Three Applicant Vignettes TRAINING EXERCISE H

Transcription

1 Three Applicant Vignettes TRAINING EXERCISE H Is the substance use likely to be considered material to the disability? TRAINING EXERCISE H: THREE APPLICANT VIGNETTES Introduction Is substance abuse material to an individual s disability? Sometimes the answer to this question seems impossible to determine. In this activity, we will explore ways to assess and report on a person s substance use. Instructions 1. On pages 5 8 of this module, you will find three vignettes that illustrate a series of hypothetical observations and write-ups a case manager may create to assist the DDS with a determination. 2. Read through each write-up. 3. Based on the information in each vignette, determine whether you think the individual will be found disabled by SSA. The Story of Sam When Sam was a youngster, he was quiet and somewhat withdrawn. He grew up with his mother and stepfather. Sam s stepfather was a big, husky guy with a booming voice who often intimidated Sam and his mother. The stepfather also would drink heavily and, at those times, became physically and verbally abusive to both Sam and his mother. Sometimes, when the stepfather would return from a bar, he would wake Sam up and beat him for some perceived transgression even if it were not so. Sam s mother, also afraid of the stepfather, did not protect Sam. Sam grew into a teenager who had very few friends. His schoolwork was poorly done as he remained so anxious and frightened at home. He did not tell anyone about the situation because he was ashamed. At times, he thought about suicide, even as a Module VII 5

2 young teenager. At one point, at age 14, Sam tried to hang himself in the garage. His mother found him and released him, comforting and chastising him at the same time. They decided to keep this another secret from Sam s stepfather. Sam barely finished high school. His teachers noticed a change in him and sent him to the school guidance counselor. Sam was clearly very depressed; he remained, for a brief period, in counseling and then quit, feeling it didn t help. He took up drinking and found that, then, his terribly overwhelming sad thoughts went away for a while. He snuck drinks at home and also began smoking marijuana. He liked the euphoria that this drug gave him. After he left school, Sam continued to drink and smoke marijuana. When he was not using, he felt his depression overtake him. He tried to work at several part-time jobs at Wendy s, warehouse work, Lowe s, and a supermarket but these jobs did not last. Sam simply could not keep up with the work, and he was let go. These rejections caused him to drink more, and the vicious cycle continued. Each time, he stopped using, he became so depressed that he thought of killing himself. One day, Sam became so depressed that he cut his wrists severely. His mother found him and, this time, called an ambulance. For the first time, Sam was hospitalized and treatment was begun for his depression. This began in 2002; at the age of 24, Sam was beginning to have appropriate treatment and to work on the underlying issues related to his depression. Although his alcohol and drug use continues, it has decreased slowly. Sam remains in treatment and also remains very depressed. His suicidal thoughts are less frequent; he takes medication although not always as prescribed because sometimes he feels it doesn t help. He does attend his clinic appointments regularly and acknowledges the difficult effort he needs to make to manage his depression and to lessen the symptoms. He still has been unable to work and lives at home with his mother, who looks out for him. Even so, he has begun to make progress on a major depression that has haunted him most of his life. Is Sam s substance use likely to be considered material to his disability? The Tale of Theresa Theresa grew up with her parents and two brothers. She was the oldest in the family and was expected to help with the care of her brothers. Her parents both were employed and relied on Theresa to assist them when she was fairly young. Theresa 6 Module VII

3 resented this demand a bit but insists that she loved her brothers even so. Schoolwork came easily for Theresa in the elementary and middle schools. In high school, she felt awkward, unpopular, and worried about her future. She was introduced to alcohol by some friends at a party and found that this use eased her worries. Although she began to drink regularly on weekends, often consuming 6 12 beers a night, she believes that she kept this hidden from her parents. She figured she was just simply getting along and doing what the other kids did. After high school, Theresa went on to a community college and did well. However, she continued to drink and began experimenting with other drugs. She liked the feeling of being high and felt that it did help her to relax. She moved on to a four-year college and this is where her substance use began to interfere significantly with her schoolwork. She decided to leave after a year and went to work in a computer position that paid well. Unfortunately, Theresa continued to drink and use drugs; her use increased and the experimentation expanded until she began using cocaine on a regular basis. She felt that this drug made her more productive and more energetic. However, her employer began to notice that her work was not consistent. Theresa was given a warning to improve her work. Finally, as her use continued, she was let go. Theresa then drifted from friend s to friend s to live. She had intermittent jobs but continued to use cocaine and alcohol. She did not feel that this was a problem for her but rather blamed her loss of work on her employers. Her friends also used with her, and she became estranged from her family. So, no one in her life was suggesting that she receive help. Finally, on her own, Theresa decided that her life was not going well. Six months ago, she found herself having physical health problems, including gastrointestinal symptoms and intermittent breathing problems. She went to the local social services agency. They gave her a referral for substance use treatment, which she accepted. She has been attending treatment regularly for the last four months. Her use has abated, and she is back in college. Is Theresa s substance use likely to be considered material to her disability? The Narrative of Nolan Nolan grew up in a tough neighborhood, where fights and abuse were commonplace. His mother frequently hit Nolan with whatever tool was handy these included a broom, telephone cord, belt, or stick. Nolan and his four brothers were all disciplined Module VII 7

4 in this way. As he grew up, the treatment by his mother made him angry. He did poorly in school and the other kids made fun of him his clothes were tattered, and he couldn t learn, he said. Nolan left school at 16, finishing the tenth grade but just barely. He continues to have difficulty reading and writing. He is unable to read the newspaper but can write his name and read very simple sentences though this takes time. As a youngster, Nolan got in many fights. At the age of 8, he was hit on the head with a baseball bat and was knocked out. He received no medical treatment. When he was 10, he got hit by a car while crossing the street and was taken to the emergency room. He was pronounced ok, according to him, and was sent home. After that, he said, he did have some headaches. After he left school, Nolan started hanging out on the street with other kids. He sold drugs, bought things he wanted, and acted as if he had no cares. He began using drugs and found that he liked the way they made him feel. He became very aggressive and didn t let anyone push me around, he said. He continued to get into fights and, often, would be hit and briefly knocked out. The drug and alcohol use continued. As time went on, Nolan got into legal difficulties; he was arrested for assault several times as well as robbery and possession of drugs. He served five years in prison, from age When he was released, he was on parole and managed to serve his time with only one violation, for which he served an additional year in prison. After his second release, he complied with parole. In his early 30s, Nolan met Mary Sue, a nurse s assistant who worked at a local clinic. They married and had two young children. Mary Sue did her best to help Nolan with his problems. Neither of them understood why he was so impulsive and quick to anger. He did not want to become angry with his family but found that he did so easily that it worried him. He did not feel that he could control his feelings and behavior. This was very troubling to him. Many times, Nolan tried to work. He found that he had trouble focusing, didn t finish the jobs on time, and was let go. This fed his anger and also caused him to feel worthless. He felt that his prison history made employers reluctant to hire him, and he acknowledged that he wasn t a good worker. He was puzzled by all this. He said the doctors had told him he had an antisocial personality disorder. He didn t know what it meant except to say that it meant he had done illegal things and didn t act right. Nolan began to attend a mental health clinic to try to find out about how he could control his behavior better. He said that they told him he was depressed, but that it wasn t the depression that caused all his problems. His therapist and psychiatrist decided to have Nolan evaluated on a battery of neuropsychological tests as they wondered about the possibility of brain damage from Nolan s extensive past head injuries. Through the testing, he was found to have severe and global cognitive deficits that clearly impaired his functioning. 8 Module VII

5 Is Nolan s substance use likely to be considered material to his disability? Module VII 9