Mary is a 28-year-old American woman, who has been referred to our agency by her parents and boyfriend. She has had problems within the family setting, and there is a need to undergo therapy as a recommendation from a rehabilitation center where she has been for a month as a result of drug addiction. Mary is the mother of two children who is supported by her boyfriend and parents. Both children are going to school and all school business is taken care of by her boyfriend.
I. SUBSTANCE ABUSE HISTORY
According to Mary, she has a soft spot for alcohol and heroin. She uses heroin through injections. She first engaged in drugs at the age of 14, whereby she started with occasional drinking at weekend parties and later began using injection during her free time. Since then, the only time that has passed without using the drugs is when she has no money or when her parents are at home monitoring her. Her budget for the use of drugs is around $15, which is an amount that varies according to her daily activities or the availability of money. The longest she has spent without drugs was one month when she has been held in the rehabilitation center after attacking her fellow workmates with a gin bottle. This incident was related to hallucinations that she occasionally experiences because of the drugs. Mary has admitted that she has access to heroin, and she uses it “from provisions” which comes from her friends. According to Mary, the effects of heroin exceed her longing for alcohol, which has presented a problematic situation. This was because she had been barred from accessing heroin after her stint at the rehabilitation center. She states that she has had to commit petty crimes such as stealing from her parents to finance her lifestyle. She has also been noticed picking up her classmates’ belongings to exchange with drugs. The use of drugs made her drop out of school countless times.
II. PSYCHOLOGICAL FUNCTIONING
Mary is in an emotional rollercoaster. She is caught between situations whereby she knows that her plans have to change. Another situation that puts her in a dilemma is the fact that she cannot accept the limitations that come with the decision to quit drugs. She wants everything to remain the way it is, but this would make it impossible for her to go back to the normal family life. She resents the monitoring from her parents and boyfriend since she feels that they treat her like a baby. She is frustrated and at some points, she gets problems with memory being unable to properly express herself and concentrate. She is sometimes agitated and restless as a result of her frustrations. Additionally, she exhibits signs of anxiety and anger, whereby she is agitated due to simple things that can be avoided.
At the time of intake, Mary was working part-time in the financial office. She has a peer counseling certification that she has obtained while in rehab. Additionally, Mary holds a certificate in accounting that has allowed her to get a job in the financial firm. She has been awarded several certificates, including the best worker of the month in the company, though she has had to struggle and face challenges to reach such recognition. From the rehabilitation center where she had been taken because of her violent nature at work, she was described as a hardworking woman and the one who could change. Her part-time job brings in about $70 per week, which supplements the income from her boyfriend’s mechanical job. Since she dropped out of school, she had various full-time jobs that she lost due to her problems with alcohol and heroin. The earnings from her job are used to cater for her 2 children who have been living with her parents since her problems as a result of arguments and fights with John, her boyfriend.
Mary does not provide support to her children since she has purchased her stock of alcohol and heroin that she usually hides in a location not disclosed to her boyfriend. Thus, she can now afford to finance her way through the process of obtaining drugs.
IV. LEGAL HISTORY
Since she has started to use heroin and alcohol, Mary has been engaging in petty criminal activities that have brought her into the negative contact with the law. It started when she was 14 years old, whereby she used to steal her classmates’ gadgets and offer them for sale. Situations, where she was caught at her local police station for a night before she was bailed out by her parents, became regular. However, her theft cases have not been taken to court. Thus, no prison sentence has been made against her. She has also been arrested twice for trafficking small portions of marijuana to her house, whereby she has acquitted after pointing out the peddler who has sold it to her. She has also been arrested for allegedly planting drugs of unknown value in one of her workmate’s bags to extort money from her to buy silence. The case was canceled once she agreed to undergo a court-supervised withdrawal from heroin and alcohol addiction.
Mary has been sentenced to a month in a rehabilitation center for allegedly attacking her workmates with a gin bottle to drug-related effects. She was released from rehab with the agreement that she would report to the local probation officer twice a month for her progress of recovery to be monitored.
V. SOCIAL HISTORY
According to the gathered information, Mary is the last born child in a family of three, where her two elder siblings are boys. Mary was born in Chicago and had lived there all her life, except for one year that she spent in Maryland with her boyfriend. Mary has two children, a boy and a girl aged seven and nine, respectively. She has the feeling that she is doing her boyfriend a favor by living with him and bearing him children, as she feels that she is “one of a kind”. Mary’s family is extended, and there are close ties within this family since they keep in touch through annual gatherings. On her father’s side of the family, various relatives have been struggling with the use of drugs for some time. Two of her uncles have died due to alcohol-related complications, while one of her aunts has been disabled as a result of an accident caused by drunk driving.
One of Mary’s aunts is currently incarcerated for forgery that she has undertaken to finance her heroin addiction. Mary is very close to her son, while the daughter is close to her boyfriend. There is no history of sexual abuse in the family, but there has been violence caused by drunken disagreements.
VI. PHYSICAL HISTORY
Mary has been attending the clinic to get sleeping pills. She has been unable to sleep without the use of these pills since the start of her recovery process. She had instances of hallucinations when she was 20 years old, and, as a result, she was admitted to a mental hospital for five weeks. She also struggles with weight issues, whereby she has been put on medication due to anorexia. She has lost her appetite due to the excessive use of alcohol and heroin since her schooldays.
VII. TREATMENT HISTORY
Mary sought help from a mental health facility due to hallucinations that were accompanied by anxiety and stress. She could not remember the drug that was prescribed to her. She also had instances of memory loss, uncontrolled anger and anxiety, though she had no suicidal tendencies. She has also received treatment from heroin addiction when she was 20 years old but has no other history of seeking medication.
Mary was comfortable and controlled during her first interview. She seemed a little depressed and anxious. She faltered along the way in the interview, because there were some details about her addiction history that she could not remember. However, her memory and understanding of all the questions that were asked were average. She was dressed in a long flowing dress and low-heeled shoes that were tidy and well-kept. Mary exhibited signs of insomnia.
During the first three sessions, Mary underwent an orientation meeting, followed by the assessment, treatment plan development session, and a therapy session. In between the sessions, she had to report to the rehabilitation center. Mary was subjected to an NCAD test and drug abuse screening test (DAST). On both tests, Mary scored 0.49 and 0.44 respectively, which pointed out the need for her to receive outpatient care. According to the scores, it was evident that Mary had problems with substance abuse, criminal behavior as well as low self-esteem. Mary agreed to undergo the entire treatment process as she was worried about what would happen to her due to the results of the tests.
Mary’s boyfriend has been doing all the necessary duties to facilitate her treatment, including taking her to the hospital. She does not have a national identity card, neither does she have a driver’s license, as she has lost them during her blackouts out after using drugs. When she is free at home, she visits her friends and relatives who in one way or another possess alcohol or heroin. She is not sociable, as her friends are the only people she spends time with outside the family. Sometimes she feels rejected and lonely, and after talks with her parents and boyfriend, she feels unwanted. She is a Christian, though the last time she attended church was nine years ago.
IX. TREATMENT PLAN
In the session that included treatment plan development, Mary was at the center of the activity. She was aware of all her problems, including the addiction to alcohol and heroin, as well as peer pressure and frustration. Thus, the following are the goals and objectives related to her case:
1. Quit alcohol and heroin use
a. Note the conditions that led to the use of drugs;
b. Identify 5 alternatives to alcohol and heroin;
c. Identify five ways in which her drug addiction negatively impacts her family.
2. Stay away from the wrong side of the law
a) List down five major crimes that can bring her into contact with the law;
b) Identify the negative effects of criminal behavior and the effects they have on her drug abuse;
c) List down all negative consequences of crime on her life and those on her family.
3. Formulate strategies to handle trauma and withdrawal
a) Learn and practice various methods of preventing symptoms of stress, anxiety, and anger;
b) List six ways in which stress, anxiety, and anger affect her life;
c) Learn ways to engage others when powerlessness exhausts her.
X. COURSE OF TREATMENT
During the initial treatment process, Mary will collaborate with therapists to ensure that her problems are solved. It will be done using cognitive behavior therapy (CBT), as this is the most relevant modality to be used in such a case of addiction. There is a need to prevent relapse in the process of treatment because the technique is based on the theory that learning processes are key for the development of maladaptive behavioral patterns (Carrol & Onken, 2005). The therapists also identified that counseling, as well as clinical interpretation and assessment, were important in this case.
In an attempt to reduce the feelings of loneliness, therapists came up with the modality of support group meetings to instill a sense of belonging into Mary. Additionally, Mary was supposed to identify and correct all the problematic behaviors she had, including anger, feelings of being unwanted, and anxiety. It was done through the application of different skills that would be used to stop yearning for drugs and eliminate the issue of powerlessness (Carrol & Onken, 2005).
According to the values of CBT, there was a need to look forward and predict the problems that Mary would face in the process of the treatment to ensure that there was an enhanced plan to raise the level of her self-control (Carrol & Onken, 2005). Some of the techniques to be used include:
a) The exploration of positive and negative effects of continued abuse of drugs;
b) Identifying self-monitoring strategies to recognize cravings;
c) Identification of risky situations that might lure her back to drugs;
d) Developing strategies for coping with cravings;
e) Avoiding circumstances that can lead to cravings;
f) Identifying ways in which loneliness makes her crave for drugs and increased intake;
g) Identify other related issues that expose her to the risk of drugs.
Mary started engaging in treatment after three months whereby she seemed in the proper mentality to undergo the process. All the necessary coping strategies and skills that she needed started to become visible.
XI. DISCHARGE SUMMARY
Mary went through the treatment process for one year and three months. It was followed by the strategies to keep her away from drugs, as self-control is one value that she has gained from the treatment. She has been enrolled in the probation center where she has to report once a week for six months. There will be a couple of screenings and DAST tests as part of the program requirements. Regarding the issues of anxiety, stress, and hallucinations, she has to be in therapeutic counseling. She will also need help in solving her anger problems.