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.
To begin with, is vital to understand the history of co-occurring disorders. Late in 1970s mental health providers started noticing that their clients commonly had mental illnesses and a substance use disorder. Then, “by the 1990s, substance abuse treatment programs typically reported that 50 to 75 percent of clients had co-occurring mental disorders, while clinicians in mental health settings reported that between 20 to 50 percent of their clients had a co-occurring substance use disorder” (SAMHSA, 2005). That being said, one needs to understand that co-occurring disorders affect people from different walks of life, cultures, socioeconomic status, and racial backgrounds. Furthermore, is important to keep in mind that many of the cases that were reported and diagnosed in the past and present are not an accura...
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
Tom, a depressed client stated that he had a negative part of himself, who tends to withdraw from others and is compounded by his occasional drug usage. As a Gestalt practitioner, I would take the client’s history and gather impressions of their environmental field; the role peers have played in the process, and the emotional factors. This would lead to ascertain whether there are unsatisfied needs due to separation from their peers or drug usage which may upset the balance of her moods. Due to the holistic nature of Gestalt therapy, other influences will be assessed. Gestalt therapy is the preferred therapy in this case because it assists the client get in touch with himself, tap into ways to release tensions, and discover alternative ways to satisfy their
Canada, H. (2009, December 16). Best Practices- Concurrent Mental Health and Substance Use Disorders. Retrieved from Intergrated Treatment: www.hc-sc.gc.ca
services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers. Journal of Substance Abuse Treatment, 31(3), 267-275.
`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.
Case management must believe in the autonomy of the client. We must be committed to the process and we will implement the principles taught in order to obtain total client participation and empowerment (Woodside & McClam, 2013). The drugs are not the only problem; the way of life that has debilitated them and left them on the streets has to be addressed and the case manager has to look at the back story that has delivered the addict to their current situation. Those that suffer from abuse, mental illness and/or trauma creates a person that only knows how to cope with life by turning to substances for an escape from reality. In case management, there are many problems in working with the homeless addicted population. This population finds it difficult to maintain or keep up with any goals, so it would have to be the social workers main objective to keep the lines of trust and communication open for greater outcomes at every level of treatment. It is a challenge and the case manager has discovered that if the approach is multidimensional; the addiction can be combated by providing hope and a chance to break free from these cycles of addictions leading to a better way of
Smyth, N. (1994). Addictions counseling: a practical guide to counseling people with chemical and other addictions/The addiction process: effective social work approaches/Clinical work with substance-abusing clients (book). Social Work, 39(5), 616.
Ruddy, N. B., Borresen, D. A., & Gunn Jr., W. B. (2008). Colocating with medical professionals: A new model of integrated care. In The collaborative psychotherapist: Creating reciprocal relationships with medical professionals (pp.115–133). Washington, DC: American Psychological Association.
The term ‘dual diagnosis’ refers to people who suffer from grave mental illness and have problems with drugs or alcohol to the extent that their mental and physical health is affected. The condition of substance misuse disorder does not entail that there is dependence or an addition rather it defines a spot where the person’s use of drugs or alcohol has become problematic and it impairs the person’s tone of spirit and their ability to work as part of a community. Some reasons that people who are mentally ill drink and get hold of drugs include they are self-medicating, to normalize entry into social groups, to run away or to disengage because their spirit is difficult so they why would rather be “numb” than deal with their troubles. In this paper I will cover the following topics substance abuse’s role in offending behaviors, challenges for both client and clinician’s perspective, interventions and techniques that can be used with this population and some research findings.
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.
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).
"Substance Abuse and Mental Health: Overcoming Alcohol and Drug Addiction While Coping with Depression or Anxiety." Helpguide.org: Understand, Prevent and Resolve Life's Challenges. Web. 14 Dec. 2010.
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