Janice Jones, a 42 year old white female has come to Greater Cincinnati Behavioral Health (GCBH) seeking help with her dependence on alcohol and other issues. She was recently arrested for drunk driving and realizes that her life is spinning out of control (her words). Six months ago her divorce was finalized from her husband of 20 years and she feels her life is over. Since her husband left she simply has not been able to function. She explains that her husband was her entire world and she can’t imagine life without him. Janice has cut herself off from all her friends and relies heavily on her daughter Dorothy to handle her daily affairs. She explains that she needs a drink just to get out of bed and another before she eats breakfast that her daughter comes over every morning and prepares. If it weren’t for Dorothy she probably wouldn’t eat. Just to get through the day she must drink and the day she was arrested was after Dorothy and she had spent the morning doing her weekly grocery shopping. Janice explains that since her divorce she has been terminated from her position as a paralegal; for missing too many days of work. She is living off the alimony she receives from her ex-husband who is an airline pilot. You explain to Janice that she must stop drinking before there can progress with her personal issues. Janice hesitantly expresses she is ready to stop drinking. After a complete compilation of Janice’s social history you have tentatively diagnosed her with the following disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) retrieved 5/5/2012 http://psychcentral.com/disorders/sx13. Axis I- 303.90 Alcohol Dependence
296.21 Major Depressive Disorder
Axis II-301.6 Dependent Personality Disorder
Axis IV- Recent Divorce/Unemployment
Axis V- 60
Since Janice has agreed to stop drinking you realize that you have a potential crisis situation. According to About.Com Alcoholism “When a heavy or frequent drinker suddenly decides to quit “cold turkey” they will experience some physical withdrawal symptoms which can range from mildly annoying to severe and even life-threatening” retrieved 5/1/2012. Janice has admitted to being a daily heavy user of alcohol for a little over six months. You have noticed that she appears to have some shaking of her hands which could be the beginning of Delirium Tremors (DT’s). You decide to ask her to go to the local hospital which has a specific unit for alcohol and substance withdrawal. She agrees and you take her to the hospital where she is immendialtly admitted and given Valium to ease the withdrawal symptoms she has already begun to show. The nurse explains that you have done the right thing and that Janice will remain hospitalized for the next 7 to 10 days. She advises there be no contact for the first five days. That by then her head will of cleared and she will have passed through the worst of the withdrawals. You ask Janice if you would like her to visit and possibly get started on her treatment plan so she has a plan of action upon her release. She reluctantly agrees.
You return to see Janice on day 5 of her treatment to discuss her treatment plan. According to Summers Janice is in the 3rd stage of recovery “developing a treatment plan” (2009 p330). However after you speak with her you quickly realize that she is not in stage 3 but stage 2 “contemplation” (Summers 2009 p330). Janice complains that she just doesn’t know if she’s ready. That ever since she stopped drinking she has all these emotions that she feels she is not ready to deal with. The nurse informs you that she spends hours in her room crying and refuses to engage in any of the programing designed to prepare her for her release. This is what Summers defines as “Ambivalence” a normal and expected response. Summers continues to explain “that collaboration and good listening skills are...