TPC Journal V8, Issue 3- FULL ISSUE

The Professional Counselor | Volume 8, Issue 3 235 Mesosystem: Interactions between two or more environments where an individual exists. In Jason’s West Virginia and Ohio communities, there were several changes in economic and medical systems that impacted his use of opiates. The shutting down of coal mines and businesses associated with the coal industry (housing, rail transportation, and facility maintenance provision) made a significant economic impact on communities and extended to multiple industries outside of mining. New houses were not being constructed, and local small businesses began to struggle and disappear. As a result, the need for concrete diminished and Jason’s boss was forced to lay off workers. Families like Jason’s were faced with a difficult choice: remain in a community in which they and multiple generations before them had lived and hope jobs would one day return or uproot their families in search of employment opportunities elsewhere. Many families chose the latter—which left the small town void of human resources and an adequate tax base from which to provide municipal and human services. Jason’s long-term treatment provider should take into account employment opportunities within the community and assess if Jason has adequate training for today’s workforce. Vocational rehabilitation counseling is recommended to assess his skills and to determine if further education is needed. All of the local helping service providers (e.g., medical, addictions, mental health, vocational, and school professionals) in Jason’s town are overwhelmed because of high needs and dwindling financial resources. As such, Jason’s counselor must be aware of mesosystem-level obstacles; these interactions between microsystems may be fraught because of the challenges being experienced in each system. For example, the process of one facility making a referral to another can be difficult because of high demand and a lack of resources in either system. For clients like Jason, already struggling with shame and disenfranchisement, a mesosystem-level challenge might be taken personally and be potentially triggering. A counselor working with Jason through an ecological lens could engage with him regarding such an obstacle, and draw parallels to other system-to- system interactions that have affected him (e.g., how decline of coal is impacting other economic opportunities in his town; how the influx of cheap heroin is impacting hospitals, treatment centers, and neighborhoods). As mentioned above, increasing a client’s awareness as a person in a system may help create more accurate assessments of the forces at play within the respective environments. Exosystem: Interactions between two or more environments, at least one of which does not include the individual . In addition to the economic shifts noted in the previous section, important changes in the way pharmaceutical companies marketed prescription opioids to both consumers and medical providers impacted the availability of these narcotics in the communities where Jason lived. Jason was told by physicians that the drugs he was prescribed carried a very low risk of addiction and was given documentation supporting the effective and safe use of Oxycontin as a treatment for pain (Van Zee, 2009). Jason was not aware that his physician had attended an all-expenses-paid pain management conference at a Florida resort, hosted by Purdue Pharma, or that his doctor had been invited to become a speaker for the company. He also was not aware that his physician was being tracked by Purdue as a frequent prescriber of OxyContin and thus receiving increased attention and gifts from their regional sales representative, who was eagerly pursuing an annual sales bonus that could more than double her salary. These distal variables had a profound effect on Jason as an individual, along with many other examples in the mesosystem: his Ohio boss’s enforcement of company policies regarding drug use and addiction; health care policies about prescription opiates, addictions treatment (including medication- assisted therapies), and insurance for people with pre-existing conditions; drug traffickers contaminating heroin with fentanyl and pushing an influx of heroin into Jason’s vulnerable community; and state and local policy regarding the availability and administration of naloxone—which likely saved Jason’s