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Drug Addiction Diagnostics and Therapy Prescription Case Study

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Updated: Apr 13th, 2021

Name: Rosa Lee Cunningham

DOB/Age: 1936/ 53

Dates of Interviews: 1990-1994

Evaluator: Leon Dash

Reason for Assessment

Rosa Lee Cunningham is a 53-year-old woman who constantly struggles with substance abuse and theft. She has served several prison terms for theft and drug dealing in the last four decades. She has eight children; five of them live with her and they also struggle with substance addiction. One of her children is serving a prison sentence for involvement in the theft and the other five that live with her have also been incarcerated on numerous occasions for committing various offenses. Therefore, Rosa Lee has faced numerous hurdles in her quest to make a better life for herself and her children. Poverty and lack of social support are some of the main factors that have made it difficult for Rosa Lee to overcome her drug addiction. She lives in a neighborhood where drug consumption is common, which reveals the high level of moral decay that exists in poor urban settlements (Dash, 1996, p. 22).

Rosa Lee and her children are forced to live with their addictions due to the socio-economic problems they experience. She is an embodiment of the urban struggle where some residents resort adopts negative habits to escape from their pain and suffering. Her heroin addiction forced her to share dirty needles with other users which made her acquire HIV. Her two children; Bobby and Patty have also contracted HIV because they share needles with their mother. Therefore, this shows the serious effects of substance abuse and addiction which threaten the wellbeing of all members of her family (Dash, 1996, p. 29). Moreover, her illiteracy hampers her from following medical instructions properly which diminishes her chances of recovery from crack cocaine and heroin addiction.

Rosa Lee dropped out of school at a very young age and later got pregnant with her first child at the age of thirteen. Therefore, her little education has made her ignorant about other important issues that are beneficial to her wellbeing. The situation is replicated in the lives of her children who faced numerous difficulties while they were growing up due to their mother’s constant problems with the law. As a result, Rosa Lee has had to depend on food stamps to feed her children and grandchildren, some of whom are not in a position to get gainful employment positions. Substance addiction, criminal tendencies, Illiteracy, constant arrests, and incarceration are the main problems Rosa Lee and her family deal with daily (Dash, 1996, p. 33). Also, inadequate social support systems, dysfunctional communal ties, and grinding poverty have denied Rosa Lee and her family members a chance to lead a happier life.

Sources of Information

The main source of information used in this case study is Leon Dash’s Book that documents the struggle Rosa Lee has faced breaking out of drug addiction and her impulsive stealing habits. Other additional publications will also be used to shed more light on the topic to find out appropriate remedies for drug addictions and other problems that are related to this destructive habit. The manual of therapeutics for addictions and other published sources that describe issues related to narcotic dependency will be used to shed more light on the matter. The study will mainly rely on peer-reviewed sources to come up with appropriate proposals that recommend suitable addiction therapy solutions that conform to Rosa Lee’s lifestyle and needs.

Psychosocial History

Rosa Lee Cunningham was born into a large family in Washington. She faced a lot of problems while growing up which made her drop out of school at an early age to get married. She got pregnant with her first child while still in her adolescence and this exposed her to various social evils that changed her life. She is addicted to heroin and crack cocaine and this has increased her dependency levels. The dirty needles she uses to inject heroin in her veins have made her get infected with HIV. Therefore, behavioral as well as social factors that influence Rosa Lee’s addictions need further inquiry (Dash, 1996, p. 55).

She served her first prison term in the 1950s for theft and since then, she has had constant brushes with the law. It is worth noting that in forty years, she has served more than eight prison sentences mainly due to stealing and drug selling. Significantly, her children have also picked up substance abuse habits from their mothers..Her daughters engage in prostitution and other crimes to obtain money to sustain their drug consumption habits. As a result, her habits have led to conflicts between Rosa Lee and other extended family members who are not pleased with her character. It is interesting to note that even after going through several rehabilitation programs in prison, she has never changed her negative habits (Dash, 1996, p. 61). She admits that she only went for the programs to improve her record in prison to increase her chances of getting parole.

She has a history of child abuse and neglect because she was born in a large family of more than ten children. Her parents struggled to raise her and her siblings in an upright manner. Moreover, they grew up at a time when racial segregation policies in Washington, D.C., and the rest of the country had taken root, which made it difficult for newly arrived African American immigrants from the south to get meaningful jobs. She is barely literate, due to the reading difficulties she faced in school while she was growing up. The case study is an accurate illustration of social inequalities that have existed in America for many generations and how they cause poor people to engage in substance abuse, prostitution, and crime (Dash, 1996, p. 67).

Therefore, high levels of deprivation create problems for Rosa Lee and other poor urban residents who are not able to access meaningful socio-economic opportunities. Rosa Lee’s father was an alcoholic, who passed away when she was still very little and routinely subjected his wife, Rosetta to frequent episodes of violence. Rosa Lee’s mother would take out her frustrations on her through constant beatings and she still bears a lot of bitterness towards her mother (Dash, 1996, p. 69).

Her turbulent family history left Rosa Lee with psychological and emotional scars that have not healed. Her failure to address these issues exposed her to a life of hopelessness characterized by substance abuse and stealing. However, some of Rosa Lee’s brothers and cousins have managed to make a better life for themselves and they are neither drug addicts nor poor like her. The negative effects of racial segregation and poverty did not deter them from improving their economic status (Dash, 1996, 71).

In the 1930s, economic effects caused by the Great Depression made it difficult for newly arrived black families from the South to get jobs. Rosa Lee’s parents had to do menial jobs to earn a living which was barely enough to satisfy the needs of the whole family. Since they were illiterate, they were not qualified for proper government jobs which would have enabled them to enjoy a more decent life. Rosa Lee’s current situation mirrors the one faced by her parents as she was growing up because she has many dependants who rely on her for food and shelter. She is a negative influence on her children and grandchildren who are constantly breaking the law by consuming drugs and engaging in illegal activities (Dash, 1996, p. 75).

Current Status

Rosa Lee’s typical day involves going to different governmental offices to obtain various services. For instance, occasionally she receives social welfare support from the government to help her take care of her domestic needs. She has a large family that depends on her and even though she battles with different problems she does her best to create a congenial atmosphere for all her family members that live in her house. Rosa Lee also admits that she shares drugs with her two children, who are also addicted to crack cocaine and heroin. She constantly checks with the authorities to find out if she is still eligible for food stamps and other welfare benefits because one of her daughters will soon be getting out of jail. Moreover, she admits that she occasionally relapses and finds herself consuming drugs. This is can be attributed to problems in the neighborhood she lives in where peddlers sell different types of narcotics to addicts (Dash, 1996, p. 77).

Her children also contribute to her household even though six of them are addicts. However, she still has criminal tendencies and she encourages her children and grandchildren to steal clothes and other items from nearby stores which they sell afterward. This shows that even though Rosa Lee insists that she wants to change, her craving for drugs and criminality has yet to subside (Dash, 1996, p. 79). It is evident that drug abuse and crime are part and parcel of her persona and she is not willing to give up these practices. Her thieving habits have alienated her from her two sons, Alvin and Eric; the only children of the household who do not have any criminal records. Shoplifting has always been a way for her to make easy money, to help her purchase drugs. On the day she was shoplifting with her grandson she was waiting for the court’s verdict on a previous crime of shoplifting which she had committed a few months earlier.

Even though she takes methadone, to help her fight her addictions, she has not been able to turn her life around positively. On the day of her sentencing, she admits all charges leveled against her by the prosecution and claims that she is working hard to turn her life around (Dash, 1996, p. 81).

The judge gives her two months to stop using drugs after which she should return to the court to explain why she should not be taken to prison. After two months, the judge hands a suspended sentence and she is required to undergo a drug counseling program to help her overcome her drug habit. She always had a knack for stealing since when she was a child, according to her brother Ben. Her behavior can be partly explained by the harsh poverty she and her siblings had to contend with as they were growing up.

She admits that she has to hide money away so that her five substance-addicted children do not get a chance to steal it. However, the little money she makes from shoplifting and monthly social welfare cheques is wasted on drugs. It seems shoplifting has become a permanent feature of her life and she knows how to hide her real character to gain favors from different people. She has even influenced her children and grandchildren to take part in the habit and they are growing up thinking that it is a normal way of life. She justifies her stealing habits by claiming that the business owners she steals from exploiting their customers by selling them goods at exorbitant prices (Dash, 1996, p. 84).

Indicators of Use/Abuse/Dependency

Attitude and Behaviour of Rosa Lee

Rosa Lee uses poverty and social inequalities to justify her stealing tendencies. Her illiteracy compounds her problems because this has made her ignorant about other opportunities that may be beneficial to her wellbeing. This makes her grumpy and she assigns responsibility for her failures and mistakes to other people.

Social Functioning of Rosa Lee

She has poor relations with her brothers and other extended family members due to her negative lifestyle habits. However, she cares deeply for her children and grandchildren and she manages to live with them in her apartment even though the poverty they find it difficult to survive. She relies on their love and support to get through the various difficulties she faces in her life.

Occupational Functioning of Rosa Lee

She does not have a steady job and she colludes with her children and grandchildren to steal items from shops in the city which are later sold on the black market. Occasionally, some of her children offer financial support but most of the money earned by the household is wasted on drugs. She also gets social welfare money from the government which is barely enough to satisfy her children’s and grandchildren’s needs.

Financial Aspects of Rosa Lee

Since she is illiterate, she does not know the importance of budgeting and good financial management skills. The little money she makes is spent on things that are not important in her life and this exposes her to an unending cycle of poverty. Consequently, this is one of the major problems that have made it difficult for her to stop stealing and consuming drugs.

Familial Relationships of Rosa Lee

Rosa Lee is not on good terms with her brother and two sons who view her as an embarrassment and a bad influence. The rest of her children live with her and they face similar substance addiction problems. Moreover, six of her children were fathered by different men when she was actively involved in prostitution.

Legal History of Rosa Lee

She has served eight prison terms in about forty years. Her stealing habits have been the main reason she has found herself in and out of prison on numerous occasions. More often, she excuses her stealing behavior by claiming that the country’s economic and social system is unfair and it makes it difficult for the poor to survive.

Health History of Rosa Lee

Most of the problems that Rosa Lee has faced in her life are directly related to the psychological makeup of her mind, the most notable of which is drug addiction. During her childhood, she had reading difficulties which slowed down her learning progress till when she dropped out of school. She also suffers from HIV because she uses shared needles to inject heroin into her blood vessels.

Spiritual History of Rosa Lee

Her parents were Christians and as she was growing up, she attended church service every Sunday, where she served as an usher. However, even though she believes in God her lifestyle does not reflect the main Christian teachings. She encourages her grandchildren to go to church only on a few occasions despite her belief in God.

Diagnostic Impression

Rosa Lee’s constant lies about her willingness to stop consuming drugs show that she has adopted a disguise that she relies on to hide her true character. She suffers from panic disorders which expose her to high levels of stress when she thinks about her failures as a parent. She gets a false sense of security from her relationship with her children and grandchildren. Therefore, she is not willing to distance herself from the harmful environment that is responsible for her relapses. Moreover, there are no incentives that encourage her to drop the drug habit and this compounds the situation she is facing. These depressive episodes trigger negative memories about the past. Consequently, Rosa Lee constantly reflects on her inability to act as a good role model for her children and grandchildren (Miller, Gold & Smith, 1997, p. 49).

Crack cocaine increases dopamine levels in the brain and this makes users experience psychotic effects such as delusions and hallucinations. Also, Rosa Lee’s crack cocaine consumption has affected her brain transmitters and this has affected her brain functions. As a result, whenever she consumes the drug, she becomes aroused for short periods and afterward, she starts experiencing anxiety attacks. The dependence on cocaine for dopamine stimulation makes Rosa Lee experience uncontrollable cravings for the drug to satisfy her urge. Therefore, she risks taking an overdose which may have adverse effects on her long-term wellbeing. Consequently, her behavioral and cognitive functions depend heavily on cocaine and heroine consumption and this situation makes it difficult for her to think logically. (Miller, Gold & Smith, 1997, p. 53).

Rosa Lee has a high dependence level on cocaine and becomes excited after consuming the drug. She has bouts of paranoia which are not very frequent because she has developed her mechanisms of dealing with effects that arise after consumption. However, she has to contend with other effects such as mood swings and loss of appetite which make her irritable. Also, because of staying in a crowded environment, she rarely has time for herself and this has affected her sleeping patterns. She has drooping eyelids which indicate that she does not get enough sleep at night. Her inability to read affects her judgment and this makes it difficult for her to understand written medical instructions clearly (Miller, Gold & Smith, 1997, p. 56).

The patient suffers from HIV Aids due to injecting heroin using dirty needles and her previous involvement in prostitution. Therefore, continued substance abuse is likely to affect her CD4 cell count and this will eventually weaken her immunity. The patient needs a lot of support to help her overcome the social problems she is facing. Several symptoms in her body reveal that she now has AIDS. Her body is frail and she cannot walk alone without external support (Miller, Gold & Smith, 1997, p. 63). Erratic patterns of substance abuse, poor eating habits, and the inability to adhere to prescription medicine dosages have weakened the patient. She is breathing heavily and additional tests that were conducted reveal that her internal respiratory organs are severely damaged. The patient has a persistent dry cough and this shows that she may be suffering from tuberculosis.

  • Axis I: 290.31 Hallucinations, Manic Disorders, Stress, paranoia. Main Cause: Drug Addiction.
  • Axis II: C67.12. Poor diet, lack of sleep, Inability to rest
  • Axis III: 643. 24. HIV Aids, Tuberculosis
  • Axis IV: 56. 33 Impulse to steal, Family problems, Illiteracy, Lack of social support


Rosa Lee needs to go through group therapy to allow her to interact with other substance abuse addicts who are facing similar problems. This is a behavioral intervention that will allow her to focus on factors that encourage her to relapse whenever she tries to stop (Spitz, 2001, p. 27). Also, group learning will improve her attitude towards what life has to offer. She will be in a better position to participate in different activities that are beneficial to her healing. More importantly, she will learn about the relationships she has with her close family members and how they encourage or discourage her to consume narcotics. She needs to find out more about specific environmental factors that are responsible for her relapses to help her to overcome substance abuse.

She also needs medication to help her cope with her addictions. Even though she has been taking methadone, she needs other medications to detoxify her body due to the long term effects of drug consumption. She needs to take naltrexone, to help her overcome her cravings for both heroin and crack cocaine because it has fewer side effects on the body (Brick, 2008, p. 78). This drug acts as an antagonist and she can be given an injection once a month. Naltrexone is the best option for her at the moment because she faces difficulties following doctors’ prescriptions given that she is unable to read and write. However, if she needs a more cost-effective option, she can opt for an oral dose of Suboxone. This drug is also appropriate for her because it does not induce severe withdrawal symptoms in a user’s body (Margolis & Zweben, 1998, p. 91).

A combination of behavioral and medical interventions will enable the patient to overcome her cravings for drugs. However, additional social remedies should be used to help their children overcome their drug habits. If possible, she should be encouraged to move from her current residence to another area where the external environment will not encourage her to engage in substance abuse. All family members need to be offered moral support to encourage them to overcome their destructive habits. This will protect them from different risk factors that are caused by drug addiction.


Brick, J. (2008). Handbook of the medical consequences of alcohol and drug abuse. New York, NY: Haworth Press.

Dash, L. (1996). Rosa Lee: A mother and her family in urban America. New York, NY: Harper Collins.

Margolis, R.D., & Zweben, J.E (1998). Treating Patients with Alcohol and Other Drug Problems: An Integrated Approach. Washington, DC: American Psychological Association.

Miller, S. Gold, M., & Smith, E. (1997). Manual of therapeutics for addictions. New York, NY: Wiley.

Spitz, H.I. (2001). Group psychotherapy of substance abuse in the era of managed mental healthcare. International Journal of Group Psychotherapy, 51(1), 21–41.

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