Overview

Marcel is a 21 year old bisexual African American man. He referred

himself for inpatient treatment for drug and alcohol abuse. Marcel is
currently homeless, unemployed and has charges pending from bad checks.
Marcels family history includes both parents being drug addicts and a
childhood of physical, sexual, and emotional abuse from them. Marcel has
not had contact with his parents for seven years. He states that his
relationship with his sister is fair. He also talks of a network of friends in
the gay community. Marcel has also talked about a lot of sexual abuse from
intimate partners in the past including rape. Marcel has also used sex as a
way to get drugs and money. Marcel first used alcohol at age 14, when he
also had his first sexual encounter with a man. At this point he then began
using other drugs, including inhalants, marijuana, amphetamines and
cocaine. At 21, four months prior to entering treatment, he began using
crack. Marcel came self-referred in regards to his substance abuse.
If I were the case manager for Marcel I would try to pick two things
with him to focus on. I would want to mainly focus on Marcels drug abuse
especially because this is what Marcel expressed wanting to get help with.
The second thing I would hope to focus on with Marcel would be
homelessness. Both of these issues are things that need to be addressed
before Marcel would be able to focus on and work through other issues he
might be facing. Furthermore, both the issue of substance abuse and

homelessness need to be tackled simultaneously in order to be the most

effective.
Some of Marcels strengths include his network with local the gay
community. This is strength because this is a group of people with whom can
help support Marcel in reaching his goals emotionally and maybe physically.
Another strength that Marcel has shown was his ability to recognize the need
and to ask for help. Asking and recognizing that you need help is a huge
strength that should be acknowledged and celebrated as a first big step
towards goals.
The people who should be included with my work with Marcel would
include a drug counselor, someone who is a part of the local communitys
housing, and a therapist. Marcels sexual orientation affects the intervention
plan and process because it is very important that we find a drug treatment
program that is LGBTQ friendly as well as housing that is also LGBTQ friendly.
This is vital because Marcel has the right to feel safe and comfortable where
he ends up living and the most successful way for Marcel to feel safe and
comfortable in his substance abuse program is if it is also excepting of his
sexual orientation. Marcel would also most likely feel more comfortable in a
more diverse substance abuse and housing program. Being around more
ethnic diversity and/or people of color could help make Marcel feel more
comfortable in terms of being vulnerable and trying to work through what is
going on. Marcels age is also another factor, its important for Marcel to be

around those near his peer group age so he can find and make new friends
and help develop a support network in his recovery as well as where he finds
housing.
Information and resources needed to help select options are
treatment options and the costs as well as pros and cons of each facilitys
treatments. The pros and cons could include things such as if you share a
room, is a kitchen available, do you have to provide your own food or help
pay any bills. For outpatient treatment pros and cons may include the length,
how often you meet, and still needing to find a place to stay. Marcel and I
would need to determine either an abstinence only approach or a harm
reduction approach to his recovery which could be dependent on the kind of
substance abuse treatment (inpatient or outpatient) because it is a huge
factor.
Some of the community referrals I would make would include
ones for substance abuse treatment, housing, and other assistance programs
that help with living expenses. Agencys I would probably call would include
the Bellingham opportunity counsel, transitional housing and HUD (Housing
and Urban Development). I would expect Marcel to be receptive to
assistance because he was self-referred and because all planned goals would
be agreed upon.
In Marcels case we would evaluate outcomes of our plans by
what is working well and what isnt in accomplishing set goals. Things that

help Marcel complete goals we would use again to help with new goals.
Things that could help Marcel reach goals could be support networks, maybe
certain thought process strategies, or local agencies that are supportive and
promote positive changes. Next steps could be new plans with new set goals.
If older step ideas didnt work we could try to figure out new and maybe
smaller steps. If older steps were successful and older goals met, we could
make new plans to reach new goals.
Implications that we would most likely run into with community
intervention is the lack of community support. Marcel is likely to face a lot of
social stigmas associated with his drug addiction disease as well as with
being homeless. Due to the social stigmas associated with these two subgroups that Marcel falls into it would also be a moment where I would need
to work with Marcel and us advocate for him and those facing similar
situations. Implications with prevention planning could include if housing and
substance abuse treatment are not coinciding, if maybe planned steps were
too big at first, and running into unexpected barriers. In working on Marcels
case we could maybe (with permission) use his case as an example to help
advocate and push for policy reform to help individuals who need issues
addressed simultaneously in order to be affective.
A review of the population presented in the case scenario.
Substance abuse addictions are a huge problem effecting 65% of
American families (Dorsey. 2010). It has been proven that helping an addict

get clean is way more cost effective than the alternative of an addict
continuing their using. An addiction can cost health care providers a lot of
money, crime and jail time associated with drugs and the damage it does to
families let alone all the harmful effects it can have on the addict. Substance
abuse addictions are a major problem in America that are dramatically
underfunded and have a major social stigma.
A common stereotype of the homeless population is that they are all
alcoholics or drug abusers. The truth is that a high percentage of homeless
people do struggle with substance abuse, but addictions should be viewed as
illnesses. Addictions require a great deal of treatment, counseling, and
support to overcome. Substance abuse is both a cause and a result of
homelessness, often arising after people lose their housing (National
Coalition, 2009).
In many situations, however, substance abuse is a result of
homelessness rather than a cause. People who are homeless often turn to
drugs and alcohol to cope with their situations. They use substances in an
attempt to get temporary relief from their problems. But in reality,
substance dependence only exacerbates their problems and decreases their
ability to achieve employment and get off the streets. Some people may
even view drug and alcohol use as necessary in order to be accepted among
the homeless community (Didenko and Pankratz, 2007).
Model for intervention:

Understanding the interconnectedness of the two issues at hand is

what makes a wrap around strength based model the most ideal for my
client. But, it would be difficult to do a wrap around strength based model if I
did not have a team to do it with. A wrap around strength based model would
be ideal because it would provide a stronger support system for my client
and more of safety net for Marcels comfort. It would also provide 24 hour, 7
days a week, 365 days a year support for my client. This would help secure
my clients success in always having someone on hand to help my client in
whatever he needed assistance with. But, because wrap around is primarily
used with children or those with mental illness it might be hard to convince
an agency of the necessity of doing a wrap around strength based model
with my client. From what I understand it would potentially be very hard to
get the funding to do this model with my client.
The model that is more likely to be funded for Marcel and the 2cd best
option would be the strength based model approach. So most likely if Marcel
was my client I would do strength based model approach. The strength
based model would potentially help empower my client, make it understood
that my client is in control and would facilitate and support positive change
for my client. Breaking an addiction is difficult for anyone, especially for
substance abusers who are homeless. For example motivation to stop using
substances may be low. For many homeless people, survival is more
important than personal growth and development, and finding food and
shelter take a higher priority than drug counseling. This model would help

my client approach substance abuse treatment in a positive light that could

help prevent relapse. This approach would also help my client in terms of his
lack of housing because we could focus on the positive steps we are taking
verse all the steps we havent taken yet or that still need to be done.
Many homeless people have also become estranged from their families
and friends. Without a social support network, recovering from a substance
addiction is very difficult. Marcel doesnt have much of any contact with
family but by using the strength based model Marcel and I could focus on his
support network in the gay community. But, it has been found that homeless
people may have difficulty remaining sober while living on the streets where
substances are so widely used (Fisher and Roget, 2009). Unfortunately,
many treatment programs focus on abstinence only programming, which is
less effective than harm-reduction strategies and does not address the
possibility of relapse (National Health Care for the Homeless Council, 2007).
In using the strength based model we can start Marcels recovery with harm
reduction strategies in order to remain more positive in terms of substance
use. When working with Marcel, Marcel and I would determine a plan of
either abstinence or harm reduction depending on what Marcel would like to
do and what we think would be more effective.
Ethical Concerns:
Two things I would need to stay conscious of when working with my
client would be the social stigmas of addicts and the homeless communitys.

I would specifically in Marcels case have to be aware of the

interconnectedness of both of these ethical concerns and how each issue
dramatically impacts the other. Recognizing stigmas such as all homeless
people are addicts and vice versa. Both the issue of addiction and the issue
of homelessness need to be addressed simultaneously in order to be more
effective in reaching the goals I would imagine Marcel would like to reach.
Those higher goals Marcel would most likely have would be to get clean and
to have a residency. It is also important to recognize that Marcel might have
certain social ideas ingrained as well. Another reason why the issues need to
be addressed simultaneously is to help Marcel stay on the path of his goals.
Social stigmas and thoughts can push against Marcel achieving certain goals
for example a common thought or stigma of the populations that Marcel falls
into is that they cannot change. This is not an encouraging thought that is
pushed by larger society. These social stigmas play a large role and it is
important to recognize them.
It is also very important to recognize the vulnerability of Marcel
because of the population groups he falls into and to make sure to handle his
case with care and respect. It is important that the case manager lets go of
any biases towards these two populations and stays focused on the client
and their needs.
Services available to that population in the local community.

The closest inpatient treatment facilities to Whatcom country would be

Gray Wolf Ranch in Port Townsen WA. Or Dragonfly Retreat in Wenatchee WA.
Gray Wolf Ranch does not take insurance but Dragonfly Retreat does. There
are also two outpatient facilities in Bellingham those are Belair Clinic and
Bridges Treatment and Recovery. None of these treatment programs say if
they are LGBTQ friendly but that would be something to look into for the
client if that is a concern.
The Light House Mission is a homeless shelter here in Bellingham that
would be a great resource. The Lighthouse Mission Ministries is a privately
operated, non-denominational Christian ministry. The Light House Mission is
open 24 hours a day and is Whatcom County's only walk-in crisis homeless
shelter for men, women with children. The Light House Mission would be a
temporary step till more solid residency has been found. In the mean time
looking into resources such as Transitional Living Communities would be a
very good option to have for Marcel. Transitional Living Communities are in
place to help people such as addicts have a transitional place to stay till they
find another place of residency. It would be worth looking into the Transitional
Living programs around Whatcom County as options for Marcel.
Laws or policies that affect services to this population.
Public policy has favored a very punitive approach to substance abuse,
even though medical and public health experts agree that treatment and
prevention are more effective. Due to publics policys approach to substance

abuse there is little funding being spent to help get and keep addicts clean.
Even though research has proved time and time again of all the money that
could be saved by helping addicts get clean and stay clean funding for
substance abuse programs always seems to be on the chopping block.
As with public policy being very punitive with substance abuse the
same goes with homelessness. Whatcom County has only one homeless
shelter (which is a church affiliated one), Whatcom County covers a lot of
area and having only one shelter in the county seems problematic. The next
closest shelter is in Mt. Vernon.
There are very few federal substance abuse treatment and prevention
programs that target funds specifically to the homeless population.
Substance abusers who are homeless have different needs than those who
are housed, and programs need to be created to address those needs. The
programs that already exist also need to be strengthened by getting more
funding and gaining more support (National Coalition. 2009).
Service provision to this population (of how services to this
population are generally provided).
Services for this population typically have to be self-driven. You cant
force someone to get clean; they have to want it for themselves. Once
someone is willing to receive help depending on insurance or income they
can get different levels of assistance in getting clean. Depending on the
assistance they decide on determines how the help is provided. Inpatient and

outpatient assistance for example are very different approaches to getting

clean and how services are provided. Inpatient is when the client stays for a
certain amount of time within a facility were all services are available during
the duration of their stay. They would meet with counselors one on one, do
group counselling, and do different activities to help them target things such
as triggers. In outpatient treatment you do a lot of the same things but you
return home after each session which for many people can make it harder to
stay or to get initially clean. But it can also be a time when family support or
the help of support networks can really be utilized to help with success.
Funding for services to this population.
Some of the largest factors that prevented people from being treated
for addiction were the high costs and lack of insurance (NASADAD). Since
many homeless people do not have health insurance, substance abuse
treatment may be unattainable. Other barriers to get services could include
long waiting lists, lack of transportation, and lack of documentation, stigma,
past experiences (National Coalition. 2009).
I would assume that because my client is unemployed and homeless
that my client does not have any type of health insurance. But there are
programs such as Health Care for the Homeless Inc. that we can use as a
model for ways of funding services. That program includes treatment for
addictions in their health care provisions for the homeless. This program

would be one to look into to either help fund Marcel or to help us advocate
for his treatment.
Since substance abuse is both a cause and a result of homelessness,
both issues need to be addressed simultaneously. According to Didenko and
Pankratz (2007), stable housing during and after treatment decreases the
risk of relapse. Substance abuse on its own is inadequate and needs to be
combined with supported housing opportunities. In addition to housing,
supported housing programs offer services such as mental health treatment,
physical health care, education and employment opportunities, peer support,
and daily living and money management skills training. Successful
supported housing programs include outreach and engagement workers, a
variety of flexible treatment options to choose from, and services to help
people reintegrate into their communities (National Mental Health
Association, 2006). Supported housing programs that include substance
abuse services would help homeless people treat their addictions and reestablish residential stability (National Coalation.2009).

References

National Association of State Alcohol and Drug Abuse Directors (NASADAD). Policy
Brief: Overview of NASADAD Priorities. 2007.
Retrieved from: http://www.nasadad.org.
Michael, Dorsey. (March 20, 2010). Over sixty-five percent of American families are
affected by addiction to either alcohol or drugs.
Retrieved from: http://www.examiner.com/article/over-sixty-five-percent-of-americanfamilies-are-affected-by-addiction-to-either-alcohol-or-drugs
Health Care for the Homeless Inc.. Addiction Treatment.
Retrieved from: http://www.hchmd.org/addiction.shtml
National Coalition for the Homeless. (July 2009). Substance Abuse and Homelessness.
Retrieved from: http://www.nationalhomeless.org/factsheets/addiction.html
Didenko, E. and Pankratz, N. 2007. Substance Use: Pathways to homelessness? Or a
way of adapting to street life? Visions: BCs Mental Health and Addictions Journal, 4(1), 9-10.
Retrieved from: http://www.heretohelp.bc.ca/.
Fisher, G.L., ed., and Roget, N.A., ed. Encyclopedia of Substance Abuse Prevention,
Treatment, and Recovery. 2009. SAGE Publications, Inc.
National Health Care for the Homeless Council. Addiction, Mental Health and
Homelessness. 2007.

Retrieved from: www.nhchc.org.

National Mental Health Association. Ending Homelessness for People With Mental
Illnesses and Co-Occurring Disorders. Apr. 2006.
Retrieved from http://www.nmha.org.