Liz

Liz is a thirty-nine-year-old mum to two children. Liz had been sexually abused by her father when she was nine. Her father then died when she was twelve. Liz told her mother when she was sixteen years old that her father had abused her. Liz’s mother did not believe her and said that she made the abuse up and now her father was dead he could not answer for himself. Liz and her mother have a strained relationship now. Liz drinks too much and this is now becoming a dependency upon alcohol which Liz is starting to realise. Liz’s partner left their home when her drinking became too much for him to deal with. Her mother says that she needs to just stop drinking and will be very critical of Liz telling her that she is not right in the head. Liz believes her mother and wonders now whether her memory of the abuse is correct.

Liz has been late picking up her children from primary school three times in the past half term, and on two occasions they have not had any packed lunches with them when they arrived for lessons.

• How might you seek to engage with Liz and her children?
• What sort of support might you offer? What might other services offer?
• What might a good outcome look like for Liz and her family?

Gemma and Tom

Gemma is a twenty-five-year-old who has just had her first child with her boyfriend Tom. Gemma’s baby boy tested positive for cocaine when he was born. Gemma and Tom had been together for some ten years and had misused many drugs during their teens along with criminal activity. Gemma’s history was one of parental drug use, alcohol misuse, domestic violence, and neglect. Gemma had not seen her father since age of fourteen when her mother left the family home with Gemma and her sister to move area due to domestic abuse. Both parents misused drugs and alcohol and Gemma’s father was a drug dealer with Gemma regularly witnessing drug-taking and drug deals. Gemma’s mum was aware of this behaviour but ignored it due to the domestic abuse that would take place if she challenged her husband.  Gemma had a younger sister who had mild learning difficulties which her parents had put down to her playing up but there are questions about whether her sister displays Foetal Alcohol Syndrome traits. Gemma was the parent to her sister and protected her along with making sure that she got to school on time.

Tom’s parents drank alcohol most nights which they normalised as something that every parent did. Tom’s parents were not there for him emotionally and he often felt that they did not care what he did. Tom’s parents were often hungover in the morning and he can remember having to get himself to school from an early age. Tom’s parents ran their own business and earnt good money. They would buy whatever Tom wanted but would then tell him that he was a needy child who was always wanting things.

When Tom and Gemma came together with their shared backgrounds of parental substance misuse they easily connected over normalised and learnt behaviours which led them to misuse drugs. Through teaching Tom and Gemma how their childhoods have affected them they were able to make the changes and become abstinent from drugs. The couple had not been aware that their traumas had affected them.

Given that Gemma’s baby has tested positive for cocaine:

• What concerns might you have for the baby?
• How might you explore these concerns with Gemma and Tom?
• What range of outcomes can you foresee for Gemma, Tom, and the baby?

Naomi

Naomi is twelve years old. She gets up in the morning and helps to get her sisters ready for school as Mum drinks too much alcohol and is still asleep. Naomi and her sisters are never late for school and Naomi has never told anyone about their mum’s drinking problem.

School start to notice that Naomi is quiet, often tired, and that her school uniform looks like it has not been washed recently. Naomi’s school performance has recently worsened, and homework is either not completed or poorly done. The school notices that Naomi’s sisters are showing the same behaviours and are guarded in what they say about home. Mum has never attended parents’ evening and does not engage with teachers when at the school gates which is not often as Naomi will walk her sister’s home.

Naomi worries about her mum constantly and knows that she is drinking wine as she finds the bottles in the bin or behind the sofa. Naomi has been told by mum to not tell anyone about her drinking or they will be removed into care and split up. Naomi worries that her mum will die.

Naomi’s mum Claire knows that her drinking has become more of a problem ever since her partner Greg left the home four months ago. Greg was not the father of the girls, the father left years ago when she started to drink too much. Claire knows that drinking every night is stopping her from getting up in the mornings to get the girls ready for school but does not know how to the break the cycle. Naomi is so good at being the little mum that Claire justifies her behaviour of drinking. Claire wants to get some help but is scared to tell anyone because social care might remove her children. Claire feels embarrassed to go to the local shop anymore to buy her wine as there have been comments said to her. So, Claire now has her alcohol delivered to the home. It is also costing her money she does not have. Claire was drinking a bottle of wine each day, but this has increased recently to two with her starting to open a third bottle.

• What are the risks to Naomi and her sisters?
• How might you work with Claire?
• In seeking to reduce the risk of harm to Naomi and her sisters, what are the priority areas of work likely to be?
• What sort of help and resources are the family likely to need?

Dual diagnosis – parents who misuse substances and have mental ill-health

A person who suffers from a mental health issue is more likely to drink alcohol or use drugs to self-medicate in order to relieve symptoms of depression, anxiety, insomnia, PTSD, personality disorders and trauma.

Craig

Craig was diagnosed some twenty years ago with Schizophrenia. He battles daily with the intrusive thoughts in his head for which he takes medication for. He managed to become abstinent from alcohol and Heroin ten years ago and was doing really well until a recent family death and before he knew it, he was drinking alcohol again. He says that alcohol stops the voices. Craig was afraid to carry his medication with him in case he was stopped by the police as he has a police record.

How would you help Craig and which issue would you focus on? Craig’s mental health or substance misuse?

Clare

Clare suffers from depression and has been diagnosed with PTSD from abuse throughout her life from childhood to recent years. Clare lost her mum when she was young and lived with her Auntie. Clare binge drinks when anniversaries arise of which there are many and where Clare’s focus can be. Clare has hoarding tendencies also and constantly says that she will sort the home out, but the depression stops her from doing this. Clare struggles to access services because she finds it difficult to leave the home.

How would you support Clare?

Laura

Laura suffers from anxiety and depression which becomes worse in the winter months. Laura will binge on alcohol and smoke Cannabis daily in order to cope with the depression. Laura is happy to cut down on her alcohol use but believes that the Cannabis is better at helping her depression than medication that she is prescribed.

What support would you give Laura?

George

George started to drink alcohol after his marriage fell apart. George slowly slipped into depression after his wife stated that the marriage fell apart due to him being Autistic. George had often thought that there was something wrong with himself but never looked into this further as he seemed to function okay. Georges drinking levels increased to him becoming alcohol dependant which he had not realised. George was now drinking daily which was making him more depressed. His GP told George to stop drinking as this would make his depression better. George had not been honest about how much he was drinking to the GP.

What support does George need?

Criminal Exploitation

Harry

Harry’s mother Diane had been a drug user since she was twelve starting on cannabis. Diane then went on to misuse other drugs which led her to be smoking heroin by age of eighteen. Diane then met her boyfriend Andrew who also misused drugs. Diane became pregnant with Harry who was born addicted to drugs. Harry is now twelve and lives with his mother and grandparents. Andrew and Diane lived together until Harry was six, but Diane then left with Harry who has since had no contact with his father. Diane is currently cutting down on her methadone and focuses on her recovery more than Harry; she expects her parents to look after Harry. The grandparents struggle with Harry and often leave him to his own devices. Harry gets into trouble at school and is often excluded due to his behaviour. Harry will often not go to school and hangs around the local park where he has made friends with some older boys, he thinks are cool because they smoke and drink cans of beer. These boys have asked Harry if he would like to join their gang where they do jobs sometimes for their friends. But Harry has to swear that he will not tell anyone, or they will get into trouble. They tell Harry that he will get paid if he does the job well. Harry is excited about being involved with this gang of boys and getting paid money.

What Harry does not realise is, he is going to be drug running and is being exploited. Harry starts to run errands after stealing a bike, so he can get around quickly. The gang give Harry a phone which makes him feel important. Harry gets paid some money which then turns to being paid in cannabis. Harry would prefer money, but the cannabis is okay – but his new friends then take it from him. Within weeks Harry is drug running and being controlled by the gang of drug dealers. Harry wants to stop but they have threatened him, so Harry decides to carry on for a few more weeks before he stops. No one at home notices that he is out all the time and Harry feels that they do not care anyway.

What steps might you take to start to help Harry?

Which agencies may need to be involved?

Which PDSCP resources might help here?

Who else may be at risk?

What will happen to Harry if he does not receive effective help now?

 

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