Substance Abuse Counseling Diagnosis

Part 1: Treatment Planning and Individual Treatment
Assessment Process
Assessing for substance abuse can be tricky, given the client’s potential for denial, their perception of social stigma related to substance abuse, and even the therapist’s own biases. Therefore, structured interviews and collateral interviews offer “a more complete picture of both the user and the impact they are having on others in their environment,” (Chapter 5, Slide 4). A diagnostic interview will yield information pertinent to a DSM diagnosis.
Milo clearly has a history of substance use behaviors that make this case easier to diagnose. The DSM-IV offers clear guidelines for diagnosis. Diagnostic criteria for substance abuse include a “maladaptive pattern” over a twelve-month period including recurrent situations that lead to failure to fulfill obligations at school, work, or home, and physically hazardous situations. Milo’s case study reveals hazardous situations (blackouts while driving), and the building up of tolerance to alcohol, as well as withdrawal symptoms. Milo also has comorbidity with social anxiety, one of the commonly related problems linked with substance abuse.
Ethical and Legal Considerations
Milo’s case should be treated with sensitivity and the same ethical considerations of any other client, meaning that confidentiality should me maintained. The therapist should not, for example, divulge information about Milo’s history of driving while intoxicated. Although he did hit an animal, Milo did not directly harm a human being and therefore there is no reason to divulge this information. Additional screenings and assessments might also help address any underlying or comorbid issues such as depression. Finally, the therapist may need to work with other healthcare workers to address Milo’s tendency to have seizures.
Evidence-Based Treatment Techniques
There are a number of different evidence-based treatment techniques useful for substance abuse. However, systematic reviews show that there is no one technique that is necessarily more efficacious than others, and each client may respond differently to different techniques (Waldron & Turner, 2008, p. 238). Individual and group therapies may be indicated in Milo’s case. Presenting problems are clearly linked to both social anxiety and substance abuse. The client is aware of the problem, and having experienced several frightening incidences lately is in a position of readiness to change. Current symptoms include the inability to stop drinking due to withdrawal symptoms like delirium tremens and even seizures.
The short-term goals for Milo’s treatment should include abstinence and commitment to therapy. Because Milo’s withdrawal symptoms are severe, short-term inpatient treatment is recommended. An in-patient setting may help Milo withdraw in a controlled manner, making it also less likely for a relapse. Milo may also be eligible to receive pharmacological interventions like Antabuse or Campral (Rose, 2017, Slide 13). Also, Milo would benefit from a thirty-day program because it would help inculcate some new coping habits that the client can transfer to his daily life as an out patient. Long term goals for Milo include abstinence but also regular counseling sessions to help manage the client’s stress and help him develop better coping mechanisms and resilience. Mindfulness techniques are strongly recommended as long-term solutions that will help Milo achieve overall objectives. Outcome criteria will be linked not just to Milo’s term of abstinence but also to his performance in motivational interviews, which should allow the client to develop desired cognitive and behavioral changes that will prevent relapse. Alternatively, Milo might decide that he eventually would like to envision himself being able to drink in a healthy manner, which could be a feasible goal within a harm reduction framework (Rose, 2017, Slide 14). Depending on Milo’s insurance and what his family can afford, the methods of service delivery will vary, but all should be solution-focused and as short-term as possible.
References
Rose, S. (2017). Notes on Chapter 5: Assessment and Diagnosis
Waldron, H.B. & Turner, C.W. (2008). Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child and Adolescent Psychology 37(1): 238-261.
Part 2: Article Critique
Gonzales, R., Anglin, M., Beattie, R., Ong, C., & Glik, D. C. (2012). Understanding recovery barriers: Youth perceptions about substance use relapse. American Journal Of Health Behavior, 36(5), 602-614. doi:10.5993/AJHB.36.5.3
Introduction and Article Summary
In “Understanding Recovery Barriers,” Gonzales, Anglin, Beattie, et al (2012) explore ways young people (under age 25) conceptualize the factors causing relapse. The authors use a convenience sample from substance abuse programs, comprising 118 individuals, using a focus group and thematic analysis as the methods. Results revealed five main themes in youth relapse patterns including negative emotions, stress, cognitive factors, socialization, and environmental factors. The authors group these five themes into three main categories: individual factors, social influences, and broader environmental issues.
Major Strengths
It is singularly important to study the patterns of youth relapse to better address the needs of this vulnerable population. The study also shows that youth relapse is complex, and that most individuals will reveal multiple factors impacting their behaviors. Also, this research takes into account micro, mezzo, and macro level issues, making it of use to social workers.
Major Weaknesses or Gaps
There are some methodological weaknesses in this study. It was a convenience sample, and the methods also asked for retrospective self-reflection. The methods also did not allow for longitudinal data collection, which is important in studies designed to understand relapse patterns.
Areas of Consideration for Substance Abuse Counseling
The authors address several issues of concern to substance abuse counselors. Counselors need to focus on individual, sociological, and environmental factors, and help their clients to understand how these three domains intersect.
Personal Reflection and Conclusion
I appreciated that this article takes into account the complexities of substance use relapse. The authors acknowledge that relapse is related to multiple issues and that focusing too much on personal psychology may be ineffective. Targeted interventions need to take into account other variables like socialization and context.