Assignment task:
Revisit your chosen case. Angela
Review the Dahlgren-Whitehead Model and pay close attention to the two outermost layers of the model: Living and Working Conditions as well as General Socio-Economic, Cultural and Environmental Conditions.
Consider how factors such as educational attainment, income, stress, violence, discrimination, and the state of the local economy could contribute to the development of a substance use disorder.
Submit a 2- to 3-page paper in which you:
1. Briefly introduce the individual featured in your chosen case.
2. Analyze the broader community and environmental factors that may have contributed to the development of a substance use disorder for the individual featured in your case. Need Online Tutoring?
Be sure to address factors associated with the two outer layers in the Dahlgren-Whitehead Model: Living and Working Conditions and General Socio-Economic, Cultural and Environmental Conditions.
Use the Learning Resources to support your Assignment. Make sure to provide APA citations and a reference list.
Transcript - Angela Peters
Client Background
Angela Peters is a 23-year-old White woman, who has been married to Michael Peters for two and a half years. The couple has one small child, Megan, aged 18 months. Michael is employed by a large government contractor. Much of Michael's work is classified and involves lengthy periods of international travel. Michael finds the travel exhausting, but the overtime pay from his international assignments allows the family to live in an elegant home in an upscale neighborhood.
Angela grew up in one of the poorest areas of California. Angela was an only child, and her parents were somewhat distant, as they were heavily preoccupied with work and financial concerns. Angela was a quiet child who rarely socialized with anyone besides her best friend Emily. Angela felt ashamed of her poor upbringing and generally tried to avoid attracting any attention. Emily grew up in the trailer next door to Angela's and was a kind and loyal friend. Neither of Angela's parents graduated from high school, and Angela herself left school after the 11th grade to work as a cleaner in a motel. She needed to help the family make ends meet after a car accident left Angela's mother with a permanent disability.
As time passed, Angela continued to work at the motel but also picked up a second job waitressing at a popular restaurant. Angela and Michael met at the restaurant in the fall of Michael's final year of graduate school. Michael and his friends were frequent customers who socialized for hours over many rounds of food and drink. Michael and his friends were a noisy, outgoing group and tended to flirt heavily with the waitstaff.
Over time, Michael began to refer to Angela as his "favorite waitress," as he was drawn to her shy smile and kind demeanor. Angela, in turn, was flattered by Michael's attention and was impressed by his work ethic and ambition. Michael began to ask Angela to come back to his apartment after her restaurant shifts and the two fell into a casual dating relationship.
One evening that winter, Michael arrived at the restaurant and found Angela serving a table of young men celebrating a birthday. Michael glowered as he watched Angela smile at her customers. Pulling her aside, he demanded to know why she was flirting with them. Angela stammered that she was only trying to be polite and do her job. "I want you all to myself, Ange," Michael replied. Angela was frightened by the rough way Michael grabbed her arm but was pleased that Michael wanted to date her exclusively.
The couple began to see one another more often and began to occasionally talk about the future of the relationship. Michael was due to graduate in May and had a job lined up in Washington D.C. Angela did not feel she could leave her parents and imagined that she and Michael might need to try a long-distance relationship. One day during a conversation about the future, Michael blurted out, "No! No, there's no way. I cannot handle you living here away from me. Marry me, Angela. Let's go to D.C. together. We'll send money back to your folks."
Angela and Michael threw together a small, last-minute wedding 2 weeks after Michael's graduation. Neither set of parents was enthusiastic about their rapid decision to marry. Angela's parents felt Michael had a "fast" lifestyle and "showy" attitude, and they worried that he seemed possessive. They were also dismayed to learn that Angela would be moving across the country. Michael's parents cautioned him that Angela was only out for a "get-rich-quick payout" and will "ruin" him. The only person in Michael's family who has been friendly to Angela is his sister, Susan.
The couple moved shortly after the wedding and settled into their new city. Angela found a part-time position at a local restaurant and sent money home regularly. Angela deeply missed being near Emily, but the two friends spoke nearly every evening. Michael adjusted to his new job and got a promotion after 5 months. Michael found his work incredibly stressful and felt lonely being away from his graduate school friends, but he told himself things would get better in time. Michael and Angela had fun attending cultural events and exploring the nightlife in their new city. However, Angela quickly became pregnant and her interest in going out sharply declined. After Michael was promoted at work, his supervisors sent him overseas for longer and longer stints. He found himself feeling anxious during these assignments and apprehensive about Angela's loyalty during his absences. When Michael returned from work trips, he would volley between bestowing affection on Angela and accusing her of infidelity. Angela gave birth to Megan during one of Michael's international assignments. Her parents were unable to travel due to her mother's fragile health but sent their best wishes. Emily flew in for a week to help Angela and cook her favorite meals. Angela's sister-in-law, Susan, came by to bring a baby gift and meet her new niece. Michael was working at a particularly remote international site with an unreliable cellular connection at the time of the birth. Most of the couple's video calls with the new baby were hampered by connectivity issues. When Michael finally returned home, he struggled to bond with baby Megan. He looked at Megan with a mix of awe and bewilderment and gruffly handed her to Angela any time she cried. Angela threw herself into her new role as a mother but found herself frequently feeling sad and hopeless. She found baby care incredibly consuming and often felt like she could not summon energy to eat or care for herself.
Angela began to notice that Michael's anger, jealousy, and suspicion were increasing. Whenever she actually felt up for an outing to shop or meet friends, Michael would first beg her not to go and then shout horrible insults at her and accuse her of seeing other men. On a few occasions, Michael got so upset that he slapped Angela. Afterward, Michael would apologize and insist that he didn't mean to say or do anything to hurt her.
"You know I love you, Ange, right? You know I'm just stressed? You know that I won't ever do that again?" Angela wanted to believe that these were isolated mistakes, and the outbursts were often followed by a period of tranquility in which Michael showed great tenderness and affection. She even wondered at times if maybe she deserved his hostility and aggression. However, these peaceful stretches never lasted, and Angela began to feel increasingly afraid for her and Megan's safety. On three occasions, the outbursts became so loud that neighbors noticed and called the police. Angela did not agree to file a police report.
When Megan turned 12 months, she learned to walk, and Michael seemed to feel slightly more comfortable around her, as she was now big enough to play games that he remembered enjoying as a child. Michael learned that Megan loved to knock down towers of blocks, and he patiently played blocks with her most evenings after work. Michael continued, however, to mourn the child-free life he and Angela used to have. He often said that things would never be the same and that Megan took all the attention and affection Angela used to bestow on him. He told Angela that he never wanted a child, that it "cramps my style" and that "it's hard to get used to all the crying and diapers."
Angela felt very alone. Her family had had only minimal contact with her since the wedding, and Michael's possessive ways had kept her from making many new friends. The only local person in whom she could sometimes confide was Michael's sister. Susan had come to visit the couple about once a month since Megan's birth, and it was Susan who introduced Angela to cocaine. She showed Angela how to snort it and gave her a stash to use between visits. Angela quickly realized that cocaine made her feel euphoric, energetic, and talkative. She would notice the high almost immediately after a single snort. And the effects would disappear quickly, so that Michael would not know.
Over time she began to use cocaine more frequently and could no longer imagine facing a day without it. She found that it made it easier to deal with the feelings of loneliness and worthlessness she experienced as she raised Megan and navigated Michael's explosive temper. Sometimes, she wondered if she was becoming addicted, as she was snorting increasingly larger amounts. Lately, she had even been leaving Megan home by herself in the crib when she needed to buy coke in between Susan's visits. She knew leaving Megan was not ideal, but she figured she was only gone for an hour at most, and she needed the cocaine to get by.
Present Functioning
On a Saturday morning, during the most recent altercation, Michael punched Angela in the face while she was holding Megan in the driveway of their home. Because she was high from just having snorted several lines of cocaine 15 minutes earlier, Angela fell to the ground with Megan still in her arms and hit her head, which began to bleed. This was observed by a neighbor, who called the police. The police talked to Michael- Angela could not really comprehend what was said-but did not arrest him. Angela and Megan were taken to the hospital, where both were examined and given drug tests. Because Angela tested positive and Megan showed a few signs of neglect, the hospital staff made a set of recommendations and contacted the local division of child protective services (CPS).
A social worker from CPS met with Angela and Megan at the hospital to assess
Megan's welfare and develop a safety plan. The CPS social worker told Angela that they do not automatically remove a child because a parent is experiencing a substance use disorder but that substance use can interfere with safe parenting. She highly recommended that Angela seek treatment for her cocaine use and provided Angela with referrals to several treatment programs, including an intensive outpatient program that included on-site childcare. She also provided Angela with a referral to an agency that supports victims of intimate partner violence. The CPS worker told Angela that she would meet with her again in a few weeks to see how she and Megan were doing.
Angela is overwhelmed. She feels lost and hopeless. She doesn't know what to do about her volatile relationship with Michael. She does not believe that she is a "hardcore addict," and she denies having a cocaine addiction. She feels embarrassed that CPS is investigating her parenting and deeply afraid that they might take Megan away from her.