Laura is a very successful businesswoman in the high-stress high-powered world of corporate finance. She has been referred to you by the company’s employment assistance program. Laura presents herself as a no nonsense business professional. She is frank and honest about the events that has brought her to your office. Laura tells you that although she tells herself that she will only have one or two glasses with dinner, she usually finishes the whole bottle. “About five years ago I started having trouble sleeping and started to take a tranquilizer (5 mg Valium?) I normally take one or two pills every two to four times a week to help her sleep through the entire night.” In the morning, she drinks at least 3 to 4 cups of coffee daily, even on the weekends. She noticed that her sleeping problems developed around the same time her Dad died. He was only in his early 50’s and they were very close. His death hit her hard and she says she wanted to give in to a big depression. However, she fought it and lost herself in her work. She makes it a point to work out at least three times a week in the morning before going to work. In addition to the above medications, Laura is also prescribed Xanax? as needed for panic attacks and diet pills (amphetamine congeners) to control her weight, a problem she had since she was a child. Over the last year she has become more reclusive. She can barely make it to business dinners and after-work functions. Lately however, she has noticed that she has been steadily increasing her use of wine. Before, she would only have a few glasses with dinner but now “….more often than not I finish off the bottle before going to bed. I just can’t seem to stop. A lot of times I will come home and tell myself that I’ll only have one glass and no more but by the time I go to bed, the bottle is empty and I’m deciding whether I should open another or not. I never used to drink to excess or take anti-anxiety medication before. Now I can’t seem to stop drinking or taking these ‘downers’ at social events. I can’t seem to control when I take them and things are happening that I’m not too happy about. Of course, the alcohol adds to my weight problem which then causes me to take more of my Redux. Then I have to increase my Xanax to calm my nerves and also take my Valium to make sure I get a full night’s sleep. It has become a very vicious circle. All this has been going on for about a year but last week put the “cherry on the pie.” Laura tells you that last week she was to meet the firm's top client at a business luncheon. She could not get out of bed that morning. It took all her willpower to get up and get dressed. As it was, she was still 20 minutes late, "which is inexcusable." She was so nervous and sick she had to excuse herself in the middle of her presentation. In the bathroom, she took another Xanax? to calm her nerves. Then at the luncheon she could not stop herself from ordering several glasses of wine and had to be assisted to her car after the meeting was over. "My client spoke to my boss and staff and then canceled his account with me. The next day I met with my boss and he recommended (ordered) I make an appointment with our EAP program (or be terminated.) I’m really scared. Work is all I have. I can’t afford to blow it. Do you mind if I smoke?"

Case Questions (provide a detailed response to each question based on the information provided and your reading of the text and film.

1. What would your initial assessment of Laura be?

2. What would you say Laura’s main drug of choice is and do you think she will need to be placed in a detoxification program to address this problem?

3. Based on Laura’s emotional situation and the medications she is taking, what if any dangers do you need to be aware of?

4. Based on the information Laura has given you who would you need to contact to advise them of Laura’s situation and what would you need from Laura to make these contacts?

5. If Laura’s boss calls your office to find out how Laura is doing how would you respond to his inquiry? What are his rights to know if Laura did keep her appointment with you?

6. What possible dual diagnosis issue(s) might Laura have and how would you do to confirm this possibility.

7. Are there any other issues that you feel may need to be addressed in this case?