trouble during his incarceration because he did not follow some of the basic rules, such as making his bed. They said it was almost as if he could not remember to do it, rather than him blatantly breaking the rules. They also reported that Mike fell down frequently. Overall, the prison staff described Mike as likeable, kind-hearted, and a “good” inmate. Within 3 days of his release from jail, he was hospitalized in a psychiatric unit because he was experiencing difficulty with coordination (e.g., walking and getting in and out of a chair) and with memory (e.g., he got lost on the sidewalk in front of his home). Within a week after his release from the unit, he needed to be hospitalized again. Mike was linked with an outpatient treatment facility and was assigned a case manager. A few days after he was released from the hospital, he was arrested for public drunkenness. Fortunately, the police contacted Mike’s new case manager and did not put him back in jail. He was placed in a lockdown long-term treatment facility for 6 months and was then transitioned into a group home. Mike can no longer take care of himself independently. He needs to be reminded to shower and brush his teeth. He is confused about how to operate a washing machine. Although he is pleasant and has an overall good disposition, he has difficulty interacting with others. Mike forgets what is being discussed and begins to make up stories to try to stay in the conversation; unfortunately, the stories have little or nothing to do with the conversation. He rambles and ruminates about irrelevant things (e.g., having to repair the concrete foundation of a home that no longer exists). He does not seem to understand consequences, as evidenced by not understanding why he was being incarcerated; he would frequently ask prison staff and other inmates, “Why am I here? Why are you keeping me here? I want to go home.” In addition, other residents at the group home have taken advantage of Mike’s good nature; for example, at mealtimes, if they tell Mike they are hungry, he will give them his meal. Then later he will forget and tell the staff that he is hungry and missed the meal. Mike seldom leaves the group home unattended. Nonetheless, Mike always carries a laminated piece of paper in his pocket with his full name, address, and the group home phone number written on it because this is beneficial in helping Mike (or others who are trying to help Mike) find his way back to the group home in case he wanders away. He demonstrates difficulty staying on task and needs frequent redirection during conversations. His abilities to function and comprehend information are impaired. Questions (use relevant citations where necessary) 1. What are your diagnostic impressions? 2. Based on your diagnostic impressions what is your diagnostic conclusion? In other words, what is the complete DSM 5 diagnosis? 3. What therapeutic interventions would you consider using with Jessica? Why? 4. What are the environmental factors that can help people diagnosed with NCDs stay safe at home and in public? As a rehabilitation counselor, what supports can you put in place for Mike? 5. Mike might be feeling lonely in the group home and might be missing his mother. What can you as his case manager do to help Mike with this transition? How could rehabilitation counseling case management professionals help Mike understand that he may not be able to return to live at his mother’s house, especially considering such a delicate topic? – the question is basically asking what counseling skills would you need to use in combination with which counseling theory or theories.
