The following report is a reflection on a case study of mental health issue, in which a psychiatric counselor/ Assessor (Mark) is conducting a follow up session with the subject (Gavin). In the video, Mark uses the ASSIST screening tool to identify the signs of problematic substance use by Gavin (Bogenschutz et al., 2014). The video starts with Mark informing Gavin the reason for the assessment being the concern shared by Gavin’s mother, regarding the early warning signs of mental health problem shown by Gavin, as a result of which she wanted an evaluation to be conducted to identify any problematic sign of substance use. The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) is a screening tool that helps in the detection and management of substance use and problems related to it in a healthcare setup, it was developed for the World Health Organization by a team of substance abuse researchers (World Health Organization, 2016). The tool can be used by primary healthcare professionals to provide intervention for all substance use related issues (McNeely et al., 2014; Saitz et al., 2014; Hingson & Compton, 2014).
The initial contact between Gavin and Mark went very well, as Mark explained Gavin the reason for the assessment, which was the concern related to Gavin’s mental health and substance use which worried Gavin’s mother. Gavin seemed to agree that his mother was worried because of Gavin’s substance use and was concerned of his mental health. However, he believed that such concern was misplaced, and she really did not need to worry about Gavin. Mark also followed up with Gavin nicely, asking him what he was doing as of recently, and how he was engaging his time. Gavin told that he has been very busy with his project, which was a personal challenge for him, and he was motivated to see it to completion. He expressed that he was happy with his life and was very focused on his work. However, there seemed to be an element of sarcasm in how Gavin replied, but he honestly replied mark, for example Gavin clearly commented that the TAFE course was not the best and the teachers were just pathetic. It seemed like Mark was able to develop an honest communication with Gavin (Suffoletto et al., 2015).
Mark was able to develop rapport with Gavin, going through his experiences with the TAFE course, and his project. Gavin shared a lot of information with mark regarding his project, of which he was very secretive about, and after initial sense of apprehension to share such details. Gavin’s initial response of being asked details about his project was of incredulity and mistrust, which Mark was able to overcome in due course, and thus maintain an open and honest conversation. This showed that a significant amount of rapport did develop between Gavin and Mark, and Gavin became more and more comfortable to share his thoughts and plans with Mark. This also showed that a therapeutic relation was being developed and Mark was able to get some very important points answered by Gavin, such as his willingness to smoke cannabis to help him ‘open his mind’ and ‘think differently’ which was very necessary for Mark to complete his project. Gavin showed a sense of pride in his project, stating that it would have immense impact on the lives of people and ‘change the way we see the world’ which showed that he was feeling at ease in the conversation (Humeniuk et al., 2016; Patson et al., 2017).
Initially, Gavin was not very open or willing towards the suggestion to stop smoking cannabis. His unwillingness was mainly accredited to his desire to complete his project, which needed a significant mental capacity and the ability to think out of box, and in an open minded manner. It was evident that Gavin was used to smoking cannabis during such stressful times, as it helped him to think, and he believed that cannabis was the only known mechanism by which he can improve his thinking abilities to be able to complete the project on time. Moreover, it also was evident that Gavin knew the potential mental health effects of Cannabis use, as he later confessed that he often heard voices, harshly criticizing him and being mean to him, which he understood was the side effect of his cannabis use. However, his sole focus was to first finish his project on time, using Cannabis to help him, regardless of its outcome, as he believed that the side effects were more like the price he had to pay or the sacrifice he had to make to achieve greatness. However, later on, he was open to the suggestion to try to stop smoking cannabis but failed to show much conviction towards it (Palfai et al., 2016).
Gavin mentioned that smoking Cannabis was causing him to have auditory hallucinations. He confessed that he could hear people criticizing him, in a mean and unfair manner behind his back, when in fact there was no body within the earshot. Gavin was reluctant to express this problem to Mark initially, but on subsequent questioning, he started expressing concerns about how smoking cannabis is taking a toll on his health. Even though cannabis admittedly helped Gavin to increase his focus and work more efficiently on his project, he is afraid that it is also making his mental health worse. Gavin said that he has been hearing the voices since the last 2 months, and it mostly has been happening during the night times. The voices were mostly saying very ‘mean stuff’ about Gavin, which was very distressing for him, and was also affecting his sleep and thus affecting his overall health as well (Marques et al., 2015).
During the interview Gavin mentioned that he smoked cigarettes very often, drank alcohol only on occasions and smoked cannabis whenever he needed to increase his focus and think better and thus used it whenever he had to work on his project. He acknowledged that cigarettes and alcohol did not hamper his lifestyle; however, smoking cannabis has been a financial drain on him, as he used to spend about 100 dollars every week on it to purchase two to three cones of cannabis. He also mentioned that he have not been attending his TAFE classes as regularly as he should have, but however he blamed it more on the poor quality of teaching and incompetence of the teachers, than the effect of substance use. Gavin however did mention that smoking cannabis was affecting his social life. He was unable to attend social events such as dinner dates, as he was engrossed with his project and smoking cannabis made him forget it (Rahm et al., 2015).
In the interview, it was possible to identify some of the most significant stressors that affected the mental health of Gavin. The most significant of those stressors was his project, that demanded a significant amount if his time and mental capacity, and demanded high focus to complete the work. Gavin believed that his project had a groundbreaking opportunity, which can change other’s lives and can make him immensely successful, but to achieve that he had to put in a lot of hard work and he had to carry a lot of burden. In fact he considered the burden and the responsibility to be so huge that it could not be comprehended by either Mark or his teachers. As a result of which Gavin had to put in every bit of his effort on the project, which was significantly stressing his mental health and pushing him to continue using cannabis. Gavin also seemed to be stressed with his mother’s concerns, as he believed that he was doing what was necessary, and his mother was over-concerned about him. The incompetence and poor teaching at TAFE also seemed to have been a stressor for Gavin (Cooper et al., 2017).
The interviewer (Mark) was able to develop a therapeutic relation with Gavin by the end of the interview, overcoming the initial challenges during the interview. Gavin was initially not very trustworthy of Mark, thinking that he may steal his ideas, or he is trying to be privy to his work secrets. However, Mark was able to instill a sense of confidence in Gavin, implying his intention to purely understand the situation in a better manner, so that he can assist Gavin. Soon enough, Gavin started speaking more honestly and frankly, and expressed his deep seated concerns and fears and the problems he was facing while completing the project or due to smoking cannabis. By the end of the video, Gavin agreed for a follow-up session the next day, which showed that he was comfortable with Mark to continue the sessions, and thus showed that a therapeutic relation was developed between them (Wolff & Shi, 2015).
Conclusion:
From the interview it could be concluded that effective communication is a vital strategy in the development of a therapeutic relationship with the client or patient. The interviewee was initially reluctant to share much specific information with the interviewer, but later confidence was instilled through effective communication and providing assurances to the interviewee. I believe that due to the effective communication skills, Gavin was able to open up and share his thoughts and feelings, which helped in the successful completion of the interview, and helped Gavin to understand how smoking cannabis is affecting his health and lifestyle.
References:
Bogenschutz, M. P., Donovan, D. M., Mandler, R. N., Perl, H. I., Forcehimes, A. A., Crandall, C., … & Lyons, M. S. (2014). Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA internal medicine, 174(11), 1736-1745.
Cooper, S. G., Whyte, S., Hansell, C., Horvath, K., Mahr, C. W., Mokadam, N. A., & Kirkpatrick, J. (2017). Incidence of Depression and Anxiety in Patients With Durable Left Ventricular Assist Device. Circulation: Cardiovascular Quality and Outcomes, 10(Suppl_3), A212.
Hingson, R., & Compton, W. M. (2014). Screening and brief intervention and referral to treatment for drug use in primary care: back to the drawing board. JAMA, 312(5), 488-489.
Humeniuk, R., Holmwood, C., Beshara, M., & Kambala, A. (2016). ASSIST-Y V1. 0: First-Stage Development of the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and linked brief intervention for young people. Journal of Child & Adolescent Substance Abuse, 25(4), 384-390.
Marques, T. C. N., Sarracini, K. L. M., Cortellazzi, K. L., Mialhe, F. L., de Castro Meneghim, M., Pereira, A. C., & Ambrosano, G. M. B. (2015). The impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of addicted persons. BMC Oral Health, 15(1), 38.
McNeely, J., Strauss, S. M., Wright, S., Rotrosen, J., Khan, R., Lee, J. D., & Gourevitch, M. N. (2014). Test–retest reliability of a self-administered Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary care patients. Journal of substance abuse treatment, 47(1), 93-101.
Palfai, T. P., Tahaney, K., Winter, M., & Saitz, R. (2016). Readiness-to-change as a moderator of a web-based brief intervention for marijuana among students identified by health center screening. Drug and alcohol dependence, 161, 368-371.
Patston, L. L., Travers, K. A., & Newcombe, D. A. (2017). The Acceptability and Feasibility of Screening for Alcohol and Drug Misuse in a Hospital Emergency Department. Addictive disorders & their treatment, 16(3), 111.
Rahm, A. K., Boggs, J. M., Martin, C., Price, D. W., Beck, A., Backer, T. E., & Dearing, J. W. (2015). Facilitators and barriers to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care in integrated health care settings. Substance abuse, 36(3), 281-288.
Saitz, R., Palfai, T. P., Cheng, D. M., Alford, D. P., Bernstein, J. A., Lloyd-Travaglini, C. A., … & Samet, J. H. (2014). Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. Jama, 312(5), 502-513.
Suffoletto, B., Kristan, J., Chung, T., Jeong, K., Fabio, A., Monti, P., & Clark, D. B. (2015). An interactive text message intervention to reduce binge drinking in young adults: A randomized controlled trial with 9-month outcomes. PloS one, 10(11), e0142877.
Wolff, N., & Shi, J. (2015). Screening for substance use disorder among incarcerated men with the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST): A comparative analysis of computer-administered and interviewer-administered modalities. Journal of substance abuse treatment, 53, 22-32.
World Health Organization. (2016). The ASSIST screening test version 3.0 and feedback card.
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