Alcohol, opioids, dual diagnosis, and the treatments that actually save lives.
5 cases
A 41-year-old general contractor self-refers after his wife discovers he's been buying oxycodone from a coworker. What began as a legitimate prescription for a back injury has become severe opioid use disorder. Walk through destigmatization, assessment, MAT selection, buprenorphine induction, and long-term treatment planning.
A 44-year-old man presents requesting alprazolam refills after his previous psychiatrist retired. He's been on escalating doses for 3 years, now taking alprazolam 2mg TID — and sometimes more during stressful weeks. He's not trying to get high. He's terrified of what happens when he runs out. His previous provider kept increasing the dose because nothing else seemed to work, and now you've inherited a patient who is both physiologically dependent and meeting criteria for a use disorder. You can't just refuse to prescribe — but you can't keep doing what was done before.
A 38-year-old pharmaceutical sales rep is referred after a DUI. He drinks 6-8 drinks nightly and endorses significant depressive symptoms. Untangle the classic dual diagnosis question: is this independent MDD driving the drinking, or alcohol-induced depression that will resolve on its own?
A 29-year-old software engineer presents for anxiety treatment. He's bright, functional, and dismissive of any concern about his daily cannabis use — 'it's legal and it's the only thing that helps.' His anxiety is worsening despite (or because of) daily use, and he can't see the connection. This case explores the clinical challenge of cannabis use disorder when the patient doesn't believe it's a problem.
A 31-year-old tow truck driver is brought to the ER by his brother after five days without sleep, paranoid delusions about government tracking, and visual hallucinations. He tests positive for methamphetamine. The clinical question isn't whether meth caused this — it's whether meth is the whole story, and what happens when it clears.
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