Alcohol and drug addiction: causes, effects, and treatment

Substance Abuse Case Study: Levi

In recent years psychology researchers have made significant gains in developing effective diagnostic and treatment tools for compulsive and addictive behaviors. In addition, there is a growing body of research that explores the concept of duel diagnosis, with increasingly streamlined treatment plans being designed to address underling mental health disorders in conjunction with detoxification and rehabilitation from substance abuse.

The client in this case study, Levi, is an HIV positive man in his mid-30's who has disclosed an escalating pattern of tranquilizer and cocaine abuse. His case not only presents as a possible duel diagnosis of mood disorder and substance abuse, but given his HIV positive status and his declining health, it's probable he will need comprehensive care. Levi's willingness to disclose his substance abuse to Dan indicates that he may be more motivated to seek treatment at this time, and it also indicates that he has a positive rapport with Dan that should be used to encourage more intensive support. A wide variety of studies have established the importance of positive rapport in therapeutic relationships, and it is specifically efficacious in the treatment of patients with substance abuse. In fact, positive rapport has been shown to increase retention in counseling and improve post-treatment outcomes for substance abuse treatment. What's more, motivation to seek treatment, which Levi exhibited by making the call and confiding in Dan, is highly associated with stronger treatment outcomes (George et al., 2001).

Levi's counselor, Dan should consider the current models that are being developed and implemented to treat HIV and AIDS patients who have comorbid substance abuse issues. A treatment plan for Levi should include counseling support, substance abuse treatment, and medical care. Since it's clear that Levi has a longstanding relationship with Dan, it's important that Dan encourage Levi to make an office visit. Levi likely needs a full physical exam, laboratory tests, and consultation regarding medications for HIV and anxiety. According to Volkow et al. (2010), treatments such as highly active antiretroviral therapy (HAART) can often contribute to lasting remission of HIV and also reduce the risk of transmission. For a client like Levi, a full assessment of his viral load, overall health, and immune system functioning will help medical doctors and mental health providers work together to stabilize his physical condition and support his psychosocial needs. According to Conway and Tossonian (2010), individuals with low mood who feel marginalized by their HIV positive status may be avoidant or apathetic towards support interventions. Since Levi has yet to inform his family of his health issues it is quite probable he has experienced marginalization and that he feels isolated. Conway and Tossonian (2010) suggest that, in such cases, a clinician can make a positive impact on the client by engaging in "seek and treat" methods. This entails making repeated effort to engage the client in medical care and therapy with the aim of reducing their sense of marginalization, isolation, and hopelessness.

Levi's lack of supportive relationships should also be addressed in his therapy. In many cases relationships and social responsibilities can strengthen the effectiveness of substance abuse recovery and relapse prevention. In her studies regarding relapse prevention VanDeMark (2007) noted that subjects who had social support and affective support had higher rates of success in treatment. Since Levi is hesitant to share his medical diagnosis with his family, his therapist should begin exploring ways to help him connect to more supportive relationships. It is important to note that Levi's work is likely to be mostly solitary because he repairs automobiles, so he may not have the opportunity to meet people and form relationships through his workplace. His treatment plan should address ways in which he can join groups, either formal support groups or informal community groups. A HIV support group would be ideal, as one of the precipitating factors for his low mood, anxiety, and isolation is his diagnosis of HIV. Participating in a group would alleviate some of his isolation and likely raise his awareness that other individuals have similar experiences. Peers often provide helpful feedback, support and information, and access to this type of interaction may encourage Levi to make some behavioral changes regarding his relationships, health care, and substance use.

Levi can likely make improvements to his health by exploring treatment options for his HIV and his substance abuse. If he commits to stopping his cocaine use it's quite likely his physical health and weight may improve because cocaine, a stimulant is often associated with weight loss. In addition, Collins et al. (2008) note that many of the current medical treatments for HIV can dramatically reduce viral loads, lowering the risk sexual transmission. Through treatment, Levi may gradually decide that he can safely pursue a relationship, and this social interaction may have positive affects on his mood and self-esteem.