Counseling: Assessment Of Addictive Behaviors

Counseling: Assessment Of Addictive Behaviors

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Counseling: Assessment Of Addictive Behaviors

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Counseling: Assessment Of Addictive Behaviors

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Question:
Discuss about the Counseling for Assessment of Addictive Behaviors. 
 
Answer:

Counseling in the Area of Substance Use
The primary objective of the counseling is to help Ruby, Amira, and Sammy to maintain abstinence from alcohol and addictive chemical. The secondary objective is to assist these clients to recover from the potential harm caused by the addiction (McLeod, 2013).
In this case study, the first and foremost step in counseling is to

Make Ruby, Amira and Sammy admit of their addiction by confrontation and reframe their thoughts in a way feasible for the successful outcome. As Ruby and Amira are already seeking help, therefore, they are aware of their adversity so; confrontation may not require.
Provide encouragement and motivation
Well monitor abstinence by screening tests, breathalyzers, and self-report of relapse (Kelly et al., 2015) 

 
Assessment of Substance Use
Assessment of substance abusers requires taking history, cultural background, sexual history, family relations and mental health into consideration. In the case study the first step of the treatment for Ruby, Amira and Sammy includes their initial assessment of the above mentioned parameters.
History of these three clients in the case study may include interrogation to know about the mode of drug intake (smoking or injecting), a level of craving, etc. Family history may include marital status, alcohol abuse by friends, domestic violence, and abuse (sexual, physical, emotional or verbal). Sexual history includes identification of a type of sexual activity, sexual satisfaction, and reproductive health. Assessment involves the screening of physical health consequences such as liver disease, ulcer, anxiety, depression, and others (Bowen et al., 2014).
Assessment of Ruby, Sammy, and Amira also include physical exam to identify the presence of the following and require DSM-V criteria:

Neurological symptoms such as memory loss, blackouts,
Communication and Emotional difficulties such as rapid, slurred speech, attention deficit, agitation, suicide ideation, etc.
Physical signs such as constricted or dilated pupils, unsteady gait, needle track marks (Mills et al., 2012)

Approaches to the Treatment of Drug Addiction and their Evidence Base
Literature research provides evidence, which supports the treatment, approaches useful for substance users like Ruby, Amira in the case study. It includes “behavioral and family-based interventions” in addition to medication. Psychosocial treatments are recognized to be the basis of “Drug and alcohol treatment.” Those approaches are discussed below:  
Figure: Systematic approach to providing psychosocial interventions for AOD use 
(Source: Graham & Reynolds, 2013)
Case Study of Ruby:
The issues identified in this case are high alcohol dependency, parental isolation, no siblings, loneliness due to separated friends, and poor performance in studies.
The treatment options that are suitable based on her condition include:
Brief interventions: consist of 5-30 minutes and are delivered in hospitals wards, general setting, and community in both outpatient and inpatient setting. It includes assessment phase followed by advice on a way to reduce harm. It includes positive aspects and FRAMES approach (feedback, responsibility, advice, menu, empathy, and self-efficiency) (Shearer & Byford, 2015).
Behavioral approaches- These approaches aim at enhancing the ability of Ruby to resist drugs by modifying their attitudes and abuse related behavior. It increases active participation in recovery and ability to resist drug or alcohol use. Some of these brief interventions are:
Contingency Management (CM) This approach aims to reinforce positive behavior in Ruby and promote healthier activities. Therapists may provide incentives to help Ruby to stay away from addiction and enhance active participation. Clients can earn low cost incentives in the form of prizes or tickets for movies, food items by involving in drug treatment and remain abstain from addiction (McLeod, 2013).
Motivational Enhancement Therapy (MET) in the approach Ruby will be motivated by a therapist to participate in the treatment by assessing the desire to get recovered. The therapist acts empathetically, yet is directive while explaining Ruby about the need of therapy, and elicits “self-motivational” statements to bring the internal change. It consists of a 2-3 session and is first line option. It can be used in all phases of treatment and is recognized best approach for decreasing alcohol abuse (JR Stewart et al., 2015). 
 
Intensive Psychosocial Treatments are:
Cognitive-Behavioral Theory (CBT) it includes peer discussions. It focuses on learning by teaching coping skills. Ruby can learn the “positive and adverse consequences of using alcohol” and learn to overcome her distorted thinking style and factors causing the craving” (Graham & Reynolds, 2013). It is combined with “acceptance and commitment therapy” to retrain Ruby with painful events such as thoughts, bodily sensations that were ignored or not addressed. Research has indicated this method to be effective in stress, depression and chronic illness (Baillie et al., 2013).
Dialectical Behavioral Therapy (DBT) includes group skills training, behavioural and cognitive modification, telephone counselling, reflection, empathy, and acceptance. It consists of 12 months duration. It includes direct discussions, coping craving and options of medication (Sobell et al., 2013).
Community solutions tend to collaborate with individuals and their families, to develop knowledge required for making positive changes. The community programs provide that provides prevention, intervention and treatment designed in a way to promote health and well being. These include helping families in supporting children in overcoming relapse. It includes youth intervention programs such as “Family Court Referral Program” and “school referral program” (Larimer, 2013). Intervention services consist of decreasing violence, sanctioning adolescents if violating the probation through alcohol infraction. The later deals with educating students about effects of alcohol and drug abuse through workshops, seminars, etc. Community solutions include “Adolescent alcohol and Drug diversion program”. It involves screening for usage, diversion programs according to level of dependency. It includes referral services to different community programs (Donovan & Marlatt, 2013). In this community programs the people dependent on the alcohol or drug are made aware of how their choices influenced their life.
Rationale: CM will be helpful as Ruby spends excess money on her drinking, and she does not want her parent to know that she desires to seek help.  MET will help her reinforce positivity and motivate her (Mills et al., 2012). Motivation is required in all the phases of treatment but mainly during initial phase of treatment for moral boost up.  CBT will help Ruby to get over from the chronic illness, stress and depressions (Reynolds, 2013). CBT is helpful in triggering positive attitude. DBT is applicable for Ruby as telephonic counseling will be highly beneficial as she cannot seek help from her parents. Therefore she needs empathy and acceptance to ease the process of cognitive modification. Community programs will be advantageous as they help in anger management and counseling along with medicine, psycho education, and treatment in problem solving groups (Sobell et al., 2013).
The psychological issues identified during counseling: anger, depression, violent behavior, attention deficit, anxiety, burnout and high level of relapse.
Duration: Ruby may take less time of 12-14 months to overcome relapse and cravings, and strictly adhere to the medication. However, if they do not sort to seek family support, it will longer time considering her psychological issues. Being highly dependent on alcohol she will initially take more time to resist relapse.
Relapse prevention plan which is best suited for her is twelve step approaches which include AA to abstain from alcohol. It will be followed by pharmaceutical therapy. 
 
Case Study of Amira:
The issues identified in this case are high alcohol and drug dependency (heroin), low connectedness with parents, stress for being arrested for soliciting.
The treatment options best suitable for her include:

Brief interventions: To reduce the addiction, through FRAMES approach.
Behavioral approaches- Amira is a patient of drug addiction. Therefore, these approaches will enhance the ability to resist drugs.
Contingency Management
Motivational Enhancement Therapy
Cognitive-Behavioral Therapy
Community solutions
Dialectical Behavioral Therapy and
Self help groups Client can participate in peer support programs or Group therapy during the treatment to maintain abstinence. This approach helps in “positive social reinforcement” by engaging peer discussions as all the people in the group have similar problems (Donovan & Marlatt, 2013).

Rationale: CM is applicable for Amira as her parents are not aware of her addiction, and she does not want them to know about her adversity. Amira can enhance her positive behavior and healthier activities through this approach by earning incentives to stay away from addictions. MET will boost up Amira to reinforce positivity (Mills et al., 2012). CBT is applicable for Amira because it will help to manage emotional regulations and anger, which are caused due to the addiction. DBT includes group skills training, behavioural and cognitive modification, telephone counselling, reflection, empathy, and acceptance (). It consists of 12 months duration. It includes direct discussions, coping craving and options of medication (Reynolds, 2013). It will help Amira as she does not want to reveal her parents about her soliciting and arrest. Self help groups promote group therapy and per support. It enhances positivity by engaging with different people experiencing similar trauma (Graham & Reynolds, 2013). Community programs will be advantageous as they help in anger management and counseling along with medicine, psycho education, and treatment in problem solving groups (Sobell et al., 2013).
The psychological issues identified during counseling: anger, depression, violent behavior, anxiety, burnout, and high level of relapse.
Duration: the duration of this process may require three years in the case of Amira as she is highly dependent on alcohol and drug and has high chance of relapse.
Relapse prevention plan for her include Twelve step approach is best method for her to resist craving mainly NA (Larimer, 2013). Inpatient services in rehab will be highly beneficial for her detoxification. Later it can be followed by pharmaceutical therapy. 
 
Case Study of Sammy:
The issues identified in this case are – high alcohol dependency, poor physical health and failing eyesight.
The treatment options best suitable for him include:

Brief interventions and Behavioral approaches
Contingency Management
Motivational Enhancement Therapy
Cognitive-Behavioral Therapy
Dialectical Behavioral Therapy
Group therapy sessions
Community solutions

Rationale: CM will be helpful for him to get money or food as the incentive as he has no source of income or family to take care. He needs MET to achieve the confidence to resist the craving for alcohol. It will enhance positive thoughts in him initially needed to start the treatment process (Mills et al., 2012).  CBT will help him to overcome his craving and improve his distorted thinking styles. It is evident of relieving stress and depression. DBT includes group skills training, behavioural and cognitive modification, telephone counselling, reflection, empathy, and acceptance. It consists of 12 months duration. It includes direct discussions, coping craving and options of medication (Sobell et al., 2013). Sammy can learn the “positive and negative consequences of using drugs and alcohol” by participating in the group sessions (Graham & Reynolds, 2013). Community programs will be advantageous as they help in anger management and counseling along with medicine, psycho education, and treatment in problem solving groups (Sobell et al., 2013).
The psychological issues identified during counseling: anger, depression, violent behavior, anxiety, burnout, muscle tension, pain in spinal cord and high level of relapse.
Duration: the duration may be more than three years considering the issues identified and high chance of relapse.
Relapse prevention plan  includes listing of signs of relapse, development of strategies for these signs, identification of future “high-risk situation” and teaching coping skills and mindfulness skills and restore their emotional equilibrium. The best method is the twelve step approach to resist craving. He requires admitting in rehabilitation (inpatient services) to undergo process of detoxification followed by pharmaceutical therapy (Shearer & Byford, 2015). 
 
References
Baillie, A. J., Sannibale, C., Stapinski, L. A., Teesson, M., Rapee, R. M., & Haber, P. S. (2013). An investigator-blinded, randomized study to compare the efficacy of combined CBT for alcohol use disorders and social anxiety disorder versus CBT focused on alcohol alone in adults with comorbid disorders: The Combined Alcohol Social Phobia (CASP) trial protocol. BMC psychiatry, 13(1), 199.
Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., … & Larimer, M. E. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA psychiatry, 71(5), 547-556.
Donovan, D. M., & Marlatt, G. A. (Eds.). (2013). Assessment of addictive behaviors. Guilford Publications.
Graham, P., & Reynolds, S. (2013). Cognitive behaviour therapy for children and families. Cambridge University Press.
Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., … & Schuckit, M. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. American Journal of Psychiatry.
Johannesen, M., & LoGiudice, D. (2013). Elder abuse: a systematic review of risk factors in community-dwelling elders. Age and Ageing, afs195.
JR Stewart, B., Sindicich, N., Turnbull, D., M. Andrews, J., & A. Mikocka-Walus, A. (2014). Changes in Australian injecting drug users’ mental health problems and service uptake from 2006-2012. Advances in Dual Diagnosis,7(4), 151-161.
Kelly, P. J., Leung, J., Deane, F. P., & Lyons, G. C. (2015). Predicting client attendance at further treatment following drug and alcohol detoxification: Theory of Planned Behaviour and Implementation Intentions. Drug and alcohol review.
Larimer, M. (2013). Preventing alcohol abuse in college students: A harm-reduction approach. Alcohol problems among adolescents: Current directions in prevention research, 147.
McLeod, J. (2013). An introduction to counselling. McGraw-Hill Education (UK).
Mills, K. L., Teesson, M., Back, S. E., Brady, K. T., Baker, A. L., Hopwood, S., … & Ewer, P. L. (2012). Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: a randomized controlled trial. Jama, 308(7), 690-699.
Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2015). Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clinical psychology review, 38, 25-38.
Ryan, A., Holmes, J., Hunt, V., Dunlop, A., Mammen, K., Holland, R., … & Lintzeris, N. (2014). Validation and implementation of the Australian Treatment Outcomes Profile in specialist drug and alcohol settings. Drug and alcohol review, 33(1), 33-42.
Schutte, K., Lemke, S., Moos, R. H., & Brennan, P. L. (2015). AGE-SENSITIVE PSYCHOSOCIAL TREATMENT FOR OLDER ADULTS WITH SUBSTANCE ABUSE. Substance Use and Older People, 314-339.
Shearer, J., Tie, H., & Byford, S. (2015). Economic evaluations of contingency management in illicit drug misuse programmes: a systematic review. Drug and alcohol review, 34(3), 289-298.
Sobell, L. C., Sobell, M. B., & Ward, E. (Eds.). (2013). Evaluating alcohol and drug abuse treatment effectiveness: Recent advances. Elsevier.

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