No Longer ALONE - SAMHSA Publications And Digital Products

No LongerALONE(A STORY ABO U T ALCOH OL, DRUGS, DEP RESSI ON, AND T RAUMA)Isabel, Maria, and Rosa Accept Help andGive Recovery a Chance

AcknowledgmentThis publication was developed as a collateral product to Treatment Improvement Protocol (TIP) 51, Substance AbuseTreatment: Addressing the Specific Needs of Women. It was prepared for the Substance Abuse and Mental Health ServicesAdministration (SAMHSA) by the Knowledge Application Program (KAP), a Joint Venture of The CDM Group, Inc., andJBS International, Inc., and with the subcontractor, TMNcorp, under contract number 270-09-0307, with SAMHSA, U.S.Department of Health and Human Services (HHS). Christina Currier served as the Contracting Officer’s Representative.DisclaimerThe views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions,or policies of SAMHSA or HHS.Public Domain NoticeAll materials appearing in this publication except those taken directly from copyrighted sources are in the public domain andmay be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. However,this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office ofCommunications, SAMHSA, HHS.Recommended CitationCenter for Substance Abuse Treatment. No Longer Alone (A Story About Alcohol, Drugs, Depression, and Trauma). HHSPublication No. (SMA) 13-4781ENG. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.Originating OfficeQuality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance AbuseTreatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857.Electronic Access and Copies of PublicationThis publication may be ordered or downloaded from SAMHSA’s Publications Ordering Web page at http://store.samhsa.gov.Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).HHS Publication No. (SMA) 13-4781ENG — No Longer AlonePrinted 2013

No LongerALONE(A STORY ABO U T ALCOH OL, DRUGS, DEP RESSI ON, AND T RAUMA)Main CharactersIsabelMariaRosaGloriaOther CharactersEduardoMrs. SmithMartaJorgitoRobertoSofia1CarmenSocial WorkerPsychiatrist

1Maria and Isabel meeting at a restaurant.Isabel, it’s great to see you!It’s great to see you, too,Maria. It’s been a long threemonths, but so far, it looks likeI’m doing well.2a2bI’m taking control of my life.For years, I used drugs with myex-boyfriend, Roberto. At first, it wasjust pot, but that led to other drugs.3a3bThe drugs were helping me withmy anxiety. I had to take care of mylittle brother and sister, and I hadfallen way behind in school. I thoughtI wasn’t going to graduate.Isabel! Isabel! I don’t understandthis homework. Help me!2

4a4bYou know, Maria, I didn’t think I wasin trouble, not even when the policearrested me for driving under theinfluence. I had to go to court, paythe penalties, and agree totreatment. It was a nightmare!56I went through the same thing.I denied having a problem withalcohol even after my bossgave me an ultimatum and Istarted treatment. That’s whenI realized I had a problem withdepression, too.At a beauty parlor Maria, you’re drunk again. Two days agoyou fought with Ana and gave Mrs. Smith abad haircut. You’re a very good hair-dresser,but you need to go home now.I am going to give you one last chance.I know your mom is sick and you needthe job. Here, I got you this information.If you want to work here, then youneed to get some help!3

78At the New Life Center, Maria meets withGloria, one of the center’s counselors.I was not being honest withGloria or myself. I couldn’t control it.But I kept denying it.Maria, have you ever feltthe need to cut down onyour drinking?No, Gloria, I have it all undercontrol. When I am drinking toomuch, I just stop myself.9In another part of town, Rosa, another woman suffering from alcohol and drug abuse, cries for her children.My kids! I can’t believe it!My kids are gone! I lost them.I got drunk and stoned andthen passed out. That’s whenJorgito and Sofia got hurtplaying with the stove andthe fire started.1011At the Child Protective Services office,Rosa meets with a social worker.Rosa, the court decided that yourchildren need to go into foster care fornow. You need to get into a substanceabuse treatment program.I can’t sleep. I still havenightmares about my exhusband hitting me. The onlything that helps me get mymind off it is cocaine.No, you can’t take my kids. I’lldo better this time, I promise!I understand that you are upset, but,don’t worry, they will be okay. You will beable to visit them, as you get better.4

1213At the New Life Center.Thanks for sharing your stories. Nowyou know that you are not alone. Youcan choose to stay, and we can faceyour circumstances together.One week later at a private session.Rosa, I would like to recommendthat you see a psychiatrist.Why? What’s wrong with me?Don’t look at it that way.A psychiatrist can help youunderstand how the situation youlived in with your ex-husband hasaffected you and can help you findways to better deal with it.14At the psychiatrist’s office after evaluating Rosa.Rosa, you are suffering from posttraumatic stress disorder, or PTSD.What is that?It is a state in which you can’t stop remembering a traumaticevent. You tend to relive it over and over again with flashbacks,bad memories, or nightmares. It can also make you feel as ifyou are in a constant state of high alert. You might feel irritable,and sometimes you may want to stay away from a place thatreminds you of the trauma. Or maybe you want to avoid aperson who reminds you of the traumatic event.5

15What? You mean that, eventhough he is gone, I’m stillsuffering because of him?Yes, you are, but we can do different things tomanage your PTSD. I recommend you receivetherapy for PTSD. You will learn some skills tocope with situations that trigger your relivingthe trauma. I am also prescribing medicine foryou that may help reduce the frequency of yournightmares, so that you can sleep better.16One week later at the New Life Center,Gloria leads a group session.17My Aunt Clara hasbeen a great help.Today we are here to work on your goals.Whether your goal is to get your driver’s licenseback, keep your job, or get your children back, wewant to make a change in your lives, and we needa plan. We need to think of people who can helpus. Can you think of anyone? Maybe there are alsoplaces we could go for help. Can you think of any?My boss, Carmen,is helping me a lot.I think this groupis helping me.You see, we are not alone in this journey. Wecan also think of joining a spiritual group, oryou may believe in someone who will helpyou maintain hope and regain inner strength.So, what else do we need for our plan?18Three months later, Isabel runs into her ex-boyfriend, Roberto.No thanks, I amOK. I don’t needanything.Roberto, get away from me, bothyou and your weed. I am done withthat stuff and with you, too!6But I miss you, sweetie.You look great. Why don’twe go have some fun? Ihave some pot, too.

19aIsabel is trying to study at the library.19bStaying clean isn’t easy. I keepbumping into Roberto. I’m alwaysso angry. Gloria’s right, I need tomake more changes in my life.20Meanwhile, at the beauty parlor.Hey Maria, you’ve been lookingvery good lately. Do you want meto give you a free haircut?Sure, Carmen. Why not? I do feelgood. At the New Life Center, theyhelped me get sober and sent meto a doctor for my depression. Sheprescribed medicine that helps.21It was hard to stop drinking.Then I felt so sad and hopeless. Igo to therapy now, too. Betweenthat and the medicine, I’m feelingso much better.Just look at you now! You tookcharge of your life!7Hmm Thismight help.

22Well, I still takeantidepressants.And that’s okay. Lots of peopleneed medicine, and you probablywon’t be taking them forever.23Rosa meets with Gloria in private at the New Life Center.What is happening,Rosa? What’s troublingyou?24aI feel awful. I diddrugs again.24bI was following mytreatment, and it’s beenso hard. I have so manythings to take care of. Ihave been looking for ajob for weeks, and no onehas called me back.8

25I moved out of the apartment to help me forgetabout how horrible it was to live there with my exhusband. I’ve been living with my Aunt Clara, and shehas been great. But I need my own place, and I needmy children now. It was just too much for me and Idid coke again.I see, Rosa. But doyou think cocaine isgoing to help you getyour kids back?No, of course not.OK, let’s work on a plan to make sureyou don’t have another relapse.26At the next group meeting.27It is incredible what you all have accomplished,both as a group and as individuals. Each of youunderstands your own value and merit, as well as thatof this group. Now, the work continues, and we needto prepare for the possibility of relapse.So, Maria, tell me onesituation that mightmake you want to havea drink?Well, taking care of my mom, who is sick, andworking full time is tough. Sometimes I feelhelpless, and I start getting anxious, and then Ifeel like having a drink.So what are you doing to keepyourself from drinking?28Well, when I feel like grabbing a bottle, I go for a walk or a runin the park instead. I also like to meditate or call a sober friend.It was hard at first to clear my mind, relax, and have positivethoughts, especially when all I was thinking about was a bottleof booze to help me forget about my problems. But I amgetting better at meditating, exercising, and staying sober.9

29Great! So Maria has identifiedsome things she can do to take hermind off the idea of drinking whenshe has a problem.3031What if someone offersone of you drugs or alcohol?How do you say “no”?Well, I kept bumping into Roberto, my ex-boyfriend, and have tried toignore him. It’s hard, you know, because sometimes I miss him and thedrugs. But a few weeks ago, I confronted him and told him to get lostand that I was done with him and that stuff.To tell you the truth, I thought it would be harder to say “no”than it really was. It’s hard to stay clean, but it’s worth it.32Great job! So you will always encountersituations in your lives that may lead youto have a relapse. These situations maybe external or may be inside of you. Theimportant thing is to prepare yourselfand have an idea of what you needto do to avoid a relapse.10

33A few years later Isabel just graduated from thecommunity college. She will soon begin classesat the university and has become a speaker for adrug abuse resistance program. She visits studentsin youth programs at high schools to talk aboutabstaining from drugs.34Isabel speaks to a group of high school students. And you may think drugs are cool and that you are undercontrol. But all I can say is drugs can take control of your life.It happened to me for a few years, and it wasn’t easy to getout of it. I still need to work hard on it.Stay clean and sober; you’re worth it. It’s OK if your friendsdon’t get it. Look for real friends who can help you when youneed them the most. You are in charge of yourself.35Meanwhile at the beauty parlor Wow, Maria, what anice haircut you gaveMrs. Smith!Yes, she was niceenough to give mea second chance.We all deserve asecond chance.36Maria became a peer counselor. She helps other women in substance abuse treatment avoid relapse.Being there for other women helps Maria remember her own commitment to stay sober.Hi Patricia, how’s it going?Is everything OK?11