Give examples of the problem manifested; include material from online sources (like magazines, newspapers) in order to bring the problem to life for the reader. also add statistics
Review the attached of Mr. Xavier., which depicts his development and progression with opioid addiction. In reviewing this case, answer the following questions:
A. How does a person in active addiction think?
B. What causes their addiction?
C. Why can’t they stop?
D. What is the link between mental health and addiction?
F. If were to treat Mr. Xavier, what psychotherapeutic approaches would be best suited for him as he begins treatment?
A Downward Spiral
Raymond Xavier, a divorced 29 year old semi-employed landscaper presented to a private human
service professional with a complaint that his life was in a downward spiral. At the time of the
appointment, he had been without a permanent home for over 6 months. He had lived in various places,
including his car and friends’ homes. For over 1 month prior to presentation, he had been living in a tent
in the woods. He had called his parents on his recent birthday, and they had offered to pay for addiction
treatment as long as they could pay directly.
Mr. Xavier reported that his problem started at age 24, when he had a new wife and young child and
had taken on two jobs to make ends meet (working in factory as a local delivery driver). During this time,
he reported feelings isolated, depressed and having an overall lack of energy. When he injured his back
and could not get to work because of the pain, a friend offered him a few tablets of acetaminophen-
oxycodone (Percocet). Not only did his pain disappear, but his energy and mood improved. For the first
time in his life, he felt “normal and happy.”
Mr. Xavier continued to use one to four Percocet tablets per day for 1.5 years. He never took more than
one pill at a time. Then at age 26, he snorted half a bag of heroin (about $5 on the street). “It took about
10 minutes, but I was transported into an indescribable euphoria. Life taking that first Percocet times
10…..You chase that first feeling for the rest of your life. It never repeats.” Within months of starting
heroin, he began using it intravenously in an effort to glimpse the euphoria again.
After that first experience with heroin, the progression of use was rapid. Within 6 months, Mr. Xavier
was unemployed, separated from his family, and homeless. “I was sleeping in my car or on the streets….
Using up to 30 bags ($300) daily.”
Mr. Xavier began to reach out for help. He enrolled in outpatient rehabilitation for opioid users. The
cravings to use, even while in treatment, were intense. Mr. Xavier reported multiple relapse. He added
cocaine to the heroin injections, and “speedballs” became Mr. Xavier’s drug of choice for a while, but he
then returned to using only heroin. The first multiple accidental overdoses occurred in a vacant house
when he was 27. He had been admitted to “about 10 detoxes and rehabs” but would typically relapse
within hours or weeks of discharge. He had also gone sporadically to Narcotics Anonymous meetings for
years.
To acquire money for his habit, he broke into homes, stole from relatives and wrote bad checks. “Every
penny went to drugs. I’m lucky not to be in prison, but not so lucky in that everybody hates me.” He
decided to move to Martha’s Vineyard a year prior to the consultation because it “sounded like a quiet
place.” He brought some methadone with him, but the eventual withdrawal was “fierce.”
He continued to use heroin and oxycodone when he could easily get them. Otherwise he drank alcohol
heavily, although he said “I need to stop drinkingthat’s what really gets me in trouble.” He also took
diazepam (Valium) sporadically; however he did not consider that to be a problem but more of a way to
get through the day.
He worked occasionally as a landscaper. His bosssomeone he had met at a NA meeting—had made it
clear that he would call when there was extra work to be done, but that until Mr. Xavier got clean, the
boss would not actually expect him to show up. He had held a variety of other odd jobs, including office
supplies salesman, veterinary assistant, and gas station assistant. He had not seen his daughter in over 2
years.
On examination, Mr. Xavier appeared somewhat unkempt. He was generally cooperative but appeared
restless, and at one point he urgently left the room; when he returned, he reported that he was
experience 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 homicidally. He said he was hopeful that if he
could get some suboxone (buprenorphine and naloxone) he might be able to keep a job and maybe get t
be a real father. Laboratory results were negative for HIV, Hepatitis A, B, and C.
Barnhill J.W. (2014) DSM-5: Clinical cases. American Psychiatric Association.
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