Final Project Case Study: Lisa

Evette RowleyAugust 21, 2011

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Case Study: Lisa

Thirty-two years old Single mother of 8 year old twin boys Mexican-American Heterosexual Referred by attorney

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Substances(Valdez, Mikow, & Cepeda, 2006; SAMHSA Treatment Episode Data Set [TEDS], 2007)

Marijuana (12 years old) Alcohol (12 years old) Cocaine (14 years old) Heroin (16 years old) Current methamphetamine use

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Implications(Smith & Capps, 2009)

AlcoholPoor judgment – multiple DUI,

jeopardy of losing childrenDanger to self & others – violence

Methamphetamines“Fight or flight” responseAggression – rage and blackoutsHallucinations – hearing fathers voice

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Biological Predispositions(Faulkner, 2009; Edwards, Svikis, Pickens, & Dick, 2009; Prescott, Madden, & Stallings, 2006)

Genetic predispositionFather - chronic heroin userChildren at risk

Risk factorsHigh toleranceStressful life situations

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Cultural Considerations(Wadsworth, Raviv, Reinhard, Wolff, Santiago, & Einhorn, 2008; Whiting, Simmons, Havens, Smith & Oka, 2009; Caballero, Ramos, González, & Saltijeral, 2010; Valdez, Mikow, & Cepeda, 2006; Harris, 1994)

Abject poverty Domestic violence

Witness to her mother’s abuse Gang affiliation

Fighting = survivalSense of belongingIdentityPower

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Therapy Model(Shorkey, Windsor, & Spence, 2008; Peregoy, 2009)

Underserved population Language barriers Lack of culturally relevant providers Confianza Limited linkage to community resources Terminate after one contact

Detoxification Inpatient treatment program Disease model & recovery process

Family Treatment Support groups

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Assessment & Diagnosis(Chamberlain & Jew, 2009; Smith & Garcia, 2009)

Chronic phase DSM-IV criteria – substance dependence

Self-admission of dependence Extensive drug history Family/peer influences Related legal problems

Dual diagnosis PTSD related to domestic violence Schizophrenia

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Treatment Plan & Intervention Strategies (Smith & Garcia, 2009)

Substance dependence Concept of addiction Alter lifestyle 60-day inpatient treatment Weekly individual and peer support Daily AA & NA meetings Aggression & violence

Gang affiliation Avoid people & places

Legal problems Probation Regular urine specimens Remain crime-free

Family therapy

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Ethical & Legal

ACA Code of Ethics (2005)Avoid bias & stereotypesSupport client independence &

freedom of choice Confidentiality

Harm self & othersChild abuse & neglect

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Case Study: Lisa

Challenging & complex Genetics Trauma

• Domestic violence• Poverty• Gangs• Surviving through fighting

Protective factors Family Resilience & determination

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ReferencesAmerican Counseling Association (2005). ACA Code of Ethics. Alexandria, VA: Author.Caballero, M., Ramos, L., González, C., & Saltijeral, M. (2010). Family violence and risk of substance use among Mexican

adolescents. Child Abuse & Neglect, 34(8), 576-584. doi:10.1016/j.chiabu.2010.02.001Chamberlain, L.L. & Jew, C.L. (2009). Assessment and diagnosis. In Stevens, P., & Smith, R. L. Substance abuse

counseling: Theory and practice (4th ed.), (p. 116-152). Upper Saddle River, NJ: Pearson Education, Inc.Differences in Substance Abuse Treatment Admissions between Mexican-American Males and Females. (2010). Differences

in Substance Abuse Treatment Admissions between Mexican-American Males and Females, 6.Edwards, A. C., Svikis, D. S., Pickens, R. W., & Dick, D. M. (2009). Genetic Influences on Addiction. Primary Psychiatry,

16(8), 40-46.Faulkner, C.A. (2009). Etiological theories of- substance abuse. In Stevens, P., & Smith, R. L. Substance abuse counseling:

Theory and practice (4th ed.), (p. 86-115). Upper Saddle River, NJ: Pearson Education, Inc.Harris, M. G. (1994). Cholas, Mexican-American girls, and gangs. Sex Roles, 30(3/4), 289-301.Peregoy, J.J. (2009). Working with diverse cultures: Exploring sociocultural influences and realities in ATOD treatment and

prevention. In Stevens, P., & Smith, R. L. Substance abuse counseling: Theory and practice (4th ed.), (p. 332-359). Upper Saddle River, NJ: Pearson Education, Inc.

Prescott, C. A., Madden, P. F., & Stallings, M. C. (2006). Challenges in Genetic Studies of the Etiology of Substance Use and Substance Use Disorders: Introduction to the Special Issue. Behavior Genetics, 36(4), 473-482. doi:10.1007/s10519-006-9072-9

Shorkey, C., Windsor, L., & Spence, R. (2009). Assessing culturally competent chemical dependence treatment services for Mexican Americans. The Journal Of Behavioral Health Services & Research, 36(1), 61-74.

Smith, R.L. & Capps, F. (2009). The major substances of abuse and the body. In Stevens, P., & Smith, R. L. Substance abuse counseling: Theory and practice (4th ed.), (p. 31-85). Upper Saddle River, NJ: Pearson Education, Inc.

Smith, R.L. & Garcia, E.E. (2009). Treatment setting and treatment planning. In Stevens, P., & Smith, R. L. Substance abuse counseling: Theory and practice (4th ed.), (p. 153-188). Upper Saddle River, NJ: Pearson Education, Inc.

Valdez, A., Mikow, J., & Cepeda, A. (2006). The Role of Stress, Family Coping, Ethnic Identity, and Mother-Daughter Relationships on Substance Use Among Gang-Affiliated Hispanic Females. Journal of Social Work Practice in the Addictions, 6(4), 31-54.

Wadsworth, M. E., Raviv, T., Reinhard, C., Wolff, B., Santiago, C., & Einhorn, L. (2008). An Indirect Effects Model of the Association Between Poverty and Child Functioning: The Role of Children's Poverty-Related Stress. Journal of Loss & Trauma, 13(2/3), 156-185. doi:10.1080/15325020701742185

Whiting, J., Simmons, L., Havens, J., Smith, D., & Oka, M. (2009). Intergenerational Transmission of Violence: the Influence of Self-Appraisals, Mental Disorders and Substance Abuse. Journal of Family Violence, 24(8), 639-648. doi:10.1007/s10896-009-9262-3