Medical complications

There may be a need to further examine Frankie if he does not stop using fry or other substances.

The medical complications to the heart, kidneys, lungs, and brain would be worse if he has

HIV/AIDS or any other STDs. Because he has been on the streets, he probably has not seen a

doctor for anything until he ended up in the emergency room.

Case Study 2

Tina is a 29-year-old African American female. She has been using marijuana and alcohol since

she was a teenager and progressed to using cocaine by her early 20s. Tina reports snorting

cocaine for a couple of years when working as a dancer. She then discovered crack, which has

been her drug of choice for the last 6 years.

Tina has been in and out of jail several times over the past few years, usually on prostitution

charges. While in jail, she always tests for STDs and HIV/AIDS. She has repeatedly tested

positive for chlamydia and has received treatment numerous times. Despite the treatments for the

STD, she continues to test positive. During her most recent incarceration she was diagnosed with

pelvic inflammatory disease, had an abnormal Pap smear, and tested positive for HIV. Other than

being a little underweight she looks good and states that she feels fine with the exception of

some abdominal pain.

Tina is very excited about her "new life" with her boyfriend, by whom she has been trying to

become pregnant. Having HIV/AIDS does not seem to be a major concern for Tina because she

knows that there is medication out there for the disease. She reports that she was already getting

off drugs before the bust because she wants to get married and have a baby now that she's found

the right man. She reports her main support to be her boyfriend of 2 months. She does have a

couple of female friends but does not consider them close.

She has been court ordered to go to substance abuse treatment. She has made several treatment

attempts before and states she doesn't understand why she has to go to treatment now when she

was already planning to stop her drug use voluntarily. She is now being admitted to a 30-day

inpatient treatment program; otherwise, she faces going to jail for a minimum of 1 year.

Issues for the alcohol and drug abuse counselor

Relapse

This is the main area of concern. Tina has a long history of substance abuse. She reports little to

no social support for her recovery. The nature of crack addiction suggests that a 30-day inpatient

setting will "only be the beginning" of the treatment episode. The connection and consequences

of high-risk activities need to be discussed and risk-reduction practices demonstrated and

rehearsed. It appears that Tina is clearly in denial about her addiction and diseases and does not

understand treatment and recovery. This may be exhibited through her either becoming a

"compliant client" just to get along or a defiant, angry client because she doesn't think she needs