Ms. W is a 39-year-old Caucasian, single mother, of two children that presented with suicidal ideation with a plan. Her plan was to overdose on alcohol and psychotropic medications. On intake, she was intoxicated with an alcohol level of .193 and no other addictive substances were in her system. She reported that she had just gotten out of the hospital two weeks ago after being admitted for an intentional overdose on her psychotropic medications and has not followed-up with any outpatient providers. She has been drinking for a week and a half, and she was experiencing alcohol withdrawal symptoms of shaking, hallucinations, cold sweats, and possible seizures.
Ms. W has a long history of mental health issues that started with being sexually abused from the age of 12 through 15. She again was sexually assaulted several times in her 20s and had multiple domestic violence relationships. She experiences nightmares and flashbacks on a regular basis that prevents her from sleeping through the night. She also experiences times when she can’t stop crying and her anxiety has been so bad that she was not able to care for herself or her children. She also has consistent feelings of helplessness, worthlessness, and hopelessness. Finally, she has been consistently suicidal for the past three days. Ms. W has the following mental health history: several hospitalizations, with the last one occurring two weeks ago. She has attended outpatient treatment several times, and she usually stops going after a few weeks. Her psychotropic medications include the following: Zoloft, Klonopin, and Geodon.
Ms. W has been using alcohol since the age of 15 and she reports that the longest period of sobriety has been a few months. She reported the following symptoms of alcohol use: increase in tolerance, cravings, family issues related to her use, employment problems, physical withdrawals, and multiple attempts to cut back and stop her use. Ms. W reported that she has experimented with several other drugs including THC, cocaine, PCP, and heroin, but she never used them regularly. Her last use of any of those substances was two years ago. Her toxicology screen was negative and she denied any substance abuse treatment and she has not attended any 12-step programs.
Ms. W lives with her family, which includes her two daughters who are 16 and 19. Also in the home are her parents and her grandson who is one year old. Her boyfriend has just moved in to avoid being homeless. She reported that her mental health and substance abuse issues have caused problems in her treatment. If they ask her to leave, she will be homeless. She is unemployed and she has not worked in the last year. She was working as a cashier at a local store. She was unable to go to work because she was intoxicated. Ms. W’s legal history includes several DWIs, and she was incarcerated for six months for her third DWI. She has no current legal issues.