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Maria Santiago Case Study: Issues Related to Employment and Substance Abuse Teaching Module


Maria Santiago is a 63-year-old, single Latina, in recovery after 20 years of alcohol abuse. She works in discharge planning with patients her age or older who also suffer from alcohol dependency and attends college to become a substance abuse counselor. Sexual abuse by her stepfather with no protection from family members left her feeling unprotected, depressed, and with low self-esteem. She feels cultural acceptance of drinking in the home, as she was allowed to drink at an early age. She finally attended her first AA meeting, sought therapy, and has worked a 12-step program for more than 20 years. Five years into her recovery, she was diagnosed with HIV, which she contracted years earlier when drinking. She knows she will be going to AA meetings for the rest of her life. Her boss is aware of her health problems; others at her job are not. In her job as a discharge-planning assistant, she sees homeless alcoholics with no one to take care of them. She is more confident of her ability to resist drinking, as she no longer cares what people think of her.

Teaching Guide

Addresses hope of recovery at any age; connection between trauma and addiction in women suffering from shame; low self-esteem and depression; addiction as a potential asset when working in the addiction field; substance abuse and unhealthy relationships; how addiction impacts work, health, and family; impact of cultural beliefs and influence of cultural norms; role of shame preventing seeking of help; individual and societal factors supporting sobriety; distinguishing supportive people; role of 12-step programs; and workers' disclosure of substance abuse and HIV status plus confidentiality.

Classroom Activities and Assignments

Include researching cultural norms and mental health in ethnic populations; creation of genogram; discussion of workplace substance abuse issues; biopsychosocial and substance abuse assessment; role play; design of a substance abuse awareness and education program, including high-risk behaviors; addressing cultural groups among employees; literature review of differential risks for substance abuse of childhood sexual abuse survivors; etiology and treatment of substance abuse in women; exploration of factors associated with supportive long-term recovery and treatment; and suggestions for guest speakers. Has additional suggested supportive article.

Competencies for Maria Santiago Case Study:

  1. Integrate into the practice of social work an understanding of the life experiences and unique needs of older persons with substance abuse/misuse concerns who belong to specific racial, ethnic, and socioeconomic groups; of men and women; and of those with different sexual orientations.
  2. Incorporate into treatment and service planning the relationship of race, ethnicity, and culture on health status, health belief, help-seeking behaviors, health practice (i.e., traditional medicine), and health outcomes. Include knowledge of (a) immigration and (b) acculturation/assimilation.
  3. Develop strategies to change policies, regulations, and programs to improve the well-being of older persons with substance abuse/misuse concerns and their caregivers, particularly historically underserved groups.
  4. Conduct a comprehensive geriatric assessment of psychosocial factors that affect physical and mental well-being of older persons with substance abuse/misuse concerns.
  5. Identify ways to ascertain the health status and physical functioning (e.g., ADLs and IADLs) of the older person with substance abuse/misuse concerns in order to provide assistance.
  6. Conduct assessment and intervention strategies for substance/drug/alcohol abuse in later life.
  7. Understand the effects and interactions of multiple chronic conditions, medication, nutrition, and sudden or on-going causes of changes in cognitive states and functional capacity.
  8. Assess and address impacts of social and health care policies on practice with historically disadvantaged populations.
  9. Adapt organizational policies, procedures, and resources to facilitate the provision of services to diverse older persons with substance abuse/misuse concerns and their family caregivers. (a) Contribute to the development of policies covering work site inspections and safety regulations that would apply to special needs of elderly such as special provisions made for the handicapped. (b) Advocate for the development of new roles and new options in work settings for elders, such as specialist, consultant, part-time work, and flexibility in hours.
  10. Understand differential assessment and intervention strategies associated with early-onset and late-onset substance abuse.
  11. Be able to identify, locate, and appraise quality of empirical evidence supporting assessment and intervention in older persons with substance abuse/misuse problems.