Assessment and Intervention in Addiction - Essay Example

Assessment & Intervention in Addiction Number Introduction This assessment is based on a case study on a 27-year old male patient, Paul. In the case study, information provided is analysed based on the five key areas or domains that are to help illumine greater understanding on Paul. The discussion on Paul is accompanied with questions that are to help sustain more comprehensive understanding and assessment on Paul’s psychological and addiction problems. It is from this that the overall information that has been divulged is formulated for the benefit of Paul and those who may have a situation similar to his. A brief Statement of the Case Study Paul, a 27 year old, has been an injecting drug user and has been presented at a local Alcohol and Drug Assessment Service, six weeks after release from prison. He opposes treatment but attendance is a condition of his parole and has numerous convictions for burglary, assault and possession of drugs for supply. Paul has been convicted for burglary, assault and possessions of cannabis, numerously. Initially, he had had a motor cycle accident at 19 and has not worked since. Since then, he has had anger and impulse control problems. Assessment reveals that Paul had no specific plans to harm anyone in particular, but possesses a firearm and states his willingness to shoot himself and others with him. The head injury also left him prone to anger, impulse control problems, short-term memory impairment, poor concentration and inability to work. Paul has a history of childhood conduct disorder and abuse of drugs and substances such as alcohol and cannabis, benzodiazepines and polydrug. He also used intravenous opioids regularly from 19 years of age and continues to use cannabis daily and occasional benzodiazepines. On direct questioning, Paul has admitted to depressive symptoms since his most recent incarceration, and met DSM IV-R criteria for a diagnosis of Major Depressive Episode over the past six weeks. The patient is also hepatitis C positive and admits to having shared needles, besides engaging in unprotected sex especially when using benzodiazepines. He has also had little contact with his family and lives with friends who use intravenous opioids on a daily basis. He is currently on a waiting list for methadone maintenance therapy (MMT) and has been offered detoxification. Identifying 5 Key Areas/Domains for Assessment of Paul and Indicating Where It Is Important That More Information Is Given Whanau Relationships From the foregoing it is clear that there may have been correlations between the prevailing affairs in Paul’s social environment and his penchant for substance reliance and drugs abuse. This is underscored by the fact that Paul began to engage in drugs abuse and substance reliance at a relatively young age. Particularly, Paul has a history of childhood drugs and substances abuse of such as alcohol and cannabis, benzodiazepines and polydrug. By the time he is 19, he is already dabbling in intravenous opioids regularly and benzodiazepines, occasionally. An unstable childhood must have also exacerbated Paul’s proclivity to drug use. Specifically, Paul has a history of childhood conduct disorder. It is this kind of situation that may have heightened the chances for Paul’s engagement in drugs (Blume, 2005). Question Some of the questions that Paul may be asked to help better understand and help him are: Whether or not he feels he should stop using drugs Whether he thinks it is possible for him to totally reform, or not How he feels about his ‘lost’ and loveless childhood How he perceives his social environment How he thinks his social environment perceives him Peer Relationships The reality of Paul’s history of drugs abuse and psychosocial instability may also be comprehensively and better understood in light of peer relationships. The fact that Paul is hepatitis C positive, shared needles and engaged in unprotected sex especially when using benzodiazepines gives an inner and more critical understanding on the Paul’s peer relationships. According to Adams (2008), 99% of documented cases of shared needles among drug abusers happen among familiar social circles. It is for this reason that intravenously administered recreational drugs are always used among gangs, dark alleyways and secret rendezvous. The fact that these drugs and substances are legally proscribed against public use for recreational purposes makes their supply, procurement and use confined to covert operations and criminal dealings. This makes the use of these drugs and substances extremely peer-dependent. In a closely related wavelength, it is important to consider that Paul’s history of childhood conduct disorder and abuse of drugs and substances such as alcohol and cannabis, benzodiazepines and polydrug also bespeaks the reality of negative peer relationships. This is especially the case since it was impossible that Paul procured criminalized drugs such as alcohol and cannabis, benzodiazepines and polydrug on his own and initiated himself into their use without the input of his social circle. The strength and possibility of Paul’s peer relationship as the factor that pushed him into a life of drugs and are underscored by Paul having used intravenous opioids regularly from 19 years of age and his continuation in the use of cannabis from day-to-day and occasionally, benzodiazepines. It is impossible that Paul could have secured himself benzodiazepines. This is because, as opposed to cannabis sativa, benzodiazepines are harder to distribute and access (DiClemente, 2003). In a different vein, Paul’s dabbling in crime must also have been informed and inspired by peer pressure and relations. It is most probable that Paul obtained his gun through illegal means. As such, it is most obvious that his social circle or peer relations must have influenced him into obtaining thus gun. This is the case since illegal gun sales and distributions are done with a high degree of covertness and this requires the input of insiders, to avoid detection by law enforcement agencies. In like manner, it is very obvious that Paul’s long stint with crime had most likely been abetted by his social circle. It takes a criminal associate to engage an individual into a life of crime and Paul is therefore not an exception (Velasquez, Maurer, Crouch & DiClemente, 2001). Conversely, the influence of peer pressure and peer relations on Paul’s life can best be understood by factoring the reality of Paul having had very little contact with his family. The import of this fact is that the situation severed Paul from a critical source of positive socialization and acculturation. This is because it is within the setting of a family that values are inculcated within an individual. As a corollary to this development, Paul lives with friends who use intravenous opioids on a daily basis. It is important to note that this contributed to Paul’s way of life (of drugs and crime) in two ways: by introducing and engaging Paul in a life of drugs; and directly and indirectly taking from Paul, the resolve to reform (Geldard & Geldard, 2005). The veracity of the standpoint above is bolstered by research study findings that (Adams, 2008) provides. Adams (2008) conducted research studies on drug users, drug users who are undergoing rehabilitation and those who have been successfully rehabilitated. To reach the aforementioned active drug users, Adams (2008) had to go to the streets, high schools and institutions of higher learning (i.e. Colleges and universities) for primary information. Rehabilitative centers helped Adams (2008) link with those who had successfully quit drug abuse and substance reliance and those who were still undergoing rehabilitation. All the participants took part in their own volition. In all the three cases, the participants in the research were assured of utmost confidentiality. Interestingly, the research findings established that at least 70% of drug and substance abusers had at one time tried to reform their lives but their peers clung to them and held them back. Similarly, 50% of those undergoing rehabilitation cited their disassociation from peers as one of the strongest source of confidence in their reform program. Again, further consistency was shown by the fact that over 70% those who had been successfully rehabilitated attributed their newly rehabilitated and drug-free lifestyle to extrication from negative influence and considered the acquisition of new friends as a prerequisite to the maintenance of this victorious life. In this regard, Adams (2008) concludes that it is for this reason that most rehabilitative centers disassociate their patients from their like-minded peers. This disassociation helps in catalyzing and facilitating the unlearning of old drug and criminal habits and the learning and acquisition of newer habits such as persistence and personal responsibility (Hamilton, Kellehear & Rumbold, 1998). Question Some of the questions that Paul may be asked to help better understand and help him are: How he got initiated into drugs and substance reliance Who supplies him with the drugs and substance and guns If he has ever thought of and tried quitting drugs and crime How his friends react whenever he has tried to reform How he views his friends How he views his family Why he was unable to live with his family during his nascent stage of development Mental Health Investigations on Paul’s case would also require the consideration of Paul’s mental health. This is because Paul’s rehabilitation largely relies on his mental and psychological wellbeing. The consideration of Paul’s mental is informed by an aspect of duality: Paul’s engagement in a life of crime and drugs are caused by and are symptomatic of mental disturbance; and the abuse of drugs and substance must have altered Paul’s mental state and undermined his mental health (Adams & Grieder, 2005 and Sellman, 2009). Another point that establishes the nexus between Paul’s mental health and his addictions and criminal nature is his background. Having not had the chance to enjoy the love and care of his family, it is true that not only did Paul lack a valuable repository to draw values from, but the same also must have denied him the humane aspect and inculcated bitterness in him. It is therefore not fortuitous that the assessment reveals that Paul has no specific plans to harm anyone in particular, but possesses a firearm and states his willingness to shoot himself and others with him. The veracity and gravity of the postulation immediately above is further reinforced by Erikson’s Development Model which qualifies the ages below 20 as being very pivotal in an individual’s psychosocial and personal development (O’Shea, Moss & McKenzie, 2007). That these aforementioned antecedent factors (alienation from his immediate family and exposure to negative influence) had not been attended to and Paul’s engagement with bad friends and drugs and crime at a young age could only mean that Paul could not grow into a mentally stable person. The import of this is that to treat Paul of his drug addictions and to attempt to shift his social environment and peer relations would be tantamount to treating symptoms. Another strong indicator of Paul’s wanting mental health is the head injury that left him prone to anger, impulse control problems, short-term memory impairment, poor concentration and inability to work. In this case, the proneness to anger, impulse control problems, short-term memory impairment, poor concentration and inability to work are to be taken as symptoms, in lieu of the mental illness itself. All these symptoms are in turn consistently related with a life of crime and drugs. For instance, Paul’s inability to work could easily push him to a life of crime since he does not have a family, yet he must meet his basic and personal needs. Paul’s proneness to anger, impulse control problems, short-term memory impairment and poor concentration are also likely to exacerbate his criminality and drug abuse as they can be emotionally frustrating (Manthei, 2000 and Donovan & Marlatt, 2005). According to Petry (2005) and Keane (2002), drug abuse and substance reliance do not only have far reaching implications on mental health. Benzodiazepine alone has the capacity to atrophy a patient’s cognitive abilities and propound anxiety and depression when consistently used as is the case with Paul. In this light, Fisher and Harrison (2009) contend that attending to mental health is important when treating a patient who has engaged in drug abuse, crime and suicidal tendencies. Question Some of the questions that Paul may be asked to help better understand and help him are: Why he was unable to live with his family during his nascent stage of development What he thinks of his family as opposed to his friends, and vice versa Why he is always annoyed easily and unable to perform a task that demands impulse control Why he is unable to concentrate on what is being discussed Physical Health According to Rollnick, Mason and Butler (1999), it is important that counseling and rehabilitative services and approaches factor the physical health of the patient. The rationale behind this standpoint is that physical health is directly related to psychological health so that one cannot exist without the other. For instance, Paul’s inability to live with his parents is a physical and social reality which extensively damages his emotional and psychological health. The import of the foregoing is that the treatment being administered on Paul must factor Paul’s material and physical wellbeing, professional etiquette, hygiene, personal touch and interpersonal skills and cultural competence. One of the elements that strongly emphasize Paul’s need for physical attention is the head injury which left him vulnerable to anger, impulse control problems, short-term memory impairment, poor concentration and inability to work. This definitely calls for a scan on Paul’s brain (Hyman, 2007). Trauma history (i.e. Sexual, Physical or Other Forms of Abuse) Information obtained from Paul’s report shows cases of extensive trauma. There is first emotional and psychological trauma in Paul being disassociated from his family at a very young age. This is the very factor that makes him callous and bitterly hateful to the point of harboring suicide-murder ambitions. The most formidable form of physical trauma again was his motorcycle accident which left him with a head injury serious enough to render him left him susceptible to anger, impulse control problems, short-term memory impairment, poor concentration and unable to work. This is because the physical injury may have left Paul with extensive psychological impairment (Miller and Rollnick, 2002). As is recommended by Kahn (1997), it would be important to first deal with Paul’s trauma history in its entirety before attempting to correct other aspects of his wellbeing such as rehabilitation from drugs and substance abuse. Question Some of the questions that Paul may be asked to help better understand and help him are: How he feels about his childhood upbringing What he thinks can make up for his lost and loveless childhood What else he feels he lost after the motorcycle accident Conclusion: Using the Information to Formulate the Problem Based on the information provided at the referral, the following dimensions may warrant further investigation. First, asking Paul why he was unable to live with his family during his nascent stage of development will serve as a window into Paul’s life and give room for the provision of patient-based psychotherapy. The same applies to asking Paul what he thinks of his family as opposed to his friends, and vice versa, though this question may help the team to understand the extent to which Paul is embedded into his peer group. This will enable the team to skillfully determine when, how and if Paul should be disassociated from his peer group. To ensure that Paul is successfully accorded effective psychotherapy, it will be important to determine why he is always annoyed easily, unable to perform a task that demands impulse control and to concentrate on what is being discussed. This will enable the team to determine the extent and nature of his trauma. According to Ministry of Health (1994), that these questions are important for the formulation of the problems accosting Paul is underscored by the fact that they are the key to understanding the extent of Paul’s psychological health and Paul’s psychological health is the starting point of his behavioral and physical integrity. References Adams, N. & Grieder, (2005). Treatment Planning for Person-Centred Car: The road to mental health and addiction recovery. Elsevier Academic Press. London. Adams, P. (2008). Fragmented Intimacy: Addiction in a social world. Springer: New York. Blume, A.W. (2005). Treating Drug Problems. New York: Wiley Press. DiClemente, C. (2003). Addiction and Change: How addictions develop and addicted people recover. New York: The Guilford Press. Donovan, D. & Marlatt, G (Eds). (2005). Assessment of Addictive Behaviours. New York: The Guilford Press. Fisher, G. & Harrison, T. (2009). Substance Abuse: Information for school counsellors, social workers, therapists and counsellors. Boston: Pearson Education Inc. Geldard, D. & Geldard, K. (2005). Basic Personal Counselling: a training manual for counsellors. Melbourne: Pearson Education. Hamilton, M., Kellehear, A. & Rumbold, G. (1998). Drug use in Australia: A harm minimization approach. Melbourne: Oxford University Press. Hyman, S. (2007). Addiction: a disease of learning and memory. American Journal of Psychiatry, 162 (8), 1411-1422. Keane, H. (2002). What’s wrong With Addiction? Melbourne: Melbourne University Press. Kahn, M. (1997). Between Therapist and Client: the new relationship. New York: W.H. Freeman & Company. Manthei, R. (2000). Counseling: the skills of finding solutions to problems. Pearson Education, Auckland. Miller, W. R. & Rollnick, S. (2002). Motivational Interviewing. New York: The Guildford Press. Ministry of Health (1994).Guidelines for the management of patients with co-existing psychiatric and substance use disorders. Wellington: Ministry of Health. O’Shea, R., Moss, S. & McKenzie, W. (2007). Writing for Psychology. Melbourne: Cengage Learning Australia Pty Limited. Petry, N. (2005). Pathological Gambling: Etiology, comorbidity, and treatment. Washington, DC: American Psychological Association. Rollnick, S., Mason, P. & Butler, C. (1999). Health Behavior Change: A guide for Practitioners. Los Angeles: Churchill Livingstone. Sellman, D. (2009). The 10 Most Important Things Known About Addiction in Addiction, 105, 6–13. Smith, D. & Seymour, R. (2001). Clinician’s Guide to Substance Abuse. New York: McGraw Hill. Velasquez, M., Maurer, G., Crouch, C. & DiClemente, C. (2001). Group Treatment for Substance Abuse: A stages-of-change Manual. New York: The Guilford Press. Read More