Jessica is a 34-year-old who became a paraplegic in college after a freak basketball accident. She now works in a government agency as a records clerk. While her job is secure and she earns enough to cover her bills and save some, she has been depressed for the past 10 years. She has been hospitalized on two occasions when she became suicidal, stating that her life was not worth living. She has some family support, but her father is very distant, and her mother busy with a job and children still in high school. After her accident, Jessica began smoking marijuana occasionally. Eventually, the pattern of use was every weekend and day off, and now she smokes some nearly every day. She is able to function in her job, but is listless. She believes that she cannot cope with the pain of life unless she is high most of the time. One day she comes to work smelling of pot. Her boss, who is an understanding woman, speaks with Jessica about the absolute necessity that she never come to work smelling of marijuana again, or her job will be in jeopardy.
Mary: Jessica, you are a valuable and responsible part of our staff here. I have depended on you for many things over the past years, and you have always been reliable. However, today you came in smelling like marijuana, according to several people in the office and—I want to be honest with you—there is an odor of marijuana around you now. I am not here to lecture you or to report you. I want to help you. Can you tell me what is happening?
Jessica: I need this job, Mary. Will you promise me that what I tell you stays between us?
Mary: Jessica, as long as you never come in to the office smelling of pot again, this can stay between us. However, if the problems persist, I will be required to take other action. I could not allow someone to come to work drunk day after day, could I?
Jessica: No, I suppose not. OK, I trust you, and you have always been honest with me. What is bothering me is nothing new, and I am sure will not be a surprise to you. I just do not have much to live for. My life was ruined by the spinal injury. The world for me is reduced to a constant struggle to perform basic things like going to the bathroom, preparing food, getting in and out of cars, asking for help, and never being able to have the life that I dreamed of before. There have been times when I had hope that I could have a more or less normal life, or even have a modicum of happiness. But now, after fifteen years as a paraplegic, I don’t see any hope. It will always be this daily struggle, and what for? I know that I am smoking too much dope, but it does help me to get through the day. For a little while, I actually feel good after getting high, and then afterwards I am just numb and I can get through the day. Is not that better than just being miserable all the time? I promise you that I won’t come in to work ever again smelling like pot.
Mary: Thank you, Jessica, for being so honest with me. I think there is more hope that you are seeing now. Would you be willing to consider counseling for help?
John is a 28-year-old Native American man who has been abusing alcohol since high school. At present, John has a responsible position administering a tribal public assistance program. John is affable, well-liked, and committed to helping his people. At the same time, he is bitterly disappointed that his sports career did not reach a professional level. While he had a lot of promise, his emotional outbursts and pattern of drug abuse started to cause problems in high school. And, while he went to college on a sports scholarship, he argued with coaches and other players, eventually quitting college in his sophomore year. John drinks to numb his anger and pain. Henry is an elder in the tribe who notices John’s distress and goes to talk with him.
Henry: John, you have done really good work helping our people here on the reservation. So many look up to you as a role model, especially the boys. You are kind to them and take time to make them feel important. You are a valuable member of our tribe. But John, I am wondering if there is something bothering you.
John: Henry, thank you for your kind words. I am really OK. I’ve been feeling a bit down about the lack of funds to help all those who need it. The BIA in DC does not release the money that has already been allocated to us. Those guys would rather spend it on fancy offices and parties while our people starve.
Henry: I do not doubt it, and you’ve been effective in working to improve these programs. But John, I am asking about how you feel inside. You seem to be troubled. Is there anything I could help with?
John: I do not know. I suppose it is kind of stupid, but I have been feeling as though my life is already over. I did not achieve the career that I wanted. I am back here on the rez and life will be pretty much the same from here on. Of course I want to help, but I do not see much ahead for myself. I can not even play pickup games of basketball anymore because I am too out of shape and get tired too easily. I am only 28! This should not be happening so soon. As far at the job goes, we will be fighting with the white government for all of our lives, and they will be trying to break all of their treaty obligations just the way they’ve always done. Our children will always be struggling and our elderly without the care they need.
Henry: John, things are not so bad. They are getting better. Our people have much more pride and there are many programs that are helping. John, I want to speak to you bluntly. I am worried about your drinking. It seems to be increasing, and you do not look as healthy as you did a year ago.
John: Henry, I respect you as one of our elders and thank you for your concern. But my drinking is my own business. It helps me to get through the night, to be able to sleep, and to have a little fun. It is not a problem.
Henry: John, your drinking is my business. I do not want to see you suffering. You have got to find a different way to deal with the destruction of our traditional culture. We are working towards rebuilding and teaching our young to feel good about themselves and our traditions. And alcohol plays no part in that. You can be a leader of our people. You have had success with the language program. Do not give up on these things. Believe in yourself and our people.
Levi is a 35-year-old man who is HIV positive. He works as an auto mechanic. Since learning that he was HIV positive 10 years ago, Levi has been on medications that have stopped the progression to AIDS, and Levi is fairly healthy. However, the emotional toll has been much more serious. Levi has withdrawn from most social interactions. He has not told anyone in his family, and has fallen away from most of his friends. He has been able to obtain a variety of medications for anxiety, and often takes more than the prescribed dosage. In addition, he has had a cocaine habit that he views as his one area of excitement in life. His pattern of use is on weekends, or sometimes as a pick-me-up to get to work. He tends to use the anti-anxiety medications in the evening to help him relax and sleep. He sees his life slipping away in what has come to feel like an increasingly empty lifestyle. He calls a counselor to talk about his problems.
Dan, thanks for fitting me into your schedule. I have been feeling more down for the past few months, and do not really know how to deal with it. As for as being HIV positive, my physical health is alright, but my mental health is not so good. I spend most of my time by myself, except for work, and at work I am essentially a cog in a machine. I actually enjoy work because I almost lose a sense of time when I just concentrate on fixing an engine. But when I leave work, life comes crashing in on me. I do not have anyone special in my life. As you know, I made a decision to be celibate after finding out I was HIV positive. But I still have desire, not only for sex but, more importantly, for love. I have tried all kinds of hobbies: hiking, biking, camping, running, fishing, music, and even building models. But in some ways all those things just feel like marking time while my life goes by. I thought I was over it, but for the past few months the thoughts have been keeping me awake again, hours of regretting that I am positive, wishing that it somehow magically had not happened, that I could have a normal life. Then it all comes crashing back in on me. I can not have a normal life. Having sex with someone is a potential death sentence for them. I could not live with that, nor could I even enjoy the sex.
I’ve been to see you off and on for the past 10 years, but I need to tell you that I have not been honest with you about my drug use. I use tranquilizers to get through the weekdays, and then cocaine for a little excitement on the weekends. It is almost like I have a relationship with the drugs. But it is not working for me anymore. The cocaine just does not feel as good as it used to, and I been feeling more anxious and jittery. There have a few times recently that I was confused, even thinking that people were outside the door who were going to hurt me when there was no one there. Once I thought I heard them talking. That just about shot my heart through the roof! I have felt weak at times and I have been losing weight. I think that I might need some serious help.
Roberta is a 16-year-old African American, a high school sophomore whose grades have recently been dropping after having been a high achiever in elementary, junior high, and in her freshmen year. An excellent athlete, Roberta abruptly quit the swimming team last week. Her parents, teachers, and school counselor are all at a loss to explain the changes. Roberta had a serious injury to her leg this past October, and was treated with muscle relaxants and pain medications. After a lot of inquiry from the adults in her life, Roberta reports that she has continued to use pain medications because they help her to feel better, and that she is obtaining these through friends, spending nearly all of the money she makes from her part-time job.
I just hate not being able to be involved in sports. It was my life. I want to swim, but it hurts my leg too much. If I could get more medications to help, I could be able to be on the team, but the doctors make excuses for not renewing my perscriptions. Those old fossils are upset because I have been getting meds from my friends. Well, what am I supposed to do? Hello! If the docs would give me the drugs I need to function, then I would not have to go to my friends. You are a school counselor. Are not you supposed to advocate for us? Can you help me to get these prescriptions? If I could get through this pain, then I would be able to swim again. I am sure that after a month or so I would be back in good shape. The swimming season might be over, but soccer will be starting soon, and I would be ready for that. But without the medication, I just can not do the conditioning exercise that I need. Do not you see how stupid it is that they will not give me the meds? I know that you can help me. You understand kids better than the doctors or my parents. Will not you explain to them that they are holding me back? I mean, I have got a good job, I am dependable. Yeah, my grades have dropped some, but that is because I am in such pain all the time. If they all want me to get my grades back up, then give me the damn meds so that I will be able to concentrate.
Steve is a freshman in college in a regional metropolitan center. Steve is increasingly isolated in his dorm room and has been missing a lot of classes. He grew up in a more rural setting, and the urban center is somewhat intimidating to him. He is having difficulty making friends. He has not yet chosen a major, but is very interested in music and political science. He has begun more experimentation with drugs and alcohol. While he feels happier when he is high, his drug use has not yet had any real negative consequences for him. Andy, the dorm student counselor, notices Steve’s distress and goes to talk with him about his life.
Andy: Hey Steve, what is going on man? You are kind of isolating yourself in your dorm room here. How are you feeling?
Steve: Oh, I have just been more tired lately. It is no big deal—I am fine.
Andy: Steve, as an RA to look out for everyone here, and I am worried about you. You have been getting pretty drunk and high a lot, and you seem to be kind of sad. Could we just talk about it some?
Steve: Well, you are right. I have been using a lot more than in the past. Getting drunk or high is not good for me, I know, but it helps to calm me down. I do not seem to fit in with any group here. Back home I had friends and was busy all the time. Here I just do not get it. I am nervous and others students do not seem comfortable with me. When I try to talk to people, I do not know what to say, and I feel sort of stupid.
Andy: Yeah, in a new climate everything kind of changes and you have to get acclimated. But there are a lot of groups that would welcome you here, Steve.
Steve: Maybe you could give me some help with that. Another thing is that three weeks ago my parents told me that they are getting a divorce. It is really bothering me. They have been fighting for years, and maybe it is for the best, but I have a younger sister and brother at home who are all broken up over it and I am not there to help them. Dad has been leaving the house a lot and is back to drinking. Mom is just depressed. It is really hell for the younger kids. I do not know if I should even be here. Maybe it would be better for me to leave school for a while. What do you think?
Tommy, a 22-year-old, has just returned from a tour of duty in Iraq. During his time there, he was nearly killed by a IED that destroyed his vehicle and killed two others. Tommy was in the hospital for a concussion after the accident, and was never able to return to his unit. He is married and has a two-year-old daughter. Since returning, Tommy has been going to bars during the day and often drinking until passing out at home during the evenings. His wife, Angie, is extremely alarmed, not only for Tommy but for herself and their child, as Tommy gets very angry at times. While Tommy refuses help, Angie has contacted a veteran’s organization about the situation.
I am only here because my wife and family think I should try this. They are overreacting. I am just going through an adjustment period and I will be fine. It is normal, do not you think? I was over in that hell hole for a year, saw my buddies killed and maimed, come back home where my wife and family treat me like some sort of crazy person, and on top of that, no one will offer this veteran a job. I go and sacrifice myself for this country and then it treats me like a piece of crap. Of course I am angry—it is normal. If I were not angry about it, then there would be something wrong with me, right? I was in the hospital for months recovering from the IED, but they took good care of me and I am fine now. People want to put me down by accusing me of being nuts, but they just use it as an excuse to control me.
I just need time by myself, and that is why I go to the bar. Some of my friends are there. They are the only ones who understand—some of them were over in Iraq too. I feel more safe when I am with them. I do not get any pressure from them. We can just sit and be quiet together. Sometimes the memories of what happened just replay in my head over and over like a movie. You might think it is bad, but the alcohol works for stopping that horror film.
After a year in a half-way house, Tony has been released on a three-year parole for a sentence involving distribution of amphetamines. While in prison, and again in the half-way house, Tony participated in chemical dependency programs. Tony has neither the means nor the intention to use meth again, but now that he is associating with some of his old friends, he has been offered meth and he is having a hard time resisting the temptation. He has gone to his counselor to ask for assistance.
Well, I came in to talk with you because I am really worried. I am trying not to use, but it is getting really hard to resist. No one will talk with me except for all my friends who are using. My job sucks, I live in a rat-hole, and neither my wife nor my kids will have anything to do with me. Life just seems hopeless. Sometimes I think about ending it, but I do not really want to do that. I am having so much trouble sleeping that I a zombie at work, and I am making mistakes that might get me fired and violate my parole for my job. I do not enjoy or look forward to anything. It is hard to see my life getting any better. I am losing weight. I do not have any energy. I get to thinking that if I could just use a little, I would have the energy focus to do well, and feel energized in my life. And at the same time I already know that it is a fantasy, and that if I use again my life will go down the toilet. I feel trapped. That is why I came to you. So, what should I do?
Andrea is a 17-year-old Hispanic in the U.S. illegally. She crossed the Mexican border with her mother last year. Mama is finding sporadic work. At times Andrea has been able to work with her mother. However, there are many days when Andrea is left by herself in the rundown building where they live with other illegals. Various drugs have been offered to Andrea. Mama has on a couple of occasions returned to find Andrea passed out on the couch next to a bottle of aerosol spray. Mama doesn’t know what to do to help Andrea. She has gone to the local Migrant Council to ask for help.
Sometimes I like it here in the U.S., and at other times, no. We never have enough money, and people are always asking my mother for money. There is no water in our building, and most of the time no electricity. There is nothing to do. We are afraid to ask for help because of being illegal. We had so much hope when we dreamed of coming here. But we had to pay everything to the Coyotes to get across the border so we had nothing when we got here. My mama tries her best. She cleans houses. Sometimes I help her. But other days I am left here by myself, with nothing to do and no money. So I talk with other people here, and they are mostly out of work with no money too. I started smoking pot with some of the other young people. Some of them are mean, so I try to stay away. But I get so bored that I have to find somebody to talk with. My friend Angela is good to talk with, but she has bad drug habits. A couple of times I have huffed with her, but I really do not like it that much and will not do it anymore. Mama is so worried about me, and I think it is ridiculous. It was her idea for me to come in here (to the Migrant Council). I am really alright, if we just had a little more money.
- Show awareness of the impact of treatment on clients from different cultural and ethnic backgrounds.
- LEARNING ACTIVITIESCollapse All
- [u03s1] Unit 3 Study 1Studies
Complete the following:
- Project Case StudiesLAUNCH PRESENTATION |TranscriptClick View Case Studies to view eight case studies, and select two that you will work with to complete your class project.
- [u03a1] Unit 3 Assignment 1Theoretical Analysis
To complete this component of your course project:
- Select your two case study subjects for your project and explain why you have chosen them.
- Analyze current trends in compulsive and addictive behaviors that are directly related to your case study subjects.
- Discuss the theoretical models of treatment you feel would be most helpful for your case study subjects. Support your recommendations with documented information from your research, using research with publication dates within the last three years.
- Review your course project description for an understanding of how this assignment fits into your course project as a whole, and the Theoretical Analysis Scoring Guide to learn how you will be graded on this assignment. Suggested guidelines: 2 pages, 4 references.
- Case Studies: http://media.capella.edu/CourseMedia/HS5264/cases/cases.asp