Gary is a 42-year-old Black American engineer at a local firm. He has always been a high achiever and can push himself hard. In the past year, he was in a serious MVA when a drunk driver hit his car. Gary lost his arm in the accident and fractured his neck. After a long hospital stay and months of physical rehabilitation, he is very nervous driving and reports experiencing "panic attacks" and general anxiety. He tried counseling once but said, "It wasn't for me." He has been diagnosed with Panic Disorder, Post Traumatic Stress Disorder and Alcohol Use Disorder. He is a heavy user of alcohol (20-24 drinks per week, mostly on the weekend). His physician initially prescribed Paroxetine/Paxil (20 mg per day) but Gary reports the medication "didn't work" and "killed his sex drive" - he quit taking it after 10 days. The prescriber believes Gary's PTSD  and Alcohol Misuse are the primary problems and if he can address that, the panic will likely subside. Gary is hesitant to go to counseling and convinced he "only needs Xanax". His PCP is open to prescribing another SSRI and Naltrexone (Vivitrol) but wants Gary to try counseling before she considers an anxiolytic.  Be mindful that communicating benefits, effectiveness and side effects with clients improves medication adherence. You must be specific and provide detailed medication education for Gary.

1. Why do you believe Gary is reticent about counseling? (Perhaps Gary may be apprehensive taking another medication and/or frustrated regarding his medication's efficacy, side effects, etc.)  How would you engage Gary if you were the therapist? Could there be cultural considerations to explore (e.g., fears based on cultural or societal influences)?

2. During the evaluation, Gary reports he previously "doubled up the dosage" on his Paxil and "quit cold turkey". How would you educate Gary about the Side Effects of SSRIs, Serotonin Syndrome, Discontinuation Syndrome, and Alcohol's interaction with antidepressants? 

3. Why would the prescriber be hesitant to consider an anxiolytic?  Discuss with Gary concerns related to anxiolytics and alcohol misuse. Additionally, educate Gary on Naltrexone, medication-assisted treatment (MAT). Discuss MAT, the rationale for use, benefits (pros/cons), side effects, interactions and adherence. 

Answer rating: 100% (QA)

1 Garys reluctance towards counseling could stem from various factors Given his past experience of trying counseling once and feeling it wasnt effecti... View the full answer