COU304A-Alcohol and Other Drugs
Sarah, a 22 year old female, has come by the women’s drop‐in centre where you work for information and advice. Sarah has been living with her partner, Nick, in and around Sydney’s inner suburbs for the past five years. She and Nick have been using heroin for about as many years. When Sarah was 12 years old, her father, whom she says was a “mean drunk”, left suddenly and never came back. At 13 she started drinking and smoking cannabis. At 15 she dropped out of school and at 17 she moved in with Nick who introduced her to heroin. She says she’s no longer in contact with her mother who ‘cut her off’ a couple of years ago when she found out she was using. She says her mother was a smoker but “never touched any drugs, not like my dad”. Sarah says she has no other family.
On assessment, Sarah reports injecting around $300‐$400 of heroin each day which she says she needs “just to function” and not “hang out”. She says the amount varies depending on “how good the junk is” which she says has been “pretty mixed lately”. She says she injects around 2‐3 times a day and last used yesterday when she finished work. Sarah says she started off smoking but changed to injecting not long after when she was about 19. Sarah says injecting gives her a better “rush”. Recently, Sarah started sex working so she can pay for heroin. Sarah tells you that Nick is unemployed and that they’re at risk of eviction because they can’t pay the rent. Sarah reports that she also smokes cigarettes and drinks alcohol daily. She adds that she has a ‘joint’ “now and then” “if there’s one going”. She says she probably drinks “about a bottle” of wine each night to get her through the night. She says if she can’t score enough heroin, she’ll “hunt around for some “oxy” or benzos” to “tie me over until I can get some ‘H’”. She says Nick gave her some cocaine to try recently but she “really didn’t care for it that much.” Sarah tells you that the alcohol and heroin help her to “deal with how things are”.
Sarah tells you her relationship with Nick has been “up and down” and that they’re not having sex that much. Sarah says that when they do have sex, Nick never wears a condom “…cause he says he’s not one of my clients”. Sarah says he’s hit her before. She says she doesn’t want to make him angry by asking him to wear one. Lately Sarah has been feeling dizzy and nauseous. She also hasn’t had her period for about 6‐7 weeks. She thinks she might be pregnant. She says she is not sure she can stop using heroin or work to have a baby “although I’ve always wanted kids”. She says she is really confused about what she should do and wants advice so she can make a decision. Her friend who works with her at night told her not to stop using “H” if she‘s pregnant “cause it’d worse for the kid than to keep using.” Her friend has been telling her Nick is bad for her and has offered her a place to stay. She says sometimes she thinks her friend is right and adds that she’s been thinking about “getting off the gear”. Sarah is teary and says “I’m tired of it all. I just don’t what should I do?”
Questions for consideration
1. What does the literature say about the role of risk and protective factors in substance use? What risk and protective factors can you identify in this case study?
2. Describe Sarah’s substance use patterns. What substance(s) does Sarah seem to be most dependent on?
3. Of the substances Sarah is using, which pose a greater risk of harm to withdraw from and why?
4. What other potential harms can you identify? What potential harms are there for Sarah? If Sarah is pregnant, what are the potential harms for the baby?
5. Is Sarah’s friend correct in advising her not to stop using heroin if she is pregnant? Why/why not?
6. Assess Sarah’s stage of change
7. What counselling approach would you apply to engage Sarah? Describe the approach, its evidence base and provide examples of the specific strategies and/or techniques you would use
8. What treatment options would you recommend to Sarah and why? Include a brief summary on the evidence base for the options recommended
9. What other issues can you identify in the case study? What referrals would you make?
10. Explain how attitudes and stigma could impact Sarah’s treatment and the handling of her case. Provide examples of how negative attitudes and stigma can be mitigated.