Substance Abuse Therapy - Assignment Example

?Substance Abuse Treatment Plan for Lisa of Substance Abuse Treatment Plan for: Lisa Substances Abuse and Implications of Abuse Lisa is a 32 year old heterosexual Mexican American female and mother of twin boys, age 8. Lisa has a history of substance abuse and she currently is a heavy drinker and and a methamphetamine user. Lisa has abused substances since she was 12 years old with marijuana and alcohol being the main substances. By the time Lisa was 14, she was using cocaine and by age 16, she was shooting heroine. Lisa states that within the last five years, she continues to drink and use methamphetamines. According to a study by Rios-Bedoya, Wilcox, & Anthony (2008) Lisa may be having more difficulty because she started using substances so early in her life. Currently, Lisa is having blackouts that last from several minutes to several hours. Unfortunately, it is not currently known whether the blackouts are a result of her substance abuse or of some other medical situation. This is a concern because they tend to happen when she is feeling rage. Lisa reports that when she is feeling angry, she often hears her father’s voice and she lashes out in the way that her father did with her mother. Biological Predispositions Lisa has a predisposition to alcohol because her father used heroin all his life and died of an overdose. It is not known at this time whether Lisa’s mother uses drugs. Family Considerations Lisa has twin sons who are eight years old who were staying at her mother’s during the time of the incident. She has a boyfriend, Charlie, who she acted out violently toward to the point that he called the police. The children may have to be removed from Lisa’s custody because Lisa will not stop her substance abuse. In fact, her referral came because she is on her third incident of driving while under the influence (DUI). It is not known whether Lisa’s mother is capable of handling the children at this time. Lisa’s mother has been a battered woman in the past and may have some challenges because of it; this would have to be investigated further before it is known whether she could take the children in a long-term situation. Family services may have to be called in to investigate. The relationship between Lisa and her children is not revealed at the current time and this would have to be investigated. It is not known whether the children have endured abuse at her hand or whether her blackouts put her children in danger. Also, according to a study by Macdonald, Erikson,Well, Hathaway & Pakula (2008) violent outbursts may be inherent in cocaine abuse. As stated previously, it will be very important to understand the relationships that Lisa has around her and how she is interacting with them. Lisa’s living situation is unknown. Whether she is still living in poverty and whether she is on welfare or not, are factors that should be addressed because this would also determine the situation for the children in her home. Lisa is a fighter. Her father taught her to box with her brothers and cousins when she was small, and she is used to fighting to survive. Cultural Considerations It is not known whether Lisa is working with the traditions of her Mexican American heritage. She self-identifies as a heterosexual Mexican American, but it is not known whether she just says this or she really lives a Mexican lifestyle. This would have to be researched. If she does, there may be religious considerations (many Mexican families are Catholic) or there may be issues around treatment that are important. As an example, many Mexican American families may not feel that treatment is important and they may rely on the community to take care of the family member rather than looking for outside help from therapists. Also, Lisa may be dealing with the conflict that comes between cultural obligations and substance abuse (Stevens, Andrade & Ruiz, 2009). If it is suggested that Lisa go into a treatment program, and she is very involved with her Mexican heritage, this could cause another conflict for her. As an example, Cano, Dermatis and Bunt (2009) state that treatment facilities pose a particular problem for Hispanic substance abusers when the values of the culture are not taken into consideration. As stated previously, more research must be done to understand the cultural considerations for Lisa. Therapy Model The therapy model that I would recommend for Lisa is Cognitive Behavioral Therapy (CBT). This therapy has been successful in many different situations and it has been an effective therapy model used for substance abuse treatment and for methamphetamine treatment (Smout, Longo, Harrison, Minniti, Wickes & White, 2010). It has also been effective in combination with a spiritual religious model described by Hodge (2011). Because Lisa is Mexican, she may have religious beliefs that have a bearing on her methamphetamine use. By combining the two, we could sort out those ideas that were unproductive and provide a way for Lisa to see these beliefs differently (Hodge, 2011). Lee and Rawson (2008) found that CBT was effective in decreasing methamphetamine use but that it is better used in combination with other models. I would suggest this therapy model for Lisa because it is important for her to begin to take responsibility for her actions and for her children. Also, it would be important to get into the reasons why she is continuing to use methamphetamines instead of changing behavior. CBT is one of the most effective methods of behavior change in many types of substance abuse situations. Assessment and Diagnosis Of the different substances that are being used by Lisa, the methamphetamines may be doing the most damage to her overall health, because it lasts longer in the body and it and much of the drug does not change once inside the body (Otero, Boles, Young, & Dennis, 2006). Over time, methamphetamine use creates a structural change in the brain that affects motor control and memory. Because Lisa uses methamphetamines in coordination with cocaine and alcohol, it is very important to have her seen by a physician that understands addiction. She would need to have a complete physical and an assessment of any physical issues. It would be important to assess whether her acting out against Charlie was physical or induced by the drugs. Also, there may be cognitive deficits that have not been diagnosed that also maybe a cause for her temper and her acting out in a dangerous manner (Otero et al., 2006). Galloway and Singleton (2008) suggest that the degree of craving that methamphetamine users have is an indication of the degree of their using. It would be necessary to understand the degree of Lisa’s addiction to methamphetamines and cocaine so that the proper assessment of treatment could be done. There are many issues for Lisa that she is not discussing, and it can be to her advantage to know where she is in her drug abuse. The assessment of whether she needs to go into treatment in a treatment facility or whether she can work within an out treatment program would need to also be assessed. The assessment of methamphetamine use is appropriate as Lisa comes to counseling admitting that she is already using methamphetamines and cocaine. She was driving while under the influence of methamphetamines. The assessment of the situation can be further explained through a narrative with her asking questions about her use and the frequency of this use. Lkashef et al. (2008) suggest that as methamphetamine users begin to move away from their addiction, depression may be one of the issues they face. The authors use that using Bupropion to help with the depression allows users to be abstinence longer. The assessment of Lisa’s depression would be assessed using the Beck Depression Scale. According to the American Psychiatric Association (2000) the diagnosis for Lisa would be 304.40 Amphetamine Dependence or 305.70 Amphetamine Abuse. As the therapist interviews Lisa there would be a better understanding of which diagnosis would be best. Using the case study, it would seem that Lisa is amphetamine dependent but with more information it may be more clearly seen as methamphetamine abuse. Treatment Plan and Intervention Strategies Initially, the discussion with Lisa would be about the situation as it stands and what we can do to help. I would have her sign release forms so that I could gain an understanding of what she had done to date with other therapists and doctors. I would also explain treatment to her, explain what CBT was and how it worked. I would explain that she would have homework to do and that the homework was essential to her moving forward. I would explain to her that if I see that she is a danger to her children, that I will have to report this to Children’s Services or whatever program that was necessary. I would also talk about her outburst with Charlie and why this happened. An intervention would be to get her into a treatment program whether it was residential or individual. In the process, I would assess which program would be the most beneficial for her. A more complete history of medications, whether over-the-counter, prescription, or illegal would be taken. Lisa may have to spend a couple of weeks or months in a treatment facility that can deal with her withdrawal symptoms. The challenge for this would be that the children would need somewhere to stay while their mother was in rehab. The relationships between Charlie and Lisa is not well known, so I do not know whether there would be an option for the kids to live with him. Lisa’s diet would have to be assessed also, because eating well is an important aspect of her plan. A client who is withdrawing from substance abuse has the need for good nutrition. The children are a concern in this situation. I would want to know whether she and Charlie are making the methamphetamines in the home or whether she is purchasing them somewhere else. If in the home, the children would be in more danger. Lisa may need parenting skills. There is not enough known about her relationship to her children, but parenting is an intervention that may be needed. Also, her relationship with Charlie may need individual counseling to make sure that she is getting the help she needs in this area. Lisa may need ongoing support from a program like Narcotics Anonymous or other support programs in her area; this would be determined in treatment. Ethical and Legal Considerations Confidentiality is an essential part of any treatment for clients. However, this may not be able to be kept because the counselor may have to disclose as Lisa is a danger to herself and to others. The children may need to go to a foster home and this would mean that the counselor would have to be careful with how he or she provided information to children’s services if she or he did not have permission from Lisa. However, if Lisa proves to be a danger to her children, the counselor can provide information about the situation to children’s services. Another issue that is substantial will be informed consent. The counselor must provide information about informed consent to Lisa so that Lisa understands the type of relationship she is entering into with the counselor (American Counseling Association, 2005). The children are underage, so any conversation with them will have to be with Lisa or another parent or guardian. References American Counseling Association. (2005). ACA Code of Ethics. Retrieved from http://www.counseling.org/Resources/aca-code-of-ethics.pdf American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). Arlington, Virginia: American Psychiatric Association. Cano, D., Dermatis, H., & Bunt, G. (2009). Do Hispanic patients adapt as well to a residential therapeutic community as do members of other ethnic groups?. Substance Abuse: Official Publication Of The Association For Medical Education And Research In Substance Abuse, 30(1), 79-80. DOI:10.1080/08897070802606485 Galloway, G. P., Singleton, E. G. (2008). How long does craving predict use of methamphetamine? Assessment of use one to seven weeks after the assessment of craving. Substance Abuse: Research and Treatment, 1, 63–79. Retrieved from http://www.la-press.com/how-long-does-craving-predict-use-of-methamphetamine--assessment--article-a971#downloads lkashef, A. M., Rawson, R. A., Anderson, A. L., Li, S., Holmes, T., Smith, E. V., . . . Weis, D. (2008). Bupropion for the treatment of methamphetamine dependence. Neuropsychopharmacology, 33(5), 1162-70. DOI:http://dx.doi.org/10.1038/sj.npp.1301481 Hodge, D. R. (2011). Alcohol treatment and cognitive-behavioral therapy: Enhancing effectiveness by incorporating spirituality and religion. Social Work, 56(1), 21-31. Retrieved from ProQuest database. Lee, N., & Rawson, R. (2008). A systematic review of cognitive and behavioural therapies for methamphetamine dependence. Drug And Alcohol Review, 27(3), 309-317. DOI:10.1080/09595230801919494 Macdonald, S., Erikson, P., Wells, S., Hathaway, A. & Pakula, B.(2008). Predicting violence among cocaine, cannabis, and alcohol treatment clients. Addictive Behaviors 33, 201–205. Doi:10.1016/j.addbeh.2007.07.002 Otero, C., Boles, S., Young, N. K., Dennis, K. (2006). Methamphetamine addiction, treatment, and outcomes: Implications for child welfare workers. national center on substance abuse and child welfare. Retrieved from www.ncsacw.samhsa.gov/files/Meth%20and%20Child%20Safety.pdf? Rios-Bedoya, C. F.,Wilcox, M. P.,and Anthony, J. C. (2008). Children taking risks: The association with cocaine and other drug use by young adulthood. Addictive Behaviors, 33, 1154–1161. DOI:10.1016/j.addbeh.2008.04.016 Smout, M., Longo, M., Harrison, S., Minniti, R., Wickes, W., & White, J. (2010). Psychosocial treatment for methamphetamine use disorders: a preliminary randomized controlled trial of cognitive behavior therapy and acceptance and commitment Therapy. Substance Abuse: Official Publication Of The Association For Medical Education And Research In Substance Abuse, 31(2), 98-107. DOI:10.1080/08897071003641578 Stevens, S. J., Andrade, R. C., & Ruiz, B. S. (2009). Women and substance abuse: Gender, age, and cultural considerations. Journal Of Ethnicity In Substance Abuse, 8(3), 341-358. DOI:10.1080/15332640903110542 Sugarman, D. E., Nich, C., & Carroll, K. M. (2010). Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders. Psychology Of Addictive Behaviors, 24(4), 689-695. DOI:10.1037/a0021584 Read More