Rosa Lee Cunningham: Case Study in Substance Use Disorder

Introduction and Reason for Assessment

Subject: Rosa Lee Cunningham
DOB/Age: October 7, 1936 (age 56)
Date of Interview: October 7, 1994

Rosa Lee Cunningham was discovered having a seizure at Washington's Howard University Hospital due to heroin overdose. Despite being enrolled in a drug treatment intervention, Rosa showed no inclination to quit drugs. In fact, she expressed a wish to access methadone, a synthetic drug with heroin-like effects. Several days before the interview, Rosa awoke with a fever and a worsening condition; by noon, she had been admitted to the emergency room (Dash, 1996, Prologue).

Rosa states that her level of drug consumption depends on how much money she has available and how accessible heroin is. She also reported a history of Preludin use — a drug she initially began taking by injection as an energy booster and for weight loss. Rosa's son's girlfriend had previously helped her administer Preludin injections before Rosa transitioned to heroin addiction.

Psychosocial History

Rosa Lee Cunningham Wright, aged 56, is a Washington-born African-American woman. Her father, Earl Wright, died at age 36 from liver cirrhosis caused by chronic alcoholism, when Rosa was only 12 years old. Rosa reported that her mother passed away in 1979 from natural causes (Dash, 1996). The family lived in poverty, relying on sharecropping as their primary source of income; Rosa's parents also came from sharecropping families.

Rosa had a strained relationship with her mother during childhood. She admitted to stealing, partly to please her mother, who would initially feign disapproval but then show affection if the stolen item was sufficiently valuable. Her mother also frequently used physical punishment, driven in part by expectations she had for Rosa — for example, she hoped Rosa would become a domestic cleaner and attempted to train her accordingly. Rosa strongly resented this, contributing to her deep dislike of her mother.

At the time of the interview, Rosa reported being the mother of eight children — two girls and six boys. She became pregnant for the first time at age thirteen, with her second and third pregnancies occurring at ages 14 and 15, respectively; she kept her third child. At sixteen, Rosa was forced to marry Albert Cunningham after becoming pregnant with his child (Dash, 1996). The marriage lasted only four months, ending when Albert physically attacked her following her affair with a neighbor. Rosa reported no sexual abuse within the marriage. She delivered eight children by six different men and is a grandmother to 32 grandchildren. After her eighth child, Rosa underwent a hysterectomy (Dash, 1996).

Rosa's addiction appears to have been transmitted to her children. She reports that five of her eight children abuse some form of substance. Her eldest child died from AIDS (acquired immunodeficiency syndrome). Rosa's psychosocial history reflects the intergenerational cycle of abuse and drug addiction that has shaped her family across multiple generations.

Current Status: Rosa is currently hospitalized for HIV (human immunodeficiency virus) treatment and requires daily methadone administration. She resides in a housing authority building and is raising a great-grandchild (Dash, 1996). She maintains her home well and reports turning to cleaning as a coping mechanism when distressed.

Indicators of Use, Abuse, and Dependency

American society has a long history of widespread drug use — both legal and illegal. Those who become dependent on or abuse drugs are often seen as making destructive choices: damaging personal relationships, ruining their health, and risking imprisonment. They pose a danger to themselves and those around them (Wasilow-Mueller and Erickson, 2001). For women in particular, drug-related issues can present distinctive challenges for prevention, therapy, and intervention. Both addiction and abuse constitute critical social and public health concerns, though each plays a different role in the causes and consequences of substance use.

In Rosa's case, multiple early indicators of dependency were present across several life domains:

Rosa reported relying primarily on government assistance for her basic needs. She also admitted to theft and resale of stolen goods (Dash, 1996). At the time of assessment, she was selling Xanax and Darvon — medications prescribed by her physician for back pain — at $3 per pill to friends on methadone. She had previously sold heroin and marijuana as well.

Rosa received both welfare and Social Security benefits. Lack of income and assets kept her in public housing. She had previously attempted to earn money through illegal activities such as prostitution and drug sales. She also admitted to financially assisting her children in purchasing drugs, thereby facilitating their substance abuse and perpetuating the family's addiction cycle (Dash, 1996).

Rosa described a social life centered on family gatherings, including regular meetups with friends at McDonald's. She reported close bonds with her children and grandchildren (Dash, 1996). However, these relationships were deeply entangled with legal problems and drug addiction. For example, her daughter Patty was serving time in a state prison for theft and was accused in connection with a former boyfriend's death.