Week 7

  

• Revisit your chosen case. Angela
• Review the Dahlgren-Whitehead Model and pay close attention to the two outermost layers of the model: Living and Working Conditions as well as General Socio-Economic, Cultural and Environmental Conditions.  
• Consider how factors such as educational attainment, income, stress, violence, discrimination, and the state of the local economy could contribute to the development of a substance use disorder. 

Submit a 2- to 3-page p++++ in which you:  

• Briefly introduce the individual featured in your chosen case.  
• Analyze the broader community and environmental factors that may have contributed to the development of a substance use disorder for the individual featured in your case. 
• Be sure to address factors associated with the two outer layers in the Dahlgren-Whitehead Model: Living and Working Conditions and General Socio-Economic, Cultural and Environmental Conditions. 

Use the Learning Resources to support your Assignment. Make sure to provide APA citations and a reference list.

 

• Dahlgren, G., & Whitehead, M. (2021). The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows.Links to an external site. Public Health, 199, 20–24. https://doi.org/10.1016/j.puhe.2021.08.009  
• Minnesota Department of Health. (2022, October 3). Social determinants of substance use & overdose prevention.Links to an external site. https://www.health.state.mn.us/communities/opioids/prevention/socialdeterminants.html 
• Carnevale Associates. (2021, June). Info brief: Addressing the social determinants of health in substance abuse prevention.Links to an external site. https://www.carnevaleassociates.com/file_download/inline/c18c74f3-26a8-440a-ab9b-c5fb6949bb87 
• Amaro, H., Sanchez, M., Bautista, T., & Cox, R. (2021). Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism.Links to an external site. Neuropharmacology, 188, 108518. https://doi.org/10.1016/j.neuropharm.2021.108518  
• Jalali, M. S., Botticelli, M., Hwang, R. C., Koh, H. K, & McHugh, R. K. (2020). The opioid crisis: A contextual, social-ecological framework.Links to an external site. Health Research Policy and Systems, 18(1), 1–9. https://doi.org/10.1186/s12961-020-00596-8  

© 2023 Walden University, LLC

Transcript – Angela Peters

Client Background

Angela Peters is a 23-year-old White woman, who has been married to Michael Peters
for two and a half years. The couple has one small child, Megan, aged 18 months.
Michael is employed by a large government contractor. Much of Michael’s work is
classified and involves lengthy periods of international travel. Michael finds the travel
exhausting, but the overtime pay from his international assignments allows the family to
live in an elegant home in an upscale neighborhood.

Angela grew up in one of the poorest areas of California. Angela was an only child, and
her parents were somewhat distant, as they were heavily preoccupied with work and
financial concerns. Angela was a quiet child who rarely socialized with anyone besides
her best friend Emily. Angela felt ashamed of her poor upbringing and generally tried to
avoid attracting any attention. Emily grew up in the trailer next door to Angela’s and was
a kind and loyal friend. Neither of Angela’s parents graduated from high school, and
Angela herself left school after the 11th grade to work as a cleaner in a motel. She
needed to help the family make ends meet after a car accident left Angela’s mother with
a permanent disability.

As time passed, Angela continued to work at the motel but also picked up a second job
waitressing at a popular restaurant. Angela and Michael met at the restaurant in the fall
of Michael’s final year of graduate school. Michael and his friends were frequent
customers who socialized for hours over many rounds of food and drink. Michael and
his friends were a noisy, outgoing group and tended to flirt heavily with the waitstaff.
Over time, Michael began to refer to Angela as his “favorite waitress,” as he was drawn
to her shy smile and kind demeanor. Angela, in turn, was flattered by Michael’s attention
and was impressed by his work ethic and ambition. Michael began to ask Angela to
come back to his apartment after her restaurant shifts and the two fell into a casual
dating relationship.

One evening that winter, Michael arrived at the restaurant and found Angela serving a
table of young men celebrating a birthday. Michael glowered as he watched Angela
smile at her customers. Pulling her aside, he demanded to know why she was flirting
with them. Angela stammered that she was only trying to be polite and do her job. “I
want you all to myself, Ange,” Michael replied. Angela was frightened by the rough way
Michael grabbed her arm but was pleased that Michael wanted to date her exclusively.
The couple began to see one another more often and began to occasionally talk about
the future of the relationship. Michael was due to graduate in May and had a job lined
up in Washington D.C. Angela did not feel she could leave her parents and imagined
that she and Michael might need to try a long-distance relationship. One day during a
conversation about the future, Michael blurted out, “No! No, there’s no way. I cannot
handle you living here away from me. Marry me, Angela. Let’s go to D.C. together. We’ll
send money back to your folks.”

© 2023 Walden University, LLC

Angela and Michael threw together a small, last-minute wedding 2 weeks after
Michael’s graduation. Neither set of parents was enthusiastic about their rapid decision
to marry. Angela’s parents felt Michael had a “fast” lifestyle and “showy” attitude, and
they worried that he seemed possessive. They were also dismayed to learn that Angela
would be moving across the country. Michael’s parents cautioned him that Angela was
only out for a “get-rich-quick payout” and will “ruin” him. The only person in Michael’s
family who has been friendly to Angela is his sister, Susan.

The couple moved shortly after the wedding and settled into their new city. Angela
found a part-time position at a local restaurant and sent money home regularly. Angela
deeply missed being near Emily, but the two friends spoke nearly every evening.
Michael adjusted to his new job and got a promotion after 5 months. Michael found his
work incredibly stressful and felt lonely being away from his graduate school friends, but
he told himself things would get better in time. Michael and Angela had fun attending
cultural events and exploring the nightlife in their new city. However, Angela quickly
became pregnant and her interest in going out sharply declined. After Michael was
promoted at work, his supervisors sent him overseas for longer and longer stints. He
found himself feeling anxious during these assignments and apprehensive about
Angela’s loyalty during his absences. When Michael returned from work trips, he would
volley between bestowing affection on Angela and accusing her of infidelity.

Angela gave birth to Megan during one of Michael’s international assignments. Her
parents were unable to travel due to her mother’s fragile health but sent their best
wishes. Emily flew in for a week to help Angela and cook her favorite meals. Angela’s
sister-in-law, Susan, came by to bring a baby gift and meet her new niece. Michael was
working at a particularly remote international site with an unreliable cellular connection
at the time of the birth. Most of the couple’s video calls with the new baby were
hampered by connectivity issues. When Michael finally returned home, he struggled to
bond with baby Megan. He looked at Megan with a mix of awe and bewilderment and
gruffly handed her to Angela any time she cried. Angela threw herself into her new role
as a mother but found herself frequently feeling sad and hopeless. She found baby care
incredibly consuming and often felt like she could not summon energy to eat or care for
herself.

Angela began to notice that Michael’s anger, jealousy, and suspicion were increasing.
Whenever she actually felt up for an outing to shop or meet friends, Michael would first
beg her not to go and then shout horrible insults at her and accuse her of seeing other
men. On a few occasions, Michael got so upset that he slapped Angela. Afterward,
Michael would apologize and insist that he didn’t mean to say or do anything to hurt her.
“You know I love you, Ange, right? You know I’m just stressed? You know that I won’t
ever do that again?” Angela wanted to believe that these were isolated mistakes, and
the outbursts were often followed by a period of tranquility in which Michael showed
great tenderness and affection. She even wondered at times if maybe she deserved his
hostility and aggression. However, these peaceful stretches never lasted, and Angela
began to feel increasingly afraid for her and Megan’s safety. On three occasions, the

© 2023 Walden University, LLC

outbursts became so loud that neighbors noticed and called the police. Angela did not
agree to file a police report.

When Megan turned 12 months, she learned to walk, and Michael seemed to feel
slightly more comfortable around her, as she was now big enough to play games that he
remembered enjoying as a child. Michael learned that Megan loved to knock down
towers of blocks, and he patiently played blocks with her most evenings after work.
Michael continued, however, to mourn the child-free life he and Angela used to have.
He often said that things would never be the same and that Megan took all the attention
and affection Angela used to bestow on him. He told Angela that he never wanted a
child, that it “cramps my style” and that “it’s hard to get used to all the crying and
diapers.”

Angela felt very alone. Her family had had only minimal contact with her since the
wedding, and Michael’s possessive ways had kept her from making many new friends.
The only local person in whom she could sometimes confide was Michael’s sister.
Susan had come to visit the couple about once a month since Megan’s birth, and it was
Susan who introduced Angela to cocaine. She showed Angela how to snort it and gave
her a stash to use between visits. Angela quickly realized that cocaine made her feel
euphoric, energetic, and talkative. She would notice the high almost immediately after a
single snort. And the effects would disappear quickly, so that Michael would not know.

Over time she began to use cocaine more frequently and could no longer imagine
facing a day without it. She found that it made it easier to deal with the feelings of
loneliness and worthlessness she experienced as she raised Megan and navigated
Michael’s explosive temper. Sometimes, she wondered if she was becoming addicted,
as she was snorting increasingly larger amounts. Lately, she had even been leaving
Megan home by herself in the crib when she needed to buy coke in between Susan’s
visits. She knew leaving Megan was not ideal, but she figured she was only gone for an
hour at most, and she needed the cocaine to get by.

Present Functioning

On a Saturday morning, during the most recent altercation, Michael punched Angela in
the face while she was holding Megan in the driveway of their home. Because she was
high from just having snorted several lines of cocaine 15 minutes earlier, Angela fell to
the ground with Megan still in her arms and hit her head, which began to bleed. This
was observed by a neighbor, who called the police. The police talked to Michael—
Angela could not really comprehend what was said—but did not arrest him. Angela and
Megan were taken to the hospital, where both were examined and given drug tests.
Because Angela tested positive and Megan showed a few signs of neglect, the hospital
staff made a set of recommendations and contacted the local division of child protective
services (CPS).

A social worker from CPS met with Angela and Megan at the hospital to assess
Megan’s welfare and develop a safety plan. The CPS social worker told Angela that

© 2023 Walden University, LLC

they do not automatically remove a child because a parent is experiencing a substance
use disorder but that substance use can interfere with safe parenting. She highly
recommended that Angela seek treatment for her cocaine use and provided Angela with
referrals to several treatment programs, including an intensive outpatient program that
included on-site childcare. She also provided Angela with a referral to an agency that
supports victims of intimate partner violence. The CPS worker told Angela that she
would meet with her again in a few weeks to see how she and Megan were doing.

Angela is overwhelmed. She feels lost and hopeless. She doesn’t know what to do
about her volatile relationship with Michael. She does not believe that she is a “hard-
core addict,” and she denies having a cocaine addiction. She feels embarrassed that
CPS is investigating her parenting and deeply afraid that they might take Megan away
from her.