Choose only ONE Case Study:
1. Andrew 30 years
Andrew has been released from an 18 month prison sentence following offences of deception and domestic violence. His own account of his childhood describes heavy drinking parents with considerable domestic violence. He was in trouble at school in his early teens, fighting and truanting and he effectively left school aged 15. He had a brief work experience placement under a government scheme, but does not have a work record.
By his own account he had begun using various drugs and alcohol before leaving school. He has a substantial record of convictions mostly for pub/street violence, thefts and deception. He has a conviction of assaulting the 14 year old son of his then partner by striking him with a torch, some 8 years ago. At the time it was suggested his use of alcohol and very heavy use of amphetamines (injected) were the main factors in this offence. He now portrays it as his anger at discovering the boy had sexually assaulted the younger daughter of the family.
Since the offence against his step son he has undergone ‘anger management’ group work, reduced his drinking to acceptable levels and has demonstrated what appears to be genuine remorse. He has separated from the partner of the time but does still have occasional contact with his step son and daughter when they request it (they are both now over 18years).
His most recent offences occurred whilst he was squatting with a partner. They both were injecting amphetamines and getting banking details from dustbins and then using these to order goods from catalogues. They were both homeless, using drugs and he had become violent and paranoid. He claims he had tried to get work. The local authority were refusing to offer housing help as they claimed he had rent arrears from 2 years previously. He states he was in prison at the time and so should not be held liable.
On release from prison he moved in with his mother. This is a one bed roomed flat in an old people’s complex and not really suitable. The local authority continues to maintain they will not offer housing help until Andrew begins to pay back rent arrears. You have received a call from Andrews’s sister who wants the call to remain confidential but she tells you Andrew has started drinking excessively and is in effect bullying the whole family including his mother.
2. Afzal 18 years
Afzal is a third generation British Muslim. He is due to be sentenced at magistrate court for 8 offences of theft (shop-lifting), possession of heroin and failing to answer bail. Pre-sentence enquiries have revealed that he has been injecting heroin daily for at least 6 months and has begun to smoke ‘crack’ cocaine. His mother has refused to have him home after a long period of him stealing from her (she has not reported this to the police), and older siblings have also refused to help him as they feel his behaviour has affected their social standing. Afzal did not do well at school and left at 16 years with no qualifications, however he appears particularly intelligent. He believes that his poor achievement at school was due to him attending a ‘failing’ school, on a rundown estate. He has no significant hopes for his future but does appear to be motivated to address his drug problem as the exclusion from family is making him depressed. He has been living temporarily with acquaintances on his estate that he knows through the drug trade, and this has led to difficulties in contacting him which partly explains his failure to attend court. Whilst he has not been charged with supply offences it has become apparent that he has begun to be involved in low level supply in order to supplement his own use. He has previous convictions for theft (shoplifting) and driving without a licence. The court has indicated that it would be willing to consider a non-custodial sentence.
3. Robert 32 years
Robert is coming towards the end of a four year prison sentence for a number of household burglaries.
His parents separated when he was 10. He does not speak about his father. His mother remarried when he was 14 and he regards his step father as supportive. He did well at school and studied surveying at college. He had been employed in this trade for 2 years before he began using heroin. His heroin use quickly escalated and he lost his employment and gave up playing rugby, which he had played to a good standard.
He was first sentenced to imprisonment (2years) when he was 24 years old. When released from prison he gave the impression that he was determined not to use heroin again and that he would restart his career. His probation officer accepted this view and supervision was based largely on boosting his motivation. He relapsed within 6 months whilst he was still on Probation supervision following release from prison and was sentenced to 3 ½ years imprisonment for new multiple burglaries of homes.
During his second prison sentence he accessed a drug programme (12 step model) and successfully completed it. He is an intelligent man and following the experience of his first release felt he should have significant support on release. He showed considerable motivation and secured a place in a residential rehabilitation hostel using the same model. He stayed at the hostel for 6 months but was eventually asked to leave for the accumulation of minor indiscretions (use of alcohol, inappropriate relations with another resident, possession of pornography (legal)). He returned to his home area and continued to appear to comply with probation supervision. Again he relapsed and began using heroin and received his present sentence for burglaries of dwelling houses.
Again he has secured a place on a prison based drug programme (12 step) and suggests that his last relapse was due to arrogance in that whilst he was doing well he felt able to take heroin occasionally as a ‘reward’. He is again due for release and feels that he is now in a position to succeed in being drug free. During discussions about release plans he has disclosed for the first time that he was a victim of sexual abuse whilst a child but declines to discuss it.
Robert has never been violent during any of his offences.
4. Steven 28 years
Steven is on probation for assaulting a man at a bus stop. He was drunk at the time and it was raining. The victim was sheltering in the on-street doorway of Steven’s home. Steven interpreted this as the man attempting to break in but now accepts that his drunkenness led him to misinterpret the situation. He has a record of convictions for similar behaviour, largely represented by ‘pub fights’.
He is one of a large family who all drink very heavily. He also is part of a social and working group who all drink to excess. He has skills as a roofer and is generally in work. His social pattern is to go to the pub each day straight after work, and at weekends he drinks continuously.
He lives with his partner and 12 year old son. He has no convictions of domestic violence but he has acknowledged that at times he is violent to his partner. He insists he has never been violent to his son, which his partner confirms. He complains that he has back pains but puts this down to his work.
He has become aware that his behaviour is getting worse and he fears the loss of his relationship. He is motivated to change his drinking behaviour but feels it is impossible to achieve due to the influence of his social circle.
Learning Outcomes that need to be met:
1. Demonstrate a critical knowledge and understanding of a range of theories and explanations of substance misuse
• Briefly describe a range of theoretical explanations for substance misuse and addiction including biological, psychological and social models
• Consider and assess the advantages and disadvantages of these theories for accounting for substance misuse when applied to the case study of your choice
• Critically compare and contrast the range of theories in relation to each other considering the individual, social and political implications of each theory.
• Consider more than one theory of addiction and compare and contrast these in relation to the case study
• Consider the social and political implications of each theory- do they have any implications for the types of treatments for addiction that are offered?
• Be clear not to confuse theories of drug taking with theories of addiction. There is some overlap however often the theories differ. You may wish to consider both however if so, state clearly which you are referring to.
• If you are constrained by the word allowance, in relation to the above, consider theories of addiction rather than theories of drug taking
2. Demonstrate an understanding of contemporary approaches to and debates about working with substance misusers and of resources available in addressing substance misuse.
• Describe a range of treatment options in relations to the main issues highlighted within the chosen case study
• Critically appraise the value including strengths and weaknesses of the treatment options highlighted
• Consider key areas from your learning including current legislation and policy, a range of therapy options, statutory and non-statutory service provision
• Marks will be awarded for complexity and critical rigour within your approach to treatment options.
• Consider the social political and financial implications of things such as enforced treatment for example.
• Likewise what are the implications of residential or community based treatments? You could also consider the debates around harm minimisations versus total abstinence, and some of the international comparisons and examples.
3. Formulate an assessment and intervention strategy based on a case scenario.
• Choose a case scenario from the list of examples
• Identify the key issues within the case scenario when considering treatment needs and options.
• Demonstrate an ability to critically apply the theories of substance misuse and treatment options to the case scenario of your choice.
• There is a large amount of material to consider and therefore structuring and organising your work is essential.
• Identify the significant issues within the case scenario that you have chosen from the examples and consider these systematically, discussing and debating each issue in turn.
• You may wish to identify the addiction cited within your chosen scenario and consider the theories of addiction here, before considering the range of treatment options.
• You may wish to consider the key issues for treatment against the areas identified by the National Treatment Agency (NTA 2006) for monitoring progress. These are as follows: • Drug and alcohol use (and detox options) • Physical and psychological health • Criminal involvement and offending • Social functioning