SCENARIO
You are a clinician in an OASAS Licensed Program. Richard Ortega (Ricky) has seen you for 5 individual sessions of treatment for his opioid use disorder (in early remission). He is a very charming , persuasive and likable 32 year old Puerto Rican American male. He is married with 3 pre-school children and has a good union job providing heating ventilation and air conditioning (HVAC) services to the Marriott hotel chain in the NYC Burroughs. Despite wearing steel toe boots, he managed to break 3 toes on his left foot last year and was out of work for 4 months – debt has piled up. He was over prescribed an opioid medication and became dependent. He began buying pills from a coworker before he went back to work, so that he could go back to work (every step still hurts) and start getting full paychecks to support his family again (worker’s comp was only paying two-thirds of his salary).
Recently Ricky was arrested for possession of opioid Rx pain pills. He is on pre-trial probation for felony possession of a controlled substance and is due back in court next month; you have a signed consent form to communicate with his probation officer (who you know well from previous shared cases – you have a trusting relationship). If he violates his probation or gets convicted he will lose his job. Ricky is required to maintain participation in treatment as part of his probation deal, otherwise they would hold him in jail until his next court date. “I can’t break my kids’ hearts – I am not my Dad.” He reports that he forgot to fill out the ‘continuing case’ report for workers comp and “it has raised hell with everything”, including his insurance coverage which is temporarily cancelled, but starts again in 10 days – he shows you the paper. He knows you need to get paid for visits at the agency and figures it would be ok if he sees you this week, like he has to, but you just date the visit for next week so he doesn’t blow his probation and lose his job. Or maybe he could just skip the visit but you can still tell probation that he is in compliance with pre-trial weekly counseling anyway because he will be good to go next week. His wife is being seen at the clinic as well and maybe you could bill this as a family session for a couple of weeks.
Discussion Questions
How do you respond?
What are the options for you both here? Discuss your dialog with him including anticipated reactions from him.
Start your discussion with him right after he tells you all this and asks “So what do you think?” What’s your first response? Where do you go from there? How does this end?
