Christina reports having several relationships that serves as meaningful components to her treatment. The most important relationship the patient described is her relationship to her unborn children. The patient has expressed feeling extremely guilty about the troubled relationship she has with her living children, and this is a source of motivation for the patient to change and becoming more parent-oriented in her life choices. Another relationship the patient reports as important is her recovery includes her living children.
She states she is committed to being compliant in treatment to increase her chance of regaining parental custody of the children in the future. Also, it appears that reconnecting with the children, and proving to them that she is trustworthy and capable of being a good mother is of significance to the patient. The last relationship that the patient describes as meaningful is her relationship with her partner. Aside from the past abuse, the patient feels she is safe and supported when with her partner.
And while, from clinical standpoint, the patient’s relationship with her partner is considered a complicating factor, the patient is inclined to view the relationship as a protective factor. There are several reasons that lend to the patient’s perspective of her relationship including the reality that his is one of the few people in her life that has remained by her side after receiving knowledge of her addiction and past behaviors. Secondly, the patient’s partner provides for her financially, and without his support, she believes she will undoubtedly resort to her past behaviors.
And finally, the patient’s attachment to her partner is further consummated by the partner’s controlling behaviors disguised as protective measures; by intentionally isolating the patient as a means of controlling her, the partner deceptively asserts his reason is to reduce the exposure of the patient’s drug use triggers. Culture The patient grew up in a rural area, and her first exposure to drug use occurred at a childhood friend’s house. Her friend’s mother offered the adolescents marijuana, and according to the patient that experience “opened her up to a new world.
The patient reported regular use after that experience, and as she became more daring and experimental in her drug use, she always found someone within her community to supply her needs. Recreational drug use in rural areas is not uncommon, and as the patient immersed herself more deeply into that lifestyle, she came to realize that individuals who used and misused drugs were more commonplace than she ever expected. The patient observed a culture of drug use within her rural area, and ingrained in that culture were shared beliefs, values, and ideas.
As an adult who primarily used benzodiazepines, the patient also experienced being rejected by other individuals in her area whose primary drug of choice was methamphetamine. The patient stated those individuals thought she felt she was superior to them because she did not use methamphetamine. Being exposed to and eventually apart of a drug using culture has a significant influence on the patient’s perspective and worldview. A second culture that has shown to be impactful on the patient’s life is the assimilation to her partner’s culture.
The patient values her partner beliefs, and as a gesture of respect to him, she freely submits to the immersion of his culture. She resides in a neighborhood where she is considered an outsider because she does not speak the same language as many of her neighbors. To overcome this barrier, the patient reports she is attempting to learn to speak Spanish. Christina also noted a change in her relationship behavior, where she once was a very combative partner, she now freely submits to her partner’s uthority in part to subscribe to his cultural beliefs of gender roles, where males are expected to exert dominance and control over women.
Spirituality Spirituality is not a factor the patient emphasizes. However, that is not to say that the patient does not have any spiritual or religious beliefs; she simply has never reported any beliefs related to spirituality or religiosity. In fact, when the patient was asked whether or not she held have spiritual beliefs, she replied by stating the last time she went to church was to attend the funeral of her late aunt.
Exploring this aspect further with the patient may be beneficial because many individuals with substance use issues find strength in acknowledging and putting trust into a high power. On the other hand, depending on the patient’s experience and her true beliefs, she may believe that a high power does not exist and is reluctant to share that because she believes it would be deterring to the counselor. In which case, promoting spirituality may weaken the therapeutic alliance. Past Treatment History
Christina reported that has not been involved in a formal treatment program prior to enlisting in the PATHway program. The patient did report having a brief period of sobriety, lasting approximately three months. When probed about the methods she employed to remain abstinent from drug use, the patient stated that a major source of her motivation to discontinue drug use came from fear that she would harm her first child as she was six months pregnant when she decided to stop using substances.
As for previous mental health treatment, the patient reportedly spent two weeks in a psychiatric hospital following a suicide attempt when she was around 16 years of age. At that time, she also received her bipolar and depression diagnoses. In outlining the patient’s history of drug use, it is unclear whether the diagnosing clinician considered her drug use as a differential diagnosis. Safety Concerns The safety concerns that are paramount to Christina’s case are the possibility of a drug relapse and the potentially devastating ffects it may have on her fetuses as well as the possibility of future physical and emotional abuse by her intimate partner.
For preventative measures, the counselor and patient have drafted a relapse prevention plan to help the patient recognize behavior patterns that lead to relapses, including the recognition or triggers and cravings, In coloration, the patient and counselor also developed practical strategies to counter those feelings and include calling the counselor or 24-hour crisis helpline when she experiences strong and persistent cravings.
The patient has also received information on proper use of her medication, Suboxone, which is used to help deal with the negative physical symptoms of opioid addiction. In addressing the safety concerns that the patient’s relationship presents, the counselor has reviewed safety planning and community resources that may be available to the patient if she is in need of them. Christina’s safety concerns would be lessened by the presence of healthy sober supports, however, at the present time, healthy sober supports outside of PATHway’s clinical staff is unattainable due to several confounding factors including her relationship with her partner.
