You are a clinician in an OASAS Licensed Program. Richard Ortega (Ricky) has seen you for 5 individual sessions of treatment for his opioid use disorder (in early remission). He is a very charming , persuasive and likable 32 year old Puerto Rican American male. He is married with 3 pre-school children and has a good union job providing heating ventilation and air conditioning (HVAC) services to the Marriott hotel chain in the NYC Burroughs. Despite wearing steel toe boots, he managed to break 3 toes on his left foot last year and was out of work for 4 months – debt has piled up. He was over prescribed an opioid medication and became dependent. He began buying pills from a coworker before he went back to work, so that he could go back to work (every step still hurts) and start getting full paychecks to support his family again (worker’s comp was only paying two-thirds of his salary).
How do you respond? What are the options for you both here? Discuss your dialog with him including anticipated reactions from him.
Start your discussion with him right after he tells you all this and asks “So what do you think?” What’s your first response? Where do you go from there? How does this end?