• 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).

• grow excessively more withdrawn from reality and from her duties as a mother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

-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• more withdrawn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)

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)

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

• 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

• 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).

• 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).

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

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)

Low income

Low socioeconomic status

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

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.  

Dis.- none

dev.- none

religion- not specified

e- black american

socio- low

sex- heterosexual

indig- not spec.

national origin- USA-miami

gender- female