PS511 Unit 7 Stimulant Use Disorder Case Study Example

Gift Cards for Clean Tests: A PS511 Unit 7 Case Study on Methamphetamine Use Disorder and Contingency Management

[Student Name]

Purdue University Global

PS511: Chemical and Psychological Dependency Counseling

Unit 7 Stimulant Use Disorder Case Study

[Instructor Name]

[Date]

The client, her family, the clinic and every detail of the case are composite and illustrative; the sources cited are real.

Presenting Problem

Dani is 29, a home health aide who travels between clients in three towns on the Range. Two years ago a coworker offered methamphetamine during a stretch of double shifts, saying it would "get you through the week." Dani began using on long shifts, then on days off, and for the past eight months has smoked methamphetamine every day. Dani's mother, who cares for Dani's six-year-old son on weekdays, called our clinic after finding a pipe in Dani's purse. Dani came to intake the next day and said, "I want to stop before I lose my kid or my license."

History

Dani uses about half a gram a day, more on weekends. Dani has lost fifteen pounds, sleeps three or four hours a night and twice in the past month felt sure people were watching the house. Dani was written up at work for missing a client visit. Two attempts to quit lasted three days, ending each time with exhaustion, heavy sleep, intense craving and a low mood Dani describes as "the worst I've ever felt." There is no history of injection or of other drug use apart from occasional alcohol.

DSM-5-TR Diagnosis

The DSM-5-TR uses the same eleven criteria for stimulant use disorder as for other substances and asks the clinician to specify the substance (American Psychiatric Association, 2022). Dani's history supports using more than intended (1), failed attempts to stop (2), much time spent using and recovering (3), craving (4), a missed visit at work (5), continued use despite her mother's distress (6), giving up time with her son on weekends (7), continued use despite paranoid thinking and weight loss (9), tolerance (10) and withdrawal, marked by exhaustion, oversleeping and low mood (11). That is ten criteria.

Diagnosis: stimulant use disorder, amphetamine-type substance (methamphetamine), severe. Dani's brief paranoid episodes should be assessed by a psychiatric prescriber, since methamphetamine can cause psychotic symptoms that usually clear with abstinence.

Why Contingency Management

Dani's prescriber has no approved drug to offer for methamphetamine, so the core of the plan has to be behavioral. Contingency management gives people tangible rewards, such as vouchers or prizes, when objective tests confirm they have not used. Brown and DeFulio (2020) pulled together the trials on rewarding people for methamphetamine-free tests and found, consistently, less use and longer runs without it during the weeks the rewards were offered. They also found that effects tended to weaken after rewards ended, which means contingency management works best as the first phase of a longer plan.

Methamphetamine pays Dani immediately; contingency management works by paying something back just as quickly for not using.

Designing the Plan

Petry (2000) describes the principles that make contingency management effective. The target behavior must be objectively verified. Rewards must follow quickly, ideally at the same visit. Their value should increase with consecutive successes and reset after a positive test, then return to the higher level after a few negative tests so the client is not discouraged for long. The behavior should be checked often enough that the client experiences the link between not using and being rewarded.

Applying those principles, Dani's plan runs for twelve weeks. Dani will give a urine sample twice a week, on Mondays and Thursdays, scheduled around her client visits. A clean sample earns slips from a fishbowl at the front desk; the first earns one slip, the next two and so on, with a cap. Most slips are small notes of praise, many are worth a $5 gift card for the gas station or grocery store, a few are worth $20 and one is worth $100. A positive or missed sample resets the number of draws to one, and three negative samples in a row restore the previous level. The clinic's grant funds the prizes.

Dani chose gas cards as a main prize, since driving between clients costs a great deal and Dani has been short on gas money because of the drug.

Other Parts of the Plan

Contingency management will be paired with weekly individual counseling using cognitive behavioral strategies to identify triggers, especially long shifts and exhaustion, and to plan responses. Dani's employer will be asked, with written consent, whether Dani can be moved off double shifts for three months; the first trigger for use was a work schedule. Dani's mother will join a session on how to support recovery without being responsible for monitoring it. A psychiatric evaluation will address the paranoid episodes and sleep.

After the Rewards End

Because Brown and DeFulio found effects often fade when rewards stop, the plan tapers rather than ending suddenly. In weeks thirteen to sixteen, testing drops to once a week with smaller rewards. Dani will be connected to a peer recovery group that meets after evening shifts, and counseling will continue weekly for at least six months.

Safety and Child Welfare Questions

Two safety questions arose during assessment. Dani drives between clients' homes, often early in the morning after little sleep, so the plan asks Dani not to drive within several hours of using and to tell me if that rule is broken; the risk to Dani and to others on rural roads is real. The second question was Dani's son. Dani uses at home in the evenings while the boy is in the house. I explained my duties as a mandated reporter at intake and assessed whether the child was being neglected or exposed to danger. Dani's mother provides most daily care, the boy attends school regularly and Dani agreed to use nowhere in the house and to keep no drug or pipe there. I documented the assessment and will review it each week, and I discussed it with my supervisor. A report would follow if the situation changed.

Goals

Within four weeks, at least six of eight samples are negative. Within twelve weeks, Dani reaches four consecutive weeks of negative samples, sleeps at least six hours on most nights and has no missed client visits. Within six months, Dani's weekend time with her son is restored, a goal Dani named first.

Conclusion

Dani meets ten DSM-5-TR criteria for a severe stimulant use disorder involving methamphetamine. With no approved medication, contingency management offers the strongest evidence, and Brown and DeFulio's review supports it while warning that effects can fade. Petry's design principles, applied through twice-weekly testing, escalating prize draws and gas cards that address a real need, give Dani an immediate reward for not using, and the tapered aftercare plan aims to keep those gains once the prizes end.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Brown, H. D., & DeFulio, A. (2020). Contingency management for the treatment of methamphetamine use disorder: A systematic review. Drug and Alcohol Dependence, 216, Article 108307. https://doi.org/10.1016/j.drugalcdep.2020.108307

Petry, N. M. (2000). A comprehensive guide to the application of contingency management procedures in clinical settings. Drug and Alcohol Dependence, 58(1-2), 9-25. https://doi.org/10.1016/S0376-8716(99)00071-X