Culture Shock: Personal Experience of Treating a Patient

My client Cesar Milan is a 22-year-old Hispanic male who has been in recovery for 9 months. Cesar was referred to me by his former therapist with a suspension he has relapsed. Cesar has a history of severe Alcohol Use Disorder and moderate Stimulant Use Disorder. Cesar also has a history of Post-Traumatic Stress Disorder (PTSD) from physical abuse as a child with distressing recollections and intrusive dreams from the trauma.

Cesar has demonstrated through outpatient therapy and AA meetings he has the ability to maintain a sober lifestyle.

Cesar has many strengths and resources to assist in his recovery.

Cesar has the support and engagement of his uncle to help him through recovery. Cesar has training as an automobile mechanic and dependable employment in that field.

Cesar was able to recognize his substance use problems. His beliefs and desires to keep his employment drove him to commit to treatment. Cesar also has a social network from members of his AA group to support and engage in his recovery. Cesar has risk factors that could negatively impart his recovery. Cesar still suffers from PTSD as a result of his childhood physical abuse. Cesar’s PTSD and trauma from abuse cold be a factor for his continued use.

Cesar’s girlfriend who also heavily uses drugs and alcohol has resisted treatment. Cesar is still in a relationship with his girlfriend, however they no longer reside together. Cesar’s association with his girlfriend could be a trigger for relapse. Cesar has a poor relationship with is parents due to prior abuse.

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The emotional trauma from this poor relationship could be a relapse trigger. Hispanic males are statistically more likely to abuse alcohol, marijuana, and cocaine according to the Substance Abuse and Mental Health Services Administration. Some underlying issues to explore is Cesar’s family history of alcohol abuse, culture shock issues he may have, along with his exposure to traumatic events. Some cultural issues that may have an effect on Cesar is a lack of Hispanic providers or providers who are culturally competent, have knowledge of cultural differences and awareness of values that are important to members of the Hispanic community.

Studies have shown Hispanic Americans tend to involve family members in health care decisions. With Cesar’s family dynamic this could be an underlying factor that needs further exploration. Cesar’s recovery management plan will focus on the principles of focused recovery, client empowerment, Destigmatization of the recovery experience, evidence-based interventions, integration of services, monitoring and support, and continual evaluation. My recommendation is for Cesar is an Intensive outpatient rehabilitation program, allowing him to continue to live at home during treatment.

My recommendation is a 90-day treatment, based on recovery progress treatment can be extended following ongoing evaluations. This treatment program will work toward Cesar’s goals. He will be evaluated for assessment of recovery support needs and attend individual counseling at least 3 days a week for 2-4 hours a day.

Treatment will include behavioral therapies: Contingency management therapy using positive reinforcement by providing rewards and privileges for compliant behavior such as remaining drug free, participating in counseling sessions as outlined in his goals/objectives. Cognitive behavioral therapy to prevent relapse by helping Cesar to understand triggers and consequences of drug use. Providing him with training to recognize situations or states of mind where he is most vulnerable to use. Focus on teaching coping skills when presented with the opportunity to use.

Motivational interviewing to enhance your self-motivation for change and recovery from addiction. Group counseling to offer social reinforcement with peer discussion and support 3 days weekly. Post intensive outpatient therapy will consist of weekly face to face meetings, updates from family (uncle) on Cesar’s progress.

Cesar will consent to random urinalysis 12-step meeting attendance with updates from sponsor. Cesar will be referred to a psychiatrist for issues related to PTSD with weekly monitoring reports. A post treatment relapse prevention plan will be written by Cesar to stay healthy and prevent urges for relapse to occur. This plan will identify Cesar’s stressor and his solutions to resist temptation when presented.

Suggested methods to this plan will include:

• sleep
• proper nutrition
• exercise
• yoga
• mindfulness meditation
• attend all therapy and counseling sessions
• attend support group and attend meetings regularly
• avoid people, places, or things that are tied to previous drug or alcohol use
• surround yourself with positive and supportive people
• keep the mind occupied
• continue creative endeavors