The Romano Family

Case Study: The Romano Family

Substance use, abuse or addiction involves a number of independent variables - biological, psychological, cognitive, social, developmental, and environmental (Fisher & Harrison, 2009). Prior to the 1970's, substance abuse prevention and treatment theories developed in isolation to multivariate factors (Substance Abuse & Mental Health Services Administration, 2004). It may be that the most well known and widely imitated treatment approach is the Minnesota Model which embraces the disease concept of addiction (Fisher & Harrison, 2009). Classified as a disease because it is chronic, progressive, and with continued use, possibly ends with death; treatment is a continnum designed with the belief that total abstinence is the only option that can be completely successful. Although incurable, t he disease of addiction can be arrested and treated - an individual can be in the on-going lifelong process of recovery (Fisher & Harrison, 2009). Behavioral models (aversive conditioning, covert sensitization) treatment focuses on associating the addictive behavior with some negative consequence - nausea is the most commonly used negative consequence - or a reward for maintaining non addictive behavior (Fisher & Harrison, 2009). Similar to the Minnesota model is 12-step Facilitation Therapy. Based on the principles of Alcoholics Anonymous (AA), Fisher and Harrison (2009) tell us that the structure and ritual, as well as the spiritual nature of the 12 step programs encourages self improvement an overall contentment with life. Motivation Enhancement Therapy helps individuals recognize and use personal resources to make changes; like motivational interviewing, it relies on an individual's readiness to change and use procedures to facilitate the probability of change (Fisher & Harrison, 2009). Cognitive Behavioral Therapy is based on the Social Learning Theory model and focuses on teaching effective coping skills for high risk situations to avoid relapse (Fisher & Harrison, 2009). Although rare as a single treatment option, pharmacological procedures are used in treating addictions (Fisher & Harrison, 2009). Medications such as xanax of valium are used to reduce uncomfortable and dangerous withdrawal symptom, as well as medications to reduce cravings or deter use (Fisher & Harrison, 2009).

Substance abuse problems and treatment methods vary depending on the needs of the client. Likewise, assessments and treatments must not be based on rigid pre-conceived perceptions of any population (Fisher & Harrison, 2009). Crucial to the effectiveness and competence of treatment providers is a theoretical knowledge of diverse populations (Fisher & Harrison, 2009). Room (2005), as cited by Fisher and Harrison (2009; p. 51) proposes that "ethnic and cultural identity in a diverse society is partly assigned (stereotyped) and partly constructed" for both visible minorities (identifiable by skin color, language, age, physical disabilities or external characteristics) and invisible minorities (those with learning disorders and differences; and those with different sexual orientation). Not surprising, what appears reasonable or normal from the perspective of one person's culture may not be reasonable or normal to someone from another culture (Summers, 2009). In African American (Black) populations, the role of alcohol varies; but in general, it is seen as a "party food" (Fisher & Harrison, 2009; p.63) that sets the tone of celebrations or gatherings Fisher & Harrison, 2009). The impact of substance abuse within the African American population as evidenced by the 2004-2007 SAMSHA National Survey on Drug Use and Health (NSDUH) (2009) survey findings show substance abuse problems on a national percentage rate for Blacks is 10.0%. Fisher and Harrison (2009), citing Caetano, Clark, and Tam (1998) and Kingree and Sullivan (2002), propose that the risk factors for Blacks include environmental, cultural, and historic factors. In addition, developmental issues (thawed achievement), geographical factors (number of taverns and liquor stores in community), racism, and discrimination heighten the risk (Fisher & Harrison, 2009). According to the NSDUH 2004-2007 survey (2009), 10.1% of Latino and Hispanic populations have substance abuse problems. Language barriers, lower self-esteem, dropping out of the education system and exposure to substance use and abuse by family members place this population at high risk (Fisher & Harrison, 2009). 19.4% of American Indians or Alaskan Natives have substance abuse problems (NSDUH, 2009). A study by Jones-Saumty, Hochhaus, Dru, and Zeiner (1983) suggested that higher incidences of depression resulted in compulsive drinking among Native Americans (Fisher & Harrison, 2009). Other risks factors may include feelings of alienation and the use of substances as a coping mechanism (Fisher & Harrison, 2009). Twelve percent (12%) of Native Hawaiian and other Pacific Islanders abuse substances (NSDUH, 2009). Relocation and Euro-American values present many conflicts for this pop0ulation - traditional values versus newly acquired values can place these individuals at risk for alcohol and drug problems (Fisher & Harrison, 2009). Drug use in Italy is not viewed as dangerous to society (Solivetti, 2001); and although unauthorized drug trafficking is punishable with up to three years imprisonment, drug use, itself, is not punished at all. Moreover, Italian youngsters are introduced to drinking when they are about 10 to 14 years old (Allamani, Cipriani, Voller, Rossi, Anav, Karisson, & Osterberg (2005).

The movie "Dreamgirls" featured a song whose lyrics say, "It is more than you, it's more than me. No matter what we are, we are a family. ...we need you ...we are a family. Families have a remarkable ability to maintain homeostasis. Jackson (1957), as cited by Fisher and Harrison (2009); p. 204), defines family homeostasis as "the natural tendency of families to behave in a manner that maintains a sense of balance, structure, and stability in the face of change." The central concept of family homeostasis is predictable family roles (Fisher & Harrison, 2009). Any shift or threat to the family's sense of balance, structure, or stability as a result of changes in one member forces every member to change or adapt. Harvard physiologist Walter Cannon discovered the body's primitive inborn and automatic response that prepares it to fight or flee from perceived attack, harm or threat to survive (Neimark, n.d.) In the same light, family systems that are faced with a member's alcohol or drug (AOD) abuse instinctively fights or flees (copes, controls, minimizes, denies) to protect itself (Frederikson, 2012).

The Romano family consists of Mr. and Mrs. Romano and six