Assessment of an adult with high alcohol consumption - Assignment Example

Reflective Commentary on a Placement Portfolio Part I: Illustrations (Words 709) Introduction Alcoholism is a major cause of morbidity and mortality in the UK. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol (Velleman et al., 2003, 103-112). Long-term, escalating levels of alcohol consumption can produce tolerance as well as such intense adaptation of the body that cessation of use can precipitate a withdrawal syndrome usually marked by insomnia, evidence of hyperactivity of the autonomic nervous system, and feelings of anxiety (Handley and Ward-Smith, 2005, 213-244). A need for daily use of large amounts of alcohol for adequate functioning, a regular pattern of heavy drinking limited to weekends, and long periods of sobriety interspersed with binges of heavy alcohol intake lasting for weeks or months strongly suggest alcohol dependence and alcohol abuse (Schuckit et al., 2003, 163-170). A. Assessment of an Adult with High Alcohol Consumption: Reflective Commentary: In my placement, I participated in many activities related with adults having addictions with drugs and alcohol. In this reflective account, I would present a running and critical account of my activities to find out the extent of my learning through such activities (Cunha and Novaes, 2004, s23-s27). The first account is that of a 43-year-old male who was misusing alcohol and was diagnosed to be alcohol dependent. I was involved in his assessment and intervention in this service setting where I was placed (Chung et al, 2005, 5-27). Despite several attempts and multiple detoxification attempts, he could not come out of it. Both the family and he were willing to give it a try again, and they self-presented to the service to seek help. On assessment, I introduced myself to the client and requested the family to stay out of it until being called for to participate (Worden et al., 2008, 831-835). I ensured total confidentiality of our conversation, and this was important to gain confidence from the patient and to extract information, so a care plan can be developed based on this assessment (Gaume et al, 2008, 62-69). The assessment of his alcohol problems would provide the foundation of case conceptualization and treatment planning (Holtforth et al., 2004, 80-91). Although ideally, the alcohol assessment should take place within the context of comprehensive biopsychosocial assessment of clients and their environments (Mack and Frances, 2003, 125-146), the assessment took place in the setting of the service provider. I decided to perform a structured interview to elucidate the factors, such as, social support, family environment, psychopathology, use of drugs other than alcohol, and his employment (Walters, 2008, 326-333). I was aware of the fact that the more aspects of client’s life that were impaired due to alcohol use, the treatment would need to be more involved and comprehensive (Gatti et al., 2008, 132-137). To facilitate this assessment process, in addition to the clinical interview, I decided to do a structured interview and self-report methods. Overall, the assessment was sufficiently broad to capture the extent and complexity of many factors that accompanied, potentially maintained, and were affected by his alcohol use (Wright et al, 2008, 411-421). The structured clinical interview that I used was from the Diagnostic Interview Schedule (Vinson et al, 2007, 1392-1398). This is known to establish a reliable and valid diagnosis of Alcohol abuse and alcohol dependence. This included information about his aetiology, course, his readiness to abstinence (Canagasaby and Vinson, 2005, 208-213). With minuter questioning, I elicited the relationship of alcohol and his other life problems. I also assessed his relapse risk and strengths and resources. To assess the severity of his alcohol problem, I used Addiction Severity Index that yielded scores in seven areas of functioning of the client. These were alcohol use, drug use, medical history, employment, legal and social life, and psychiatric health (Schmidt, 2007, 541-548). Although self-report methods are used in the assessment and treatment of alcohol misuse and dependence, their reliabilities may be questioned (Butler, SF., 2005). However, my aim was to measure his current alcohol consumption, run a screening and diagnostic measure, and to measure the characteristics of his drinking in relation to his readiness, so this information could be helpful in the treatment planning process (Daiter et al., 2007, 87-92). The day I did the assessment, the client was alcohol free, and since I ensured confidentiality of the interview that was conducted in the service setting, the reliability of the information would be acceptable (De Silva et al., 2008, 49-50). I used a screening tool that included a consumption measure in this patient, although his diagnosis of alcohol dependence had been an established one. I decided to use the WHO AUDIT tool (Bradley et al., 2003, 821-829). This is a 10-item tool to assess recent drinking with questions on quantity and frequency, alcohol problems, and alcohol dependence. I used this diagnostic measure to assess the severity of the alcohol problem in this patient (Gache et al., 2005, 2001-2007). In my view, this was a suitable choice in this client where the alcohol problem is already suspected, and the evaluation interview is being conducted at the premises of the service provider (Smith and Shevlin, 2008, 1093). In this assessment process, I learned how the academic learning about alcohol assessment procedures can be applied in the practice area (Kranz, 2003, 724-741). While using the theoretical learning in the assessment process, I was able to consolidate my learning and was also able to identify my gaps in learning, which I decided to study further in order to be able to apply them in practice in my next opportunity. B. Group Work with a Group of Clients (Word 611): This is the second reflective account of my activities in the placement. This was executed among a group of inmates who were rehabilitating in my placement. The organization where I was placed is dedicated to residential treatment of adults affected with alcohol or drug problem, where both the phase 1 and 2 treatments consist of interpersonal group therapy and workshops (John et al, 2003, 263-269). I executed many such group therapy sessions, and this account is the result of reflections on them (Loughran et al, 2008, 106). The sessions involved the participants in the group, and group therapy has been considered to be the treatment of choice for people with alcohol problems. It is also known that group therapy clients achieve their gains earlier in the treatment. This happens in my opinion due to the fact that group uses therapeutic forces within the group, constructive interactions between members, and interventions of a trained leader to change the maladaptive behavior, thoughts, and feelings of emotionally distressed individuals (Passetti et al, 2008, 451-455). The clients who were in the process of abstaining had their own distresses and they were evidently emotionally unwell. These persons were carefully selected and were allowed to meet in the group guided by me. The idea was to help one another effect personality changes through interactions. My role was to provide various technical maneuvers and theoretical constructs to direct the group members to interact among each other (Cebulla et al, 2004, 1045-1054). The group consisted of 8 people, and the idea was to optimize motivation. I decided that in order to optimize motivation, the session should explore the topics of consequences of drinking, the likely future course of alcohol-related life problems, and the marked improvements that could be expected with abstinence (Ness and Oei, 2005, 139-154). The discussions used to be open ended with topics such as how to build a lifestyle free of alcohol. The discussions would cover the need for a sober peer group, a plan for social or recreational events without drinking, and approaches for re-establishing communication with family members and friends (UKATT Research Team, 2005, 541). It was important to note that as time passed on, the members of the group started to open up and intercommunicate, and the discussion would proceed and encompass all even starting from the verbal cue of another (Carroll and Onken, 2005, 1452-1460). The most important topic perhaps was strategies for relapse prevention that was discussed in the group. I encouraged the participants to recognise each other’s and their own individual situations where risks of relapse were high (Brook and Spitz, 2005, 33-81). I then suggested the modes of coping, and invited all of their suggestions about how would they strategise coping, and what do they know about available help and how would they seek it (COMBINE Study Research Group, 2006, 2003-2017). All of them agreed that it is important to develop customized modes of coping that would be used when the craving for alcohol increases or when any event or emotional state makes a return of alcohol drinking likely. All of them agreed about developing appropriate attitude towards slip. Many of them suggested that recovery is a painstaking process of trial and error, and they felt that they need guidance about development of appropriate coping strategies (Litt et al, 2003, 118-128). Reflecting on these, I found that this is a very effective means to develop a support group among the clients themselves, since alcohol related research implicates that rehabilitation is an ongoing process where the clients themselves may create support groups among themselves, and group therapy is an important pathway for that (Ghaye and Lilleyman, 1997, 17-51). I also realized that to extract maximum benefits from group therapy, as a leader I lacked ability to connect the verbal exchange within the group to the theoretical nuances of the alcohol science, and the knowledge deficiency can be met up further learning, and it also needs communication skills, where I lacked. I need to work on that. Part II : Organisations: Meeting Aims and Objectives (Words 1000) : Several organisations offer treatment and support services for men and women who are affected by alcohol adversely. The aims of such organisations are to understand the client needs throughout the treatment pathway including provision of appropriate medical treatment and to bring them back to their families and to re-integrate them to the community (Ribeiro, 2004, S59-62). The objective of such organisations is to provide a holistic approach of treatment in appropriately suitable conditions in order to motivate clients to make major and lasting changes in their lives (Touquet and Paton, 2006, 510-511). In the UK, there are around 500 counseling and advice centres around the country to help people with alcohol problems, Most of them are funded by NHS and are free. There are several large chains of residential detox treatment centres in the UK such as Female Only Detox Unit, Promis Treatment and Recover Centre, Supporting People, and 12-Step Treatment Centres. These provide residential treatment from the time of cessation of use for 21 to 28 days. All of these centres provide family therapy and aftercare (Twombly, 2003, 211-235). A typical programme provides a wide range of residential and rehabilitation treatment services to those affected by alcohol and drugs and related problems. These treatment programmes are backed by continuing research into effectiveness and outcomes (Ryan et al, 2006, 28-34). These programmes are ethically designed in such a way that they reflect the diversity of the individual, respecting their needs and their rights to make informed choices. The programme construction and development occurs through involvement of the clients into those (Garnick et al., 2006, 19-26). The treatment programme is usually delivered in two separate phases, and these are all delivered in a safe, alcohol and drug-free environment. A newcomer usually is subjected to detoxification from alcohol in the first two to three weeks (Humphreys, 2003, 621-622). This is usually a very challenging time for the clients. The programme aims to provide appropriate medical and emotional support to the clients to help them recover. In the phase one the two-week newcomer programme is instituted. This consists of eight group sessions based on motivational interviewing. Usually through this, the client is able to explore his lifestyle and attitude to change. Towards the end of this phase, the client should become more self-aware and be able to set some goals (Gold and Brady, 2003, 115-122). Many programmes comprise a programme of workshops focussed on skills including stress and anxiety management and dealing with cravings. A key worker would work with the client throughout the treatment programme in order to offer practical and emotional support (Thornicroft and Tansella, 2004, 283-290). A report generated on the findings of this phase would lead to an aftercare plan where the client is actively involved in the decision making process. This phase may also include other complementary therapies (Nabitz et al., 2005, 193-201). The scenario throughout the world is not much different. In the US, where the problem with alcohol and drugs is a problem with a far larger magnitude, such rehabilitation programmes would evaluate the patient’s condition at entry, sometimes in-house, sometimes through a local hospital or personal physician (Appleton, 2005, 251-262). This is conducted in order to determine whether the facility would be able to safely handle the patient. Findings suggest that in most of the cases, these facilities are experienced enough and well equipped to handle such clients. Initially sedation is employed for detoxification. The subject is immediately introduced into the rules and discipline. These include responsibilities of own room, personal care and laundry. The client is expected to follow a rigid and timely schedule of meals, activities, and appointments (Marquis, 2004, 308-327). In the US, each week, there are at least three two-hour sessions of group therapy. Participation in group, work, and play therapies; self-help groups, and other activities are mandatory since they have therapeutic values (Mohr, 2004, 61-77). To allow full concentration on de-addiction and to avoid outside influences, communication with the outside world is usually deferred. The most important thing to note is that exercise, group games, and free times, are all scheduled. The clients are also treated with individual therapy. The cousellors and group leaders are experienced social workers, nurses, and psychologists (Wilson, 2005, 476-484). In the UK, moreover, the maintenance of sobriety is ensured by a further four weeks of interpersonal group therapy and workshops, written assignments, and one-to-one counselling. These workshops include drink and drug refusal skills, managing negative thoughts, and building self-esteem (Davies et al, 2004, 346-350). The programme thus focuses on four areas. They are drink and drug use and resulting damage, avenues to get to know self, ways to cope with things as they are, working on family relationships, and raising quality of life. In these programmes, considerable space is provided for the future activities, where the clients are encouraged to set their own goals and decision about extended care and eventually moving on (UKATT Research Team, 2005, 544). Once an individual has completed detox, their emotional, psychological, and social needs are met be extension programmes. These extension programmes in the UK allow the clients to live as a part of the safe and secure community. They participate in the smooth running of the facility along with maintenance of safety and trust within the group. They undergo a structured treatment programme that consists of group therapy, individual counselling, and assignments (UKATT Research Team, 2008, 228-238). The individual treatment programmes developed in collaboration with the clients would include insights into the effects of substance misuse in individual’s life, in-depth work on issues underlying substance misuse, focus on life and social skills in order to reintegrate into the community, and exploration of potentials for future employment (Keene and Li, 2005, 1145-1161). The individual counselor serves an important role to develop plans during and after treatment keeping in mind the individual requirements and individual goals. The mental acumen that are developed through group therapies are management of craving, managing anger and exploration of the scenario, relapse prevention and exchanging criticism. The unique feature in the UK is help in development of practical skills of independent living and vocational development for future employment (Copello et al, 2006, 802-810). The clients are encouraged to participate in community or social care activities and frequent outings (Sharp and Atherton, 2006, 540-558) . The UK centres usually get referrals from several sources. These are health authorities, social services, general practitioners, probation, private individuals, other sources, alcohol and drug agencies, consultant psychiatrists, and other treatment centres. Usually these are funded by different sources with contribution from the clients remaining optional. In contrast, in the US, these programmes usually cost $80 to $150 daily, with this industry growing to ensure 20% profits to their shareholders, the basic structure being the same where attempts to alter the patients’ knowledge and experience about their addiction to help them keep sober (Luty and Carnwath, 2008, 245-247). In reality and ideally, these programmes should involve a multidisciplinary team of physicians, nurses, psychiatrists, social workers, psychologists, and ministers and priests (Galanter, 2006, 307-309). All of them have individual roles, and they undertake much of the ongoing care of these substance abusers in professionally run detoxification facilities. To conclude, these programmes throughout the world have an excellent safety record and provide excellent programming for abstinence for those who are ready, that is, who undertake them in a correct frame of mind and continue in the aftercare. The aftercare mainly involve participation in the self-help groups, where the newly earned sobriety through such programmes the clients can get a great deal of specific information about addictions, and extensive amount of practical training in social skills, authority acceptance, developing and maintaining relationships, and alternative ways to handle problems ( Macdonald et al., 2007, 247-268). .III. Experiences in this Placement (Words 974) My placement experiences are exciting and thrilling in the sense that this provided an opportunity to gain professional skills that are never explained in academic reading. To know the science of counselling and to apply that to the clients are two different ballgames altogether. I keenly observed and learned from the clients I had been assigned to during my clients (Brennan and Little, 1996, 53-71). The two things that I came to know better are the interpersonal skills including the skills to communicate and the personal attributes that are absolutely necessary for this profession of counselling in a detox or rehab unit. I came to understand that recovering from addiction is a hard work for the client, his family, the employer and the provider, and the counselor. I have seen clients for whom the how it is difficult to cope with in the first few weeks, when a literal battle ensues (Brechin et al., 2000, 83-96). This the time, the support needed is maximum. Denial is the most important problem that a counselor encounters. I encountered a situation that can be stated here. During the early part of my placement, I did the mistake of talking to a client’s family during the initial interview in absence of the patients. Later I found that the client is refusing me, and this culminated into rejection of the therapy (Davies et al., 2000, 131-146). I discovered subsequently that holding the conference with the family in his absence was a blunder on my part since this construes an additional area of the client’s concern despite the fact remains that holding a family conference in presence of the client is not always practical (Doel and Sawden, 1999, 51-92). I decided that a more thorough insight of the client’s psyche is necessary and the client must be given adequate explanation for the family conferences later on the treatment schedule, once the trust between me and the client builds up (Eraut, 1994, 13-46). Ideally, holding such discussions in presence of the client avoids an additional area of concern to the patient. The skills of communications were very important on my part, and I did never allow such a situation to repeat during my placement by allowing appropriate communication with the patient. Thereafter, I used to discuss openly the use of outside information in my presentations to the patient. I indicated that I honour binding confidences, but also, I encouraged openness (Klenowski, 2002, 27-51). It is my observation in many cases that once the client has agreed to start treatment, there are many prompt improvements. These benefits operate in a positive manner to make the client and the family feel better about the decision to enter treatment, and my job there was to help motivate to increase determination to continue (Moon, 1999, 11-32). I understand that detoxification and medical and psychiatric treatment in the earlier part of the therapy brings into clear focus, the havoc that addictive behaviour caused into the clients’ interpersonal relationship within the family or job. May clients are remorse and depressed understanding the actual economic problems they are facing and their true implications (Ghaye and Ghaye, 1998, 19-29). While interacting with clients, I understood how foolish they feel about themselves, and the clear understanding of their own disastrous behaviour may take a heavy toll on their self esteem. Many patients have been seen by me to behave in an unpredictable bizarre manner in such situations. This was an opportunity to support them cope with such reactive behavioural states by sheer display of interpersonal skills and by personal attributes (Kolb, 1984, 23-45). Obviously, the patient’s nerves are taut and his coping skills limited. I have observed them closely to be running out of patience. They are immature and without understanding at this stage, and I have learned the hard to be patient at this stage of intolerance, and I have learned at the wake of time that use of human skills to provide understanding to them is the best thing to do. Relaxation techniques and other means to defuse the anxiety should be mainstay to support the addict’s clearing mind, and interpersonal skills could be the best way to deliver those (Moon, 2004, 49-61). Most of them would be angry and would have negative thinking. The three big emotions, such as, anger, guilt, and depression, all take precedence over everything. I have used the skills to communicate to change their thoughts and behaviours that promote them. Guilt, anger, and depressive moods are common during recovery and rehabilitation process (Taylor and White, 2000, 52-82). I understood that these are high risk emotions that should be managed with utmost care, and gradually through these processes, a therapeutic relationship would build up between me and my clients, where they could be suggested how to control them, since these are the emotions that might lead to relapse in future (Tomlinson and Trew, 2001, 12-64). I have seen these things expressed in different forms in my clients. Some of them would say “I am no good,” while others may express these emotions through different phrases. It had been an important skill to recognize them from the verbal cues delivered by the clients. I could recognize the thoughts of guilt, anger, and depression. I could also learn things by observing their body languages and by facial expression. Some would avoid people and activities of enjoyment such as games. Some would drift from conversations indicating trouble concentrating. Many would not eat properly, so crippled by anxiety that doing nothing, and thinking and feeling hopeless (Winter et al., 1999, 27-69). Only good communication skills can help the clients in these states. To be able to make them understand their own minds and suggest them about control of emotions is a display of communication and interpersonal skills. These skills could help strengthen my relationship with my clients. 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