Reflections on a Story from Clean
Reflect on one of the stories from Part I or II of Sheff’s book, Clean, (Martina, Luke, Jacqueline, and Kevin). At what point might a social worker intervene and have impact on the outcome? What multilevel systems are involved in the story that impact or dismiss the substance use issues? What are your thoughts about Sheff’s assertion that prevention and treatment services fail to make a difference in the growing issue of substance use in this country?
400 Words APA format
Sheff, D. (2013). Clean: overcoming addiction and ending America’s greatest tragedy. Boston: Houghton Mifflin Harcourt. ISBN: 978-0547848655
- NASW Materials: NASW Standards for SW Practice with Clients with Substance Use Disorders
- SAMHSA Materials: Applying Substance Abuse Confidentiality Regs
- SAMHSA Materials:Drug Abuse Screening Test (DAST-10), Other Screening Tools
- PsychCentral: Symptoms of Substance Use Disorders (Revised for DSM-5)
- Optional Textbook:Vaughn, M. & Perron, B. (2013). Chapters 4–5, pp. 49–86.
Listen and Watch
- Overview of How to Diagnose Substance Use Disorders Using DSM-5– Time 57:34 min/Transcript
- Substance Use Assessment Series; watch videos 1-5. – Time 61:35 min (several videos, CC available as well as transcript, requires UNE login.)
- 10 Ways to Use Patient Placement Criteria to Improve Treatment-Addiction Counselor Training Series,Episode 192 of the Counselor Toolbox podcast with Dr. Dawn-Elise Snipes, Time 58:35 min. Transcript.
2 days ago
University of New England
Story to use:
DRUG USE BEGINS INNOCENTLY enough. A child is handed a joint and takes a puff. He’s given a beer and has a sip. Some don’t like it and they stop. Many of them continue to use occasionally, and some use frequently. Some become addicted. So many of the stories about addiction begin the same way: “He was a good boy”; “She was a joy, moral and smart and funny and . . .” Of her son, Kevin, Jacqueline Periman says, “He was my beautiful golden-haired angel child.” The earliest pictures of Kevin were taken in the hospital on the first day of his life: His mother, striking with long brown hair parted on the side, gazing into the blue of her son’s eyes. In a photo that takes my breath away, his head rests on his mother’s bare shoulder. Mother and child look serene, at peace. Jacqueline grew up in West LA near Beverly Hills. She had two much older— older by nearly twenty years—brothers. “I was kind of ‘oops.’” Looking back, she says that her childhood was surreal. In her home, it was considered normal for ei- ther of her brothers to be passed out drunk or stoned at the dinner table. Her mother mostly didn’t notice; she was devoted to the care of her husband, Jacqueline’s father, who was dying of Alzheimer’s disease.
“We weren’t really raised,” Jacqueline recalls. There were fights when one brother accused the other of stealing their father’s medication. Paramedics came and went. When Jacqueline called 911, the dispatcher would ask, “Which brother is it now?” Alzheimer’s killed Jacqueline’s father and, later, her mother. When she was a teenager, one of her brothers was admitted to UCLA Medical Center after an accident. A doctor told her that he didn’t think he would make it. “I thought, Let’s get it over with.” Her brother survived that time, but not for much longer. Six years later, he committed suicide. Soon after, her other brother died of cancer. Both brothers were high most of their lives. Jacqueline earned a degree in anthropology at UCLA, where she fell in love with and married a fellow student. Her husband got his pilot’s license and a job at a regional airline and then with TWA and American. The couple moved to St. Louis, where she worked at the St. Louis University Hospital as a medical assistant in the ob-gyn department. They had two children: Kevin, born in 1988, and Jill, born three years later. Jacqueline and her husband divorced in 1996, when the children were eight and five.
Given her brothers’ addictions, Jacqueline worried about drugs and talked to her children about them. Kevin had asthma and so she was particularly appalled when she smelled marijuana on him when he came home one evening after playing with friends. He was twelve. “What are you thinking?” He said what kids say: “I just wanted to try it.” And she believed him. When she caught him drinking a beer, he told her the same thing, and she believed him again. She thought, Kids experiment. Kevin read a lot and loved Legos and science; in the evenings, he’d stand mesmerized in the backyard looking through a telescope he’d built himself. He charted the planets and their moons. But then he became an adolescent and all that stopped. He seemed tired all the time. He was surly, and sometimes Jacqueline thought he might be depressed. She brought him to see a psychiatrist, who diagnosed him with ADD and noted that Kevin might also have bipolar disorder. He prescribed Depakote. Kevin became “different, he drifted away from me,” Jacqueline says. He was thirteen when she discovered that he had taken pills from her medicine cabinet. When she confronted him, he again said he was curious. She said: “You have no idea how dangerous this is. You should have asked me if you were curious.”
Before they divorced, Kevin’s parents had moved to a neighborhood in Chesterfield, Missouri, because it was reputed to have a good school district. Kevin attended Parkway Central High. She began hearing rumors from other parents that she found absurd: that her son had become the “cocaine king” of Chesterfield County. She confronted him. Kevin was adamant in his denial. “You know I’d never do anything like that.” At home, a watch disappeared. A silver bracelet. Both were family heirlooms. In their upper-class neighborhood late one night, there was gunfire, and Jacqueline ran for her children in their beds, threw them onto the floor, and held them down. It took a while for her to realize that it was their house being shot at. All the basement windows were blasted out. The next day the police came and arrested Kevin. They found a cache of drugs. He was charged with possession and dealing. He was also charged with burglary. He’d broken into a car and stolen weapons—a crossbow and a sniper rifle. Kevin was released pending trial. One night, he slipped out, and when he came home he was “sort of crazy—paranoid, anxious.” Jacqueline learned he’d taken methamphetamine. “It was already terrible by then, but everything got worse.” Once, he held his mother hostage in her room for hours, pacing. She tried to leave and he knocked her down. Finally he became calmer, and she wept and said he had to go into a hospital, but he said no, he knew he was messing up, and he’d stop. She searched his room and found spoons, needles, plastic bags with yellowish powder in them, cut-up 7-Up cans, and pens without cartridges. Soda cans and pens can be used as makeshift pipes for smoking marijuana, crack, and other drugs. Kevin’s court date came. A judge sentenced him to nine months in jail for three felonies, including dealing and the theft of the rifle and crossbow. He served the time. After that, Jacqueline says, “Everyone felt he should get out of Missouri, away from his drug-using friends, and we sent him to LA to be with his grandparents.” She thought that maybe things would be okay. But his grandfather, a psychiatrist, discovered that someone had been stealing prescription pads, and there were missing checks. Jacqueline pleaded with Kevin: This must stop. Remember your uncles. You have good grades. You can go to college. His grandparents couldn’t handle him and sent him back. She met him at the airport and was horrified. He was wired, grinding his teeth, emaciated. “What could I do? I didn’t know.” She brought him home. “I just tried to figure it out, talked to
people asked for help. Even at the hospital where I worked, no one knew what to tell me. He’d go out. Was I supposed to sit on him twenty-four-seven? I couldn’t. I’d tell people, try to get help.” He turned eighteen, which meant that she had even fewer options, because at that age in most states, children can longer be forced by their parents to go into treatment—they have to sign themselves in. One day, she found more drugs. Baggies. Small crystal rocks—probably cocaine or meth. Suboxone. She went to him and begged him to check into the hospital, but he refused. He locked himself in the bathroom. She called to him but he didn’t answer. She waited twenty minutes. A half an hour. An hour. “I worried that he could die, so I called 911.” Cops arrived. The shower was on but they heard cabinets closing. The police told Kevin to come out. When he didn’t, they told him to back away from the door because they were going to kick it in. They did. Kevin was on the floor stuffing drugs—cocaine—and paraphernalia into a cabinet. They took him away. Jacqueline went to work, and that afternoon she was paged and told that her son was downstairs. He’d just been arrested. How could he be downstairs? He’d apparently called her ex-husband, who bailed him out. She went downstairs as hospital security guards were escorting him out of the building.
Jacqueline says, “I’m bawling. He’s out there, ‘I wanna come home! Mom!’ Screaming for me. ‘Mom!’” She shook her head no, and he left. Soon Kevin was back in jail, but he was released when his father paid his bail again. Jacqueline helped him get into a youth hostel. She’d meet him for breakfast at a restaurant. He had a job, made some money, and began seeing a girl. He seemed happy, Jacqueline says. “And that’s what we want for our kids.” Shortly after he turned twenty-one, he moved with his girlfriend to LA. He and Jacqueline talked on the phone and texted for a while, but when Kevin stopped returning her calls and texts, she knew. A week went by, two. A text appeared on her phone: I love you, Mom. She left messages on his phone and sent texts. In every message and text, she told him that she loved him. Kevin was in LA for four months before he was arrested again. He spent six months in jail, and then a drug court sent him to an inpatient rehab program. He called from there, sounding better. At the rehab, patients who did well were integrated into the surrounding community. Over the months, Kevin gained
privileges—worked part-time, enrolled at Santa Monica College. He was discharged in the spring. Jacqueline sent her son notes of encouragement. She sent notes from the family dog, Gryffindor, named after Harry Potter’s house at Hogwarts; Kevin had loved the J. K. Rowling books. But again, she stopped hearing from him. When she did, she knew it was getting worse, he was going “down down down.” He smoked pot, drank, used cocaine, bath salts (a so-called designer drug related to amphetamine), mushrooms, heroin, and, mostly, methamphetamine. Sometimes he would call—when he was stuck at a gas station, for instance—begging her to wire him money, which she refused to do. She did send his grandparents money to buy him a cell phone for Christmas after his had been lost or stolen. She thought of it as a lifeline to him. She kept sending him messages. I love you. Again, and again: I love you. No response. On the eleventh of February, 2012, the door of a nondescript apartment building in Los Angeles opened and a boy stumbled out into the empty gray street. He collapsed into a nearby bush.
A day later, Kevin’s grandmother received a telephone call. Some boy said he was a friend of Kevin. “I want to offer my condolences,” he said. “I’m sorry Kevin died.” “What are you talking about?” His grandmother didn’t understand. The boy said, “You didn’t know?” She called Kevin’s father, who called Jacqueline. She heard her ex-husband’s voice and knew. There was a memorial service. There was an autopsy, and a toxicology report confirmed a long list of drugs in his body. Jacqueline wrote me and said, “I am trying to get some solace, some meaning from this crazy world. My life is shattered. I loved him with every ounce of me, I know he loved me too. The drugs won in the end.” Another note: “I am on my way to LA for Kevin’s funeral. It has been 2 weeks today, and I still do not want to believe what has happened. I had a star named after him.” A week later: “I have to do the hardest thing tomorrow, bury my son’s ashes. I am not ready to say goodbye.”
Later: “It is six weeks since he passed away. I still can’t believe he is truly gone. I have found a cemetery near my house that I go to on Sundays and just sit, sometimes write, and wonder why my son. My entire core aches. I keep looking for something that will connect me to him, but I can’t find it.” Another: “Today is 9 weeks. It’s really bad. I am having a really hard time with the question of what happens to a person when he dies. I am driving myself crazy.” Sometimes Jacqueline writes to Kevin. “Love you sweet boy, always and forever. I was numb this morning, then I could not stop crying. I love you so much. I can’t stop the tears. I wish I had a sweatshirt of yours that I could curl up in. Your blanket, anything.” Later she writes me: “For the first time I saw a young man that looked like Kevin. He was crossing the street in front of me. He had the same hair as Kevin, I could tell it was that same texture too, and that reddish color his hair got after he had been in the sun for a while. I lost it, I had tears streaming down my face. I wanted to follow this boy and scream Kevin, where is my Kevin.”
apa 529 words