Clinical Questions Pool - Assignment Example

Addiction Studies                                                 A Term Paper (if applicable)                                                 John Start (your name here)                                                 High University (your university here)                                                                                                                                                                         2                                                 Clinical Questions Pool 1.      It is quite important that biological, psychological and social factors should be put into consideration while in charge of assessment or intake for an outpatient substance abuse clinic. Below are some suggested methods and instruments that could be used in the process of assessing the degree of substance abuse in an individual: ·         Biological factors: This is the very first step that should be taken in order to fully understand why an individual has the tendency to abuse dangerous substances like drugs, harmful potion, alcohol, excessive coffee drinking etc. The first method that could be employed here is called Family Pedigree Model: the family history of the patient is probed so as to detect if any members of his/her family have previously abused the same substances or the others (Corey, 2009). Twin Method is the second technique that would be used to investigate the substance-seeking habit in the patient due to powerful effects of genes and environment.  This method is based on the assumption that a set of twins has shared similar genes that could naturally make them behave the same way; even to the point of abusing substances together.  However, when they are separated and taken to different environments, they acted differently (Hubble et al., 1999). These two models do not describe a situation where by an individual does not come from a family of substance-abusers, and does not experience a change in                                                                                                                             3 environment but still goes ahead to abuse substances. Therefore, the third method—which is Adoption Method—is quite useful in explaining that such an individual may have picked up the substance-abusing nature through adopting the habit from people around him/her (Straussner, 2003). The three methods highlighted above would be useful in carrying out the initial investigation about a patient’s biological connection with substance-abusing behavior. ·         Psychological factors: There are some psychological factors that could lead to continuous abuse of substances in people. For example, a young man whose is product of a broken home and witnessed violent quarrels between his parents might opt for dangerous substance to escape the uncomfortable world he has found himself. Likewise, mental problems could spark the urge to depend on drugs or alcohol as a means of escapism (Berger, 1991). Therefore, it is usually appropriate to inquire about the patient’s upbringing, mental state and the external influences before one can completely understand why the individual has chosen to depend on dangerous substances. ·         Sociological factors: the emergence of substance-abusing behavior in an individual could also be traced to the fact that people can pick up a bad habit from their societies through mere imitation. A morally upright individual can lose his/her sense of modesty and take to harmful substances if he/she happens                                                                                                                               4 to find himself/herself in a bad group (Galanter & Allen, 2003). The method that should be used here involved doing a background check on the patient; studying the environment where the individual lives; discovering if there are any peer influences on the individual; identifying these sources of influence and investigating their power on the patient’s psychology would go a long way into  (Galanter & Allen, 2003).   2.      Relapse prevention (RP) is a significant aspect of controlling substance-abuse behaviors in addicts.  There are some methods proposed to do this, but the commonest one is RP model proposed by Marlatt & Gordon (1985) which explains that  both immediate determinants (e.g., high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e.g., lifestyle factors and urges and cravings) can lead to relapse attitude in rehabilitated individuals. It is interesting that this RP model also defines some specific and worldwide intervention processes which therapists can use to help their clients, which include but not limited to discovering specific high-risk situations for each client and developing the clients skills for coping with those situations, motivating the client, simplifying the fact that substance abuse could be stopped, managing lapses, and helping the client to identifying relapse processes (Marlatt & Gordon, 1985). Relapse, or the return to substance abuse often occur during a period of abstinence                                                                                                                                    5 or moderate use; this often follows the process of substance-abuse treatment.  Considering the traditional substance abuse treatment, it is easy to see that the concept recognizes relapse as an end-stare, a negative outcome equivalent to treatment failure. However, this concept is flawed in the sense that it posits that a person either abstain from dangerous substances or relapse into using them. On the other hand, some models of relapse are based on social-cognitive or behavioral theories, and they demonstrate that relapse is a transitional process: which happens to be a series of events that unfold over time (Marlatt & Gordon, 1985). According to these models, the relapse process starts before the first post treatment substance use and continues after the initial use. This idea provides a comprehensive conceptual framework for intervening in the relapse occurrence to prevent or reduce how often a patient goes into relapse processes. When appropriate behavioral strategies are adopted, it is possible for therapists to help their clients get over this critical problem in their lives. 3.      Denial has been identified as one of the problems in the process of treating a substance-abuse patient. When an addict fails to reveals his/her secret act of wrongly using dangerous substances, it will be difficult for the therapists to understand the extent of his/her abuse and offer appropriate treatment to help the client get over his/her problem. However, one way of doing is to utilize the model that encourages that clients be directly confronted with the issue that he/she is a substance abuser and should thus recognize that he/she is in a big problem that                                                                                                                                    6 demands urgent solution (White et al., 2010). In the course of this, the client might realize that he/she has got no hiding place and come out clean to admit his/her substance abuse lifestyle and seek for appropriate treatment. Another model that could be used is Group Monitoring: the client would be kept under stiff watch of relatives or siblings for any misbehavior that are related to any form of substance abuse. Immediately such bad attitude is detected, therapist would be invited in to take care of the client (O’Brien & McLellan, 1996). 4.      For a case study about substance abuse issue, I have interviewed my friend who is acutely addicted to coffee. The issues affecting him include the unnatural urge that he has about drinking coffee; he prefers drinking coffee to water, even after eating the regular meals. His body has become weakened by much caffeine, and he looks sickly because of lack of sleep. He often complains of migraine and always visits the doctor to receive treatment. He has psychologically lost his connection with the outside world because of these plights.      Based on the symptoms and psychological assessment made on my friend, I discover that he should be subjected to the following treatment plan: ·         He should be taken to the substance abuse clinic to distance him from his current environment which is full of coffee and coffee-related drinks.                                                                                                                              7 ·         He should be further assessed by asking him about his history of coffee-drinking, the occurrences of such in his family, and knowing how he comes to drinking it. This will help to know the right approach. ·         However, my friend is the only one in his family who is seriously dying for too much coffee—therefore, group therapy would be appropriate. This involves mixing my friend with other addicts who are taking treatment to get out of the coffee bingeing experience. Hence, he should also be placed under family inspection, since all his family members eat meals together. And they know that he often goes for coffee after each meal. 5.      The group technique is very effective in the sense that if the addict is too weak to control his/her habit, the group could exert some pressure on him/her so as to conform to the acceptable lifestyle. But the main problem here is that if an addict is placed in an ineffective group, this could create disaffection on the part of the addict. So, instead of following the advice of the group, the addict may either run away or pick up another bad habit from the group members (O’ Brien & McLellan, 1996).                                 Program Design Question Pool 6.      Treating addicts individually have been discovered to be effective in many ways: one of the advantages of doing this is that it allows therapist to have intimate understanding of the client’s state of addiction and offers closely monitored treatment to help the client (Waller, 1999). But there are certain problems associated with this method of treatment as highlighted below: (i)                 Denial: When addicts are treated individually, they are often ashamed of denying the fact that they are using dangerous substances. On the hand, if you put the same addicts in the midst of other people in a group, they abashedly confessed their bad 8 habits when they see other doing so (Waller, 1999). (ii)               Absence of Peer Pressure: When an addict is treated alone, he enjoys the free atmosphere where by he/she could open up freely to the therapist and also expects cares and understanding in return. But the obstacle of this kind of freedom is that the addict, if shy or obstinate, may refuse to tell the truth about his/her level of addiction. This is a serious obstacle that could rob the therapist vital information needed for the treatment (Coombs, 2004). (iii)             Isolation: When isolated, some addicts feel too weird. They start to feel down or experience some kinds of depression. In this case, they may or may not fully cooperate with the therapist. The right approach to this obstacle is to convince the addict that he/she is not weird, but just needs the treatment to be a better person (Coombs, 2004). (iv)             Treatment Design: Designing a treatment technique for just only one person may be expensive and cumbersome. In this case, equal number of staff is required at the clinic to attend to one person as well as a group of clients (Lewis et al., 2001).                                                                                                                       9 (v)               Abnormal co-dependency: In a situation whereby the addict is abnormally dependent on a parent or sibling, it may be difficult to organize an individual treatment for such a person. Group technique would be helpful here. 7.      The recent changes in the health care delivery services, which limit funding for managed care like addiction treatment and the others, would have some negative impacts on the substance abuse care industry. It would reduce the urge to do more research to determine the best model for addicts’ treatment; and it would cost the industry qualified professionals since the clinics have to reduce cost by employing fewer health workers. This scenario would have a negative impact on the quality of services provided to the addicts. One of the solutions to this decreased funding is to intensify private donations or grants for rehabilitation centers or clinics. Efforts should be made to link the services of private clinics with the public institutions to ease the pressure of catering for a large number of addicts (Coombs, 2004). 8.      The best way to know whether a treatment program is working or not is to establish an evaluation system that would test the strength of all models in order to discover which are effective, and which are not. This evaluation system would rely on information gathered from the professionals and addicts alike. They could be interviewed with the use of surveys or questionnaires. All programs that are wasting money and achieve little or no success should be discarded. And any health programs that offer qualitative treatment to the addicts should be categorized as successful (Mangen & Petterson, 1983).                                                                                                                                  10 9.      There are some shortcomings on the part of treatment programs employed in many substance abuse clinics today. Five of these shortcomings are— (i)                 Lack of specificity: General treatment models are always used to treat all addicts, even though their nature of addiction is different. The right thing to do is to address specific problem with a particular solution. This is likely going to increase the efficiency of both the professional and the treatment processes. (ii)               Hidden facts: Therapists are increasingly getting dissatisfied at the way clients are not completely opening up. To solve this problem, it is advisable that a dependable relative accompany the client to the assessment/interview meeting with the therapists; relatives can motivate addicts at time to talk more their past history. (iii)             Past history: It has been observed that some therapists always rush to conclusion about the extent of an individual’s addiction to dangerous substances without actually making attempts to check the past history of their clients. This kind of attitude to practice  should be changed (iv)             Cost of treatment: Many addicts have shied away from going for therapeutic treatment because of the expensiveness of such programs. However, both private and public centers should make these kinds of treatment available to the addicts. (v)               Lack of interest: It is a known fact that people who abuse substances need emotional encouragement. But many therapists today lack absolute interest in their jobs, hence they transfer aggression to people they should be passionately catering for. But Therapists should show more cares. 10.  The following ideas should be incorporated into the practice of treating addicts so as to have a successful program in place: ·         The fundamental human rights of the patients must not be undermine—this involves letting the addict know he/she is not a bad person, but just plagued with bad attitude which he/she could do away with. ·         There must be consideration for different religious beliefs in therapy treatment. Most people in the world see religion as a part of their existence: so, to have a successful treatment program, it must be linked with the addict’s religion. ·         Constant research: Both the private and public health institutions should spend more time and fund on research with the hope of discovering the best approach for solving addiction problems in the societies. ·         Past history: References should always be made to past histories of addicts: this would help to uncover the extent of addiction and to offer the right treatment for the clients.                                                                                                                                                     12                                        Critical Analysis Question Pool 11.  The theories or models of substance abuse are based on three major concepts as explained below: (i)                 Family background: it is generally believed that some substance-abuse persons are actually carrying out what is common within their families. This biological cause of addiction has been treated mainly by treating all the family members as a group, while therapists visit the families to see how they are doing. The advantage of this approach is that siblings can exert a more powerful pressure on one another than an outsider. But the downside of this technique is that if the head of the family group is a die-hard addict, all the processes used to help the family get out of their addiction would be fruitless (Galizio & Maisto, 1985). (ii)               Psychological implications: Naturally, a child that has been subjected to series of mental anguish as it grows up would feel that his/her life does not worth living: and to escape from his/her constant sadness, he/she will take to dangerous substances (Galizio & Maisto, 1985). Such an individual should be taken to the substance abuse clinic or rehabilitation center where he/she can receive intensive therapy. Individual Therapy would be good for such a person because he/she may be shy to talk boldly about his/her past tumultuous life. The disadvantage of this system is that he/she may not be able to know that others                                                                                                                             13 also face the same problem, and they are getting along fine in their day-to-day lives. (iii)             The societal influence: The environment where people live matters a lot. If you live with drug addicts, you would one day become an addict, too. The best to treat such a person is to separate him/her from the environment and put him/her in the rehabilitation center. Although, separating the addict from its previous environment could backfire as well as, as the addict would lose contacts with relatives that have often given him/her emotional support (Galizio & Maisto, 1985). 12.   Currently, social policy has been a combination of criminal justice, mental health, social, and addiction services. Integrating all these services into each other has both some advantages and disadvantages. However, the main advantage of this integration is that it could provide speedy solutions to social problems, in the sense that a criminal is likely going to be a substance abuser, a sociopath and somehow affected by mental health problem. But the main disadvantage of this effort is that it would lead to mediocrity as all the services would be interwoven at a point in time. This would make it difficult to have professionals do their job to the best of their abilities, since there would be conflict of interests. 13.  Outlined below are the five multicultural issues that must be addressed when treating addiction in any greatly diverse communities:                                                                                                                                                  14 (a)    Language: The therapist should be able to understand quite well the language of the addict; if not, miscommunication would occur (Gordon, 1994). There are instances when addicts have misunderstood the good intentions of therapists because of poor communication. (b)   Culture: The therapist must respect the culture of the client in order to win his/her trust. This would act as a magnet to attract the addict’s attention to whatever treatment the therapists are giving (Gordon, 1994). (c)    Level of education: It is also important to know the level of education of the clients because in a multicultural setting, some cultures do not encourage Western education: hence, Western therapies would be totally rejected. Traditional therapies are the norms in these localities. (d)   Medication: it is very important to know what different cultures think about medicines. Some absolutely rely on traditional medicines and not Western ones (Gordon, 1994). Administering medicine unacceptable to some addicts would lead to unsuccessful results. (e)    Level of Addiction: It is also important to different the estimation of addiction from culture to culture: someone may be called an addict in one culture, and such may not be referred to as an addict in the other (Gordon, 1994). 14.   Against the backdrop of traditional treatment for alcohol-addicts,  these three promising techniques could be employed to treat people suffering from alcohol addiction: (a)    Work-related restriction: An alcohol addict should be put on a disgraceful list at the place of work. As long as he needs work to earn enough money, he would learn to do away with heavy drinking.                                                                                                                                                15 (b)   Religion connection: No religion encourages over-consumption of alcohol: in this case, joining a religion would be quite helpful to help the addict stay away from too much alcohol. (c)    Comprehensive Therapy: This involves combining all traditional methods of treating alcohol addicts: this involves using Group Therapy, Individual Therapy, Family Therapy, and so on. 15.    1.      Therapists and other professionals handling all cases related to mental health, addiction treatment and so on should be exposed to the knowledge of psychopharmacology. This would help them to understand how human mind and brain work in relation to drug matters. Once they have the knowledge of such, they could also understand how their clients’ minds work (Lader, 1980). Hence in these five ways outlined below the knowledge of psychopharmacology could be useful in treating or preventing addiction: ·         Mental Health Issues: Psychopharmacology would help therapists to under the mental health situations of their clients. On most occasions, mental health is directly connected with addiction problems. ·         Reaction to Medicine: Every human body had its definite reaction to the administered drugs for any treatment. Having knowledge of how this works through psychopharmacology would help therapists understand the level of dosages a patient needs (Lader, 1980). ·         Behavioral Pattern: Therapists could study their patients’ behavioral patterns through psychopharmacology by looking through their past history is there had been any problems in their family behaviors: that is, have there been some psychotics or schizophrenia in their families? ·         Use of Placebo: Therapists have often treated addicts using placebos. More information about how to use placebo is available through the knowledge of psychopharmacology (Lader, 1980). ·         Cognitive Diagnostics: Psychopharmacology also helps therapists to d\fully understand the connection between physical perception and the willingness to abuse some substances. With this knowledge, they could estimate how much exposure the addicts had had to the substances before they start to abuse them (Lader, 1980).                                                                               References Berger, L.S. (1991). Substance abuse as symptom: a psychoanalytical critique of treatment approaches and the cultural beliefs that sustain them. London: Routledge. Coombs, R.H. (2004). Addiction counseling review: preparing for comprehensive, certification, and licensing examinations. New York: Routledge. Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Florence, KY: Cengage Learning. Galanter, M., & Allen, J.P. (2003). Recent developments in alcoholism: methodology, psychosocial treatment, selected treatment topics, research priorities. New York: Springer. Galizio, M., & Maisto, S.A. (1985). Determinants of substance abuse: biological, psychological, and environmental factors. New York: Springer. Gordon, J.U. (1994). Managing multiculturalism in substance abuse services. Thousand Oaks, CA: SAGE. Hubble, M.A., Duncan, B.L., & Miller, S.C. (1999). The heart & soul of change: what works in therapy. Washington, D.C.: American Psychological Association. Lader, M.H. (1980). Introduction to psychopharmacology.  Kalamazoo, MI: Upjohn. Lewis, J.A., Packard, T.R., & Lewis, M.D. (2001). Management of human service programs. Florence, KY: Brooks/Cole. Mangen, D.J., & Petterson, W.A. (1984). Health, program evaluation, and demography. Minneapolis, MN: University of Minnesota Press. Marlatt, G.A., & Gordon, J.R. (Eds.). (1985). Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press. O’Brien, C., & McLellan, T. (1996). Myths about the treatment of addiction. LANCET, 347, 237-240. Straussner, S.L.A. (Ed.). (2003). Ethnocultural factors in substance abuse treatment. New York: Guilford Press. Waller, D. (1999). Treatment of addiction: current issues for arts therapists. London: Routledge. White, W.L., Kurtz, E., & Sanders, M. (2010). Recovery management: what if we really believe that addiction was a chronic disorder? Glattic Bulletin. Retrieved from http://www.attcnetwork.org/learn/topics/rosc/docs/RecoveryManagement.pdf      Read More