Suzanne has come by the free “drop-in” counseling clinic where you work to get some information and advice. Suzanne is a 22-year-old single woman who has been living with her boyfriend Jack in Manhattan’s lower east side for the last four years. She and Jack have been heroin addicts for as many years.

When Suzanne was 10 years old, her father, whom she says was a very heavy drinker, left her mom and the kids and never came back. At 14 she started drinking and smoking marijuana. At 16 she had dropped out of high school and at 18 she moved in with Jack. He introduced her to heroin. She reports using about a 1/2 gram of heroin per day just to be able to function and feel comfortable. In order to pay for the heroin and pay the rent on their apartment, Jack doesn’t work, instead, she works the streets at night. She usually drinks four or five beers each night before going out to work. If she can’t score enough heroin, she will try to score either some Valium or Klonopin to “tide me over until I can get some ‘horse’”. She says she has tried cocaine but, “I really didn’t care for the high all that much.” Suzanne tells you that the alcohol and heroin help to calm her nerves and get her through the night. She and Jack are not having sex all that much. When they do make love he never wears a condom. He says that’s what makes him different from her “john’s.” “Which is true because I won’t work without a condom.” Lately she has noticed that her breasts have become swollen and more tender. She also hasn’t had her period in the last 12 weeks. She is pretty sure she is pregnant and knows it’s her boyfriend’s baby. However she not sure she can stop using dope or work to have the baby even though Jack wants her to keep it. She really is confused at what she should do and is asking for you to help her make some decisions. Her friend who works with her at night told her not to stop using dope if she is pregnant “Because it’s worse for the baby than to keep using.”  “I just don’t know what I should do?”

This complex situation would provide a counselor with a variety of challenging issues to work through with Suzanne. Many different factors and influences are in play simultaneously. Helping her work through this situation requires consideration of a multitude of factors.  When looking over Suzanne’s case the drugs that she seems to be the most addicted to tends to be heroin and alcohol. Although it may seem counterintuitive because alcohol is legally available and heroin is not, withdrawal from alcohol may actually pose a greater danger. Our textbook states, “Opiate withdrawal is miserable, but not life threatening” (unlike alcohol withdrawal). This would depend on the degree of her dependence on alcohol.  Alcohol withdrawal can range from irritability to a serious syndrome called delirium tremens. This syndrome is characterized by a sudden and severe change in mental status, seizures, and includes the possibility of death. This does not mean that Suzanne’s heroin problem is not as bad as her drinking, both can cause serious harm to the Suzanne and the baby. There are a wide variety of apparent dangers in this case study. Addiction and substance abuse can cause significant physical and mental health damage depending on a variety of factors, physical safety of the client, complications during and after pregnancy, possible future legal issues stemming from her drug use and prostitution. Heavy drinking, drug use, mixing drugs, for example opioids and depressants (alcohol), the risk of possible overdose from Heroin, prostitution, withdrawal, transmittable diseases (both sexually transmitted and from drug use), physical safety in jeopardy based on who she associates with, unresolved/unidentified mental health issues caused by previous traumas All pose dangers to Suzanne. While the baby is very important to this case study Suzanne should be the first priority, the baby cannot live without Suzanne at this point in time so our primary focus should be making sure that Suzanne is living a healthy and safe life. There are many dangers for the could be at this stage, this is because the baby cannot live without Suzanne at this point in time. Some of the risk are the mothers heavy drinking leading to Fetal Alcohol Syndrome, mothers drug use leading to Neonatal Abstinence Syndrome, Mother’s prostitution/drug use exposing the unborn child to a variety of diseases and infections, Mother’s possible withdrawal symptoms leading to prenatal harm, poor nutrition and a lack of appropriate prenatal care could lead to a variety of developmental delays and many other adverse health outcomes. For example, the baby could be born with Spina bifida from low folic acid intake during pregnancy. I would give Suzanne many different treatment options as for herself and the baby’s sake she needs to get healthy and sober. I would recommend she goes to somewhere that offers no-cost/low-cost reproductive healthcare to make sure she is actually pregnant first. It is possible that her Heroin use is causing some of the issues that are making her believe she is pregnant.   I would refer her to a rehab program, specifically one that offers medication-assisted treatment. I would also make sure that my recommendations for the rehab program accept pregnant women.  I would recommend a full-time counselor. Because this is a drop-in counseling clinic it is assumed that most of the people that are dropping in will not be regulars by referring her who a full-time counselor who specializes in drug use, they can hopefully help her work through her rehab and her outpatient program and make the transfer from rehab to society again as easy as possible. I would first refer her to a low cost or even no cost pregnancy center that could make sure she was actually pregnant, and this was not just symptoms from her addiction.  I would then refer her to a treatment center as the first priority in this situation is finding her inpatient rehab facility where she will not be on the streets or having to live with her boyfriend while trying to become sober. Finally, I would also make a referral to a full-time counselor that she could have weekly or even biweekly meetings with.  Her friend is partially correct that stopping Heroin use ‘cold turkey’ can have adverse effects on the well-being of an unborn child. Heroin withdrawal symptoms in a pregnant woman can cause health risks for an unborn child.  However, continued use will likely lead to the child becoming dependent, and being born with NAS which carries its own collection of risks to the child. Is very important that if Suzanne wants to become sober that she does not stop cold Turkey in this stage. Stopping cold Turkey at this stage in her pregnancy could cause a miscarriage and this could cause irreparable damage with Suzanne’s current mental state. There is some very important legal issues that Suzanne will have to face if she decides to keep this child especially if the child is born when Suzanne is still addicted to drugs and prostituting. If the child is born dependent on opioids or exhibiting neonatal abstinence syndrome (NAS) DHHS or CPS will become involved and repercussions up to losing custody of the child are possible. It is possible that if Suzanne’s prostitution and drug use does not get resolved before this baby is born that more than likely CPS will take the child and the child will be placed into a foster home. Suzanne’s past could cause some serious transference issues. Based on the history present adults who were supposed to provide support and care appear to have fails her significantly. Suzanna’s father was a very heavy drinker and left the family when she was 10. Suzanne’s mother was either unable or unwilling to provide appropriate supervision as evidenced by early substance abuse and dropping out of school. These previous experiences may well lead to Suzanne reacting negatively or having difficulty developing a trusting relationship with an authority figure. This could impact her willingness to follow through with advice given or referrals made by the counselor. in addition to transference issues, this scenario would provide many individuals with opportunities with countertransference to occur. Some issues that could cause countertransference for example, previous drug use from the counselor’s parents. I personally I would probably have unconscious bias towards the topic of adoption. My biological father has been on drugs since before I was born. He made the decision to give me up for adoption. The counselor in this situation would need to make sure that they have awareness of self in order to prevent foisting old feelings onto current situations. In addition, a counselor would need to be engaged in self-examination, perhaps even seeking consultation, to prevent imposing their own values onto the client. The counselor’s previous experiences and relationships could easily come into play with the issue of the unborn child. Helping the client determine the best outcome for themselves would be paramount.

1. Heroin and Alcohol,

2. Although it may seem counterintuitive because alcohol is legally available and heroin is not, withdrawal from alcohol may actually pose a greater danger. Our textbook states, “Opiate withdrawal is miserable, but not life threatening” (unlike alcohol withdrawal). This would depend on the degree of her dependence on alcohol.  Alcohol withdrawal can range from irritability to a serious syndrome called delirium tremens. This syndrome is characterized by a sudden and severe change in mental status, seizures, and includes the possibility of death.

3. There are a wide variety of apparent dangers in this case study. Addiction and substance abuse can cause significant physical and mental health damage depending on a variety of factors ,  physical safety of the client, complications during and after pregnancy, possible future legal issues stemming from her drug use and prostitution.

4. Heavy drinking, drug use, mixing  drugs, for example opioids and depressants (alcohol), the risk of possible overdose from Heroin,  prostitution, withdrawal, transmittable diseases (both sexually transmitted and from drug use), physical safety in jeopardy based on who she associates with,  unresolved/unidentified mental health issues caused by previous traumas,

5. The mothers heavy drinking leading to Fetal Alcohol Syndrome, mothers drug use leading to Neonatal Abstinence Syndrome, Mother’s prostitution/drug use  exposing the unborn child to a variety of diseases and infections,   Mother’s possible withdrawal symptoms leading to prenatal harm, poor nutrition and a lack of appropriate prenatal care could lead to a variety of developmental delays and many other adverse health outcomes. For example, the baby could be born with Spina bifida from low folic acid intake during pregnancy.

6. I would recommend she goes to somewhere that offers no-cost/low-cost reproductive healthcare to make sure she is actually pregnant first. It is possible that her Heroin use is causing some of the issues that are making her believe she is pregnant.   I would refer her to a rehab program, specifically one that offers medication-assisted treatment.  

7. I would recommend a full-time counselor no-cost/low cost reproductive healthcare, rehab program, counselor

8. Her friend is partially correct that stopping Heroin use ‘cold turkey’ can have adverse effects on the well-being of an unborn child. Heroin withdrawal symptoms in a pregnant woman can cause health risks for an unborn child.  However, continued use will likely lead to the child becoming dependent, and being born with NAS which carries its own collection of risks to the child.

9. If the child is born dependent on opioids or exhibiting neonatal abstinence syndrome (NAS) DHHS or CPS will become involved and repercussions up to losing custody of the child are possible.

10. It is possible that both transference and counter-transference issues could be encountered in this scenario.