Assignment Instructions
-Case study should be 5 pages and should follow APA guidelines with appropriate content and syntax.
· Review of the case. Be sure to describe and discuss impact of specific substances effect on the client.
· Describe the strengths and needs of the client.
· Describe any bio, psycho, social factors that led or attributed to the substance abuse.
· Discuss how oppression and discrimination have affected this situation.
· What ethical issues are involved and how would you handle this based on the Code of Ethics?
· Describe the policy or service issues that impact your client. How will you advocate for the client based on these issues?
Case Study
Vignette – Susan Olin
The following vignette is based on an oral history of substance abuse taken in a single interview with an older adult willing to share her story. It is not an intake interview, an assessment or a psychosocial history. Nor is it a composite of several cases. It is simply one older adult’s personal view of her relationship with drugs. Only her name and identifying details have been changed.
Description
The interview with Ms. Olin took place at a senior center in New York City. Susan Olin is a 58 year old Caucasian, single woman who has lived in New York all of her life. She was neatly dressed and soft spoken but appeared drawn and older than her stated age. Ms. Olin appeared slightly anxious and frequently clasped and unclasped her hands throughout the interview. She explained that she was willing to be interviewed in order to help other older persons experiencing problems with substance abuse. Ms. Olin currently lives illegally in an apartment in public housing on the same grounds as the senior center where the interview took place. She is not named on the lease but sleeps on a couch in the living room of a “friend,” a man she knew tangentially in the drug world who is the official tenant. She pays him a modest rent but can only stay in the apartment when he is there, as he will not give her a key. As a result she spends a lot of time on the streets. When she is in the apartment, life is also difficult because she is trying to recover from a serious drug addiction and her friend is currently abusing heroin and alcohol, sometimes smoking crack and “blowing it in her face.” There was an underlying tone of hopelessness when she talked about her living situation because of the fact that it is her friend’s apartment and she has no financial resources of her own that would enable her to find another place to live.
Family Background
Ms. Olin describes a painful, intergenerational family history of substance abuse. She is the sole survivor of three siblings. Her father passed away many years ago. Her mother is still living but “won’t talk to her.” Both parents, she implied, had also “had problems” with alcohol and substance abuse. Ms. Olin then talked about having had two children of her own and her voice seemed to become even softer at this point in the interview. “I had one daughter who died of an overdose of drugs four years ago at the age of 21.” She then she went on to say that she herself began abusing drugs at the age of 21 and that this is when she began to have serious problems. In a monotone, emotionless voice she talked about the fact that her other adult daughter is doing very well, “has a wonderful job” right in the city but that they have not spoken in a very long time. “My oldest daughter disowned me years ago,” she said. Nevertheless, Ms. Fordham University Graduate School of Social Service 2 Olin said that the fact that her daughter has cut her out of her life is something that she does not dwell on or think about very often because she does not want to become emotionally upset.
Substance Abuse History
When Ms. Olin first began to use and abuse drugs, her drugs of choice were cocaine and heroin. Her use of drugs escalated very rapidly and began early on to interfere with her ability to function in the world. Ms. Olin attempted to stop abusing drugs but instead switched substances to the anti-anxiety drug Valium and the opiate painkiller Vicodin. This attempt to control her illicit drug use by using legal drugs failed. During this period her brother and sister (who also abused drugs) died, apparently from drug overdoses. While on the one hand this frightened her and made her want to get off drugs, it also led to deep grief which plunged her further into drug abuse. The year she was 22, for example, she was hospitalized twelve times for detoxification but each time she was released she began immediately to abuse drugs again. By then her substance use included cocaine and heroin as well as anti-anxiety drugs and painkillers. In the years that followed Ms. Olin was in and out of many detoxification and drug treatment programs with little success at staying drug free. Ms. Olin developed Hepatitis B at one point but did receive successful treatment for the illness. She also contracted Hepatitis C which is currently one of her several serious medical problems.
By her early 40’s she was homeless and has been essentially homeless ever since. She believes that this is a direct consequence of her drug addiction. She states “In the past year I finally got sick and tired of feeling sick and tired. I realized that I was getting too old to continue on the way I was going.” She applied to a hospital based detox program but was rejected because they said that her blood and urine showed no traces of narcotics, though she said she had used 12-15 hours earlier. She was finally accepted at a methadone outpatient program at a major medical center in New York City. Ms. Olin’s eyes brightened and her voice grew stronger as she talked about the help she is receiving at this hospital, which includes psychotherapy and case management as well as medical and drug treatment. “They have really helped me there…They are helping me to live drug free and are also helping me with my present everyday living problems.” She speaks hopefully of getting off methadone, too, at some point, but has no concrete plans to attempt this. She is receiving Social Security Disability (SSI) payments of $700 a month, and describes her finances as “very tight.”
Two years ago she received one of the much-sought-after Section 8 vouchers, and recognized that she was lucky to get it. Caseworkers at the hospital and the senior center tried through several realtors to find her an apartment that would accept the vouchers. However, she missed several appointments to see Fordham University Graduate School of Social Service 3 apartments. The voucher expired and cannot be renewed. If she were to apply for her own apartment in public housing, the waiting lists would be very long and her history of arrests for shoplifting might prejudice her application. Her caseworker at the senior center would like to see her enter one of the transitional housing programs with supportive services for people with mental illness or substance abuse problems, but these programs only take admissions from city shelters. She spent some time in a shelter 12 years ago and says it was a “horrible, horrible experience.” She refuses to return even to advance her access to supported housing.
Ms. Olin feels grateful that she can come to the senior center every day, because it helps her to “stay straight” and she feels good about helping some of the older persons at the center. She also appreciates having lunch and sometimes breakfast there. She describes the environment in the housing project where she now lives as “drug infested” and not healthy for someone recovering from addiction issues. She attends 12-step meetings to support her recovery process. She goes to both Alcoholics Anonymous (AA) meetings and Narcotics Anonymous (NA) meetings, partly as “a place to go,” when she is unable to be in the apartment. (AA meetings are more plentiful and they tend to have a stronger foundation than NA meetings in the 12 step model. Many narcotics addicts attend both.) She finds both very helpful and says she does not presently have a sponsor but is looking for the right person to be able to sponsor her. Ms. Olin describes herself as “being in recovery” and says she has not abused drugs for almost a year but when questioned further she discussed a painful lower back condition for which she is taking about nine to twelve pain pills (Oxycontin) a day prescribed by her physician. She seems to believe that because they were prescribed for her by a medical doctor for a “real” physical condition that it does not compromise her recovery in any way.
Aging and Substance Abuse
Ms. Olin was very open about the fact that she no longer feels she has the energy to “cop drugs” and live on the streets. Also, the access and connections she had to the drug world have diminished as she has aged. Physically she is aware that her body has aged and does not deal well with the abuse of drugs in the way it was able to when she was younger. She describes feeling worn out, tired and sad about not having her own living space at this stage of her life. Ms. Olin expresses hope about her future and thinks that she will receive the help she needs from the caseworker at the methadone program to find an apartment along with support to “stay off drugs.” She is very glad that she finally has been successful in maintaining what she describes as “sobriety and recovery.”
Ms. Olin talked initially in a somewhat detached manner about the many losses she has experienced over the years. However, when she began to speak about the loss of the relationship with her Fordham University Graduate School of Social Service 4 daughter, her eyes filled with tears. “My daughter blames me for her sister’s death,” she said. She quickly dried her eyes and went on to change the subject and to talk about “letting bygones be bygones.” At the end of the interview Ms. Olin expressed how happy she felt that her interview might help someone else.
