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Paula presents to us with some problematic substance use issues

crack cocaine

alcohol

Diagnosis: Severe Stimulant Use Disorder-Cocaine (F14.20) & Stimulant Withdrawal (F14.23)--Co-morbidity code

*Note* Women with substance use disorders (SUD) often have psychological co-occurring mental health disorders (Gorvine et al., 2021).

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As the story continues we see Paula:

grow excessively more withdrawn from reality and from her duties as a mother

verbally abuse her son Chiron

steal money from her son that was given to him by the mother figure looking after him

appear increasingly more disheveled, housing situation reflects the same theme

exhibit severe withdrawal symptoms--sickly feeling, scavenging around house, doing anything to make some money to support her habits (she likely lost her job at the hospital she had during Chiron's childhood)

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Evidence

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Timeline:

-When Chiron is of elementary age we see what may be the beginning of Paula's drug cycle

territorial

consistent rotation of men

access to drugs from Chiron's "surrogate father"

-Chiron's high school years

more withdrawn

deeper addiction

loss of occupation

still revolving door of men (word of prostitution for drugs)

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Psychological- single mother, may have dealt with some feelings of inadequacy or could explain for territorial/ "protective" behaviors towards son (Sperry & Sperry, 2020).

Social- once again an absent father left burden of child on her. Financial struggles present as well

Cultural- Living in 1980s Miami (high drug culture, especially in lower socioeconomic regions)

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Maladaptive Patterns present! As time moves, Paula uses more. Stuck in cycle of drugs-->Requires more/searches for more to achieve desired high

Perpetuants

Hangs around wrong people(guys involved with drugs)

No positive influences in life aside from the one person she will not listen to

Unhealthy coping skills

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Chiron continues to try to help mom in his teen years and after

Gives her the money

Puts blankets on her when sleeping

Later believed that he helped her to check into a facility

While her support system is not robust, he is all she truly has at the moment. No mention of any other family members in the picture

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Self Help Groups:

Client should seek out Alcohol Anonymous (AA), Narcotics Anonymous (NA) and Cocaine Anonymous (CA) self help groups

Advantages

12 Step Approach in both NA and AA suggest an improvement in quality of life and decrease likelihood of usage (Abdollahi & Haghayegh, 2020).

Self Help Group setting can foster sense of belonging in client by forming fellowships with others dealing in the same realm (Emelogu et al., 2020)

Those who participated in a group were vastly more prominent in future roles of support for others' journey to sobriety (Emelogu et al., 2020).

Group Motivational Interviewing decreased days using alcohol, drinks per day, and binge drinking days (Santa Ana et al., 2021).

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Disadvantages

Diversity and Multiculturalism issues are prevalent to treatment

Racial and ethnic minorities can be at a disadvantage due to lack of culturally adapted meetings and treatment modalities (Zemore et al., 2021).

Referral to a 12-step program by provider is far less likely for black americans and latin-x than white americans due to their lack of regular access to primary care and mental health care (Zemore et al., 2021).

Any racial/ethnic disparity in mutual help groups denotes a possibility of health disparity for the ethnic/racial minority. Minority groups face unique barriers to group mutual help participation ex) racial discrimination (Zemore et al., 2021).

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Goals:

Decrease use of substances

Increase self-love

Objectives:

Client will recognize unhelpful thinking patterns

Client will increase positive thought patterns

Client will develop strategies to identify triggers, manage cravings, and cope with high-risk situations of relapse

Interventions:

Client will engage in motivational interviewing interventions in individual therapy sessions with provider

Client will engage in mindfulness meditation every day for at least 10 minutes

Client will engage in relapse prevention skills (at least three a day)

Therapist will provide copious psychoeducational materials to client at each session end

Client will complete interoceptive exposures once a week

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Individual therapy

Group Therapy

CBT

ACT

DBT

FFT

Level of Care: Residential Care Facility (we see at end of film this is the level of care she receives--side note)

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Ethnic minority

Low income

Low socioeconomic status

Lower income area---less access to care, services

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Training is impactful to your ability to help others. Clinical experience, certifications, etc. will allow you to delve into the realm you must operate in

Provide a non-judgmental atmosphere

Provide a comfortable setting

Involve the client's community (in patient's recovery they may need the entire community support)

Continually work to foster a working relationship with the client

Challenge your clients to get the most out of their treatment---the work won't do itself on either end of relationship

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This movie and specifically this character paint the picture of reality for many children growing up under a single parent system in the world. The weight a single parent must bare to raise a child especially with lower finances can truly push someone over the edge and lead them down the wrong path. Paula definitely felt the pressure and was influenced by her environment. Previous mental health disorders could have led her to use these negative coping mechanisms we see throughout the film

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Access to care is a huge problem when it comes to minority groups, especially when they are of lower economic status. Finding services and connecting clients that fall into this demographic is often done less frequently and with less necessity. In the case of Paula, finding community mental health centers, connecting her with healthcare coverage, and getting her to a facility to treat her needs should be of the same necessity as any other person. She will require low cost or pro bono services.

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"Courage isn't having the strength to go on- it is going on when you don't have the strength"

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"No matter what the situation, remind yourself, I have a choice to heal"

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Blackout: Remembering the Things I Drank to Forget

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Blackout: Remembering the Things I Drank to Forget [Hepola, Sarah] on Amazon.com. *FREE* shipping on qualifying offers. Blackout: Remembering the Things I Drank to Forget

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Kristen Johnston (Author) Format: Kindle Edition

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Guts: The Endless Follies and Tiny Triumphs of a Giant Disaster

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Amazon.com: Guts: The Endless Follies and Tiny Triumphs of a Giant Disaster eBook : Johnston, Kristen: Kindle Store

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Addiction Counselor: Everything You Need To Know

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Therapeutic Approaches to Support Addiction Recovery

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Abdollahi, S. & Haghayegh, S. (2020). Efficacy of group therapy based on 12-step approach of narcotics anonymous on self-control and quality of life in people with substance use disorder diagnosis during recovery. Practice in Clinical Psychology, 8, 17-26.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Emelogu, N. et al. (2020). The good, the bad, and recovery: Adolescents describe the advantages and disadvantages of alternative peer groups. Substance Abuse: Research and Treatment, 14.

Gorvine, M. et al. (2021). An Exploratory Study of the Acceptability and Feasibility of Yoga Among Women in Substance Use Disorder Recovery. The Journal of Alternative and Complementary Medicine, 27, 273-281.

Santa Ana, E. et al. (2021). Randomized controlled trial of group motivational interviewing for veterans with substance use disorders. Drug and Alcohol Dependence, 223.

Zemore, S. et al. (2021). Racial/Ethnic disparities in mutual help group participation for substance use problems. Alcohol Research, 41.

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Age-30-40s

Dis.- none

dev.- none

religion- not specified

e- black american

socio- low

sex- heterosexual

indig- not spec.

national origin- USA-miami

gender- female