Relapse Prevention Sarah Assignment Help: How to Answer This Question

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Original Question

Relapse Prevention Sarah: An Unlikely Alcoholic Sarah comes to your private practice with complaints of “an undercurrent of sadness that just won’t go away.” She is a graduate student at an Ivy League school who is studying psychology. She says that while there is no rush for the first appointment, she’d like to get started “trying to figure out why I’m so miserable all the time.” She enters the office and presents as a poised, neatly dressed, plain, and pleasant young woman. You begin with some light banter, a comment about the weather lately, and the woman starts to cry. You ask her to tell you what is happening, and she begins: “I just am so sick of my life. I’m exhausted all the time. I don’t care about anyone or anything anymore and still, I’m trying to work so hard. I was valedictorian of my high school, a successful graduate of Princeton, and now I’m studying to be a researcher. Still, I feel so empty and alone all the time.” You suspect that this is a classic case of clinical depression and you ask her some questions about her eating and sleeping habits, which are both erratic. Although she appears fit and trim, she describes how she has always struggled with “this weight problem.” Sarah tells you that she has been running and doing aerobics regularly for a long time. She denies any eating disordered behaviors, but clearly, she has an unrealistic picture of her own body. In fact, at one point, she even says, “Maybe I’d stop feeling so horrible if I wasn’t so fat and ugly.” The family history reportedly includes a father who had a gambling problem, a mother who was a “shopaholic” and a fiancé who is a “workaholic.” She goes on to tell you that she is exhausted much of the time, has little ability to concentrate, and can’t make decisions. As Sarah talks about her family and other significant people in her life, you notice that they have several compulsive behaviors. Her crying gets more intense and she reaches into her bag for a tissue and you hear a conspicuous “clinking” of glass in her purse. You know that this is the first session and suspect that she will be bothered by questions about alcohol, so you cleverly, “What do you do to cope with your emotional pain? It sounds like you are carrying quite a bit.” She says she naps, works and runs. You ask if she ever drinks and she answers, “Only on occasion.” Deciding that you won’t help her if you ignore the gnawing concern created by the clinking sound of bottles, you share with her that many people experiencing the profound sadness she has described turn to alcohol, pills, or other substances to cope. You work hard to state this matter-of-factly and without judgment. She responds, “I do that sometimes.” You ask, “Do you have any with you today?” She puts her face into her hands, sobs, and nods. You ask her to be honest about what she has in her bag and she shows you a mini, airplane-sized bottle of Kahlua and a bottle of Soma, a pain medication, which she says she got from her physician. You praise her for her honesty and willingness to be open to help. You realize that combining the substances could be dangerous and assess her for suicidal ideations, which she does not seem to have. It is unclear whether the substances are a primary disorder or if she is self-medicating for depression. A quick screening with the evidence-based TWEAK screening and find that Sarah has a high tolerance for alcohol as she can drink five drinks without getting high. She hides her drinking and drinks alone daily. She does not drink in the morning but does find herself needing a drink to “get going” after her “naps.” She has been grossly out of touch with family because she doesn’t want them to worry about her. She has tried to stop using alcohol as a coping mechanism but finds she keeps going back to it again and again. She even admits, towards the end of the session, that the Soma belongs to her housemate who broke an ankle a few months ago but didn’t use the medication because it made him feel “foggy.” You let Sarah know that you have serious concerns about her use of alcohol and pills and that if she’d like to continue in therapy, you expect that she will meet to receive a full assessment with your practice colleague who has expertise in addictions. Sarah protests and notes that she only uses these substances to feel better. She argues that if she can just be in therapy about her life problems then she could easily give up the alcohol and pills. You assure her that you can continue working with her if she has the assessment with your colleague and that you are not asking her to immediately give up the substances. She seems relieved and schedules another session. You ask her if she will go without a drink or drugs until the next session (five days from then) and she says she will try. QUESTIONS 1. Why is this case study entitled “Sarah: An Unlikely Alcoholic”? What stigma and misconceptions still exist for female alcoholics and addicts? 2. What are Sarah’s depressive symptoms? and does she have a major depressive disorder? 3. What is the TWEAK screening referred to in the case study and how is it used? 4. It is common for women alcoholics and addicts to have eating disorders. What symptoms are warning signs in this case and what related concerns should be pursued?

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