Write a case study on Drug Dependence, Psychosocial Assessment, and social Support
PS521-2: Use knowledge of group formation process to evaluate problems common to dependency groups and propose appropriate interventions.
Read Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 41.) 4 Group Development and Phase ‐ Specific Tasks. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64221/
Read Center for Substance Abuse Treatment. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 47.) Chapter 5. Treatment Entry and Engagement. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64084/
Alice is a 23-year-old, Caucasian, singlemother of two daughters who are fathered bythe same man, Lewis. Lewis introduced Alice to alcohol and marijuana while she was in high school. At age 15, Alice discovered she was pregnant and dropped out of school to live with Lewis. She has alternated between staying with him and staying with her mother ever since. Her drinking increased steadily over the years. Shortly after the birth of her second daughter 4 years ago, Alice and Lewis were introduced to crack cocaine. Alice’s use of crack rapidly escalated. She also continued to drink to “come down.” She lost several fast-food jobs because of unexplained absences. Because of her children she was eligible for Temporary Assistance for Needy Families and has depended on this assistance.
To support her drug habit, Alice turned to prostitution, theft, and trading sex for crack. Before admission, she smoked crack almost daily and drank excessively. She also has injected a cocaine/heroin mix twice, at Lewis’s urging. Born in a rural community, Alice moved to a large city with her mother and five older siblings when she was 10, leaving behind an unemployed and abusive father, who was dependent on alcohol and who died of liver cirrhosis 5 years ago. Alice’s relationship with her mother always has been strained, partly because her mother struggled long hours as a cleaning woman to support her children and partly because she had numerous boyfriends whom Alice resented. It seems to the counselor that Alice has spent most of her life searching for approval and love from anyone who pays attention to her. Lewis has been incarcerated for a drug charge for the past year; he will be in prison for at least the next 5 years and will be unable to provide support for his children or for Alice. Alice had moved back with her mother when Lewis began his incarceration, but her mother threw Alice out of her house after Alice stole money from her mother’s purse. Alice has been living with anyone who will take her in for the last 9 months. The immediate events that precipitated Alice’s seeking treatment are a pending criminal charge for shoplifting (she was placed on probation for a previous shoplifting charge) and the recent removal of her children from her custody and their placement in foster care. An anonymous caller to the child welfare agency complained that Alice left her children unattended for long periods and that the older daughter was truant from school most days.
Alice has a history of criminal justice system involvement, mostly for prostitution. Her current probation officer has told her if she does not seek
treatment, she will be violating her probation. Alice has entered treatment twice before but dropped out both times after only a few sessions.
She is now shocked at the loss of her children and terrified that she could do some long jail time. She believes she is ready to change her life and
appears motivated for treatment. Although her mother is angry at Alice and appalled at the placement of her grandchildren into foster care, she has agreed to let Alice move back as long as she gets into and stays in treatment. Her mother stresses, however, that this cannot be a long-term living situation for Alice. The probation officer referred Alice to a local IOT program, where she was evaluated and admitted. Although she has engaged in many risky sexual behaviors and has injected drugs twice, Alice did not report any medical problems…allowing the client to choose continuing care goals and types of engagement can increase satisfaction, compliance, and positive outcomes…
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but has not seen a physician since her younger daughter was born. At that time, she had no prenatal care, was abstinent briefly, and did not reveal her substance abuse during the 1-day hospital stay. Alice has never been tested for HIV or other sexually transmitted diseases (STDs) and does not remember the last time she went to a dentist. She has never had psychiatric evaluation or treatment, although one of her sisters committed
suicide and several brothers also use substances. Alice reported that she has difficulty sleeping, feels “devastated” about the loss of her children, and cries frequently.Alice has never been employed regularly and has no skills, but she was a good student, is articulate, and appears to be bright.
Alice stated that she wants to change her life, primarily to regain custody of her children.She says she is “done with Lewis” because she does not think he will ever change. She realizes that she needs to cease illegal activities; give up drugs; stop getting drunk; find safe, permanent housing; and obtain training and a job. She is optimistic that these goals are achievable, but she has an unrealistic view of the difficulties she faces and the time it will take to reach her goals. She does not appear to have any close friends who do not use drugs.
Alice does not attend church and has no recreational interests. Master problem list Children, ages 8 and 4, removed from custody and placed in foster care Crack cocaine and alcohol dependence Ongoing illegal activities and a pending criminal charge.
No permanent residence No apparent job skills or work history Lack of positive support system Strained relationship with mother and
family members No recent physical or dental examination; at high risk for HIV, STDs, and hepatitis History of dropping out of substance abuse treatment (family history of substance use disorders and suicide) The IOT program assigns case managers and counselors to clients who have numerous problems that require extensive coordination with various community agencies.