Gary’s unresponsiveness towards counseling most probably stems from a cultural perspective. He is an African-American, and according to Ingersol and Rak (2016), it is stated that individuals from this racial background mistrust the mental health treatment systems, which encompass counseling and pharmacotherapy. As a consequence of a history of discrimination and oppression, they tend to approach this subject with a great deal of suspicion. Hence, mental health professionals might end up confusing this with paranoia or resistance (Ingersol & Rak, 2016). Therefore, it is recommended that a therapist takes extreme caution and consider Gary’s African- American culture, healing traditions, and socio-political experiences when recommending him to attend counseling sessions. Preferably, the best way to approach his reluctance to counsel is by conducting a frank discussion of the issues comprising race, culture, and ethnicity to evaluate and work on changing his mindset. It is also essential to highlight that anxiety is best treated by taking psychotropic medication in conjunction with therapy.
Alprazolam, also known by its popular brand name Xanax, is a type of benzodiazepine. It has been long used for the treatment of anxiety. The side effects of alprazolam are dose-related and ensue from its therapeutic effect (Ingersol & Rak, 2016). Overall, these side effects revolve around the cognitive and psychomotor aspects and issues with tolerance and dependence. Cognitive effects consist of slowing the psychomotor functioning, learning impairment, and anterograde amnesia which is defined as the incapacity to create new memories after the amnesia-inducing trauma. Conversely, psychomotor effects comprise the impairment of driving ability, although this is dependent on the dose (Ingersol & Rak, 2016). This must be pointed out to Gary as he already expresses nervousness about driving after the car accident. Lastly, tolerance and dependence might occur; however, they are rare when individuals take alprazolam as prescribed (Ingersol & Rak, 2016). Other side effects include lethargy, sedation, ataxia, slurred speech, depression, suppression, and in some instances, paradoxical agitation or excitation.
The doctor was hesitant to prescribe alprazolam to Gary as he is a moderate user of alcohol (he takes 4 to 6 drinks per week mostly, mostly on the weekends). Taking the drug and alcohol at the same time can result in cross-tolerance. Both agents upsurge the inhibitory activity of the GABA receptors in the central nervous system (Ingersol & Rak, 2016). Therefore, he might not be able to get any response from the drug. Furthermore, cross-tolerance can enhance metabolic tolerance thereby leading to dependence. In general, Gary should not drink alcohol while taking alprazolam.
It is essential to note that alprazolam, a benzodiazepine, can stimulate physical tolerance and physical and psychological dependence. Nonetheless, as previously stated, it is rare for people taking alprazolam to suffer from tolerance and dependence issues unless they are not taking it as prescribed. This is because the drug has a short half-life of about 11 to 18 hours; thus, it relies less on the liver for metabolism (Ingersol & Rak, 2016). The less the metabolism is dependent on the liver, the more minimal the chance that metabolic tolerance is induced. As a result, alprazolam will be quickly oxidized and leave fewer active metabolites in the system. Therefore, if Gary takes alprazolam on an “as needed” basis, it is highly unlikely that metabolic tolerance will ensue, hence addiction.
Reference
Ingersol, R. E., & Rak, C. F. (2016). Psychopharmacology for mental health professionals (2nd ed.). Cengage Publishing. Web.