Problem:
Kelly Miller is a 29-year-old American who identifies as white, heterosexual, non-binary, and uses she/they pronouns. She currently lives in Hyde Park, and works as an office manager at a locally-owned small business. She appears her stated age and reports no current health or mental health concerns. She is well-dressed during the appointments, with organized thoughts. She is currently single and states she would like to "dip my toes" back into the dating scene.
Recently, Kelly approached a case manager at the community center and requested counseling services, stating that she has recently experienced more difficulty managing stress. The day that Kelly made this request, you had availability and were able to meet with her for a first session. During this appointment, your efforts focused on building a relationship with the client, completing documentation, and initiating the assessment process. Kelly did not show up for the next session, rescheduled a few appointments, and then arrived late for what was the second appointment. While she seemed interested in starting counseling and displayed a bright affect during the first session, you observe a noticeable change in her appearance during the next appointment - she seemed withdrawn, spoke quietly, hesitated sharing personal information, and was non-committal when you attempted to schedule a third meeting. Additionally, regarding access to additional community and social support, she has not been back to the community center since the second counseling session.
During the first appointment, Kelly indicated that her presenting problem is related to substance use, in particular cannabis. Kelly stated that she previously experienced problems with alcohol and opioids. Opioid misuse began in her early 20s, after she was prescribed Percocet to manage physical pains associated with cancer. She reported she has not used opioids or alcohol for 16 months, reducing and eventually stopping use due to physical and mental symptoms she was experiencing as a result of periods of frequent use and followed by excruciating withdrawals.
Kelly indicated that she currently smokes marijuana daily and uses the phrase "waking and baking" to describe her cycle of use. She noted that cannabis helps her cope with her anxiety and physical pain. She reports that she sometimes has a hard time getting out of bed without using her bong, noting that she has recently had to take 7 - 8 hits to feel effects that used to be experienced with 2 - 3 hits. When working from home, she will sometimes use her marijuana vape pen if she "doesn't have too many meetings." Kelly feels that smoking might be getting in the way of her work, but that it also helps reduce stresses related to her job. She stated that weed sometimes makes her less nervous, although lately she becomes suspicious of others after smoking, causing her to isolate from others and avoid being in public. She lives alone in a studio with her cat, Mittens. She reports feeling disconnected from others, noting that she's not made close friends since moving back to Massachusetts. She now struggles to go grocery shopping and clean her apartment because of the effort and planning that are required. Kelly states that she has to take edibles to sleep, otherwise she'll be awake until 3 or 4 AM. Additional Information
Kelly signed a release of information so that you could contact a life coach with whom she previously accessed services off and on for a few years. During your phone call with the life coach, he provided the following information about this client: Kelly was born in Washington D.C. in the mid-1990s. Her mother was a maintenance technician at a factory and her father was a seafood salesman. She lived in Washington D.C. until age 11, when the family moved to Waltham, Massachusetts to support her aging grandmother.
At age 14, she was diagnosed with Leukemia, and she was treated with chemotherapy and underwent multiple bone marrow transplants. At this time, her mother became very invested in religion, bringing Kelly with her to synagogue every Saturday and involving her in numerous spiritual activities to support her health. Although she was not prescribed the substance, Kelly's mother helped her to access marijuana, which she utilized as a method of self-medication for physical pain and nausea from the chemo sessions; Kelly's mother also stated that cannabis can have benefits for both spiritual insight and mood management, and after Kelly used cannabis she and her mother would often pray together until she fell asleep. Kelly's health improved over the next year, and she was able to return to full-time studies when she was a sophomore. As she adjusted to high school, she established a social group that had a reputation for using and selling substances. During that time, she started smoking cannabis more frequently, and also initiated alcohol use. She told her parents that she was "making up for lost time." She was in an on-again/off-again relationship with a significantly older partner during her last two years of high school. She reports "barely graduating" from high school, and a year later took a few classes at a community college in southeastern Massachusetts. Kelly's cancer returned when she was 20, and the providers determined she needed more chemotherapy sessions. During this time, she was prescribed opioids, specifically oxycodone, to manage her pain. After her cancer went into remission at age 22, she continued to use opioids and needed to acquire them from a friend, as the providers stopped prescribing the medication after she finished treatment. Subsequently, she dropped out of classes due to her opioid use, at which point she was experiencing nausea and drowsiness, especially when she was unable to access the substance from others.. Her parents discovered that she was using the money they provided to her for school expenses to instead purchase opioids, after her roommates alerted them that she was sleeping all day and not caring for herself. Her parents came to visit and found pill bottles that were not prescribed to her. They cut her off from financial and relational support, stating that they were not going to support those habits, and have been distant from her since then. At that time, she stopped taking community college classes and moved to New York City. There were ups and downs in her substance use throughout her mid-twenties. Kelly moved to Manhattan, and worked as a bartender and waitressed for many years. There, she had a circle of friends that similarly used and misused a variety of substances, and partied with them most nights after finishing work. She tried cocaine and ecstasy a few times, but she found that alcohol and marijuana gave the effects that she wanted to experience. She reports having a volatile relationship with a partner within that friend group, and noted that she sometimes develops relationships with people who are dangerous, especially if they can provide marijuana and smoke with her. She reports that the weed helped with the hangovers, allowing her to get to work early the next morning. During one of their breakups, she decided to seek inpatient and residential treatment for opioid use because she had "nowhere else to go." In the discharge plans, her treatment counselors informed her that she should return to Massachusetts to be closer to family, although she'd had limited contact with them for the past several years. She was worried about her safety and substance use in NYC, and decided to take their recommendation to relocate. The life coach met with Kelly via Zoom shortly after she moved to Massachusetts in 2022, and they haven't had contact since that time. Formulation and Diagnosis. Need Assignment Help?