Clinical Social Work

CSW1- Final Paper: Client Analysis

Rutgers

Twana Barrett

Part 1: Client Information

My internship is at Integrity House Inc. (Secaucus), the mission: Integrity House is committed to helping individuals and families through an effective and measurable system of comprehensive therapeutic community addictions treatment and recovery support in a way that brings about positive, long-term lifestyle change.  The Therapeutic Community Model is based on an intensive structured model to modify the behavior of adults using illicit substances.  I am assigned to one of the long term men residential houses (B-House).  Integrity services clients dealing with substance abuse issues who are affiliated with drug court, parole/probation, volunteer and federal.  Integrity House is a structured facility that assist clients with behavioral change by utilizing individual and group (didactic) counseling sessions, Integrity assist the clients to be productive members of society.  Integrity House Secaucus is located on the land that used to occupy the Hudson County Hospital for the Insane.

For this paper my client will be addressed as Juan.  Juan is a 38 year old unemployed, Puerto Rican heterosexual male who was a member of the Latin Kings.  Juan is in treatment at Integrity for heroin dependence.  Juan was stipulated to attend this program from drug court.  Juan stated that he migrated to Florida from Puerto Rico when he was 13 years old and never felt accepted by others.  Juan stated that he started using marijuana as a coping mechanism to fit in with others at the age of 15.  Juan also stated he had a good relationship with his mother and siblings, his relationship with his fathered was tarnished because of alcoholism.  Juan stated he didn’t make friends in his neighborhood, which caused him to be lonely and isolated.  Juan stated he saw the close connection the Latin Kings had in his community and regardless of them being a gang he wanted to feel that closeness with people outside of his family circle.  The gang members smoked marijuana and drank, Juan partook in these activities because he thought it would bring him closer to the Latin Kings.  Juan realized at the age of 19, after experimenting with heroin, that marijuana wasn’t his ultimate high and he enjoyed the high and feeling of heroin.  Juan stated eventually snorting heroin wasn’t satisfying and someone introduced him to using a needle and it was a quicker high.  Juan stated he realized that using needles was a more expensive high and he had to do illegal activities to maintain his addiction.  Juan stated that he was incarcerated 5 times for robbery and was locked up for a total of 3 years for these crimes.  In between the times of incarceration Juan stated he attended 2 drug programs in Florida which led him to have a total of 8 months of clean time, however he relapsed after each time.  Juan met a young lady that was in recovery and they started a relationship.  After being with this young lady before a year, Juan realized he had 7 months clean time.  Juan would accompany this young lady to NA meetings.  Juan got into trouble in Florida and relocated to New York with his girlfriend, at this time Juan’s girlfriend was 4 months pregnant.  Juan got into more trouble in New Jersey and was stipulated to Integrity House by drug court.  While in integrity Juan learned his girlfriend was shooting heroin while pregnant with his son in New York.  Juan’s girlfriend gave birth while he was in Integrity House and the baby had heroin in his system.  Juan’s girlfriend was placed in a detox and the maybe went to foster care.  The presenting problem is Juan wants to become negative for illicit substances to get custody of his son.

Juan is a Puerto Rican male and having this background he has experienced internalized oppression.  Internalized oppression is having external racism and/or discrimination and you develop negative behaviors, drugs, unemployment, gangs, abuse, and illness, as a result of the oppression.  As a Puerto Rican male family and support is a very important aspect of their culture.   Juan culture dictates that he should be family oriented.  Juan’s family moved to the USA while Juan was young, Juan acculturated the negative ways of his new environment.  Juan’s culture is not accepted by the dominant race in the USA, therefore it can cause oppression, racism and prejudice.

Although Puerto Ricans are U.S. citizens, on arrival many are still foreign in language and culture and have to navigate unfamiliar, oppressive environments. Some of their cultural elements, including family values, gender role ascriptions, and beliefs about mental health, are rooted in their Hispanic heritage and contrast with those of mainstream society. Thus, they face the possibility of undergoing acculturation. At the same time, because of the circulatory nature of their migration, some elements of the Puerto Rican culture remain vibrant, and they face a challenging and distinctive acculturation experience. (Ramos, 2005)

Juan, as a teenager, started to pull away from his family support system to adopt the behaviors of his new environment.  Juan stated he developed low self-esteem because he didn’t have any friends in the Florida to assist him with his change of environment.  Juan decided to join a gang against his family beliefs.  Society believes Latino males are part of gangs.  

In a sample of middle school Latino boys (in the sixth and seventh grade) in metropolitan Miami they found that, although foreign-born immigrants experienced more overall acculturative stress, this stress had a greater negative impact on self-esteem for U.S.-born youth. U.S.-born boys reported more discrimination, while language conflict was more prominent among first-generation youth. The detrimental effects of acculturative stress were strongest for U.S.-born youth who were not highly acculturated to U.S. society. (Barrett, Kuperminc, & Lewis, 2013)

While in the gang Juan started using drugs.  Juan stated he started using drugs to fit in with his new group of friends and help deal with the issues and problems.  Juan didn’t understand the issues that could arise from his drug usage.

Research examining the relationship between mental health and substance abuse has documented that mental health problems, both internalizing and externalizing, may have an effect on substance use for Hispanic adolescents and adults (Buchanan & Smokowski, 2009; Chisolm, Mulatu, & Brown, 2009). For Hispanic adolescents, this pathway may work through acculturation stressors, impacting mental health and leading to substance use (Buchanan & Smokowski, 2009). Karch, Barker, and Strine (2006) found bipolar I disorder is a significant predictor of incident drug abuse, and panic disorder is a significant predictor of incident drug dependence. These researchers also found Hispanics with a substance abuse problem are the racial/ethnic group least likely to be diagnosed with a mental illness or to have received treatment, even though family reports of depression among Hispanics are comparable to other racial/ethnic groups. (Gonzalez-Guarda, Florom-Smith, & Thomas, 2011)