case management plan

Suzanne has come by the free “drop-in” counseling clinic were 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 does not work; instead, she works the streets at night. She usually drinks four or five beers each night before going out to work. If she cannot 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 is what makes him different from her “John’s”, which Suzanne says, “it 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 has not had her period in the last 12 weeks. She is pretty sure she is pregnant and knows it is 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 is really confused about what she should do, and is her asking 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.” Suzanne says, “I just don’t know what I should do?”