HOW TO CONDUCT AN ASSESSMENT INVOLVING SUBSTANCE ABUSE IN MIDDLE CHILDHOOD TO ADOLESCENCE EXAMPLE CASE STUDY

My Name: Susan Lancaster

Client Name: Michelle

Age Range: Middle Childhood to Adolescence

Description of Problem

Michelle was referred to me by a local agency due to being arrested for possession of heroin with intent to sell. While in custody, she was also drug tested and the results came back positive for heroin and marijuana, which added to her initial charges. Although, my client has not received any prior assistance for substance abuse, she is unwilling to enter a treatment program, even though it has been court mandated. She has also stated that she is not going to stop doing drugs and does not care what happens to her. My client then stated that she should just kill herself because it would be better than the life that she is living now.

With this in mind, one major problem that I would like to address in order to properly assist this client is how to reduce her current level of substance abuse. Two things that may be included in this process are the administration of a comprehensive substance abuse assessment test, along with possible implementation of a substance abuse treatment plan. A second major problem that I would like to address is how her social, biological, and psychosocial development may be negatively affecting her overall sense of self during two stages of growth. This is because she has stated that she does not care what happens to her and even threatened self-harm and/or suicide. However, in order to determine which specific treatment methods and overall plan may be required to suit her substance abuse and possible developmental needs, I would first need to acquire further information about her background history, cognitive development and current overall psychological state.

Background History

After meeting with Michelle for approximately 2 hours, she began feeling comfortable enough in my presents, to discuss some of the reasons that she may be experiencing a substance abuse problem. When I asked her why she was doing drugs, she stated that this began around the age of 11 (middle childhood) because she was exposed to marijuana within her home environment. According to Michelle, her parents were both regular users and there were many times when it was left on the kitchen table, or they would smoke it in front of her with their friends. At the time, she also tried to tell her parents that this was illegal and wrong but they said that her opinion didn’t matter because she was just a kid and to mind her own business.

According to my client, one day she had a friend spend the night, and they tried some of the marijuana that had been left on the kitchen table. Since, then she has become a regular smoker and believes that she is addicted to this drug. My client also stated that when she turned 12, she began hanging out with a new friend who sells heroin. According to her, this friend asked her to try this drug and also gave her some to sell. My client said that she wasn’t sure if she wanted to sell this drug and knew that it was wrong, but didn’t want to say no and lose her new friend. Michelle then stated that she also started having awful feelings about herself during this time because she didn’t feel like she was loved by her parents.

Since Michelle has experienced these issues during middle childhood, her cognitive, social, biological, and psychosocial development was also negatively affected. This may also be because according to Erikson’s psychosocial theory, “the combination of adult expectations and children’s drive toward mastery sets the stage for the psychological conflict of middle childhood, industry versus inferiority, which is resolved positively when children develop a sense of competence at useful skills and tasks” (Berk, 2009. p.330). This means that a child’s overall sense of self will develop in a positive manner, each time he or she successfully completes a useful skill and/or task. According to this theory, peer and adult social interactions during this stage, will also determine whether the child’s sense of self develops toward an industry or inferiority direction. This is because these social interactions affect specific aspects of the child’s individual development. These aspects are also as follows:

Self-Concept - children develop this mental impression of self, based on social comparisons that can include appearance, abilities and behaviors that others exhibit toward them. An example of how this may be affecting Michelle is due to her poor relationship with her parents. This is because if she doesn’t feel excepted or loved, it may have left her with feelings of (inferiority).

Pride In Accomplishment - This is when a child will gain a sense of inner pride because he or she successfully completed a task and/or possesses a certain skill. However, this sense of pride may be undeveloped or never gained, if the child can’t successfully complete a certain task or does not possess a specific skill. Michelle might not feel this sense of accomplishment (industry) because her parents may never praise her for skills that she does develop (inferiority).

Moral Responsibility - This is determined by how a child is able to develop and choose to practice the difference between right and wrong. Michelle may not have developed (industry) because her parents choose drugs even when she has asked them to stop. Therefore, she may not be able to comprehend the difference between right and wrong, so she has developed inferiority.

Cooperative Participation - This sense of accomplishment occurs when a child feels good about being involved and offers individual contributions in a social situation. Michelle has made it clear that she is unable to work and accomplish certain tasks with her parents. They don’t listen to her in order to initiate positive changes (industry) and just ignore her desire to help them improve the overall family environment. Therefore, she may feel a sense of inferiority due the lack of power that is needed to initiate a better family life.

Current State

I also asked my client if she is trying to deal with or reduce her level of substance abuse on her own and she stated that she is not, because the drugs are everywhere. She feels like when she is at home, there will always be marijuana available. Her parents have also recently stated that since she turned 13, they will allow her to smoke it whenever she wants to. They are also aware of the fact that she has been selling heroin but feel like they’re too overwhelmed with personal issues to really focus on her problems. Michelle then stated that she feels bad for causing legal issues but at the same time, the ongoing poor relationship with her parents has made her feel like drugs are her only mental release and that her friend who sells heroin, is the only person who really cares about her. She has also stated that she recently started thinking about suicide a lot because she doesn’t want to live this life, if she won’t have parents who love her.

After listening to everything that my client has said, I’m am convinced that she not only suffered from abnormal development during middle age but is starting to process skewed cognitive thinking that is associated with the start of adolescence as well. According to (Dahl. 2004), it is essential, “not only to deepen our understanding of specific neurobiological changes during adolescent development, but also to broaden our knowledge of how behavioral, familial, and social influence interact, in multifaceted ways, with the development of the biological systems of interest” (p. 2). While, (Walker., Stephens., Neighbors., Rodriguez & Roffman. 2011), believe that “this is time in which individuals are particularly likely to engage in health-risk behaviors, with marijuana being the most prevalent illicit drug used. Perceptions of others' use (i.e., norms) have previously been found to be related to increased marijuana use. Additionally, low refusal self-efficacy has been associated with increased marijuana consumption” (p. 727). Not only can these things occur during this stage but (Esposito-Smythers, Kahler, Spirito, Hunt & Monti. 2011), believe that “alcohol and other drug use disorders (AOD) and suicidal behavior commonly co-occur among adolescent clinical populations” (p.728).

With this in mind, I believe that my client is using drugs because her social, biological, and psychosocial development has prevented her from developing a normal level of cognitive thinking. Therefore, I am confident that her level of substance abuse may be reduced if her negative sense of self can be increased via a proper treatment plan.

Suggested Interventions

In order to successfully treat these factors, I would implement intervention methods that may initiate growth with Michelle’s overall social, biological, and psychosocial development. Therefore, the first thing that should be addressed is my client’s claims of possible child neglect and/or endangerment which also may be causing her drug use. I believe this because according to (Shelton & Van Den Bree. 2010), “children from homes characterized by poor family functioning are at increased risk of drug initiation and drug use" (Hawkins, Catalano, & Miller, 1992). Parent-to-child hostility and an absence of warmth are associated with increased cigarette and alcohol use (Brody & Forehand, 1993; Melby, Conger, Conger, & Lorenz, 1993; Shelton et al., 2008). Substance use is argued to offer a means of coping with poor family functioning, but may also reflect increased affiliation with peers (who may themselves experiment with and use substances) to gain social support and a sense of belonging (Brody & Forehand, 1993; Melby et al., 1993). Parent–child relationships that are nonsupportive or characterized by conflict can also undermine adolescents’ ability to regulate their behavior in a goal-oriented way, with self-regulation linked to levels of alcohol use.

In order to address this issue in a professional manner, I would have to follow any ethical codes that concern the welfare of a child. Therefore, since this child’s cognitive development may be affected due to a lack of adequate parental care I would make a referral to Child Protective Services. This way, my client’s home environment would be investigated by proper authorities. The second thing that I would do is offer treatment that may decrease my client’s feelings of inferiority which may have occurred during middle childhood. This could be accomplished by having her parents referred to classes, which may teach them better skills to increase Michelle’s overall sense of self. Some techniques that may develop a positive sense of self involve offering the child continuous encouragement, praise, warmth, and love. 

When researching Piaget’s cognitive development theory, he believed that there are also several cognitive changes that occur during adolescence. One specific change concerns how they think about the relation between self and others, which is called imaginary audience. During this time, adolescents start to believe that they are the focus of everyone’s attention and overall concern in life. As a result, they will also become extremely self-conscious. A second change during the adolescent stage of development is called personal fable. This is when they become convinced that others are continuously thinking and observing them. During this time of overgrown perspective thinking, adolescents will also develop an inflated opinion of themselves because they think they are uniquely special. It’s like the world can’t touch them kind of thinking. When adolescents experience imaginary audience and personal fable, it can also affect their overall problem solving strategies and predictions of consequences.

Since, my client has reached adolescence and therefore, may be experiencing imaginary audience and personal fable I would offer her personalized treatment for this via weekly therapy sessions. I could also accomplish this by teaching her that she can be who she really is because others are not completely focused and/or concentrated on her. It’s also okay to have acne or other things that may cause insecurity because we all go through this stage and have these feelings from time to time. I would also be sure to address any specific concerns that may cause her reduced levels of self-confidence and self-worth. If I was going to educate my client about personal fable, I would show her videos about teens that died from overdosing on drugs, like heroine. I’m also confident that over time, Michelle may begin to change her cognitive development because she would start to understand that this risky behavior has real-life negative consequences.

A third thing that I would do to help my client reduce her urge to use drugs is refer her to a teen based substance abuse treatment program. This way she would be able to recovery with peers who are experiencing the same issue, while also building a strong support system.

Conclusion

Michelle is a 13 year old female who was referred to me by a local agency after a recent drug arrest. She also tested positive for heroin and marijuana. Although, she hasn’t received any prior treatment for substance abuse, she is unwilling to enter a court mandated treatment program. My client has stated that she won’t stop doing drugs and has no concern about what may happen. She also stated that she would rather kill herself then live the life she has now.

Therefore, one main goal of treatment would be to implement a plan that may reduce her current level of substance abuse. While, a second major problem that I would address is how her social, biological, and psychosocial development may have caused issues with her heightened level of inferiority. This distorted way of thinking may have also begun in middle childhood due to negative home and parental factors. Some of these include drug use by parents and their refusal to work with her to improve the overall family setting. They seem to also lack the ability to offer regular love and respect, which is needed to build a healthy parent/child relationship.

Currently, my client is also exhibiting developmental issues that may be associated with the onset of adolescence, which include a negative sense of self, risky behavior and thoughts of suicide. Some of these symptoms may also be associated with an unhealthy home environment, and due to peer pressures to fit in with friends who abuse and sell drugs. Therefore, I would address all of these issues by contacting CPS to investigate her home environment, recommending parenting classes, offering weekly therapy sessions via my office and referring her to a teen based substance abuse treatment program. Once all of these things are implemented, I am confident that this may reduce my client’s current level of substance abuse, while also developing a more positive sense of self.

 References:

L.E. Berk. (2010). Development through the lifespan. Boston, Massachusetts. Allyn & Bacon.

Dahl, R.E. (2004). Adolescent brain development: A period of vulnerabilities and opportunities. Annals of New York Academy of Sciences, 1021, 1-22. Retrieved on June 15 2012 via the Kaplan Library.

Psychology of Addictive Behaviors: Social Norms and Self-Efficacy Among Heavy Using Adolescent Marijuana Smokers. Walker, Denise D., Neighbors, Clayton, Rodriguez, Lindsey M., Stephens, Robert S., Roffman, Roger A. (2011) Vol. 25, No. 4, 727–732. Retrieved on June 17 2012 via the Kaplan Library.

Journal of Consulting & Clinical Psychology: Treatment of Co-Occurring Substance Abuse and Suicidality Among Adolescents: A Randomized Trial. Esposito-Smythers, C., Kahler, W, C., Spirito, A., Hunt, J., Monti, P.  (2011). Vol. 79, No. 6, 728–739. Retrieved on June 17 2012 via the Kaplan Library. 

Journal of Research on Adolescence: The Moderating Effects of Pubertal Timing on the Longitudinal Associations Between Parent–Child Relationship Quality and Adolescent Substance Use. Shelton, H. K., Van Den Bree, B, M. (2010). Vol. 20 No. 4, 1044-1064. Retrieved on June 18 2012 via the Kaplan Library.