For this Assignment, review the Opioid Use case study. Consider how you might conduct an intake interview to assess Janelle’s opioid use.

In a 2- to 3-page APA-formatted paper, address the following:

• Describe the type of interview you would use to assess Janelle’s opioid use and explain why 
• Explain the benefits and limitations of using this type of interview
• Explain one potential ethical and one potential legal issue in conducting this type of interview with Janelle

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COUN 6204A: Assessment in Counseling and Addiction

Week 6 Case Study: Opioid Use Case Study: Janelle

Janelle is a 28-year-old African-American female who presented for an assessment due
to recent problems with the court system. Janelle had recently been pulled over for
speeding during which time the officer discovered that she had prescription narcotics
(oxycodone) in her possession for which she did not have a valid prescription. Janelle
was offered a plea bargain to participate in the county’s drug court program. This
program allows her to participate in counseling in lieu of serving time in jail for her
offense.

Janelle arrived to the initial counseling appointment on time. She was dressed
appropriately for the weather. Janelle was alert, oriented, and did not appear to be
under the influence of any substances. Her gait and motor activity was unremarkable.
She appeared to demonstrate the ability to sustain attention throughout the duration of
the intake interview. Concentration skills appeared to be intact, and there was no
evidence of psychomotor agitation. Janelle appeared to be a reliable historian, and she
was able to recall both recent and long-term events without any apparent impairment of
her memory skills. Janelle appeared to have fair insight into her current difficulties.
After reviewing the limits of confidentiality and obtaining informed consent, the
counselor provided a brief overview of the counseling process and her role in providing
services to Janelle. The counselor then began conducting a clinical interview to
determine the extent of Janelle’s substance use and to determine the presence of any
other mental health issues:

Note to students: Please note that this example is a segment of a lengthier intake
interview. A traditional intake interview is 60–90 minutes in length and would
typically cover basic demographic information, include a medical history, and
assess for potential lethality issues.

Counselor: Well, Janelle, I understand that you’re here because of a legal issue
involving the court system. Can you tell me a little bit about that?

Janelle: (shrugs) There’s not much to tell. I got stopped for speeding. I was only going a
few miles over the limit. The cops stopped me and I had some stuff on me. I got
arrested for possession. I had to go to court and now I’m here. That’s about it.

Counselor: You had some “stuff” on you.

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Janelle: Yeah, pills, oxys.

Counselor: Okay, well, if it’s okay with you, I’d like to talk about the oxycodone. How
much would you say you use on any given day?

Janelle: That’s the thing. I don’t really use that much. A few pills here or there. It’s not
like I’m shooting up heroin or anything. I just have a lot of pain. The pills help with that.

Counselor: You use the pills primarily to help with your pain. Can you tell me more
about that?

Janelle: Yeah, exactly. I mean, I don’t have a prescription for them or anything. So, I’ve
been buying them from a friend. But a few months ago, I got into a car accident and had
a lot of back pain. The doctor prescribed Vicodin, which worked really well at first. Then
it stopped working, so I started taking a friend’s oxys and they made me feel a lot better.
So I just kept taking them. Now I feel like I need to take them just to get by.

Counselor: Switching gears for a second, can you tell me about any other substances
you might use, in addition to oxys? Maybe alcohol or cigarettes?

Janelle: Yeah, I drink, mostly just on the weekends though. I hate smoking cigarettes. I
mean, I’ve tried other stuff too. But I don’t do any of that stuff now.

Counselor: Can you tell me about some of that “other stuff”?

Janelle: In high school I liked to smoke weed, but who doesn’t do that in high school? I
wouldn’t say I had a problem with it, but I probably did it every day for about a year or
so. I’ve also tried ecstasy and cocaine. But I didn’t like them and don’t do them now.

Counselor: Any other substances that you’ve used? For example, have you ever tried
pills like Valium or crack cocaine or heroin?

Janelle: I’ve taken Xanax before—those are like Valium, right? I actually really liked
those, but they are hard to find, at least for me. I’ve never done crack or heroin. I can’t
imagine doing either one of those, especially heroin. I’ve had some friends who have
started using it, and it’s just crazy how it messes you up.

Counselor: Okay, so if I can summarize what we’ve talked about so far: You use
oxycodone right now, but you’re only using it to help with pain. You also drink, mostly on
the weekends, and in a social setting. In the past, you’ve used marijuana, ecstasy,
Xanax, and cocaine, but you’re not currently using any of those substances. Does that
sound about right?

Janelle: Yeah, that’s right.

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Counselor: Good, I’m glad we’re on the same page. I’m wondering if you’ve ever had
any legal problems with substances, before getting picked up this time?

Janelle: (sighs) Yeah. I had a DUI about a year ago. I was leaving the bar and I got
picked up. Had to go through a weekend driver intervention program to get my license
back.

Counselor: Okay, anything else besides that DUI?

Janelle: No, I’ve never been in trouble besides that DUI, and now, obviously.

Counselor: Sometimes when people use substances, it can create problems in work or
in relationships. Have you had any problems in either of those areas?

Janelle: Not really. I work in a restaurant, I’m a waitress, and you know how that goes.
Everyone who works there uses something. Half the staff snorts cocaine in the
bathroom. I’ve had to call out a couple times because I couldn’t score any oxys and I
was in too much pain to be able to get through my shift. But I’ve never been disciplined
or anything. I actually think I work better when I’m on oxys. I’m more relaxed, I definitely
feel better, and I don’t let work stress get to me.

Counselor: You’ve not noticed that oxys have caused a problem for you at work, and, in
fact, it feels to you like they help you perform better.

Janelle: Yeah, I know that sounds stupid but that’s how it feels.

Counselor: I appreciate your honesty, Janelle. This information will help me better
understand how I can be helpful to you during our time together.

Janelle: Thanks. I guess it’s weird to have to talk to someone about all of this, but it’s
not as bad as I thought it was going to be.

Counselor: I’m glad to hear that. Can we talk about the impact of substances on your
relationships? Maybe relationships with your family and friends?

Janelle: (hesitates for a moment) Well, my parents are basically not talking to me right
now. When I got the DUI they were pissed. Now they are just kinda done with me. I
guess I should back up. I’m an only child. My parents are still married, I had a very
normal childhood and was raised the “right way.” So I guess they have a hard time
understanding why I didn’t turn out “right.”

Counselor: You’re using the word “right.” Is that your word or theirs?

Janelle: It’s what they keep saying. They had big plans for me. They wanted me to be a
doctor or a lawyer, or something more than a waitress. I tried the whole college thing,
but I have a hard time focusing. I don’t know…maybe I have ADD or something.

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Counselor: So you tried college, but it didn’t work out for you?

Janelle: Yeah, I made it through about 2 years. But my grades were terrible. I had a
hard time even bringing myself to go to class after a while. It was like, what’s the point?

Counselor: It sounds like you got pretty down on yourself.

Janelle: Yeah, I did. I felt like I was disappointing my parents.

Counselor: It certainly sounds like you value your family, even though things are kind of
strained right now.

Janelle: Yeah, I do. I’ve always looked up to them. My mom’s a teacher, and my dad is
a financial planner. They always have just done everything right. I know they don’t
approve of my lifestyle or the choices I’ve made, and I just feel like I let them down.

Counselor: I imagine it must feel quite burdensome, carrying that weight of feeling like
you’ve let them down.

Janelle: (tearful) Yes, it does.
.
Counselor: Well, I certainly hear from you that your family is important to you. I’m
wondering if there are any other relationships that you value which may have been
impacted by your substance use?

Janelle: Well, at this point, all the people I hang out with use something. Most of my
friends are people that I work with, and they all use. Those are the people that I usually
go out and drink with on the weekends. So my use hasn’t really affected my
friendship… maybe the opposite? I probably use more because of the people I hang out
with.

Counselor: Your friends in a way contribute to your use.

Janelle: Yeah, I would say so.

Counselor: Okay, what about other relationships? Maybe a significant other?

Janelle: (hesitates for a moment) Um, well, that’s another issue. I’m a lesbian and my
parents have a huge problem with that. In fact, they probably have a bigger problem
with that than my drug use. They keep saying that it’s a phase I’ll grow out of or that I’m
just doing it for attention… but anyway, I do have a girlfriend and our relationship has
probably been affected by my use.

Counselor: So similar to your relationship with your parents, you’ve noticed that your
relationship with your girlfriend has been affected by your use?

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Janelle: Yeah, she doesn’t use anything at all. In fact, she really doesn’t even drink. And
she hates that I use pills. We get into fights about it all the time. We’re really not even
speaking right now, after this last arrest. I worry that she’s probably going to leave me if
I can’t get my act together.

Counselor: You feel like she’s reached a kind of the proverbial “last straw” with you.

Janelle: I do. She’s a great person and she wants to be supportive, but how much can
she really take? I keep telling her that I’ve got everything under control, but then I go
and get arrested and now I have to complete this court program to avoid having a felony
on my record. I feel like I’ve messed things up for the last time. And the thing that really
stinks is that, otherwise, outside of my use, we have a good relationship. We’ve been
together for about a year, she’s someone that I can totally see spending the rest of my
life with. But I don’t know if that’s going to happen now.

Counselor: If I can summarize for a moment, in both your relationship with your parents
and your relationship with your girlfriend, you feel like it’s to the point where there may
be some long-term damage. And, please correct me if I’m wrong, what I think I’ve heard
so far is that the damage might be, at least in part, related to your substance use.

Janelle: Yeah, I guess I would have to say that’s a true statement. I’ve never really
considered myself an addict or anything, and I don’t think I do now either, but I guess
it’s hard to deny that the pills and drinking are costing me something.

Counselor: I think we’re off to a good start, Janelle. And I want to commend you for
being honest with me. It’s tough to talk about a lot of this stuff, and you’ve demonstrated
a lot of strength by coming in here and doing just that. I hope in the rest of our time
together, we can continue to explore these issues, and maybe, if you’re interested, we
can decide how we might go about working on some of this stuff. How does that sound?

Janelle: That sounds good. I was really not happy about having to come here. But I
think that this is something that might be good for me. I think I’ve been ignoring a lot of
this stuff for a long time. So maybe it’s time I started to address it.

Counselor: That’s exciting to hear, Janelle. I’ll look forward to continuing our work next
week.

Janelle: Okay, thank you.