Vignette #1 - Sheila
Sheila is in the “Maintenance” state of change in this particular vignette.
Why? (be specific)
Sheila has already gone through the ‘departure’ of rehabilitation and moving towards maintenance, but is having trouble dealing with her particular cravings and urges (Reiman, lecture 8, 2015). Sheila is currently straying from her plan to change her behavior, and is beginning to consider entering the world of substance abuse out of necessity. Sheila admits that she has drug cravings still, but is unsure about what to do about them. This is a classic indicator of her maintenance status, as she is fully aware of her drug problem and, at this stage, is tentatively still clean, but is at the cusp of relapse.
What treatment plan would recommend? (inpatient, AA, Therapeutic Community, family therapy, etcyou can use a combination of therapies as well)
Sheila’s situation may be enough to make her go through inpatient therapy, and/or a Therapeutic Community.
Why would you recommend this?
Given the dramatic nature of Sheila’s situation, it is clear that existing AA programs are out of the question, her family has already rejected her, and more. Inpatient therapy is the ideal solution for people in recovery who have a high relapse potential, because of its efficiency (Reiman 2015, lecture on June 4th). If Sheila is considering reconnecting with a crack addict and entering the world of prostitution, this can certainly count as a severe enough circumstance to place her under someone else’s care; as her family is unwilling to take part, inpatient care is the best possible option at this point.
Therapeutic Communities, at the same time, would permit her to undergo the kind of cognitive-behavioral treatment that is necessary for this particular stage of relapse prevention (Marlatt and Donovan 4). At this point in her life, Sheila needs to find ways to challenge the myths that are related to expectancies related to positive outcomes, and restructure the maladaptive thoughts that would lead her to relapse and associate herself with potential crack dealers and pimps (Marlatt and Donovan 4). Therapeutic Communities may provide her with a safe environment isolated from these negative influences and keep her in an environment that allows her to focus on her recovery. In the end, however, the best weapon Sheila has is her previous recovery, as the possibility of relapse can often bring about shame that will prevent people from succumbing to it (Reiman 2015, Lecture 8).
Why do you think this client started using drugs? (what theory supports their story?)
Given Sheila’s circumstances and personality, I believe that external reinforcement theory is the best option to consider for Sheila’s initial motivation for taking drugs (Reiman 2015, lecture on June 2nd). Conflict theory also plays into her situation, as the low socioeconomic circumstances Sheila has been surrounded with has led to her engaging in criminal activity, such as prostitution. Her environment is highly conducive to this illicit behavior, as there is little recourse for her to uplift herself from this situation. Taking drugs seems to provide external positive reinforcement at first by allowing her to feel better about her situation, which is actively very dire. From that point, after recovery, her drug cravings in her current stage certainly come from a place of negative reinforcement, as Sheila wants to take drugs to keep from feeling bad. Given that Sheila, in her current state, wants to stay clean, but cannot due to a plethora of factors, it is clear that she does not want to be in the situation of succumbing to addiction. To that end, Sheila’s addiction is the product of external stimuli that are overriding her normally strong constitution.
What obstacles do you see getting in the way of your client reaching their goals around their substance use? Why?(Gender? Race? Environment? Socio-economic status?)
First and foremost, Sheila’s socioeconomic status and environment are a terrible obstacle for her ability to reach her substance abuse goals. As someone who has been previously incarcerated, the systemic barriers that have been placed against her (not receiving the benefits she needed to live on before) do not give her the resources she needs to recover after her incarceration. The environmental barriers of living in a homeless shelter provide even fewer resources for recovery, leaving her especially vulnerable to outside forces.
Gender-based environmental factors offer further threats to her continued recovery. Not only is she more likely to experience violence at the hands of the aforementioned crack dealer, she will also experience the typical systemic sexism that prevents even well-established women from getting gainful employment (O’Brien 60, 38). Her status as a single mother places the onus solely on her to take care of her daughter, which is even more responsibility than would be expected if Sheila were a man. All of these factors and more contribute to a situation that Sheila will have a difficult time overcoming.
Vignette #2 - Jenny
Jenny is in the pre-contemplation state of change in this vignette.
Why? (be specific)
Put simply, Jenny simply does not believe she has a drinking problem. While she uses substances, she believes she has ample justification for using them, and thinks she has the situation well under control. Jenny seems to have little or no awareness of the effect her actions have on others, as indicated by the ‘forgetting’ to call her children, leaving her older child to be the responsible one in the family. As an adult, Jenny does not take good care of herself or her children, preferring instead to maintain a heavy presence in the nightlife and passing the responsibility for her drinking on others (blaming the drinking on the drinks the men at bars buy for her); this is simply an excuse to facilitate the drinking, as it is ostensibly much more favorable to reject the drink or not drink it than to drink alcohol out of a sense of obligation.
Jenny’s behavior is not tempered by a sense of responsibility toward her children, and she seems to want to maintain the lifestyle choices (bringing men home for one night stands) and irregular hours (the late bartending hours she keeps) of a younger woman without a child. To that end, her lack of self-awareness indicates that she lives in denial and is not used to understanding the consequences of her actions (Reiman 2015, States of Change).
What treatment plan would recommend? (inpatient, AA, Therapeutic Community, family therapy, etcyou can use a combination of therapies as well)
I would recommend a treatment plan that involves an intervention and motivational interviewing.
Why would you recommend this?
Jenny needs to be made fully aware of the consequences her actions are having on others. The goal of the intervention would allow Jenny to come directly face to face
with her actions and how they affect others – her children in particular. Family and friends are an important part of informing Jenny about these effects and consequences, and so family therapy would be a favorable treatment plan to take Jenny on, in order to help her become a better parent and be a more responsible figure in their lives (Reiman 2015, Lecture on June 4th).
Following that, motivational interviewing has proven to be immensely helpful, particularly for clients struggling with addiction with different levels of readiness towards making behavioral changes (Handmaker, Miller and Manicke 680). With the help of these new structures, Jenny may be able to overcome her existing difficulties with her personality and lifestyle, and come to terms with her need to adjust her life to become a better parent to her children and successfully overcome her addiction.
Why do you think this client started using drugs? (what theory supports their story?)
Looking at Jenny’s lifestyle, it is clear that her motivation follows the personality theory of internal reinforcement (Reiman 2015, lecture on June 2nd). Jenny’s behavior indicates a certain lack of responsibility and maturity; her actions show that she does not care about the consequences of her actions. In essence, Jenny uses drugs as a substitute for having a stable structure in her life, which possibly comes about due to the stress of parenthood and a fear of becoming an adult. This is why she engages in behavior commensurate with someone with low self-esteem (e.g. seeking validation from men by being sexually promiscuous, essentially leaving her children to take care of themselves, etc.). Jenny requires instant gratification for her actions, and so she engages in drug use to feel like she is having fun and in control.
What obstacles do you see getting in the way of your client reaching their goals around their substance use? Why?(Gender? Race? Environment? Socio-economic status?)
Examining Jenny’s situation, I believe gender and environment are the biggest barriers to her ability to reach her substance abuse goals. Her environment is a particular hazard, as the bar where she works inherently encourages the kind of behavior that has led to her alcoholism and drug abuse. Existing in an environment in which the disinhibiting effects of alcohol are commonly placed upon her out of a sense of gendered social obligation (and the possibility of financial reward in the form of tips) has cultivated a vicious cycle of alcohol abuse that prevents Jenny from being in a position to refuse them (Morgan 130).
Her gender plays a huge part in this substance abuse as well, as much of Jenny’s alcohol consumption comes from a sense of obligation after men buy her drinks. This is an issue unique to women, as “the problems that women have with alcohol exist through systems of domination,” particularly at the hands of men (Morgan 129). Jenny would effectively have to quit her job in order to successfully transition into a drug-free lifestyle. Removing herself from this environment would allow her the option to be removed from such enabling influences, and gain greater self-awareness about her actions.
References
O'Brien, P. (2001). Making it in the free world: Women in transition from prison. SUNY Press.
Handmaker, NS, Miller WR, & Manicke M (2001). "Pilot study of motivational
Interviewing." 86: 680–683.
Marlatt, G.A., & Donovan, D.M. (2005). Relapse prevention: Maintenance
strategies in the treatment of addictive behaviors. Guilford Press.
Morgan, P. (1987). Women and alcohol: The disinhibition rhetoric in an analysis of
domination. Journal of psychoactive drugs, 19(2), 129-133.
Reiman. (2015). Lecture 8.
Reiman. (2015). Lecture on June 2nd.
Reiman. (2015). Lecture on June 4th.
Reiman. (2015). Lecture on May 26th.
Reiman. (2015). States of Change worksheet.
