Family and Cultural Considerations in Treatment Planning

What are the family and cultural considerations (for treatment) in the case study of "Lisa"? Please give detail.

Lisa case study;

Lisa (32) is a heterosexual-identified Mexican American female and mother of twin boys (8) who has come to your agency to address substance abuse concerns at the suggestion of her defense attorney. In your initial session with Lisa, you learn that she began using marijuana and drinking alcohol at age 12, using cocaine at age 14, and shooting heroin at age 16. She claims that she has not used heroin in the last five years, although she continues to drink and to use methamphetamines.

She was referred to you because after a night of heavy drinking and methamphetamine use, Lisa had an argument with her boyfriend Charlie, pulled a knife on him, and threatened to kill him. Charlie was able to run to another room, where he called the police. Lisa attempted to stab him under the door, and finally tried to cut through the door, lodging the knife in the wood. Frustrated, she then got in her car and left. Police stopped her several blocks away, and she was charged with her third incident of driving under the influence (DUI). At the time of the incident, her sons were at her mother's house. In addition to facing charges for driving under the influence of drugs and alcohol, Lisa now faces the possibility of losing custody of her children.

Lisa lived in poverty her entire life, and grew up in the economically disadvantaged west side of San Antonio. Her father, who died of a drug overdose, used heroin as long as Lisa could remember, and beat Lisa's mother. Lisa frequently intervened. Lisa's father had wanted Lisa to be "tough," so he and his brothers had her and her male cousins box each other while the men bet on which child would win. As Lisa grew older, she learned that her survival depended on fighting. She joined a gang in middle school, and has remained connected to the gang ever since.

Lisa blacks out at times when she experiences rage. Her blackouts may last from several minutes to several hours. Lisa has always experienced blackouts, although, because she has used drugs and alcohol nearly every day for 20 years, she is unable to tell you much about the correlation between the blackouts and her drug and alcohol abuse. When she recounts this last incident with Charlie, however, she shares that she acted "just like my dad did to my mom," and that the last thing she remembers in her fight with Charlie was "my dad's voice getting really loud," even though her father has been deceased for 10 years.