A Case Study on Rosa Lee

¶ … Rosa Lee Cunningham. Elements such as the subject's health history, legal history, psychosocial history, and diagnostic impressions will be covered.

Rosa Lee Cunningham

DOB/Age: October 7, 1936

Date of Interview: October 7, 1994

Evaluator:

Reason for Assessment: Rosa Lee Cunningham was discovered having a fit at Washington's Howard University Hospital, owing to over-consumption of heroin. In spite of being enrolled in an intervention for drug treatment, there did not appear to be any inclination in Rosa to quit drugs. In fact, she wished she could access methadone, a synthetic drug with heroin-like effects. Some days prior to being interviewed, Rosa awoke to find herself with fever; her condition had exacerbated. By noon, she was admitted to the emergency room (Dash, 1996 Prologue). Rosa states that her drug consumption levels hinge on the amount of money in her pocket and heroin accessibility. The subject also had Preludin-use history, a drug she initially started taking shots of as an energy booster, and for losing weight. In fact, Rosa's son's girlfriend used to help her with taking Preludin shots prior to her shift to heroin addiction.

Psychosocial History: Rosa Lee Cunningham Wright, aged 56, is a Washington-born female of the African-American ethnic group. Rosa's father, Earl Wright, died at the age of 36 from liver cirrhosis, resulting from acute, long-term alcoholism, when Rosa was only 12 years of age. Rosa herself reported her mother's passing in 1979, a result of natural causes (Dash, 1996). The family was poor; sharecropping was their source of income. Her parents too hailed from families of sharecroppers. Rosa had a rather awkward relationship with her mother. In her childhood, Rosa used to steal, partly because of a desire to make her mother happy. She claimed that she would initially be faced with her mother's displeasure (feigned), but would later be showered with affection if the article stolen was 'nice'. But her mother frequently meted out physical punishment, owing to heroin, compromising expectations of the girl; for instance, she wished for her daughter to become a home cleaner after growing up and, thus, would attempt to train and discipline her at home. However, this was against Rosa's wishes, causing her to greatly dislike her mother.

At the time of being interviewed, Rosa reported to being a mother of eight: two girls and six boys. She first became pregnant at the age of thirteen. Her second and third pregnancies occurred at ages 14 and 15 respectively; Rosa reported to having kept her third baby. At the age of sixteen, Rosa forcibly had to marry Albert Cunningham, due to becoming pregnant with his child (Dash, 1996). Their marriage lasted for a brief 4-month period, ending when Albert launched a violent attack upon his wife. The provocation for the attack stemmed from Rosa cheating on him with a neighbor in the locality. Her marriage was devoid of any instances of abuse or sexual assault. Rosa delivered a total of eight kids, from 6 men. She is a grandmother to 32 kids. After having had eight children, Rosa reported to going for a hysterectomy procedure (Dash, 1996). Her addiction appeared to have been inherited by her children. Rosa reports that, of her eight children, five abuse some or other substances. Her eldest child succumbed to AIDS (acquired immunodeficiency syndrome). Rosa's psychosocial history springs from the endless cycle of abuse and drug addiction in the family.

Current Status: Rosa is currently hospitalized for HIV (human immunodeficiency virus) treatment, and needs to be administered methadone on a daily basis. At present, she resides in a building owned by the housing authority, and is raising a great-grandchild (Dash, 1996). She maintains her home in good shape; when distressed, Rosa finds that she turns her attention to cleaning her home.

Indicators of Use/Abuse/Dependency:

American society has a long-standing history of rampant drug consumption -- legal as well as illegal. Those who resort to dependency on drugs or drug abuse are usually seen to be making the wrong choices, wrecking personal relationships, ruining their health, and even ending up imprisoned; they are a danger to themselves as well as those around them (Wasilow-Mueller and Erickson, 2001). In case of women, particularly, drug-related issues can pose distinctive challenges for drug-dependency prevention, therapy and intervention. Addiction as well as abuse constitutes critical social and health-related concerns; each phenomenon, however, has a different part to play in the sources and repercussions of chemical consumption.

In Rosa's case, a multitude of early indicators were present, including:

Occupational Functioning: Subject reported relying mostly on government support for her basic necessities; she also admitted to stealing articles and selling the same (Dash, 1996). Rosa confesses that she is, of late, selling the drugs, Xanax and Darvon, which her physician administered to her for treating her back problems, for $3 per pill to her methadone-abusing friends; she had previously sold heroin and marijuana, as well.

Financial Aspects: Rosa reported obtaining both welfare and social security benefits. Absence of income/assets forces her to mostly reside in public housing (owned by housing authority). Rosa had previously tried to earn her living through illegal activities, like prostitution and drug sale. Furthermore, she admitted to financially assisting her children with procuring drugs for their use (Dash, 1996). In doing so, Rosa facilitated her children's journey towards substance abuse, permitting the addiction cycle in the family to continue.

Familial Relationships: Rosa reveals her social life and relationship with family to be as follows: She frequently gets together with palsat McDonalds. She shares a close bond with her kids and grandkids (Dash, 1996). These relationships, however, are fraught with legal problems and the element of drug addiction. For instance, one of her two daughters, Patty, is presently a state-jail inmate, imprisoned for theft and accused of her former boyfriend's death.

Legal History: Rosa has an extensive legal history. In her interview, Rosa claimed to have been taken under arrest no less than a dozen times (Dash, 1996), chiefly on charges of theft from businesses, and drug-related charges. Sometime in the past, Rosa was also sentenced to imprisonment for 5 years.

Health History: Rosa Lee has a disturbing medical history. Sharing needles with her HIV-suffering daughter, Patty, resulted in her contracting the infection as well. She is being administered AZT as medication for HIV. Rosa confesses to awakening each morning to stomach ache (symptoms of withdrawal from heroin), and thus has to take daily methadone doses. Overdose of heroin has, so far, resulted in Rosa suffering thrice from seizures; she is under Dilantin prescription for seizure treatment (Dash, 1996). But, as she is unlettered, she once overdosed on Dilantin, and ended up in the emergency room. Furthermore, Rosa suffers from a condition called osteomyetilis, caused by injection of heroin into the neck region, leading to bacterial infection, which, in turn, causes paralysis. She had to undergo surgery, followed by hospitalization for a period of six months. Added medications administered or prescribed to the subject include Phenobarbital and folic acid (Dash, 1996).

Spiritual History: Rosa claims to have mixed feelings in relation to the spiritual or religious realm. She was a church-goer in her childhood, and in her adult years, she also does attend service from time to time. She confesses to commencing her habit of stealing from others at church. Rosa also remembers being part of the church choir, and reminisces about a visit to the place of her mother's upbringing. Rosa has become a member of the Mount Joy Baptist Church, following a protracted absence.

Diagnostic Impressions: The very first psychological illness that crops up in one's mind after viewing Rosa's symptoms is depressive disorder. Of this class of psychological ailments typified by mood-regulation impairment, the most-commonly occurring disorders are major depressive disorder and dysthymia (an illness whose symptom is persistent low moods) (Chapman and Perry, 2008). Among elderly persons (65 years of age or older), the above illnesses may also manifest themselves with symptoms such as cognition impairment (of a syndrome known sometimes as pseudo dementia), and psychomotor retardation or agitation. Consequently, depressive disorder's symptoms are often concealed among elderly individuals; at first, therapists may construe them to be symptoms of cognition impairment or initial symptoms of neuro-endocrine and associated chronic ailments, thus making lab and physical testing of elderly people showing depressive disorder symptoms vital to elderly healthcare (Chapman and Perry, 2008). Studies reveal that clinical depression incidence is normally lower in elderly persons than in youngsters, but it is imperative, in the public health context, to attain an understanding of depressive problems in the former category of individuals. Clinical depression rates soared significantly in the last decade, indicating that in future, the 'elderly' category will include greater numbers of individuals with past or current experience of depressive disorders. Estimates indicate that by the end of this decade, depression will rise to the second-highest spot worldwide among disease-causing agents, as quantified via disability-adjusted life-years. Moreover, among elderly individuals, depression usually aggravates other ailments' course and result (Chapman and Perry, 2008).

Another ailment whose symptoms are demonstrated by Rosa is substance/drug use disorder (SUD). The entire family is affected when any one individual is afflicted with SUD. The context of family bears information regarding the development of SUDs, maintenance, and the positive and negative influences on SUD treatment. Attachment and family systems models offer a framework to understand the impact of SUD on families (Lander, et.al, 2013). Additionally, a grasp of any given family's present stage of development aids with informing impairment evaluation and determining suitable interventions. SUDs have an adverse influence on behavioral and emotional patterns of family members since its inception, leading to weak outcomes for SUD-afflicted adults and children. The family continues to be the fundamental wellspring of nurturing, attachment, and human socialization in modern-day society. Thus, SUD's effect on individual members and the family, as a whole, must be focused upon. All families and individual members are uniquely impacted by the SUD-afflicted family member; this includes, but isn't limited to, possessing unfulfilled developmental requirements, impaired attachment, legal issues, economic difficulties, emotional suffering, and also being a victim of violence. The children in the family are at great risks of themselves getting addicted or abusing a substance. SUD development is also influenced by environmental and hereditary factors (Lander, et.al, 2013). Since the family with which one grows up shapes both the aforementioned factors, looking into SUD effect on family is essential. Research delving into the relative significance of these factors reveals that both contribute to input and effect. The effect differs, depending upon the affected member's gender and familial role. For instance, if a teenager in a family gets affected by SUD, the impact on family is different from the manner in which the family will be impacted, if one of the parents is SUD-afflicted. Family members' views and principles regarding SUDs also hold significance, since these impact the affected individuals, when they strive to quit, and will also impact treatment intervention effectiveness. It has been speculated by clinicians that the so-called "attachment disorders" can transpirate increased rates in children impacted by alcohol use, partly because of neglect and abuse (when they occur), and partly on account of alcohol-induced shortfalls in social-emotional and cognitive functioning, resulting in decreased resilience. Research proves that one-third to two thirds of the cases of child abuse involve substance dependency/abuse to some extent.

Recommendations:

The subject's substance misuse history has been vast. Rosa would gain from a number of different treatment alternatives, including outpatient as well as inpatient interventions. Studies depict that consumption of drugs for extended periods of time modifies brain function, in addition to reinforcing compulsions to consume drugs. This longing persists even after quitting drug use. Since the yearning will last, the most central SUD treatment (recovery) element is relapse prevention. SUD treatment normally necessitates enrolment in a rehab intervention; it is governed by the affected individual as well as substance abused. A counselor (e.g. psychiatrist, psychologist, social worker, nurse practitioner or psychiatric nurse) in behavioral therapy offers approaches to deal with drug yearnings and relapse prevention techniques (Substance Abuse Causes, Symptoms, Treatment - Substance Abuse Treatment -- eMedicineHealth). Therapy normally entails group and individual therapy. Rosa may possibly gain from such interventions. After conducting a comprehensive analysis of a patient's condition, the nurse practitioner or doctor might prescribe drugs like methadone or nicotine patches, for managing drug cravings and symptoms of withdrawal. Random testing for drugs usually forms a central part of motivating the SUD-affected individual to abstain from drug consumption in the future. Hotlines are one instrumental resource that helps initiate substance abuse therapy and checking of relapses.

Rosa must first complete a rigorous detoxification program. The wish to quit one's dependency on a drug marks the initial step in the lengthy, challenging route to sobriety; however, for improved success rates, it may be crucial to spend some amount of time in a detox rehab intervention. Detox programs enable drug addicts to get over the withdrawal phase with minimal discomfort under the watchful eye of experts, to ensure that the patient has no access whatsoever to drugs, while also guaranteeing safe recovery (Drug Detox Rehab Programs -- Drug Detoxification Centers). Two key kinds of drug detox programs are: 1) rapid detoxification; assuming a speedy medical strategy for patient detoxification; and 2) tapering off; a longer process than the former. Both kinds of programs successfully purge the ingested/injected drug from the addict's system, whilst taking care to avoid patient withdrawal, though both make use of drastically different techniques for achieving the same result.