his body for drugs but claims that he only has sex with "nice businessmen types." Frankie is new
to the area and has been in town for about 9 months. He says his family does not approve of his
lifestyle, so they made him leave home. He is in phone contact with his sister occasionally but
only to let her know that he is "alive." Frankie lives in shelters and on the streets with other
homeless adults and youth.
Frankie decides to enroll in an outpatient program because he has been hassled by the police
lately and he went on a bad run using something called "fry" (marijuana soaked in formaldehyde,
then smoked). He ended up in the emergency psychiatric unit at the county hospital and the staff
there suggested that he seek some help. In addition, Frankie does know about HIV/AIDS and
STDs and is concerned about his sexual behavior.
Issues for the alcohol and drug abuse counselor
Referral and linkages
Frankie will need referrals for counseling and possibly testing for HIV and STDs if the facility
does not provide these services. Referrals and linkages can be obtained by getting Frankie's
written consent if the facility is communicating with another organization about services for its
clients. However, if an outside agency is providing services to the facility, then a Qualified
or Release of Information form will be required in order for the substance abuse treatment
facility to be compliant with confidentiality laws. Frankie will also need a risk assessment to help
him determine just what his risks are and risk-reduction counseling regardless of his decision
about any medical testing.
Special population/cultural competency
The fact that Frankie is gay could be a concern if the treatment facility has not dealt with
members of the gay population or has difficulty in dealing with this population. It will be
important that Frankie is assigned to a counselor who is nonjudgmental and has had some
experience with young gay men.
Relapse
With Frankie, it may not be an issue of relapse as much as getting Frankie to discontinue or cut
down his use. He is currently motivated for treatment but this "scare" may not last. A risk
reduction model may work best with Frankie as this appears to be his first attempt at treatment
and total abstinence may be unrealistic. This should be explored further with Frankie.
Denial/anger
Although Frankie may not have shown any of these emotions yet, they probably should be
explored with him (as well as others, such as depression, grief, loss) specifically as it relates to
his family and their treatment of him, as well as his having to survive on the streets.
