Respond to your colleagues by suggesting an alternate therapeutic approach. Support your feedback with evidence-based literature and/or your own experiences with clients.
The patient is a 35-year-old Caucasian female who arrives at the practicum site for counselling. The patient has been in consequent and frequent use of intravenous heroin and is also an avid beer drinker. The patient is seeking medication help to improve his health, quality of life and to avoid going to jail. The patient has a history of convictions and has served two jail terms for dealing drugs. The patient is currently unemployed and does not get involved with her family because their relationship deteriorated because of the patient’s involvement in drugs. The patient is homeless and lives with a group of friends who are frequently on the move. The patient has also struggled with mild depression since the commencement of the drug addiction phase. The patient arrived and requested for admission “I want to change my life trajectory, I am willing to change”.
The therapeutic approach taken for the patient is a review of systems. The patient denies shortness of breath, inflammation, chest pains, skin rash, history, or any urinary incontinence. The patient indicates she struggles with diarrhea and is very nauseous in the morning. The physical exam reveals that the patient speaks very rapidly and rationally, is easily irritable, pupils are round, and reactive to light. Diagnostics tests include urine toxicology and breathalyzer tests. The patient diagnosed with opioid dependency with withdrawal and alcohol dependence with withdrawal (American Psychiatric Association, 2013).
Therapies applied to the patient include Cognitive Behavioral Therapy (CBT) and Contingency Management (CM). Cognitive Behavioral Therapy is an efficacious therapeutic model that aids in the alteration of maladaptive behaviors of the patient. CBT allows the patient to improve coping skills and identify risky situations and also prevent relapse. Contingency Management is an efficacious model in the treatment of opioid dependency with withdrawal in the patient. The therapy is designed to reinforce sobriety in the patient (Chapter 20).
The perceived effectiveness of applying Cognitive Behavioral Therapy (CBT) is because it can be paired with other therapeutic techniques and medication regimen to treat the patient. CBT acquired skills can be used in treating and handling emergent mental and physical health disorders. Contingency Management (CM) can be applied in the reduction of relapse rate and dropping out of the therapeutic regiment.
Pharmaceutical treatment options considered for the management of opioid abuse in the patient include suboxone and methadone. For the patient’s alcoholic addictive disorder, the best treatment option is spearheaded through spiritual and religion support groups to help the patient recover from the addiction.
The patient’s mild depression condition can exacerbate the patient’s symptoms related to substance abuse. If the patient experiences a bout of depression, she can be motivated to re-engage in substance abuse to ease/forget about her condition/ alleviate her symptoms.
Substance abuse and addiction management is an individualized process, each patient responds to medication and therapy disparately. It is essential to be honest with the patient about the likelihood of relapse. Hence, the specific recommendations for the patient is for her to assess her agitatable state and assess how her quality of life changes amidst the therapeutic regiment. If the patient is not progressing in these criteria, the physician and therapist needs to reevaluate the therapeutic regimen applied (Sadock, et al., 2014).
The suggested treatment plan includes DiClemente’s change model which involves the phases pre-contemplation, contemplation, preparation, action, maintenance, and relapse. Relapse is a common phenomenon during substance abuse disorder management. This method is preferred because the patient is taken through a progressive phase where they can articulate on their achievement and change where necessary.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 20, “Substance Use and Addictive Disorders” (pp. 616–693