Case Management


Case Management

Just pop the hood. That is where you'll find case management, a term endemic to every social worker around the globe.

It is the engine of recovery.

Then, close the hood and begin to ask questions.

The Case Manager is the best recovery concierge you'll ever meet.

Once a treatment plan is developed, the CM will identify everything currently missing from a life that is deficient. There will be four corners to address==Bio, Psycho, Social, Spiritual.

BIOLOGICAL: Obviously, the physical body has taken a hit from substance use disorder. During the CM process, the Case Manager will help with constructing a team of physicians, should one be missing, and actual contact with them, should there be a critical disconnect.

Consider this far too common exchange between Case Manager and client in early recovery from substance use disorder:

CM--"So, who is your PCP?"

Client: "Um, I believe her name is Rhonda Smith."

CM: "Sounds like you haven't followed through with her appointments in a while?"

Client: "Well, she would have done a bunch of tests, and I was still taking stuff."

From the above conversation, we can glean the accountability that what most frightens the substance use disorder individual. Case Management at this BIO juncture can restore the physician/patient relationship and expel the toxic secrets.

PSYCHOLOGICAL: Once physical health is reengaged, good case management folds in mental health, with the PCP as the quarterback. He or she will make the proper referral to address anything from untreated depression to anxiety, to trauma, and to any concerns requiring psychotropic medications.

The Case Manager will orchestrate the process for the client in early recovery, and follow it through.

Consider this corrective exchange:

CM: "I see you went to your appointment with the psychiatrist recommended by Dr. Smith."

Client: "It was painful to sign those releases you asked for but once I did it was easier to get honest."

CM: "So, tell me about the visit."

Client: "He has started me on medication for my anxiety that is non-addictive. I already feel better."

SOCIAL: The CM is well aware of the extent of an early recoveree's isolation. Enter the social aspect of Case Management. Think about Widening and Closing here.

Chances are, the client has very few or no sober friends as his disease has progressed. The Alcoholics Anonymous triad of People, Places, and Things will be introduced at this stage, with a heavy recommendation to attend both 12-Step meetings and Smart Recovery meetings, as well.

As for the former, the CM should urge the acquisition of an AA or NA (Narcotics Anonymous) sponsor, a person ideally with five years of recovery who can be an invaluable guide through the 12 Steps and on a daily basis.

The Closing part of the CM equation may include one's social media, mobile phone, and workplace.

SPIRITUAL: Now, the conversation shifts to an exploration of the individual's potential place in this realm. Too often, the substance disorder individual is not even aware that they are bankrupt.

Just as often, he/she may not be the least bit spiritual in any traditional or religious sense. However, good CM can help flush out nascent spirituality, religiosity, or the sense of a higher power that may actually flourish in a person's recovery.

Does spirituality deserve a place at the recovery table? That's a personal decision, for sure. But do consider the words of Doctor Silkworth, who treated many alcoholics in New York City, , including one Bill Wilson, who awoke one morning to "a certain light"

"I'm a man of science," he said to Wilson at his sanatorium bedside. "But whatever it is you have, hold onto it for dear life."

Once those four areas are addressed, case management becomes a short-duration counselling session that can precede longer duration counselling, which this space prefers to call therapy.

While more cognitive-behavioural in nature, it can also be an effective segue into longer-term, longer duration (45 or 50 minutes) therapy. Science, if you will, becomes art, plumbing and wiring become tapestry.

Pop the hood.

Then learn about the driver.

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