John, 23, is checked into the emergency with severe…

John, 23, is checked into the emergency with severe gastro-intestinal pain. This is his sixth visit to the same ER with the same symptoms. He is visibly in discomfort and requires opioid pain medications. John tells you he has been taking opioids for years to deal with the flare-ups, which include vomiting and diarrhea and have led to a 40-pound weight loss and five colonoscopies. This latest flare-up occurred after he ran out of his pain medication and couldn’t get a refill. John gets very angry and defensive when the staff suggests he is addicted to painkillers. He contends that he wouldn’t be on the pain killers if the doctors could figure out what is wrong with him. When he calms down, you are able to learn a little more about his past: He tells you he has battled anxiety and panic attacks since he was a kid and diagnosed with learning disabilities. Currently, he feels the only relief for his emotional and physical pain is pain medication and that “he is trapped in this situation.” Finally, he adds that lately he’s experienced auditory, sensory and visual hallucinations. Schizophrenia runs his family.

Consider these questions and  response:

1. Is John in crisis? How do you initiate a crisis intervention? (10 points)
2. How do you implement a harm reduction approach? (10 points)
3. How do you use a trauma-informed approaches with John? (10 points)
4. How might a person with a history of trauma have behavior that could be interpreted as “noncompliance” or non-adherence? (10 points)
5. Who is vulnerable to trauma? (10 points)