Anita is referred for treatment by her primary-care physician to a local mental health agency. She is a single 27-year-old mother of two children, ages 3 and 5. She is separated from the children's father, John, but he remains a part of their lives and provides some support for the children. Anita immigrated to the United States from Puerto Rico as a child, and her parents live nearby and care for the children when Anita is at work. She works at a call center that offers technical support for a technology company. Her primary complaint is that she is anxious nearly every day and has always been referred to as a "worrier" by her family.

She acknowledges that she does worry a great deal about her family and finances, but she has found that drinking alcohol takes the edge off her worries and makes her feel more relaxed. John became concerned when he came to pick up the children for an outing early on a recent Saturday morning and one of the children answered the door. Anita was still asleep on the couch, and he found two empty bottles of wine nearby. After John confronted her, Anita agreed to see her physician. She insisted that if a doctor helped her with her "nerves," she would not need to drink to relax. After an office visit, her physician refused to provide her with anti-anxiety medications until she was seen for a more thorough assessment, explaining that any medication may make her situation worse.

He stressed the importance of assessing the degree to which her anxiety and heavy alcohol use are related. Anita refused a referral to a local substance abuse treatment agency, insisting that she needs help with her anxiety. However, she agreed to seek help at a mental health clinic.

• Describe both the strengths and challenges that are important considerations for treatment planning.

• Address the level of care that would be most appropriate for Anita based upon ASAM principles.

• How would cultural considerations inform treatment?