Case Scenario
Brandon Novak is a forty-four-year-old Caucasian male who identifies himself as a person in long-term sobriety. He presented with the problem of substance abuse disorder that he had experienced for more than twenty years. The circumstances of his referral entailed his dire condition due to the consistent use of opioids, sedatives, stimulants, cannabis, and alcohol.
Substance Use and Treatment History
Brandon has had a twenty-year-long addiction to heroin. He says that even though he was a millionaire at the age of twenty-three, the substance use disorder took a toll on his social life and relationships, and all worldly possessions were lost. For more than twenty years, he was an IV heroin user; he drank alcohol, took Xanax, smoked marijuana, and sniffed cocaine. He says that he tried everything to get high without consequences and acknowledges that he could still have a good time while using heroin.
He has undergone thirteen inpatient center programs throughout his recovery and lost count of the number of detoxes and outpatient treatments. He mentions that he tried to get rid of the drug use by flying to Helsinki to get away from the temptation. The main mistake that he made was trying to separate alcohol use from drug use. While he thought that drinking wine, for example, did not trigger the desire to take heroin, in reality, the two substances went hand-in-hand.
Social and Family History
Brandon was born and raised in Baltimore, coming from quite an interesting family. His mother is the most important person in his life, according to Brandon. Brandon mentions that his upbringing was solid, and he was raised to do good things in life; however, with substance use, everything his parents taught and expected.
His mother is a nuclear physicist on the board of Mercy Hospital, his brother is an attorney in the White House, and his sister works for his mother at Mercy Hospital. At the same time, his father died from the disease that Brandon himself is suffering (substance abuse is possibly implied). His father had never had a job in his life, and the patient mentioned that everything that his dad taught him was how to behave in prison.
From Brandon’s words, he has had a solid support system, with friends and relatives trying to aid him in alleviating the burden of the addiction. He says that consistently, people have been encouraging him to get rid of drugs and deal with the substance use disorder head-on.
Psychiatric History
There is a distinct pattern in the psychiatric background of Brandon, presenting as a continuous denial of his substance abuse disorder despite the apparent symptoms of the illness. He considered himself a unique individual with life experiences that not everyone could understand. In his own words, Brandon has a “disease that tells me that I don’t have a disease” (ShaneReinert, 2017).
Only later, Brandon acknowledges that such a perspective was wrongful, and his mental stability relied heavily on the denial of the substance abuse disorder. He did not go into treatment for decades because he thought that he could drink successfully, which turned out to be a warped perspective on his life and mental state.
Brandon defines his previous self as an alcoholic who wanted to kill himself on a daily basis, but he never hurt himself in the process. He says that such a state was a “weird purgatory” in which “tomorrow was going to be different,” but he woke up the next day to make the same mistakes he had made the day before.
Medical History
Substance use disorder was Brandon’s primary diagnosis; however, he did not seek treatment for quite a while because he did not consider it a fatal disease. He compares the disease with HIV or cancer, for which people seek immediate treatment and take medication due to the severe risk to their lives. In contrast, substance use disorder is not approached the same way because it presents an urgency to the people experiencing addiction. The impact of substance use is such that it allows a person to think that they do not have a disease.
Legal History
Brandon served a sentence (2010-2011) in prison for forging a prescription for Xanax at Walgreens in Media, Pennsylvania. He served the prison sentence at the Hill Correctional Facility in Thornton, Pennsylvania.
Education/Vocational History
Brandon is a professional skateboarder who appeared in the TV show Viva La Bam, traveled the world with Tony Hawk, and is the author of a New York Times best-selling addiction memoir titled Dreamseller. He mentioned that he had to quit his skateboarding team because of the implications of substance use, despite the fact that he made a decent living from the sport. When serving his prison sentence, Brandon took the Generational Educational Development (GED) test because he said he had time to do so.
Strengths, Needs, Abilities & Preferences
Strengths
Brandon considers his recovery to be his main priority in life. He acknowledges the mistakes he made in the past and knows how he can deceive himself into thinking that he is strong enough to live with alcoholism or substance abuse disorder; therefore, he does not allow himself any temptations.
Needs
When recovery becomes a secondary concern, Brandon mentions that staying sober becomes harder. He says that he “gives his life away” when he is not focused on sobriety and recovery all the time.
Abilities
Brandon can focus on self-development and improvement. He wrote a top-selling book and understood that turning negative experiences into something positive could allow him to achieve success.
Preferences
He prefers living a simple life free from any substance use and focuses on self-reflection. He prefers speaking openly about his past experiences so that others can learn a lesson from his mistakes and not repeat them.
Diagnostic Impressions
- F11.20 Opiate Use Disorder (heroin), severe.
- F13.20 Sedative, Hypnotic, or Anxiolytic Use Disorder (Xanax), severe.
- F13.20 Stimulant Use Disorder – Cocaine, severe.
- F12.20 Cannabis Use Disorder, moderate.
- F10.20 Alcohol Use Disorder, moderate (“DSM-5 substance use diagnosis,” n.d.).
Preliminary Treatment Plan
Considering the history of substance abuse disorder, Brandon was recommended to undergo a detox program, get a counselor, and complete an inpatient treatment program to address his diagnosis. Currently, Brandon is sober and considers sobriety his primary focus for the present and future life because, without it, he would spiral down to past habits that he never wants to re-experience.
He mentioned that getting into a Catholic Charities rehab was his only saving option because he had lost everything at that time, not even having money to buy underwear or sweatpants. The contrast between being a self-made millionaire and having to look through a pile of charity clothing to find a second-hand pair of underwear was quite eye-opening for Brandon. He considered this a sign to do whatever it took to stay sober day after day.
References
DSM-5 substance use diagnosis. (n.d.). Web.
ShaneReinert. (2017). Addiction: Tomorrow is going to be better Brandon Novak’s story [Video]. YouTube. Web.