The following protocol, TIP 48 Managing Depressive Symptoms in Substance Abuse Clients during Early Recovery, will be discussed in conjunct with class notes in order to discern ways to effectively work with clients with co-occurring disorders. Clinicians need to be able to assess accurately for mental health disorders, substance use, and readiness for change. First, when working with a population with co-occurring disorders it is vital they are able to be accurately assessed quickly so they will be able to be placed into treatment which meets their needs as quickly as possible. Diagnosing clients with depression and substance abuse/dependence, needs to meet the criteria with the current DSM. Substance abuse and dependence in the DSM tends to be confusing due to the clinician making the diagnosis based out of their limited “snap shot” of information and context. The daunting task of assessing as accurately as possible is vital to address the placement criteria. Working with those with co-occurring diagnosis may require the clinician to have specific training due to the nature of having varying complications. The training may require for those to have a multi-problem view point to cover the multidimensional problems which may or have occurred. Client’s with the diagnosis of depression and substance abuse/dependence need to have a treatment plan which is client-centered. “A client-centered treatment plan is based on a careful assessment inclusive of immediate needs, motivation for change, and readiness to change.” (p 23). Creating the therapeutic alliance and sustaining it is vital for the client to be able to trust and rely on the clinician for help. “An early and strong therapeutic alliance is critical to successful treatment.”... ... middle of paper ... ...ossible adverse interactions between an antidepressant medication and the substances a patient is abusing (such as the potential for increased sedation or intoxication).” (p 29). Working with any type of disorder can be challenging, let alone working with co-occurring disorders. It takes a skilled clinician to separate the symptoms of the diagnoses to best treat them. One way to assist the client in managing these symptoms is to educate the client on the slow process of repairing the brain, the post-acute withdrawal symptoms, and depressive symptoms. Non-judgmental and active listening techniques contribute in building a strong therapeutic alliance with the client while altering the experience of the client. Healing from substance use and depression is a very challenging and requires the partnership of the clinician and the client in order to have lasting recovery.
Fortinash, K. M., & Holoday Worret, P. A. (Eds.). (2012). Substance-related disorders and addictive behaviors. Psychiatric mental health nursing (5th ed., pp. 319-362). St. Louis, MO: Elsevier Mosby.
McGovern, M. P., PhD, & Carroll, K. M., PhD. (2003). Evidence- base Practices for Substance Use Disorders. Psychiatric Clinics of North America. Retrieved from http://www.dartmouth.edu/~dcare/pdfs/fp/McGovernMark-Evidence-BasedPractices.pdf
A lot of times several approaches are combined to treat substance abuse and dependence (Comer, 2010, p. 317). Therefore, if the sociocultural approach proved not to be sufficient on its own, I would add a psychodynamic therapy which can help clients become aware of and correct the underlying needs and conflicts that led to the disorder in the first place (Comer, 2010, p. 310). I think this will help my treatment plan be more inclusive because it will address environmental influences as well as underlying individual issues.
...ives from the implementation of an empathic, hopeful continuous treatment relationship, which provides integrated treatment and coordination of care through the course of multiple treatment episodes” (Watkins, 2015). Whether, confronted with a substance use disorder, gambling or sex addiction the way in which a counselor work with the client in an open helpful manner is the key to motivating the client to change their behaviors. “A man convinced against his will, Is of the same opinion still” (Carnegie, 1981). The most piece of the helping relationship is that the client is the lead in their care, as they are the ones that will be making the decisions for their care. A counselor is essentially a trained skillful teacher that guides an individual toward their best recovery options and it is up to the individual to make the needed changes in their life and behaviors.
`In the past, I worked in such a research setting, where if a person was found to meet criteria for opiate dependence they received treatment, however if even slightly short of DSM-IV criteria for the disorder they would have to look elsewhere. This was a continual concern for me, as the person who met criteria was not always the person with the most distress, and alternative treatments were not easy for people to find. Largely from this experience, I find the current categorical approach to classifying persons with psychopathology to be an imperfect system at best, with the primary advantage of being convenience when communicating with other professionals. I question whether this convenience comes at a severe cost to accuracy, the result of which is an artificial limit to the range of presentations that occur in psychopathology. As the example above illustrates, the particular aspect that I find most problematic is the use of cutoffs for specific symptoms, for instance the length symptoms must have been present for it to be classified as a disorder, or even the number of symptoms that need to be present. I think it is unlikely that a person who “almost” meets criteria for a disorder would be significantly different from a person with similar symptoms who just barely meets criteria. In private practice these two cases would likely be treated similarly, but in a setting where diagnosis serves as a screening tool the client who met criteria may get treatment while the other does not. In this case I feel that less specific guidelines, lacking specific numerical limits would alleviate many of the problems.
During my time in the ward, I recently had a patient with alcohol dependency in my care. My patient, Mr Grey was a 51 year old male patient who was admitted with a fractured neck of femur and consistent hypertension. Mr Grey required a vast amount of medical treatment for his injuries. As well as Mr Grey’s physiological problems he also had poor mental health problems such as depression and anxiety. We later discovered my patient had some social issues and that he was homeless.
Overcoming an addiction to alcohol can be a long and bumpy road. Many people feel that it is impossible to overcome an alcohol addiction. Many people feel that is it easier to be an addict than to be a recovering addict. However, recovering from alcoholism is possible if one is ready to seek the help and support they need on their road to recovery. Recovery is taking the time to regain one’s normal mind, health and strength. Recovery is process. It takes time to stop the alcohol cravings and pressure to drink. For most, rehab and professional help is needed, while others can stop drinking on their own. Recovery never ends. After rehab, professional help or quitting on your own, many people still need help staying sober. A lot of time, recovering
This is an area where advocacy and empowerment are essential, especially if a client feels less than able to go deal with major systems in society alone. It is also an area where a client may be coming to use for many different reasons and we should look further than just a diagnosis. It is also a field as we discussed in class that is not always culturally competent. Many other cultures can show signs for mental illness when in reality it is their way of functioning in that group. This is major reason practitioners should ask clients about their backgrounds and questions about their behavior if they are unfamiliar before placing
Therefore, when I work with substance abusers I will show empathy, encourage and validate their successes and their feelings about any failures. In addiction, I will help the person learn from their failures and normalize the situation. Furthermore, I would attempt to ensure that the person had several coping strategies in place, to help when he or she finds themselves in a difficult situation. Moreover, I intend to ensure the client has all the tools he or she needs to succeed while getting to the root of their problem through counseling.
Severe mood swings, violent rages, memory loss—each of these problems were a part of my family life during the past two or three years. These problems are the result of alcoholism. Recently, a member of my family realized his abuse of alcohol was a major problem to not only himself, but also to those around him. He would lose control of his temper and often would not even remember doing it the next day. Alcohol became a part of his daily life including work, home, and any other activities. His problem was that of a "hidden" and "high-society" alcoholism. When he was threatened with the loss of his job and the possibility of losing his family, this man knew it was time to get help. After he reached his lowest point, he took the first step towards recovery—admitting his problem.
One in five Americans, approximately 60 million people, have a mental illnesses (Muhlbauer, 2002).The recovery model, also referred to as recovery oriented practice, is generally understood to be defined as an approach that supports and emphasizes an individual’s potential for recovery. When discussing recovery in this approach, it is generally seen as a journey that is personal as opposed to having a set outcome. This involves hope, meaning, coping skills, supportive relationships, sense of the self, a secure base, social inclusion and many other factors. There has been an ongoing debate in theory and in practice about what constitutes ‘recovery’ or a recovery model. The major difference that should be recognized between the recovery model and the medical model is as follows: the medical model locates the abnormal behavior within an individual claiming a factor that is assumed to cause the behavior problems whereas, the recovery model tends to place stress on peer support and empowerment (Conrad and Schneider, 2009). This essay will demonstrate that the recovery model has come a long way in theory and practice and therefore, psychological well-being is achievable through this model.
In patient programs can also be very effective, especially for those with more severe problems. They are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. Treatment Centers differ from other treatment approaches principally in their use of the community—treatment staff and those in recovery—as a key agent of change to influence patient attitudes, perceptions, and behaviors associated with drug use. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. The focus of the TC is on the resocialization of the patient to a drug-free, free living lifestyle and delivers healthy coping mechanisms for individuals that have not been able to function in society without the use of a mood altering substance.
These tools are helpful in framing my practice into interventions that are evidenced based and effective. However, I’ve found that allowing patients and their families to be the guide for the treatment plan gives then much needed control over their lives as a uncertainty and lack of control have become the norm for them. It also keeps me honestly engaged in intentional and active listening to the patient. I am always looking to them for cues on ways to join them on their journey. Listening to my patient from a person-centered perspective cures my need to solve everything for the patient. Many of them have the solutions and we are partners in discovering the road to those solutions. Even when a patient may be full of despair and feeling low, they continually express that they are more than a diagnosis. They are a person who has many influences that may greatly impact their illness experience. As their therapist, my role is to respect their desires and goals, and help them maintain optimal functioning in this
Substance abuse complicates almost every aspect of care for the person with a mental disorder. When drugs enter the brain, they can interrupt the work and actually change how the brain performs its jobs; these changes are what lead to compulsive drug use. Drug abuse plays a major role when concerning mental health. It is very difficult for these individuals to engage in treatment. Diagnosis for a treatment is difficult because it takes time to disengage the interacting effects of substance abuse and the mental illness. It may also be difficult for substance abusers to be accommodated at home and it may not be tolerated in the community of residents of rehabilitation programs. The author states, that they end up losing their support systems and suffer frequent relapses and hospitalizations (Agnes B. Hatfield, 1993).
Client education is also a process by which clients are educated as to the course that alters health risks and behaviors associated with alcohol and other drug use and abuse primarily by abstinence but in some cases with medication to improve client health status. “Client education provides culturally relevant formal and informal education programs that raise awareness and support substance abuse prevention and the recovery process” TAP 21, competency 99 (www.samhsa.gov). Clients and family members are often unaware of the initial root cause (s) of the health impairment that led to or became the issue (s) (beyond presenting situation) of the impairment. Educating the client in a variety of forms is an essential part of the healing process and will aid in the overall wellness of the client. Some forms of client education are addressed in a class or group setting but can be significantly addressed in a one on one setting with a counselor however; the advantage of peer on peer feedback, or interaction is lost.