Treatment of Chemical Dependency

Crisis Intervention

The focus of this work in writing is making a determination of the most optimal course of action and the case formulation in a specific case. A plan of action will be provided and the crisis interpreted within a theoretical framework. A model of assessment, intervention and treatment will be used and included in the assessment will be a possible psychological diagnosis if a mental illness is believed to be present and included will be a referral to an appropriate treatment facility if it is needed and the thoughts on how the crisis will be most likely to be resolved. In addition, the substance abuse of Cassandra's family members will be discussed. The evidence on chemical dependency being passed from one generation to another will be examined and the cultural environment and genetic makeup in relation to substance abuse tendencies will be examined. This work will explain how traits are inherited in populations and genes and DNA identified as the mechanism for inheritance. Finally, this study will discuss the ethical issues that may arise during the crisis work including how the client's homicidal ideation would be handled as well as the presence of police during what is a confidential interview. Included as well will be the characteristics a crisis worker needs specifically for this case in addition to indicating what additional information would need to be gathered and how it would be gathered and how that information would change the approach with this client. Finally, this work in writing will provide a description for how the escalation in behaviors on the part of the client would be handled to ensure the client's safety.

I. The Family and Addiction

The work of Ashery, Robertson and Kumpfer (1998) reports that risk and protective factors in relation to drug abuse and chemical dependency are those that "increase or decrease the probability that problems will occur. The relationship between risk and protective factors and problem behaviors is complicated in that the salience of a risk factor may change depending on the cultural and physical context, the presence of other risk and protective factors and the developmental status of the group or individual." (Ashery, Robertson and Kumpfer, 1998, p.1) The systems perspective is often used in researchers in the elucidation of "how the individual both influences and is influenced by these contexts and the people and events in them over the course of development." (Ashery, Robertson and Kumpfer, p. 1) School-based interventions have a focus on academic achievement increase and on skills training which includes "social, decision-making, communication and refusal skills." (Ashery, Robertson and Kumpfer, 1998, p. 1) Other important points of contact for interventions are reported to include "family, recreational and religious settings, the community and the workplace." (Ashery, Robertson and Kumpfer, 1998, p. 1) Family interventions are reported to "target risk and protective factors specific to the family contexts that may involve the child or have an impact on the child." (Ashery, Robertson and Kumpfer, 1998, p. 1) It is reported that the research has "identified a number of family-level risk and protective factors associated with initiation of drug use. Specifically, studies show that the presence of substance abuse disorders among parents or other family members poses both genetic and social risks for children." (Ashery, Robertson and Kumpfer, 1998, p. 1) Other risk factors are reported to include "parental or sibling use of alcohol, tobacco and other drugs; positive family attitude toward and acceptance of substance use; lack of attachment to parents at any developmental stage; sexual or physical abuse, economic instability; and poor family management." (Ashery, Robertson and Kumpfer, 1998, p. 2) Family protective factors are reported to include "consistent and contingent discipline; a strong parent-child bond; high levels of supervision and monitoring; and parental warmth, affection, and emotional support." (Ashery, Robertson and Kumpfer, 1998, p.2) Levin, Culkin and Perrotto (2001) state that family risk factors for drug abuse and dependence includes the following:

(1) Parental drug abuse, especially paternal alcoholism;

(2) Sibling drug abuse, especially by older siblings;

(3) Family mental health problems, especially maternal depression;

(4) Family antisocial behavior;

(5) Family conflict and discord;

(6) Poor supervision of child behavior;

(7) Alienation and isolation of the family from social support networks. (Levin, Culkin, and Perrotto, 2001, p. 114)

The importance of the individual's family life in either presenting risk factors or in presenting factors that guard against the development of chemical dependency cannot be denied. The emotional support and guidance that parents either provide or fail to provide in combination with "family sanctions against drug use" or failure to have these family sanctions is extremely important in determining the drug use or abuse among children and adolescents. The family life of the individual is representative of powerful affects in the development of the individual. It is reported that the influences of the individual's genetics "also operate within the rich and complex psychological environment defined by the family." (Levin, "Culkin and Perrotto, 2001, p. .114) The family is reported as the "primary developmental framework during childhood." And it is stated that the impact of the family on the individual's life paths cannot be overstated. For the majority of individuals the family is reported as being the "primary agent of socialization, the process by which individuals are taught social behaviors, attitudes, and values." (Levin, Culkin and Perrotto, 2001, p. 115) It is reported that individuals are most likely to choose to use drugs when their peers are involved. Peer cluster theory is such that proposes a "view of peer influence that characterizes peer groups as the social framework in which many deviant behaviors, including substance abuse can emerge." (Levin, Culkin and Perrotto, 2001, p. 116) Alcoholism is reported to be "more prevalent in groups with a cultural tradition of wine making such as in France, and in countries like the United States where alcohol is easily available." (Levin, Culkin, and Perrotto, 2001, p.116) However, in Muslim societies, alcoholism is a rare condition since the religious and legal sanctions are such that discourage the use of alcohol.

II. Drug Addiction

The work of Volkow (nd) reports that thirty years of research by the National Institute on Drug Abuse (NIDA) has demonstrated that "addiction is a complex brain disease characterized by compulsive, at times uncontrollable, drug craving, seeking and use that persist despite potentially devastating consequences." (Volkow, nd, p. 1) Although the individual voluntarily takes the drug the first time by choice and does so to achieve "a pleasurable or desired emotional state -- we now know from a large body of research that this ability to choose can be affected by drugs. And when addiction takes hold in the brain, it disrupts a person's ability to exert control over behavior -- reflecting the compulsive nature of this disease. The human brain is an extraordinarily complex and fine-tuned communications network made up of billions of cells that govern our thoughts, emotions, perceptions, and drives. Our brains reward certain behaviors such as eating or procreating -- registering these as pleasurable activities that we want to repeat. Drug addiction taps into these vital mechanisms geared for our survival. And although not a life necessity, to an addicted person, drugs become life itself, driving the compulsive use of drugs -- even in the face of dire life consequences -- that is the essence of addiction." (Volkow, nd, p. 1) The individual who takes drugs experiences the rewarding effects derived from "large and rapid upsurges in dopamine, a neuro chemical critical to stimulating feelings of pleasure and to motivating behavior." (Volkow, nd, p. 1) It is reported that this rapid rush of dopamine from drugs known to be used for drug abuse is similar to but greatly magnified in its intensity to the feelings experienced by the individual in response to "pleasurable stimuli such as the sight or smell of food, for example." (Volkow, nd, p.1) Volkow reports that when the individual experiences exposure to "repeated, drug-induced dopamine surges" the consequence is the ultimate result of "blunting the dopamine system to everyday stimuli." (nd, p. 1) The outcome is that the individual's "normal hierarchy of needs and desires" is disrupted and new priorities are substitute related to the procurement and use of the drug. (Volkow, nd, paraphrased) Drug abuse is also reported to disrupt the circuits of the brain that are involved in memory and behavioral control over one's emotions and desires. The reward circuitry in the brain of the individual who is an addict becomes "increasingly dulled and desensitized by drugs" and the drugs take priority over anything else in life. It is reported to be both ironic and cruel that "eventually, even the drug loses the ability to reward, but the compromised brain leads addicted people to pursue it anyway; the memory of the drug has become more powerful than the drug itself." (Volkow, nd, p. 1) Drug abuse is "just like any other medical disorder that impairs the function of vital organs" (Volkow, nd, p. 1) Repair and recovery of the brain of the addiction individual is dependent upon treatments that are effective and that address the complexity of the disease." (Volkow, nd, p. 1) Because of the chronic nature of the disease, relapse to abuse of the individual's drug of choice is considered to be "not only possible but likely, with relapse rates similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma." (Volkow, nd, p.1) Treatment involves the change of behaviors that are deeply embedded therefore relapse "should not be considered failure but rather indicate that treatment needs to be reinstated or adjusted, or that alternate treatment is needed." (Volkow, nd, p. 1) However, the individual who is addicted must also do their part and "take responsibility to get treatment and actively participate in it." (Volkow, nd, p. 1) Ethnicity is also reported to play a great role in the individual's development of chemical dependency. While the majority of those who are chemical dependent are non-Hispanic white individuals, there is a large population of Hispanic men and African-American men who are cocaine and crack addicted respectively. Also linked to alcoholism is Serotonin deficiency. It is reported that persistent use of drugs results in the brain employing "compensatory adaptations such as down-regulation and up-regulation to restore equilibrium." (Levin, Culkin and Perrotto, 2001, p. 116) Cultural tolerance is stated to impact the "availability of drugs and drug availability increases the potential for abuse." (Levin, Culkin, and Perrotto, 2001, p. 116) It is reported as well that there is a "greater metabolic tolerance for alcohol in high-risk subjects" and that high risk subjects as well "exhibit abnormal neuropsychological feature in terms of p300 wave and executive function deficits." (Levin, Culkin and Perrotto, 2001, p. 117-118)

III. The Disease Model of Chemical Addiction

The disease model is reported to refer to the idea that alcoholism and other drug addictions 'are biologically-based illness." (Levin, Culkin and Perrotto, 2001, p. 118) Ashery, Robertson and Kumpfer (1998) report that research on chemical dependency should focus on the following:

(1) Families are embedded in a social context. Measures and analyses should consider the impact of the broader context (neighborhood, school, and work) on the family and the effectiveness of prevention programming. To accomplish this, new measures and analysis strategies may need to be developed.

(2) Longitudinal studies of family interventions should use methods such as time series analysis to maximize understanding of family processes, dynamics, and changes over short and long periods of time.

(3) Interrelationships among variables such as parental monitoring, association with deviant peers, and academic achievement should be considered when designing a measurement plan for family-based prevention intervention research projects.

(4) Meta-analyses should be conducted to provide the statistical power necessary to identify various common components and pathways of successful family-based drug abuse prevention programs.

(5) Culturally sensitive measures should be employed in determining risk and protective factors specific to subpopulations with whom family prevention intervention are being used.

(p. 325)

IV. Model of Assessment, Intervention and Treatment

Because chemical dependency is often combined with psychological issues, the client in this scenario would be screened for potential psychological issues or illnesses. The model of assessment, intervention and treatment in this scenario will be the Chemical Dependency Disposition Alternative (CDDA) program which is generally used by juvenile courts as a sentencing alternative for youth who are chemically dependent. Assessment requirements include: (1) a structured clinical interview used for determining "DSM-IV diagnoses of substance dependence, abuse or use; (2) evaluation that is comprehensive in addressing the areas of history of substance use, medical health, developmental issues, school and vocational history, strengths or resiliency factors, conduct disorder behaviors, criminal involvement, psychopathology, such as depression and hostility, familial relationships, history of physical, sexual, or emotional abuse, peer relationships, current living conditions, sexual activity, and leisure activities." (Rutherford, 1998, p. 5) The treatment program should involve the following stated elements: