You are given a case study. You must support your discussion by providing evidence-based research on the assessment, diagnosis and treatment of substance use and co-occurring disorders in direct and specific context to the case as written.

Your case study must include the following:

Assessment from a biopsychosocial and sociocultural perspective

Legal and ethical issues

Sensitivity to stigma and marginalization

Provisional diagnosis of substance related and co-occurring disorders using the DSM-5 criteria

Adolescent substance abuse 

Prenatal substance abuse

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Recovery and resilience based treatment plan based on evidence-based research

1. Referrals, coordination of care and case consultation
2. Relapse prevention plan to include community resources, individual and/or family counseling
3. Select a minimum of eight (8) current (5 years or less) research articles taken from scholarly journals (online or hard copy) to support your work.
   The course text or other course texts, are not considered research. You may use and reference the text occasionally, but please remember that this is a research-based paper. The majority of your supportive citations must come from current, scholarly, professional research journals based on evidence-based assessment, diagnosis and treatment of substance use and comorbid disorders.

The Case of Rosa
      Rosa is a 32-year-old Latina who is seeking treatment for increasing difficulty coping with daily life.  She describes having little pleasure in life and feeling tired all of the time.  Rosa works as an administrative assistant at a local human services program, and she reports the struggle to stand up for herself to her boss is a constant stressor in her life.  Though she is uneasy discussing the matter, Rosa disclosed that her frustration has led to her drinking again shortly after celebrating her 6-month sobriety anniversary.   Since resuming drinking, Rosa reports experiencing intense feelings of worthlessness, sadness, and guilt.  She expressed that she is now having problems sleeping, and often has nightmares.  Rosa says most days she feels quite hopeless about the direction of her life, and she is anxious about her ability to continue with the current state of affairs.

During her initial clinical interview, Rosa reported a troubled family life and history.  She indicated she is the youngest of her parents four children, and the only girl in the family.  Rosa indicates she is not close to her brothers, who she explained have been in and out of jail for a variety of drug related criminal offenses.  Rosa’s mother, Belinda, is a strong support figure in her life, and continues to guide her through varying challenges.  Rosa divulged that her father, who is now deceased, began sexually molesting her when she was 13 years old.  He threatened to harm her if she told anyone, and she was afraid of him from that moment forward.  Unable to cope with her trauma, Rosa said she began sneaking liquor out of her parents’ bedroom when they were not home, and drinking it until she felt “warm and numb.”  When she became a sophomore in high school, Rosa stated she began to dabble with rock cocaine (crack) when a friend bragged how amazing he felt when he was high on it.  Rosa described feeling exhilarated and invincible when she used the drug, but the high never last long, so she continued to drink alcohol as well.  She described having a weakness for the combination for these two drugs throughout much of her adult life, especially when she is stressed or receives bad news.  Rosa reported she recently “smoked a few rocks” when her boss got very upset with her for not finishing the office payroll on time.  She says she is drinking daily again, but hopes to begin attending AA/NA regularly, which she had been doing up until about a month ago.  For last few weeks, Rosa has avoided phone calls and emails from her sponsor, Cheryl, who has been trying to get her to recommit to her recovery and sobriety.

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As her initial clinical interview drew to conclusion, Rosa began to speak of her 14-year-old daughter, Christina. Diagnosis and Treatment of Substance Use  Rosa says her sense of sadness and guilt with her current life has much to do with what she says are her parenting failures.  She says her substance abuse and poor lifestyle decisions has contributed to harming Christina, who was born with Fetal Alcohol Syndrome (FAS).   She expresses guilt and remorse that Christina’s emotional, academic and social difficulties are a result of FAS, and are her fault since she drank while pregnant with her.  Rosa was married briefly to Christina’s father, an alcoholic, when she was 18. Rosa divorced and left him after he became physically/sexually abusive towards her. Christina was 18-months old at this time.  She has had no contact with Christina’s father for many years now, but feels the lack of a father in Christina’s life has had a negative effect on her development.  Rosa has begun to suspect that her daughter may be drinking and using drugs and is sexually active. She dreads the thought that her teen daughter may be pregnant.    Rosa recalled her difficulties as a teen mother, and wants a different life for Christina.  Rosa reports recurring thoughts at nighttime about her being an unfit mother, and recently she has started to consider whether she should give full custody rights to Christina’s grandmother, Belinda.