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The CASE for ALEXIA
Last week, Alexia entered the inpatient treatment program where you are a social
worker. She is being treated for alcohol and cocaine (crack) dependence. Alexia is a 32-
year-old, divorced woman who is employed as an administrative assistant at a local
human services program. She lives with her 11-year-old daughter, Christine, in an
apartment located near her job. Although she makes a relatively low salary, Alexia has
managed to support herself and her daughter without financial support from Christine’s
father. Alexia was married briefly to Christine’s father when she was 20, but she left him
after he became physically and sexually abusive toward her. He also was an alcoholic.
She had almost no contact with him for many years. Her mother, a widow, is a strong
support for Alexia and Christine, as are two cousins, Denise and Moira. Alexia reports
growing up in a “normal middle class family” and states that her childhood was “good”
despite her father’s occasional drinking binges, which she says were related to him
celebrating a special account he had landed (he was in advertising), and her mother’s
“occasional bad depressions.” She is the youngest of five children and the only girl.
Up until a month ago, Alexia was regularly attending twice-weekly treatment sessions at
an outpatient chemical dependency clinic, and she went to AA/NA regularly 3 times a
week. She had a sponsor and they kept in touch several times a week-more, if needed.
From the beginning of recovery, Alexia has experienced some mild depression. She
describes having little pleasure in life and feeling tired and “dragging” all of the time.
Alexia reports that her difficulty in standing up for herself with her boss at work is a
constant stressor. She persisted with treatment and AA/NA, but has seen no major
improvement in how she feels.
After Alexia had been sober for about 3 months, an older boy sexually assaulted
Christine after school. Alexia supported Christine through the prosecution process; the
case was tried in juvenile court and the boy returned to school 2 months later.
After Alexia celebrated her 6-month sobriety anniversary, she reports that she started
having a harder time getting herself up each day. Around this same time, she returned
to drinking daily. She says that she then started experiencing bouts of feeling worthless,
sad, guilty, hopeless, and very anxious. Her sleep problems increased, she began
having nightmares, and she lost her appetite. After a month of this, she started
attending AA/NA and treatment less often, instead staying home and watching TV. She
started her crack use again one night after her boss got very upset with her not finishing
something on time. She went to a local bar after work that day and hooked up with a
guy she met there to get crack. In accompanying him to a local dealer’s house to get
some crack, she was raped by several men. Alexia did not return home that night
(Christine was at a friend’s sleepover party) and did not show up for work the next day.
She does not recall where she was the rest of that night. However, later that day she
admitted herself to your treatment program.
Alexia reports that she began drinking regularly (several times a week) around the age
of 13. She recalls having felt depressed around the same time that she began drinking
heavily, although she states she has very few clear memories of that time in her life.
Alexia’s drinking became progressively worse over the years, although she did not
begin to see it as a problem
until after she began using crack, at around age 28. She reports feeling depressed over
much of her adult life, however her depression got much worse after she began using
crack daily.
Alexia reports having had a lot of gynecological problems during her 20s, resulting in a
hysterectomy at age 27. When asked if she was ever physically or sexually abused as a
child, she says no; however, she confesses (with some difficulty) that when she was 11,
she had an affair with her 35-year-old uncle (father’s brother-in-law).
Now, one week into treatment, Alexia reports feeling numb and tense. She talks only in
women’s treatment groups and, then, only when specifically asked a question. She feels
hopeless about her ability to put her life together and says that she only sees herself
failing again to achieve sobriety. Of her recent rape, she says that she “only got what
she deserved” for being in the wrong place with the wrong people at the wrong time.
Alexia reflects that she was unable to adequately protect her daughter from sexual
assault, and she speculates that maybe she is an unfit mother and should give up
custody of her daughter. While Christine is currently staying with Alexia’s mother, Alexia
is concerned that her ex-husband will try to get custody of Christine if he hears that she
is in the hospital for alcohol and drug treatment. He has been in recovery himself for two
years and began demanding to see Christine again about 2 months ago.
1. Identify and sort through the relevant facts presented by Alexia.
2. Identify the problems, issues, and concerns that arise with Alexia’s situation.
2a. What are the most pressing issues that Alexia should be encouraged to assess and
address?
3. Identify the positive and strengths aspects of Alexia’s situation.
4. Analyze the issues in terms of knowledge presented in the training modules.
5. Use training materials to develop a list of options and an initial plan of action for
interventions with Alexia. Who should be involved in the intervention for Alexia? Who
should also be referred for intervention?
6. Identify any additional information, research knowledge, and resources that are
needed to develop and select options; identify ways to gather what you need; gather
what you can.
7. Develop a strategy using counseling approaches with Alexia. Be sure that you have a
concrete and specific strategy for how you would address alcohol issues. What are the
intervention goals? Following inpatient treatment, what kinds of referrals in your practice
community would you make and why?
8. Identify methods for evaluating outcomes of your plan and next steps/revisions of the
plan, depending on various possible outcomes.
9. Discuss implications for community intervention, prevention planning, social policy
reform, and advocacy that are associated with Alexia’s situation.Client Assessment
1 . Please enter your information.
2 . How did you hear about us?
3 . Reason for today’s visit:
4 . I have a desire to proceed with therapy:
If no explain why

Client Observations
General Appearance:

Dress (appropriate, disheveled etc.)

Motor Activity (agitation, fidgeting, composed)

Insight:

Judgment:

Memory ( Intact, Poor):

Attention/Level of Concentration
(distractible, engaged, inattentive):

Interview Behavior:

Speech:

Safety Issues: Any identified safety issues

Background Information
Identification ( Gender, Race, Ethnicity, Age):
History of Present Problem:
Educational / Occupational History:
Family Dynamics:
Legal History (Any arrests or involvement with the criminal justice system):
Strengths:
Limitations:

Problem Identification:

What made the client decide to seek help at this time?

Share the identified challenge or problem based on clients self report

How long or often has the client experienced the problem?

Describe the emotional, physical, or psychological symptoms reported by the client?
When did the symptoms start?

Was there anything else happening when the symptoms started?

Is there any current crisis or situation that needs immediate attention?

What significant relationships does the client describe?

Describe clients current engagement in work, school

Describe the client’s current living situation

What goals might the client like to achieve as a result of working with the therapist?

Client Assessment
1 . Please enter your information.
2 . How did you hear about us?
3 . Reason for today’s visit:
4 . I have a desire to proceed with therapy:
If no explain why