SEVERAL CASE STUDIES FOLLOW BELOW

1  ADDICTION SERVICES 

Client History:

The client is a forty year old male who has had an entrenched history of different addictions to both licit and illicit substances. He began abusing alcohol at 16 years of age, binge drinking on a regular basis. He also smoked cannabis from an early age and has continued to smoke this substance all his life. In 1993 he started injecting morphine, developing a severe addiction for five years. By 1998 he was injecting heroin daily. For many of these years he led an itinerant lifestyle, often homeless and alone. He would use many of the above substances together and stated in 1994 his alcohol use was solely methylated spirits. By 2002 he began injecting Dexamphetamine and “Crystal Meth”. He originates from Sydney and grew up with his mother who was dependent on alcohol. Regardless of his drug and alcohol abuse he has worked as a cook “off and on” for 15 years. His last drink of alcohol was in 2003 when he was incarcerated for armed robbery.

Offending:

The client’s criminal history prior to this latest offence was brief. Convicted in 2001 for assault and breach of bail he was given a short custodial sentence. His one and only parole was completed. The Armed Robbery conviction was for an offence that occurred in Western Australia when he attempted to hold up a service station with a “loaded syringe”. He was at the time under the influence of alcohol and other drugs (Amphetamine) and he stated that it was “a desperate act crying out for help”. He was sentenced to 44 months imprisonment and I met the client towards the end of his sentence at Wooroloo Prison Farm

Treatment:

The counselling process revealed that both alcohol and drugs were consumed  together and that he would consume these substances until he dropped. Discussions regarding triggers would not necessarily identify the behaviour behind the substance misuse. The client felt that the only way to stop was to be totally abstinent. He attended AA meetings in prison where he discovered that he could talk about alcohol all day without wanting a drink, however conversely, talking about drugs would create urges to use. He was still smoking cannabis in prison hoping he would not be subjected to urinalysis. He was accepted into Outcare’s Accommodation Program which motivated him to try and make some positive changes in his life.

In March 2005 the client was transferred to a Work Party Detail in the Walpole area and he did not return to Perth until he was released in July. Within a short period of time the client found full time employment working as a chef in a café. He began drinking alcohol again and ontinued to smoke cannabis at night. Dexamphetamine was detected from urinalysis and he disclosed that he had taken six pills orally and had not injected them. This job lasted three months when he quit after his boss had abused him for a work related issue. When he lost his employment he began abusing alcohol again and he realised that without some structure in his life he was at risk of returning to old behaviours. He then found another job working as a chef, where he is still employed today, and he moved to the Fremantle area.

The client continued to attend counselling sessions with me and we covered many areas of need. We continued to discuss the costs and benefits of drug use and while he still smokes cannabis and drinks alcohol he does so in a more responsible manner.

Outcomes:

The client has made some significant changes in his life. Since being released from prison he has not regressed back to injecting drugs and he has not re-offended. He has developed insight into his need for alcohol, and has been able to step back from false beliefs and poor decision making. He smokes cannabis mainly to get to sleep at night. He was exited from the program in conjunction with the Department of Correctional Services decision to finish his parole unsupervised.

2  WOMENS SERVICES (ST JOHN OF GOD WOMENS PROGRAM)

The Client (Anne) first came into contact with Outcare shortly after sentencing. She was referred to Outcare’s St John of Women’s Program by Prison based Staff after a number of issues causing distress impacted on her behaviour in the Prison.

Anne had three children aged between 4 and 12 who lived in their hometown of Bunbury. A Court order was in place and agreed prior to sentencing that the Children were to live with their biological Aunt until their mother had sorted out her life and was able to provide a stable home.

Whilst in Prison Anne rarely received prison visits, especially from her children because of the distance and travel expenses. At times the lack of contact made it difficult for her to stay focused on a positive future but with the help and support of this Program, regular visits and advocating with various Agencies, she started to plan her future.

During Welfare visits it was identified that the main issues for Anne were:

• Reuniting with her Children
• Obtaining a suitable home for release
• Organising repayment of debts to:
• Homeswest
• Fines Enforcement Registry
• Centerlink
• Repcol (debt collectors)
• Anne also had addiction issues with Amphetamines and Marijuana.

During the time Anne was in Prison her Outcare Case Manager was able to contact creditors and brief them of her situation. This prevented further debts accruing and continued legal action to recover the debts.  It enabled Anne to enter into financial arrangements that would commence shortly after her release. Also with the assistance of her Case Manager, an existing debt with Centerlink proved to be in error and was written off. 

Anne was referred for assessment to Outcare’s Addictions Service with a view to addressing her addiction and offending behaviour; Counselling took place on alternate weeks to her Welfare visits.

After some time, Anne was offered Crisis accommodation with Outcare and this assisted in conjunction with her Parole plan which was now viable.

On release Anne was transported from the Prison by her Case Manager and taken to her fully furnished Unit. Anne was given orientation of the area and details of transport and local services.

Whilst living in Outcare’s accommodation and engaging with Staff on a regular basis, Anne generally remained focused on the goals set in Prison, especially in reuniting with her Children. Occasionally when things got the better of her, she was able to seek support from Outcare. She wasn’t alone.

As a means of re-establishing her relationship with her Children, Outcare provided assistance with food vouchers and multi riders to assist when the family stayed in Perth.

As Anne gradually re-established a closer relationship with her Children, her Case Manager worked closely with her and a number of Government Departments and other Agencies involved. It was agreed that she be granted permission to move from the Metropolitan area once she had a suitable address. This was achieved within approximately two weeks and enabled her to return to her hometown. As a result Anne was referred on to an Addiction Counselling Service in Bunbury.

Anne occasionally contacts her Case Manager from Outcare for assistance or just to chat.

She currently has weekend access with her Children in her home and a real chance of them returning to live with her fulltime, in the very near future.

3  COMMUNITY SUPPORT SERVICES RE-ENTRY LINK

The client was first interviewed in prison in May 2004 and requested assistance with accommodation.

The client has a history of harmful alcohol use and his offences were related to the use of alcohol.

The client was accepted onto the Re-entry Program and assistance was provided in finding suitable accommodation.  An application for Department of Housing & Works accommodation was completed prior to release and lodged.  Crisis accommodation was booked at a Perth hostel until stable accommodation could be found.  After release from prison a priority application was submitted to the Department of Housing & Works aged housing and the client was accompanied to the Homeswest office to arrange the repayment of an outstanding debt and to provide documents as required.  Homeswest had offered housing within a couple of weeks of the visit to their office however the client turned it down as he did not feel confident living alone in a house, preferring to stay in boarding houses where he had company.  The client was able to remain listed for Homeswest housing and the Outcare case manager has been acting as contact person/ advocate as the client has on occasions been difficult for Homeswest to contact but has maintained regular contact with the Outcare worker.

This client moved between several hostels due to problems arising at the accommodation and because he had been asked to leave due to alcohol related incidences.  The client has been able to abstain from drinking for a while but would periodically relapse.  Many issues that contributed to alcohol use, and subsequent offending, were related to traumatic childhood events and abuse while residing in orphanages.

The client had a very supportive Community Corrections Officer however he eventually was breached and returned to prison to serve the final few months of his sentence after which he was released a second time.  The client asked to remain on the program and as he had only a short time left to serve he remained a client.

When released the second time the client again moved between boarding houses experiencing similar problems as previously and occasionally slept on the streets.  The client is fairly good with finances and usually had the money to pay for accommodation if it could be found.

Apart from accommodation support the client was given emotional support and encouragement.  The client also had the support of counselors from an external drug and alcohol support agency and has been attending AA.  With encouragement from a CCO and the Re-entry case manager the client agreed to contact a counseling agency to address the trauma of childhood abuse and eventually was able face his abusers (representatives).  The Outcare case manager attended a meeting, acting as emotional support/ advocate, with current members of the organization who had care of him as a child.

The client was eventually put in contact with members of his family overseas, who he had never known, and with the assistance of an external support group, was given the opportunity to be reunited with them.  A trip overseas with a support person was arranged and paid for and as a result the client discovered that his family had been trying to locate him and were supportive.  The last discussion with the client indicated that he was maintaining contact with his family

After discussions with the Department of Housing & Works the client was placed in a boarding house that has only a few residents, most of whom are close to the clients age.  The accommodation is quiet, secure and available long term.  The client is happy with the housing and is making an effort to avoid the use of alcohol, realizing that he has much to lose if he were to relapse.