Final Project Case Study: Lisa

1. Final Project Case Study: Lisa Evette Rowley August 21, 2011

2. Case Study: Lisa • Thirty-two years old • Single mother of 8 year old twin boys • Mexican-American • Heterosexual • Referred by attorney

3. 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

4. Implications(Smith & Capps, 2009) Alcohol Poor judgment – multiple DUI, jeopardy of losing children Danger to self & others – violence Methamphetamines “Fight or flight” response Aggression – rage and blackouts Hallucinations – hearing fathers voice

5. Biological Predispositions(Faulkner, 2009; Edwards, Svikis, Pickens, & Dick, 2009; Prescott, Madden, & Stallings, 2006) Genetic predisposition Father - chronic heroin user Children at risk Risk factors High tolerance Stressful life situations

6. 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 = survival Sense of belonging Identity Power

7. 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

8. 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

9. 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

10. Ethical & Legal ACA Code of Ethics (2005) Avoid bias & stereotypes Support client independence & freedom of choice Confidentiality Harm self & others Child abuse & neglect

11. Case Study: Lisa Challenging & complex Genetics Trauma Domestic violence Poverty Gangs Surviving through fighting Protective factors Family Resilience & determination

12. References American 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.2010.02.001 Chamberlain, 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