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M-CAP Case Studies

Addiction Case Studies

M-CAP Case Studies Reveal the Value in Getting the Right Diagnosis

Case Study #1 – Physician
Case study #1 was a reputable physician, referred to Positive Sobriety Institute following complaints by a colleague and patients regarding her medical skills and bedside manner, respectively. She tended to be rigid and isolative, yet superficially friendly, at the workplace. For instance, she was noted to be a “health nut” who exercised between cases and only ate power bars. She arrived at Positive Sobriety Institute slightly irritated by this break in her routine yet compliant, grossly underweight, and defensive about her self-care practices. The Positive Sobriety Institute internist picked up cardiac, skin and lab abnormalities. She was also evaluated by an exercise physiologist, a cardiologist and a neuro-psychologist, and deficits were found in all of these areas. It was determined that the probable cause of her deficiencies was malnutrition. She was recommended for inpatient eating disorder treatment at a RiverMend Health Recovery Programs facility, specifically a program that had other professionals for increased identification. She successfully completed the treatment and returned to work following normal repeat neuropsychological testing. The recommendation was initially met with resistance by this physician, but several months later she said the intervention “saved my life and my career.”

Case Study #2 – Surgeon
Case study #2 was a surgeon referred to Positive Sobriety Institute by his hospital following complaints by co-workers that he was “falling asleep between cases and loudly snoring.” He was an experienced and well-liked physician at his hospital, and had a history of several chronic medical diagnoses. Following extensive interviews with both familial, personal and professional collaterals, and after a comprehensive medical and psychological assessment, it was determined that that probable cause of his sleepiness was as simple as insomnia caused by obstructive airway disease. He had a sleep study, and CPAP was recommended. He subsequently returned to work at optimal functioning, and additionally noticed improvements in his chronic medical conditions. He was trying to avoid early retirement, and expressed gratitude for his improved sense of wellbeing and the ability to retire when he was ready.

Case Study #3 – Nurse
Case study #3 was a nurse from a western state investigated at her hospital for missing narcotics, and despite a positive urine drug screen, she denied diverting the narcotics and stated she was “legitimately prescribed” the opiates for chronic pain. She was referred by a Board of Nursing when she inquired about where to have an assessment. The hospital had reported her to her state’s Board of Nursing. Her Prescription Monitoring Site information was obtained during the M-CAP, along with numerous personal and professional collateral information. Despite her objections, it was determined that she had a long history of excessive use of prescribed, mood-altering medications, and a fragmented history of medical care. Her psychotherapist was consulted, and adamantly refused to acknowledge the lengthy drug seeking history, and thereby inadvertently enabled her, along with her mother, who believed her denials. She was compassionately approached, and offered treatment and advocacy from a local professional’s program. With this advocacy and treatment, she was able to return to nursing with a “care in counseling“ agreement with the Board of Nursing in her state, and maintain sobriety in a supportive environment of her peers.

Case Study #4 – Business Executive
Case study #4 was a successful executive in a large corporation who was accused of sexual harassment while intoxicated at a corporate event. He was referred to Positive Sobriety Institute by his corporation. He denied the accusation, and denied any history of alcohol or substance abuse. He was very professional and his collateral contacts were faultless, outside of the referral source at his corporation. Through extensive labs and interviews, it was determined that he had a history of binge drinking, which he did not consider abuse, and had no recollection of the evening in question, which may have been a black-out. He expressed great shame, but was educated about alcohol use disorder and recommended to practice sobriety with the assistance of a professional’s treatment and aftercare. Due to his longstanding integrity, and devotion to his wife and children, he accepted the recommendations and continues to work at his corporation with the respect of his colleagues and supervisor.

Case Study #5 – Anesthesiologist
Case study #5 was a divorced anesthesiologist with a history of sexual acting out behaviors (multiple affairs) that led to his divorce, and chronic pain, which had been treated for two decades with opiates. Recent increased anxiety resulted in his additional use of benzodiazepines, and an openly dysfunctional relationship on which he was spending inordinate amounts of money. He was referred to his state’s Physician Health Program, and they referred him to Positive Sobriety Institute. This referral to Positive Sobriety Institute followed a workplace intervention by a trusted colleague, who said he was “worried about him.” He met criteria for substance use disorder and addiction interactive disorder (AID). He briefly resisted the recommendation for professional’s treatment, due to fear of pain without opiates and lack of companionship with women, but after several weeks in a program remarked, “I wish I would have done this years ago…I wasted a lot of time….”

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Positive Sobriety: The Book
Daniel H. Angres, MD

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