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Case One: Marcel
Marcel is a 21-year-old African-American man who was court mandated to treatment after overdosing several times and pending charges due to a number of bounced checks written over the past several months. Marcel reports that both of his parents were addicted to drugs and he experienced physical, sexual, and emotional abuse throughout childhood at their hands. His father died of liver disease at the age of 37. Marcel first used alcohol at age 14, when he had his first sexual encounter with a man. He began using other drugs, including inhalants and marijuana by age 16 and amphetamines and cocaine by age 19. At 21, six months prior to entering treatment, he began using heroin. Marcel reports that at the age of 14, he was kicked out of his family's home because his father suspected that he was gay. He has been homeless since. Marcel survived by becoming involved in sexual relationships with older men, some of whom were abusive. Marcel identifies himself as bisexual, not gay. He is not presently in a relationship but does have a network of friends with whom he has been staying with off and on. He has had numerous sexual partners (both male and female) over the past 7 years, has traded sex for drugs and money, has had sex under the influence of drugs and alcohol, and has experienced sexual assault. Marcel has never been tested for HIV because says, “I don’t want to know.”
Case Two: Jim
Jim, a 28-year old white man, has been in your treatment program for three months. Prior to coming to treatment, he had served an 18-month sentence at the county jail for drug possession and he is currently on parole. Jim has been using heroin since he was 16 and shortly before he was arrested, he began using fentanyl and “fell in love with it at first use.” At an outside NA meeting, Jim met a woman who works in the sex industry. Jim has been engaging in unprotected sex with her on a frequent basis whenever he can afford it. Jim stated that this woman couldn’t have HIV or another STI because “she is so pretty.” During an individual counselling session, Jim complains that he is having cravings and feels like he is going to use. He said that he received very little treatment in jail and was “forced to get clean” but knows that he will be sent back to jail if he gives his parole officer a positive urine screen. Jim tells you that “he can’t go on anymore in his present misery.” He also tells you that he is truly ready to give up his addiction and turn his life around if he’s just given a chance and some medication.
Case Four: Lexi
Lexi is a 32-year-old, divorced Latina woman who was employed as an administrative assistant. Last week, Lexi entered a treatment program where you are a case manager. She is being treated for opioid (Oxycontin) and alcohol dependence. She lives with her 11-year-old daughter, Christine. Although she makes a low salary, Lexi has managed to support herself and her daughter without financial support from Christine's father. She was married briefly to Christine's father when she was 20, but she left him after he became physically abusive toward her. She had almost no contact with him for many years. Her mother, a widow, is a strong support for Lexi and Christine. Lexi reports growing up in a "normal middle-class family" and states that her childhood was "good" despite her father's occasional drinking binges, and her mother's "occasional bad depressions." Until a month ago, Lexi was regularly attending twice-weekly treatment sessions at an outpatient clinic, and she went to AA/NA regularly 3 times a week. She had a sponsor and they kept in touch several times a week-more if needed. From the beginning of recovery, Lexi has experienced some mild depression. She describes having little pleasure in life and feeling tired and "dragging" all of the time. She persisted with treatment and AA/NA but has seen no major improvement in how she feels. After Lexi celebrated her 6-month sobriety anniversary, she reports that she started having a harder time getting herself up each day. Around this same time, she returned to daily drinking. She says that she then started experiencing bouts of feeling worthless, sad, guilty, hopeless, and very anxious. Her sleep problems increased, she began having nightmares, and she lost her appetite. After a month of this, she started attending AA/NA and treatment less often, instead staying home and watching TV. She started taking Oxycontin again one night after her boss got upset with her not finishing a work task on time. She went to a local bar after work that day and hooked up with a guy she met there to buy the pills. In accompanying him to a local dealer's house to get the pills, she was sexually assaulted by two men. Lexi did not return home that night (Christine was at a friend's sleepover party) and did not show up for work the next day. She does not remember where she was for most of that night. However, later that day she admitted herself to your treatment program. Now, one week into treatment, Lexi reports feeling numb and tense. She talks only when specifically asked a question. She feels hopeless about her ability to put her life together and says that she only sees herself failing again to achieve sobriety. Of her recent rape, she says that she "got what she deserved" for being in the wrong place with the wrong people at the wrong time. She speculates that she is an unfit mother and should give up custody of her daughter. While Christine is currently staying with Lexis's mother, she is concerned that her ex-husband will try to get custody of Christine if he hears that she is in a treatment program. He has been in recovery himself for two years and began demanding to see Christine again about 2 months ago.
