15.2: Case Study: Josie Bellings, Part 3

What screening should you have done before prescribing any controlled substance? Please include screening and diagnostic tools, lab work, and assessment questions.

Two months ago, you saw Josie, a 34-year-old nurse, to whom you prescribed escitalopram 10 mg daily and alprazolam 0.5 mg, three times a day as needed for anxiety.

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Today, Josie, her mom, and her boyfriend, Robs, present for a follow up visit. Josie reports, “My anxiety isn’t really any better. I haven’t been able to come in to work for the past three days. I ran out of my alprazolam and I cannot even think about going to work without it. Tell her, Robs, what it’s like.”

“Yesterday,” Robs says, “Josie couldn’t get through the day, so um, yeah, she took some of my mom’s alprazolam yesterda–.”

Josie’s mom interrupts to ask, “But why did you even give her that drug? With her history of alcohol addiction! She’s been alcoholic since she was in her early 20s. And did she tell you her dad also had problems with addiction?”

“Addiction?” Robs asks Josie’s mom. “Are you worried about addiction to this drug?”

He turns to you, agitated. “Did you know Josie’s sometimes taking up to seven pills a day? At least that I know of. Is that overusing or addiction?”

Josie starts crying. “But I can’t function without alprazolam. Robs, you know how hard nursing has been ever since orientation ended. I love my job but I just want to feel normal. And the alprazolam makes me feel that way. Please….” she pleads.

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