Client’s Brief History, Presenting Issues, Family, and Social Context
Miya, 35, is an African American woman with alcohol and cocaine stimulant use disorder and persistent depressive disorder. Lacking social support, Miya struggles to maintain sobriety and is ashamed of the things she has done to get money to source alcohol and drugs. She feels enormous “guilt” and “crippled” by her life choices but is hopeful for a better future. She believes that her drug and alcohol addiction is the reason for and the result of depression.
Miya started abusing alcohol and drugs experimentally as a teenager, and the innocent act turned into a troubling addition in her 20s. Now in her mid-30s, she thinks she cannot do without alcohol and cocaine and is depressed. Miya does not have a good relationship with her mother, the only person she could have relied on for social support. She also lacks a job and spends most of her time drinking and using cocaine rather than working. Consequently, it is becoming difficult for her to get money to fund her addiction, and she has had to engage in what she terms “shameful acts” to get money for the drugs.
Strengths, Protective Factors, Areas Where Resilience Has Been Shown
One of Miya’s strengths is a genuine desire to transition into a more responsible and active member of society, with the protective factor here being her troubled social life and depression. She has also shown resilience in the area of consistent communication. Unlike other clients, Miya continues to talk with me even when at home. She attends all treatment sessions without fail and often asks many questions about what she can do to be better.
Goals and Objectives for Client
The main goal for the client is to restore her sobriety and eliminate depressive disorders. Alcoholism and drug abuse are the root cause of her struggles, and eliminating them is my priority. Specific objectives attached to this primary goal include the following:
- Completely eliminate drug and alcohol abuse
- Maintain sobriety
- Improve the relationship with her mother
- Manage the cravings and withdrawal symptoms of alcohol and drugs
- Recover from depression and
- Increase attendance in support group meetings to once per week
Target Problem(s) or Behavior(s)
The interventions will target specific behaviors that make Miya vulnerable to alcohol and drug abuse. Such behaviors include idleness, keeping the company of addicted friends, failing to exercise, not eating healthy, failing to participate in support group discussions, and improving her coping skills. The theoretical underpinning for the intervention is that the best way to address a problem is to identify and eliminate its root causes.
Literature Review and Selection of Intervention
Basis for Selection of Intervention
The basis for the selection of intervention is evidence-based research and client information. The treatment intervention selected for Miya includes behavioral counseling, medication, examination of co-occurring health issues, and long-term follow-up to prevent relapse (National Institute on Drug Abuse, n.d.). The specific behavioral counseling for Miya utilizes cognitive behavioral therapy (CBT) techniques, which will help Miya also deal with depressive episodes, accelerating her recovery.
Miya will also take medication as part of her treatment. Specifically, she will get appropriate amounts of benzodiazepines, antidepressants, and clonidine drugs (Addiction Center, n.d.). Benzodiazepines will reduce irritability and anxiety associated with drug withdrawal symptoms, and so will clonidine (Addiction Center, n.d.). Antidepressants will relieve Miya of depression during treatment (Addiction Center, n.d.). Dosages for these drugs may vary over time to increase the patient’s chances of achieving sobriety. I will also do a long-term follow-up to ensure that Miya does not go back to abusing alcohol and drugs.
Present Theoretical Perspective of the Intervention
Presently, no theory is adequate and appropriate to guide all medication use. In the utilization of CBT, relevant models include theories of emotion and motivation, learning theory, and cognitive psychology. The theories of emotion and motivation can be physiological, neurological, or cognitive. Physiological theories suggest that people develop the emotions that they do due to responses within the body (Plieninger & Heck, 2018). Neurological theories, on the other hand, suggest that emotional responses are due to brain activity (Cherry, 2020). Lastly, cognitive theories argue that emotions are the outcome of thoughts and mental activity (Cherry, 2020). They suggest that people can change how they feel by altering their thoughts.
Learning theory is concerned with how people obtain and retain information. According to this model, a person’s experiences and the existing emotional, cognitive, and environmental factors affect a person’s knowledge acquisition and retention abilities (Bates, 2019). Thus, it will be necessary to allow the patient to acquire knowledge and skills at her pace.
Lastly, cognitive psychology is the critical examination of the human brain as a natural processor of information. If the mind processes information fast and more accurately, then the person can learn new things faster (Plieninger & Heck, 2018). In cases where a drug and alcohol addiction patient is undergoing treatment, accessing their mental capacity may help the interventionist design a customized approach.
Empirical Justification for the Intervention: Alternatives Presented and Rejected
The best treatment for drug and alcohol abuse is a combination of approaches that aim at the causes of behavioral problems and reduce the negative withdrawal symptoms that individuals experience. Using a combination of methods increases the intervention’s effectiveness and reduces the amount of time needed to attain complete healing (National Institute on Drug Abuse, n.d.). However, this is not the only treatment option available. More elaborate options involve inter-disciplinary collaboration and often include sophisticated equipment and techniques. The applicability of these approaches varies with the patient’s situation. They are generally useful in handling serious cases and repetitive episodes of relapse.
The problem with the single-subject design is that it only addresses one problem at a time and the patient serves as their own control subject. Therefore, a basis for comparison does not exist, and measuring the treatment’s extent and effectiveness becomes difficult. In this regard, the single-subject approach is less effective and must be ignored. The better alternative is using a combination of treatment methods, including behavioral therapy and medication, to ensure the patient attains the best possible outcomes within the shortest time and without spending excessive money (National Institute on Drug Abuse, n.d.). The only important consideration in applying this treatment modality is that it requires inter-disciplinary collaboration with cognitive-behavioral therapists and knowledgeable general medical practitioners, registered nurses, or pharmacists.
I will monitor Miya’s progress over time by observing her behavior and understanding her emotions. For example, I will keenly examine her whenever she has a phone conversation to see how her social interactions are changing. Within a week of careful observation, I will have gotten an idea of her conflict. Based on this information, I will improve the applied intervention to increase its effectiveness and reliability. I will also regularly have conversations with Miya to understand her feelings and the effect of the treatment on her.
Applicability of the Intervention for the Client and Practice Situation
The recommended intervention is applicable in the client and practice situation for various reasons. First, it recognizes that drug addiction is a chronic illness that is difficult to treat (National Institute on Drug Abuse, n.d.). People cannot be cured just because they stop using drugs for a few days. Thus, repeated and long-term care is needed to help most patients attain complete sobriety. The recommended treatment option is also intended to stop Miya from using drugs and help her stay sober and productive in society. Second, various principles form the basis for the recommended treatment program.
One of them is the understanding that although alcohol and drug addiction is a complex problem, it is treatable. This principle gives doctors the desire and drive to pursue the best outcomes for their patients without stopping (National Institute on Drug Abuse, n.d.). The bulk of the work involved in the patient’s treatment is detoxing or removing drugs and alcohol from the system and managing withdrawal symptoms. Behavioral coaching can also help the patient cope with the new challenges associated with ceasing drug and alcohol use.
The second principle is the idea that doctors should use a flexible approach in treating their patients. The main reason for this is that individuals are different, and no single modality is suitable for everyone (National Institute on Drug Abuse, n.d.). Understanding the patient’s situation, medical history, and general health condition will give the specialist an idea of creating and implementing the proper treatment for a given individual. Notably, in some cases, treatment approaches require multi-disciplinary collaboration. In others, one doctor with enough skills in different areas may competently handle the patient and occasion their positive transformation from addiction to complete sobriety.
All in all, early access to treatment could spell the difference between an effective intervention and a failed one. If the patient accesses treatment early enough, the doctor will have a chance to manage the disease quickly and effectively (National Institute on Drug Abuse, n.d.). Delays in seeking medical attention are dangerous as they cause the symptoms to worsen and complicate the condition. The earlier the patient’s treatment begins for drug and alcohol addiction, the easier the patient’s transformation would be. Notably, drug and alcohol addiction worsens with time as individuals become dependent on increasing the stimulant with each passing day.
Staying in treatment long is also critical as it radically improves patient outcomes. Long-term treatment of drug and alcohol addiction is the surest way of successfully reversing the adverse effects of years of abuse. Ongoing long-term treatment also boosts the body’s recovery process by targeting specific areas that require attention. Moreover, with long-term treatment, the doctor observes the patient more critically and uses this information to introduce more effective and reliable changes (National Institute on Drug Abuse, n.d.). Counseling and behavior therapies are the most typical and most preferred treatments for alcohol and drug addiction because they focus on eradicating problematic emotions and behaviors. Medication is used as a secondary treatment to support cognitive therapies. Reviewing and modifying treatment plans based on patient outcomes is also crucial. Most importantly, the doctor must identify any other existing mental disorder and treat it concurrently with the patient’s central problem.
Addiction Center. (n.d.). How medications help with addiction treatment. Web.
Bates, B. (2019). Learning theories simplified: And how to apply them to teaching. Sage.
Cherry, K. (2020). Overview of the 6 major theories of emotion. Very Well Mind. Web.
National Institute on Drug Abuse. (n.d.). Treatment approaches for drug addiction DrugFacts. Web.
Plieninger, H., & Heck, D. W. (2018). A new model for acquiescence at the interface of psychometrics and cognitive psychology. Multivariate Behavioral Research, 53(5), 633-654. Web.