Please review the Case of James, and respond in a brief essay to the questions that follow:
James is a 24 year old white man who recently finished graduate school and began working as an account executive in a Fortune 500 company. As in intern with the company, he was very successful and quickly rose to the top of the ranks amongst his peers. He was hired on immediately after finishing his MBA because of his charismatic ability to charm new clients and earn their trust. James is very successful in his business, but his boss notices that he sometimes gets out of control with his substance use. For example, he tends to drink too much when he’s out entertaining clients. The firm recently lost a $5 million dollar account because, after drinking too much, James became belligerent with the client and said “we don’t need your business anyway—you need us more than we need you”. Also, James is a binge workaholic and is suspected to use cocaine to help him “burn the midnight oil”. He tends to have episodes of a few days where he seems to be unstoppable, but will quickly turn to weepy depression when triggered by something insignificant. His coworkers say that he bounces back and forth in his moods pretty quickly and unpredictably.
In his personal life, James is a serial monogamist, having one relationship after another. His relationships become intense quickly, and he believes that each partner that he meets is “the one for him”. However, the relationships tend to end as suddenly as they begin. His partners say that they can’t keep up with James’ need for constant attention, and he is way too clingy for the average partner. His most recent partner, who was also his coworker, left in the middle of the day while James was at work, leaving behind a note that said, “I can’t deal with your moodiness—I never know which James I’ll find when I come home. I hope you find someone who can keep up with you.”
In response to this, James went out from bar to bar hoping to run into his former partner and talk out their differences. Along the way, he drank heavily at each bar, until he finally ran into his ex. He begged for the relationship to continue, and the two ended up having sex that night. James also introduced his partner to cocaine for the first time that night. In the morning, James woke up, looked at his partner and said “I don’t need you nearly as much as you need me” and walked out the door. Immediately after leaving, he feel into a deep, dark depression. He went home and attempted to overdose on the benzodiazepines that he kept in his medicine cabinet for the times when he needed to come down from too much cocaine. After swallowing three of the pills, he called his partner and said “I need to end the pain you’ve caused me—I hope you’re able to find someone to make you happy”.
Luckily, the partner calls 911 and James is transported to the hospital. You talk with his ex-partner in the emergency room, and you gather that this is one of several suicide attempts that James has made in his adult life. Each time, he has survived and seems to bounce back quickly. This time, like others, his partner feels guilty and decides to give the relationship another try.
1. Describe the steps that you would use to assess James’ needs for treatment
2. Explain how you would engage James in treatment, and describe how you believe he will react to the notion of participating in treatment.
3. Illustrate how you will ensure that your assessment is culturally-appropriate for James (filling in any gaps of information that you might need to have a ‘cultural image’ of James).
4. Which, if any, co-occurring assessment and screening tools might you utilize as you begin to work with James? Provide a rationale for your choice.
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