Addiction Treatment Plan

Tyrell is a 30-year-old African American homosexual male. He graduated from law school two years ago and feels fortunate to have a job as a law clerk in a prestigious law firm in New York. His job demands long hours, so it is not unusual for him to go several days with little sleep. His partner, James, is familiar with pushing the limits to get established in a career, so he suggested that they both take time to get away.

While on vacation, James was hoping to enjoy some downtime. In contrast, Tyrell seemed particularly keyed up the first few days. Rather than relaxing on the beach, Tyrell paced and seemed out of place among the happy vacationers. James made excuses for Tyrell’s agitated behavior, noting that it was difficult for many people to wind down after pushing so hard at work. The fourth night at dinner, Tyrell began berating a waiter who made a mistake in his order. Tyrell became uncharacteristically rude, suggesting that the waiter was not worth his time of day, and abruptly left the restaurant. James paid the bill and returned to the hotel only to find Tyrell out on the balcony of their room screaming, “Do you know who I am?!” at other guests. Becoming truly alarmed, James coaxed Tyrell back into the room and convinced him to take a walk to cool down. While Tyrell was gone, James wondered if his partner was “on something.” He went through Tyrell’s luggage and, upon finding some white powder, called Tyrell’s brother, Michael.

Michael was not shocked by James’s description of Tyrell’s explosive behavior. Michael recalled Tyrell being in trouble in college for similar behavior and that Tyrell had seen some kind of doctor as part of an agreement for him to remain in school. According to Michael, the incident blew over and the family attributed it to the stress of applying to law schools. When Michael went to visit Tyrell afterward, Tyrell seemed pretty down on himself and in a low mood in general.

Taking a risk to share an alternate explanation, James admitted that he had seen Tyrell at a club meeting some friends who were into meth, but he did not think much of it until now. The more Michael and James compared notes, the more concerned they became. James tried to convince himself that Tyrell had surely just got mixed up with the wrong people and got into “a little meth” in his attempt to keep up at work. But Michael was more skeptical and insisted that this sounded too similar to what his parents vaguely called “Tyrell’s episode.”

James and Michael’s debate was interrupted by another phone call. Tyrell was in a local hospital emergency room (ER) being treated for injuries after he took a swing at someone in a nightclub. He missed and hit a wall, injuring his hand. James debated whether he should tell the ER staff about his fears of Tyrell abusing meth or Michael’s description of the story from law school. He did not have to debate long, as the ER physician concluded that a full assessment was warranted based upon Tyrell’s insistence that he was the best lawyer in New York and the ER doctor better not “screw up” the best shot he would ever have to get out of that “crummy little hospital.” The ER physician referred Tyrell to the psychiatric crisis worker on call.

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