Problem
Read the following case and answer all questions.
Laura is a Hispanic woman in her late-forties. Laura is married and has two daughters aged 15 and 17. She works in the high-stress, high-powered world of corporate finance. Laura presents herself as a no nonsense business professional. She has come to the clinic that you are presently working in as a social worker for an assessment because her husband and two teenage children are very concerned about her drinking. Her husband has insisted that she seek professional help. Laura tells you that although she promises herself that she will only have one or two glasses of wine per day, she routinely finds herself finishing the whole bottle and sometimes half or more of a second bottle.
Laura reports that it seems to take more wine these days to help her feel relaxed at the end of a stressful day. She does not see this as a problem but she has missed a few important business meetings lately. This has made her feel quite upset with herself and guilty because she has lied to her boss about the reason for her absences. About three years ago, Laura began to have trouble sleeping and the doctor prescribed the medication Xanax (an anti-anxiety drug and central nervous system depressant). Her father died about one year ago and her use of alcohol and Xanax has steadily increased since that time. She often takes five or six times the prescribed dose of Xanax.
When her physician presented his concerns about the amount of Xanax she was taking regularly, she began to search for other physicians to obtain more prescriptions for Xanax. She now takes Xanax during the day as well as at night when she is feeling stressed. Laura notices that her mind is quite fuzzy in the mornings and she cannot remember certain things from the evening before. Of major concern to her family is that she recently totaled her 11 car in a crash on the way to work on a morning that she had a very bad hangover from drinking the night before. Laura states "I guess I am really lucky to have walked away unharmed".
Her children told her that they are beginning to feel embarrassed by her slurred speech and staggering gait in the evenings when they bring their friends home. Laura admits that she felt ashamed and guilty when her children told her that they felt embarrassed by her behavior. Laura's husband has told her the car accident terrified him and he wants her to get help.
I. What are your initial impressions of Laura?
II. Describe an approach and engagement with Laura and include professional and ethical considerations in working with Laura.
III. Provide an assessment and DSM-5 diagnosis with a rationale for choosing the specific diagnosis for Laura.
IV. Does Laura need to be referred to a physician to be assessed for possible medical detoxification/stabilization and if so provide an explanation as to why?
V. Provide a treatment plan including models or treatment used and interventions. f) Should Laura's family be involved in her treatment? If family involvement is indicated outline the rationale for including Laura's family in her treatment plan.