Case Scenario:

Alexandra is a 34 year old Hispanic female who is presenting to your human service practice for inhalant usage. She reports that she currently abused 10-12 10oz cans of computer duster on a daily basis. When she is not using, Alexandra reports symptoms of nausea, vomiting, lightheadedness and fatigue. She would like to enter into residential treatment services to address her inhalant usage as well as address an underlying gambling disorder. She reports that prior to her inhalant addiction, she was "a real bad gambler, I blew all my rent money, I couldn't save anything and could barely provide for my children. When I began duster I just stopped feeling all the pain that I was escaping with gambling and now that I'm going to lose the duster I'm afraid I won't be successful." She described initiating her gambling addiction 10 years prior after "some good luck playing cards and winning $150,000 in the lottery. I was the life of the party and everyone liked me" Prior to her gambling, she described herself as a "loner, a reject, the person always picked on or rejected or abandoned by those that mattered but that changed once I got a luck streak." She described relocating to Virginia when she was 15 years old from Puerto Rico and that English was not her first language. As a result of her cultural difference, she was often bullied by peers which increased her desire for social acceptance.She reported that her gambling habit grew rapidly and that she experienced acceptance once she began sending money to her family and "giving handouts to people and living a great lifestyle." This did not last long as evident by her spending all of her winnings within one year of receiving her lottery pay out. The amounting debt, inability to secure meaningful employment or sustain meaningful relationship "because I told all my friends and job to go screw themselves once I got my money and stopped sending money home once my habit got bad" began her experimentation with duster 9 years ago. After abusing the substance for about 6 months, she reports that she was robbed and assaulted for the remaining money from her winnings "things just got out of control from there and now here I am 10 years later, an addict with barely visitation rights to my kids and back to being the family reject."

Considering the information in the scenario:

1. What underlying issues would need to be addressed with Alexandra once she begins residential services
2. Considering the accessibility of her drug of choice, what are some relapse prevention tools that would be helpful to her?
3. What are some relapse triggers manifesting in the scenario? Identify a minimum of 2.
4. How would you address these triggers in your work with Alexandra?