Joshua is a 25-year-old methamphetamine addict. He has been in recovery from meth-amphetamine addiction for 1 month. He is a part of your outpatient chemical dependency treatment program. You are concerned, as his counselor, about his use of pain medication (opiates) for lower back pain connected with an on-the-job construction accident he had 2 years ago. He reports that his use of metha mpheta mines came after his accident, because he had friends who manufactured the drug and suggested he try it to forget about his pain. Because he has been sober for the past month, you are concerned about his opiate use as a part of his pain management regimen. He told you in today’s session that his doctor recently (in the past few weeks) began prescribing Oxycontin for him because of his self-reports of increased pain. You know his doctor and his reputation to overprescribe pain management drugs; you have heard these reports from other addiction counselors as well as clients in treatment.

1. What is the first course of action you will take in this situation and why?

2. Would you approach Joshua’s doctor about his behavior? If so, how would you approach him? How does confidentiality constrain your behavior?

3. How would you confront Joshua about his behavior in the situation?

4. What treatment approaches would you use in your work with Joshua?

5. What are some exercises you might use in your work with him to help him clarify his awareness of how he handles pain?

6. What might be some pain management approaches you would suggest for him?

7. Do you need to make a referral for pain management for him and if so, who would you make the referral to based on information you receive from him on treatment he had after the accident (type of treatment, length, effectiveness, etc.)?