Social Context

Describe the client’s family and social context. Assessment and case Formulation including psychosocial needs (supported by references). Describe the substance abuse model- Abstinence and rationale. Outline of counselling and treatment process— residential detox then residential rehabilitation with partner. Client outcomes- challenges and supports such as cultural programs, religious organisation- pastor support for education, sporting organisations, recreational PCYC…….. Identify ethical issues likely to arise.

 

As Ruby seems to be neglected by her parents and feels that they have no time for her, it seems that this is the main cause of her alcohol addiction. Hence, the cognitive behavioral model will be involved in the treatment of Ruby, as this method is focused on making individuals learn that how their personal feelings, thoughts, and behaviors, like alcohol drinking, in this case, are connected and various methods to break this kind of connections. The treatment plan will include helping the client analyze and recognize her environment, as well as, analysis of the methods of responding to the various cues to utilize alcohol, as well as, to develop new ways and methods of response to these different cues. Further, this treatment plan will involve the cognitive therapy and will attempt in reducing excessive and rapid emotional reactions, as well as, the self-defeating attitude of the client by modifying her faulty thinking, as well as, maladaptive beliefs which are responsible for these kind of reactions (Kumpfer, 2002). Moreover, this treatment plan will involve strategies that will focus on the various behavioral aspects and ways of coping instead of thinking or running away from the situation. Hence, it will involve the participation of the client in relapse prevention programs and other training programs for the development of the cognitive, behavioral, as well as, abstinence skills. This treatment method will include 12-16 sessions, usually for more than 12 weeks and will focus on developing interpersonal skills, as well as, strategies to help client expand her social support connections and other coping skills. The physical and psychological aspects that may occur in this case are changes in the behavior of the client as she is asked to refrain herself from the alcohol use. It may lead to the aggressive or angry behavior. Moreover, the difficulty faced by the client during the early stages of the plan to refrain herself from the alcohol can lead to the event of relapse. Hence, proper monitoring and participation in the relapse prevention events and various other supporting programs are highly recommended (Worley, Tate, McQuaid, Granholm, & Brown, 2013).

As Sammy is highly addicted to alcohol with the habit of drinking alcohol as soon as he wakes up and due to the deterioration of his health status caused by alcohol drinking, the use of abstinence model or 12-step model will be used in the treatment of Sammy. As this method involves the multi-disciplinary and is abstinence-oriented, hence, it will help Sammy to stop consuming alcohol and abstain himself from drinking. Firstly, this treatment plan will involve the teaching and educate the client about the use of alcohol as a major problem and its extent. Secondly, this method will involve the motivational interviewing process while counseling with the client for a better understanding of his alcohol addiction and resolving the problem (Winters, Stinchfield, Latimer, & Lee, 2007). Thirdly, this method will involve different individual and group therapies, the collaboration of the method with other supporting teams like PCYC and religious organizations for physical and recreational activities, as well as, will involve inpatient detoxification, various rehabilitation services, as well as, other outpatient services. This method will also involve the spiritual orientation and will include other symptomatic treatments for the upliftment of the client’s health status. This plan will be followed for at least 28 days with participation in the twelve step programs and meetings (Lammertink, Löhrer, Kaiser, Hambrecht, & Pukrop, 2008). Moreover, it will also include aftercare plan for supporting ongoing recovery of the client after the completion of the treatment plan as it is the life-long process. The physical and psychological challenges that may occur in this case is the occurrence of the serious symptoms that may occur when there is no alcohol consumption all of a sudden. Hence, it requires close medical monitoring of the patient due to his deteriorated health condition and alcohol addiction. Moreover, the chances of relapse are also there even if abstinence is achieved during the treatment process, thus, requiring the after care plan utilization (Khalsa, Treisman, McCance-Katz, & Tedaldi, 2008).

As Amira is a heroin addict and has been arrested for soliciting, the use of a cognitive behavioral model, as well as, pharmacological treatments will be the preferred method of treating Amira. The foremost step in the treatment plan will be the detoxification or chemical withdrawal of the client from heroin. The second step to be followed after detoxification of the client will be the use of various classes, as well as, therapy sessions that will help the client in coping the situation and overcoming the desire of using of heroin again (“Maintenance Treatment of Heroin Addiction. Evidence at the Crossroads”, 2004). The next step of this treatment plan will be the maintenance after the completion of the treatment program. It involves follow-up care by participation in the 12-step programs like Narcotics Anonymous and other supporting groups besides the individual therapy (Connell, 2006). Residential training for the period of about 30-90 days will be undertaken depending upon the addiction of the client and her improvement. The physical and psychological challenges that can be experienced by the patient may involve various withdrawal symptoms experienced by the patient on stopping heroin use like vomiting, bone pain, restlessness, insomnia, cold flashes (Blanken, Hendriks, van Ree, & van den Brink, 2010). Moreover, there can be extreme cravings for the heroin experienced by the patient in association with the withdrawal symptoms, which can lead to the relapse of the heroin addiction. Hence, the use of medical treatment during the process of detoxification is very important to minimize these withdrawal symptoms, as well as, the extreme cravings for the heroin use. Hence, the treatment plan will include the medically assisted detoxification process, cognitive-behavioral therapy, various educational and motivational lectures, individual, as well as, group counseling programs, family therapy, and the incorporation of the 12-step program as a after care plan (Future Challenges For Heroin And Other Opioid Substitution Treatment”, 2008).

 

Drugs, as well as, substance abuse are found to be the major contributing problem worldwide and has become the major problem observed among teenagers. It has been observed that several youngsters do drugs to show they are cool or because they are pressured by the peers into doing drugs. It has been found that the peer pressure has been the concerned problem regarding the drug abuse. People who are a substance or drug addict have no control over their lives and lacks the understanding regarding their surroundings. Risk factors like lack of emotional or mental resources to cope up with the stress, requiring sudden relief from distress, or having a low tolerance to handle the stress and frustration are commonly found to be the reasons for drug addiction (Shepard, 2002). In this article, I will seek to review the case of the Australian movie character, Samson in the movie titled Samson and Delilah, who is involved in the substance abuse and is a petrol sniffer.

 

Description of the character: Samson is a teenager who lives in the remote Aboriginal area of the Central Australia. He used to live with his brother and shares the battered cinder-block apartment with his elder brother. The apartment is dirty and, besides having the refrigerator, which has no eatables or food inside it, the house does not have any other kind of the real furniture. The community where he lives is surrounded by empty beer cans, milk crates, as well as, abandoned cars and litters the poor, as well as, an oppressed community where he survives. The life of Samson is miserable, and he used to live in the extreme conditions. Due to the poverty and poor conditions of his family, he has become addicted to substance abuse and sniffs petrol to alleviate his boredom and physical hunger. He wants to learn guitar and his brother has the reggae band. However, his brother does not allow him to play his instrument. Hence, to amuse himself besides beating his physical hunger, Samson has become a substance addict and used to sniff petrol for his personal amusement and to overcome his miserable life due to the poverty and isolation. He finds petrol sniffing to be the way of coping his loneliness and boredom he has in his life. Samson’s petrol sniffing addiction increases and worsens day by day due to which he is losing the touch with the real world (Gorman, 2009).

Evaluation of the case: Samson is a petrol sniffer, and his addiction is increasing day by day as he wishes to overcome the harsh cruelty of his life. His psychosocial needs indicate that Samson’s addiction to the petrol sniffing is to overcome his physical hunger and boredom as he belongs to the poor family and lives in an isolated community with his brother. His brother is not supporting in nature and devoid of having family relations due to the absence of family, Samson is found to be involved in the addiction. Moreover, the use of illicit substances, alcohol, as well as, tobacco is found to be the cause, as well as, effect of the great suffering seen among the Indigenous people. The statistics have shown that about 28 % of the Indigenous people are found to be more involved in the substance and drug abuse as compared to the other Non-Indigenous people. The isolation of the Indigenous people from the white community and the sufferings they have faced has led to the use of illicit drugs. The inequality and the lower standards of living of the Indigenous people like lack of education, healthy housing, proper sanitation, food resources, as well as, unemployment are the factors that have inclined the client to the addiction (Gorman, 2009).

Substance abuse model for the client: Depending upon the condition and level of addiction in Samson, the abstinence-based addiction counseling is chosen to treat the addiction of the client. Through counseling, as well as, through continued support, the client will be recovered from the addiction as long as the client maintains the abstinence from the petrol sniffing for a lifelong term (Laudet & Stanick, 2010). The main and foremost goal of this substance abuse model is to help Samson achieve, as well as, to maintain the abstinence from the petrol sniffing and other addictive behaviors and chemicals. The secondary goal of this treatment model is to help him recover all the damage and negative impacts the client had faced due to the addiction (Dawson, 2000).

Rationale: The abstinence-based addiction counseling will work initially by making the client understand the problem and by motivating him to recognize the occurrence of his problem, as well as, the related irrational thinking with this problem. Next, the patient will be encouraged and motivated to achieve, as well as, maintain the abstinence from the petrol sniffing. Moreover, through this counseling model of substance abuse, we will develop the required and important psychosocial skills, as well as, the spiritual development that will be helpful to the client to continue his abstinence from the substance in the lifelong process of recovery. This approach will actively lead to the formation of the strong and healthy therapeutic alliance among the client (Dodge, Sindelar, & Sinha, 2005).

Interventions: As Samson’s addiction is worsening day by day, therefore, I will follow the Abstinence-focused addiction counseling method for treating his addiction problem. The abstinence treatment model of substance abuse will initially be focused on the diagnosis mainly on the comprehensive evaluation of the client, which recognizes and determines that addiction is the biological, social, as well as, a psychological disease. Hence, the initial and foremost phase of this model of treatment of substance abuse will require the process of detoxification that will be medically supervised. Moreover, the comorbid diseases and health issues that can be associated with the petrol sniffing, as well as, dual diagnosis of the diseases like bipolar disorder, depression, hyperactivity disorder, or attention deficit disorder will also be diagnosed, as well as, treated whatever the case may be (Chi, Sterling, Campbell, & Weisner, 2013). The treatment for the substance abuse will involve the use of cultural interventions, individual cognitive based behavioral therapies, group therapies, partner therapy, as well as, the relapse prevention measures and therapy. The use of cultural interventions has found to offer the promise and hope of recovery from various kinds of addictions and substance abuse for Indigenous people. From the use of various sweat lodges to the implementation of traditional teachings, the regionally based interventions will be practiced. The use of cultural elders that will help the client to assume their traditional role and will be a constant reminder to him about his native cultural and traditional norms will be followed. Art therapy that will include traditional teachings and social culture programs will also be followed. Psycho-therapeutic practices involving spiritual and cultural domains will help the client to identify his tradition and culture (Rowan et al., 2014). Besides giving traditional teachings, will work in collaboration with the supporting teams like Uniting Church that works for the upliftment of indigenous people and acknowledges their rights. Uniting Church is the community service provider and provide various scholarships for training and education, employments, and work for the benefit of Indigenous People (Cardelus, Lowman, & Eshete, 2012). Hence, this will help the client to overcome the social determinants of his life that have forced him towards addiction. Moreover, the client will be enrolled in the petrol sniffing prevention program where the client will participate in the volatile substance rehabilitation program, will be re-engaged in various cultural activities like hunting, visit to sacred places, fishing, as well as, learning the stories. Moreover, there will be implementation of various education and communication strategies, activities for strengthening and supporting the Indegenous people community, and evaluation of the progress of the client (Bryce, Rowse, & Scrimgeour, 2010). Moreover, the use of cognitive behavioral therapy, acceptance and commitment therapy, and narrative therapy.

Client Outcomes: The outcome of this treatment model will be positive for the client as it focuses on the underlying reasons responsible for the addiction of the client to the substance abuse. Moreover, this model helps in overcoming and dealing with the medical, religious, as well as, the psychological components. This treatment plan also includes the after treatment programs that motivate and encourages the patient to continue his abstinence to the substance abuse. The total abstinence is the main motto of this program. The use of the cognitive behavioral therapy will help the client to understand the link between his addictive behavior and his surroundings and environment. Moreover, this therapy will help him to analyze his feelings that insist him to petrol sniffing and will provide ways to overcome these kind of feelings and situation (Moyers & Houck, 2011). The use of the acceptance and commitment therapy will help the client overcome psychological disorders. It is a mindfulness therapy and will aim to help the client learn, as well as, grow as a result of his sufferings. Moreover, this therapy will help the client to develop the detached relationship to his thoughts and feelings. While, the narrative therapy will help the client to re-map his future by heading in a positive and a sober direction. This therapy will highlight the positive past experiences of the client that will motivate him and will become the building blocks for his successful future (Marsh, Dale, & Willis, 2007). However, during the process of this treatment of substance abuse, the client will face various difficulties and challenges as it will be very difficult for him to refrain himself from petrol sniffing suddenly. Due to this, the client may be unwilling or unable to remain adhered to the treatment program. Frequent dropouts, as well as, withdrawal symptoms can also occur as a result of this. Moreover, lapses can often occur during the early period of this treatment plan. Hence, motivational, as well as, supporting services are very much required and important for the client’s adherence to the treatment program (Galanter, 2007).

Ethical issues likely to arise in this case: The ethical issues related to the client’s confidentiality, cultural background, and societal status are likely to arise in this case. Respect of the client in respect of his cultural background and social status is very important. As the client belongs to the poor economical status and to the Aboriginal community, it is likely that his counseling process is being affected by these parameters. However, this behavior is beyond the ethical norms and is the breach of the code of ethics, which states that the person should be treated and counseled irrespective of his caste, creed, color, and background (Scott, 2000). Moreover, as this treatment and counseling process is solely focused on abstinence process, it may work against the will of the client at certain times due to the client’s desire of drug addiction and in the case of relapse. Other ethical issues that may arise in this case can be negligence or improper counseling and treatment method for the substance abuse of the client due to the inability of his to pay for the process. As the client is poor and inefficient in paying for the counseling process and providing any other kind of financial support, it is likely to happen that these parameters might affect the whole counseling process (Bretteville-Jensen, 2006). The confidentiality, equality, and autonomy are the few ethical concerns likely to arise in this case.

The abstinence model involves the comprehensive, as well as, the multi-disciplinary approach focusing on the treatment of various kind of addictions that is abstinence-related. Various kinds of elements, as well as, methods that are widely related with the foremost treatment method while following this model involves individual therapies, group therapies, motivational and encouraging lectures, multi-disciplinary staff, recovering individuals as counselors, a therapeutic milieu, family counseling, various therapeutic oriented work assignments, utilization of the Twelve Step program, family counseling, daily evaluation of the client’s progress, attendance of the client at AA meetings, as well as, provision of various opportunities to the client for recreational and physical activity (Notley, Blyth, Maskrey, Pinto, & Holland, 2014). Even after the completion of the treatment plan, the clients are encouraged to participate and involve in the meetings and after care programs. This model has the main focus on identifying the chemical dependency to be the main problem. This model is neither punitive nor blaming, and it emphasizes on seeking the treatment to be the best and appropriate response to the chemical dependency problem. Hence, this method besides helping in achieving the abstinence from the substance abuse also provides the measures favoring the continuity of this abstinence for a life long term (Reichel & Bevins, 2009).

 

Future challenges for heroin and other opioid substitution treatment. (2008). Addiction, 103(6), 967-968.
Blanken, P., Hendriks, V., van Ree, J., & van den Brink, W. (2010). Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands.Addiction, 105(2), 300-308.
Bretteville-Jensen, A. (2006). Unresolved Issues Associated With Current Economic Models of Substance Abuse. Substance Use & Misuse, 41(4), 605-606.
Bryce, S., Rowse, T., & Scrimgeour, D. (2010). Evaluating the petrol-sniffing prevention programs of the Healthy Aboriginal Life Team (HALT). Australian Journal Of Public Health, 16(4), 387-396.
Cardelus, C., Lowman, M., & Eshete, A. (2012). Uniting Church and Science for Conservation.Science, 335(6071), 915-917.
Chi, F., Sterling, S., Campbell, C., & Weisner, C. (2013). 12-Step Participation and Outcomes Over 7 Years Among Adolescent Substance Use Patients With and Without Psychiatric Comorbidity.Substance Abuse, 34(1), 33-42.
CONNELL, P. (2006). Organization of the treatment and supervision of heroin addiction. Addiction,90(6), 843-845.
Dawson, D. (2000). Alternative measures and models of hazardous consumption. Journal Of Substance Abuse, 12(1-2), 79-91.
Dodge, R., Sindelar, J., & Sinha, R. (2005). The role of depression symptoms in predicting drug abstinence in outpatient substance abuse treatment. Journal Of Substance Abuse Treatment, 28(2), 189-196.
Galanter, M. (2007). Spirituality and recovery in 12-step programs: An empirical model. Journal Of Substance Abuse Treatment, 33(3), 265-272.
Gorman, S. (2009). Review of Samson and Delilah. History Australia, 6(3), 81.1-81.2.
Khalsa, J., Treisman, G., McCance-Katz, E., & Tedaldi, E. (2008). Medical Consequences of Drug Abuse and Co-Occurring Infections: Research at the National Institute on Drug Abuse. Substance Abuse, 29(3), 5-16.
Kumpfer, K. (2002). Prevention of alcohol and drug abuse: What works?. Substance Abuse, 23(sup1), 23-45.
Lammertink, M., Löhrer, F., Kaiser, R., Hambrecht, M., & Pukrop, R. (2008). Differences in substance abuse patterns: multiple drug abuse alone versus schizophrenia with multiple drug abuse. Acta Psychiatrica Scandinavica, 104(5), 361-366.
Laudet, A. & Stanick, V. (2010). Predictors of motivation for abstinence at the end of outpatient substance abuse treatment. Journal Of Substance Abuse Treatment, 38(4), 317-327.
Maintenance Treatment of Heroin Addiction. Evidence at the Crossroads. (2004). Addiction, 99(10), 1360-1360.
Marsh, A., Dale, A., & Willis, L. (2007). A counsellor’s guide to working with alcohol and drug users. Perth, W.A: Drug and Alcohol Office.
Moyers, T. & Houck, J. (2011). Combining Motivational Interviewing With Cognitive-Behavioral Treatments for Substance Abuse: Lessons From the COMBINE Research Project. Cognitive And Behavioral Practice, 18(1), 38-45.
Notley, C., Blyth, A., Maskrey, V., Pinto, H., & Holland, R. (2014). Exploring the Concepts of Abstinence and Recovery Through the Experiences of Long-Term Opiate Substitution Clients.Substance Abuse, 36(2), 232-239.
Reichel, C. & Bevins, R. (2009). Forced Abstinence Model of Relapse to Study Pharmacological Treatments of Substance Use Disorder. Current Drug Abuse Reviewse, 2(2), 184-194.
Rowan, M., Poole, N., Shea, B., Gone, J., Mykota, D., & Farag, M. et al. (2014). Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. Subst Abuse Treat Prev Policy, 9(1), 34.
Scott, C. (2000). Ethical Issues in Addiction Counseling. Rehabilitation Counseling Bulletin, 43(4), 209-214.
Shepard, P. (2002). Integrated medical and substance abuse treatment increases abstinence rates for people with substance abuse-related medical conditions. Evidence-Based Healthcare, 6(2), 51-52.
Winters, K., Stinchfield, R., Latimer, W., & Lee, S. (2007). Long-term outcome of substance-dependent youth following 12-step treatment. Journal Of Substance Abuse Treatment, 33(1), 61-69.
Worley, M., Tate, S., McQuaid, J., Granholm, E., & Brown, S. (2013). 12-Step Affiliation and Attendance Following Treatment for Comorbid Substance Dependence and Depression: A Latent Growth Curve Mediation Model. Substance Abuse, 34(1), 43-50.