CCE-CE-101

CASE INFORMATION

Case ID: CCE-2025-09
Case Name: Daniel Roberts
Age: 28
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: P18 (Drug abuse)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Establishes rapport and engages with the patient empathetically.
1.2 Uses non-judgemental language to explore drug use and concerns.
1.4 Elicits the patient’s ideas, concerns, and expectations regarding substance use.
2. Clinical Information Gathering and Interpretation2.1 Takes a structured drug use history, including type, frequency, and consequences.
2.2 Assesses physical, psychological, and social impact of drug use.
2.3 Screens for co-existing mental health conditions (e.g., depression, anxiety).
3. Diagnosis, Decision-Making and Reasoning3.1 Recognises patterns of substance use disorder.
3.3 Determines the need for harm minimisation strategies or referral.
4. Clinical Management and Therapeutic Reasoning4.1 Develops a patient-centred management plan, including brief intervention.
4.3 Provides harm minimisation advice (safe use, overdose prevention).
4.5 Refers appropriately to drug and alcohol services, mental health support.
5. Preventive and Population Health5.2 Discusses preventive strategies for substance-related harm.
6. Professionalism6.1 Ensures empathetic, non-judgemental, and confidential communication.
7. General Practice Systems and Regulatory Requirements7.2 Follows legal and ethical obligations regarding drug use and reporting.
9. Managing Uncertainty9.1 Recognises when watchful waiting vs. active intervention is required.
10. Identifying and Managing the Patient with Significant Illness10.1 Identifies complications of drug use, including overdose risk, dependence, and mental health issues.

CASE FEATURES

  • Young male presenting with increasing drug use and personal concerns.
  • Exploring social, psychological, and medical impacts of substance use.
  • Balancing a non-judgemental approach with appropriate intervention.
  • Providing harm minimisation strategies and referral pathways.
  • Addressing co-existing mental health concerns.

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face-to-face.

You are not required to perform an examination.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history.
  2. Outline the differential diagnosis and key investigations required.
  3. Address the patient’s concerns.
  4. Develop a safe and patient-centred management plan.

SCENARIO

Daniel Roberts, a 28-year-old warehouse worker, presents to your clinic at the request of his partner, who is concerned about his increasing drug use. He admits to using cocaine and MDMA most weekends, initially recreationally but now more frequently. He also smokes cannabis daily to help him ‘relax and sleep’.

PATIENT RECORD SUMMARY

Patient Details

Name: Daniel Roberts
Age: 28
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • Nil known

Medications

  • Nil regular medications

Past History

  • No previous mental health diagnoses
  • Occasional recreational drug use in the past, but more frequent in the last year

Family History

  • Father had alcohol dependence
  • No known psychiatric conditions in the family

Smoking and Alcohol

  • Smokes cannabis daily
  • Drinks alcohol socially (2–3 drinks per weekend)

Social History

  • Lives with partner, who is concerned about his drug use.

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

ROLE-PLAYER SCRIPT

Opening Line

“My partner thinks I have a problem with drugs, but I don’t think it’s that bad. I just want to know if I need to worry.”

General Information

You are Daniel Roberts, a 28-year-old warehouse worker. You’ve been using drugs more frequently over the past year, and your partner is getting worried. You don’t see yourself as an addict, but you know your drug use has increased and is starting to cause some issues.

You have been using cocaine and MDMA most weekends. Initially, this was just for fun with friends at parties or music festivals, but now you find yourself using every weekend and even on some weeknights when you’re feeling stressed. You also smoke cannabis daily, mostly at night to help you relax and sleep.

Specific Information

(Revealed When Asked)

Background Information

Your partner says you’ve changed, that you’re more irritable, and that your drug use is affecting your work and relationship. You’ve noticed that you’re feeling more anxious lately and have missed work twice in the past month because of being tired and sluggish after a big weekend. Financially, you’re struggling a bit because you’re spending more money on drugs than you used to.

You decided to come in because you want to know where you stand. You don’t think you need rehab or anything serious, but you do wonder if you should cut down. You just don’t know how.

Drug Use Patterns:

  • Cocaine and MDMA:
    • Used most weekends, sometimes mid-week if feeling stressed.
    • 1–2 grams of cocaine per weekend, sometimes MDMA pills.
    • Usually snorted, never injected.
  • Cannabis:
    • Daily use, usually at night to relax and sleep.
    • Smokes a joint or a bong before bed.
  • Alcohol:
    • Social drinking (2–3 drinks per weekend), but doesn’t drink excessively.
  • Other substances:
    • No heroin, methamphetamine, or prescription drug misuse.
    • No history of IV drug use.

Psychological and Social Impact:

  • Feeling more anxious and sometimes low mood during the week.
  • No suicidal thoughts, but you feel unmotivated at work.
  • Missing work occasionally due to feeling exhausted after heavy drug use.
  • Arguments with your partner about drug use.
  • Financial strain—spending $400–600 per month on drugs.
  • No legal issues yet, but worried about the risk if caught.

Emotional Cues and Body Language

  • Defensive at first, doesn’t think he’s an addict.
  • Anxious about being judged, hesitant to be fully honest.
  • Relieved if the doctor is non-judgemental and offers practical solutions.
  • Frustrated if told to quit everything immediately—wants a realistic approach.

Patient Concerns and Questions

1. “Do you think I have a drug problem?”

  • You don’t see yourself as addicted, but you are starting to wonder.
  • You want an honest but non-judgemental answer.

2. “Can I keep using but just cut down?”

  • You don’t want to stop completely, at least not yet.
  • You prefer harm reduction over quitting everything.

3. “What can I do to stay in control of this?”

  • You want practical strategies, not just “stop using” advice.

4. “Could this be making me anxious?”

  • You’ve never thought about the link between drugs and mental health before.

5. “Are there services for this?”

  • You’re open to support options, but you don’t feel ready for rehab.

Possible Reactions Based on the Doctor’s Approach

If the doctor reassures you without judgment and offers a plan:

  • You feel relieved and open to discussion.
  • You’re willing to consider cutting down or making changes.
  • You might say, “Okay, I can try to slow down a bit and see if it helps.”

If the doctor is too forceful about quitting everything immediately:

  • You feel resistant and defensive.
  • You might say, “I’m not ready to stop completely—I just want to make sure I’m not overdoing it.”

If the doctor only focuses on drug use and ignores mental health or stress:

  • You feel like they aren’t listening to the bigger picture.
  • You might say, “I feel like you’re just focusing on the drugs, but I think my stress is a big part of it.”

If the doctor suggests practical harm reduction strategies and mental health support:

  • You engage in the conversation and ask more questions about how to manage your use.
  • You might say, “So what are some ways I can cut down without going cold turkey?”

Your Expectations from This Consultation

  • You want an honest, non-judgemental conversation about your drug use.
  • You are not ready to quit completely, but you want to know if you should cut down.
  • You expect advice on harm minimisation, not just being told to stop.
  • You want to understand the link between drugs and anxiety.
  • You need to feel heard, not just labelled as a drug addict.

End of Consultation Cues

  • If the doctor listens and provides a realistic plan, you leave feeling motivated to make small changes.
  • If the doctor dismisses your concerns or lectures you, you feel resistant and avoid follow-up.
  • If the doctor explains harm reduction well, you feel open to trying new approaches.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including drug use patterns, social impact, and patient concerns.

The competent candidate should:

  • Elicit a detailed drug use history, including:
    • Types of substances used (cocaine, MDMA, cannabis).
    • Frequency, amount, and duration of use.
    • Route of administration (oral, inhaled, injected).
    • Any attempts to reduce use or periods of abstinence.
  • Assess associated risks and impact, including:
    • Social impact: conflicts with partner, work absenteeism.
    • Psychological impact: symptoms of anxiety, low mood, motivation issues.
    • Financial impact: money spent on substances, any financial stress.
    • Legal risks: previous encounters with law enforcement, concerns about possession charges.
  • Explore patient concerns and expectations, including:
    • “What do you think about your drug use?”
    • “Are you looking for ways to cut down or just for advice?”
    • “Has your drug use affected your relationships or work?”

Task 2: Assess the patient’s risk factors, including dependence, mental health impact, and legal/social consequences.

The competent candidate should:

  • Screen for substance dependence using DSM-5 criteria, considering:
    • Loss of control: using more than intended, unable to cut down.
    • Neglect of responsibilities: missing work, relationship strain.
    • Tolerance and withdrawal: needing more to achieve the same effect.
  • Assess mental health comorbidities, including:
    • Anxiety and depression, particularly related to drug use.
    • Sleep disturbances associated with cannabis and stimulant use.
    • Suicidal ideation or self-harm risk.
  • Evaluate social and legal risks, such as:
    • Relationship conflict due to drug use.
    • Legal concerns if caught in possession of drugs.

Task 3: Explain the likely risks and consequences of continued drug use, providing a non-judgemental and patient-centred discussion.

The competent candidate should:

  • Acknowledge the patient’s perception of their drug use:
    • “I understand that you don’t see this as a serious problem yet, but it’s good that you’re thinking about how it’s affecting you.”
  • Explain the potential risks of ongoing substance use:
    • Short-term effects: mood swings, poor sleep, work absenteeism, financial stress.
    • Long-term effects: risk of dependence, worsening mental health, impact on relationships.
    • Legal implications: risk of arrest for possession or impaired functioning at work.
  • Provide a non-judgemental discussion about harm minimisation:
    • “If you’re continuing to use, we can discuss ways to reduce harm, like avoiding mixing substances or ensuring a safe environment.”
  • Reassure the patient that support is available:
    • “You don’t have to make big changes all at once. We can start with small steps and go from there.”

Task 4: Develop a management plan, including harm minimisation, mental health support, and referral options.

The competent candidate should:

  • Short-term management:
    • Brief intervention using motivational interviewing techniques.
    • Assess readiness to change (using the Stages of Change model).
    • Provide harm minimisation advice (e.g., using less frequently, avoiding high-risk situations).
  • Long-term support options:
    • Offer referral to a drug and alcohol service for counselling or detox support.
    • Consider mental health support, such as a Mental Health Care Plan for anxiety.
    • Discuss workplace adjustments if needed.
  • Safety-netting and follow-up:
    • “Let’s review in a few weeks and see how you’re feeling about this.”
    • “If things get worse, or you feel like you’re losing control, we can explore other options.”

SUMMARY OF A COMPETENT ANSWER

  • Takes a structured drug use history, assessing frequency, impact, and concerns.
  • Evaluates dependence and mental health comorbidities, including anxiety and workplace issues.
  • Provides a non-judgemental discussion on risks, including legal and financial consequences.
  • Develops a patient-centred management plan, including harm minimisation and mental health support.
  • Offers referral to drug and alcohol services, balancing practical support with realistic goals.

PITFALLS

  • Being judgmental, leading to patient resistance and disengagement.
  • Failing to assess dependence criteria, missing a diagnosis of substance use disorder.
  • Overlooking mental health symptoms, particularly anxiety and depression.
  • Not discussing harm minimisation strategies, focusing only on abstinence.
  • Ignoring the legal and social consequences, missing an opportunity for early intervention.

REFERENCES

MARKING

Each competency area is assessed on the following scale from 0 to 3:

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

Competency Areas Assessed

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Takes a comprehensive history of substance use, impact, and risks.
2.2 Identifies risk factors for dependence and mental health comorbidities.
2.3 Determines when intervention or referral is necessary.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises patterns of substance use disorder.
3.3 Determines the need for harm minimisation strategies or referral.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a patient-centred management plan, including brief intervention.
4.3 Provides harm minimisation advice.
4.5 Refers appropriately to drug and alcohol services, mental health support.

5. Preventive and Population Health

5.2 Discusses preventive strategies for substance-related harm.

7. General Practice Systems and Regulatory Requirements

7.2 Follows legal and ethical obligations regarding drug use and reporting.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD