Treatment Plan for a Crack Addict

Overview of Tanya’s Case
Tanya was physically and sexually abused as a child. This caused her to experience depression and anxiety. As a way of coping with her situation and the symptoms she felt, she turned to drugs and alcohol. However, this only exacerbated the situation, as she began chasing ever-fleeting and harder-to-obtain highs. She ran away from home as a teenager and ended up on the streets selling her body for money or drugs and finally selling drugs herself. Years went by like a blur, as her addiction to cocaine, crack, heroin and alcohol took its toll on her body. She had no support system, continued to be abused by those in her environment and was finally arrested for possession.
Tanya went through withdrawal in prison, which made her feel worse than anything before. It was “like hell” for her (The Louis de la Parte Florida Mental Health Institute, 2002, p. 24). Tanya needed an intervention to help her right her mind and help her to obtain some control over her body once more. She also desperately needed a support system—something she had never obtained or possessed before in her life. This support system would enable her to fulfill her most basic needs, according to Maslow’s (1943) hierarchy of needs theory.
Assessment and Diagnosis
The Addiction Severity Index (ASI) is a useful tool in assessing Tanya as it allows for assessment to take place through a structured interview process that allows the care provider to obtain information on seven distinct areas: (1) medical conditions, (2) employment/support, (3) use of alcohol and drugs, (4) legal issues, (5) family history, (6) family/social relationships, and (7) psychiatric disorders (Samet, Waxman, Hatzenbuehler, & Hasin, 2007).
There are 12 steps to any assessment process (Saks & Ries, 2005):
· Assessment Step 1: Engage the Client—the rationale being to obtain information directly from the source.
· Assessment Step 2: Identify and Contact Collaterals (Family, Friends, Other Providers) To Gather Additional Information—so as to obtain information from secondary sources.
· Assessment Step 3: Screen for and Detect Co-Occurring Disorders—so as to understand the full scope of the patient’s problems.
· Assessment Step 4: Determine Quadrant and Locus of Responsibility—so as to understand the best approach to treatment.
· Assessment Step 5: Determine Level of Care—so as to design adequate and effective intervention.
· Assessment Step 6: Determine Diagnosis—so as to be able to treat effectively.
· Assessment Step 7: Determine Disability and Functional Impairment—so as to understand obstacles beyond the patient’s current level of control.
· Assessment Step 8: Identify Strengths and Supports—so as to ensure that intervention will be efficacious.
· Assessment Step 9: Identify Cultural and Linguistic Needs and Supports—so as to ensure that treatment is holistic.
· Assessment Step 10: Identify Problem Domains—so as to understand potential threats to successful intervention.
· Assessment Step 11: Determine Stage of Change—so as to plan treatment appropriately.
· Assessment Step 12: Plan Treatment—so as to implement the intervention strategically.
Pharmacodynamics and Pharmacokinetics
According to Gorelick and Baumann (2016), “Chronic cocaine or amphetamine abuse is associated with cognitive impairment that may persist for at least several months of abstinence. Most affected are visuomotor performance, attention, inhibitory control, and verbal memory. Several studies have found abnormalities of behavioral regulation and risk–reward decision making. This type of impairment is associated with lesions of the frontal cortex, a brain area that shows decreased regional blood flow and metabolic activity in abstinent cocaine abusers” (p. 230). Tanya’s addiction to crack has impaired her mental and physical condition. Her use of alcohol and heroin to help her to sleep after her physical highs indicates her reliance on chemicals to function normally. The charts below explain the pharmacodynamics and pharmacokinetics of her drug and alcohol abuse:
Source: Martin & Patel (2016).
Diagnosis
According to DSM-5, Tanya may be diagnosed with polysubstance abuse, as “among opioid addicts, cocaine and alcohol are the most frequently abused substances,” which is exactly Tanya’s case (“Signs and Symptoms of Polysubstance Abuse,” 2015). The criteria for this diagnosis include strong desire to use, continued use, long history of use, inability to quit usage, taking large quantities of the substance, becoming impaired by the substance. The tools to assess the substances used include urine testing and various assessment techniques.
Tanya suffers from substance dependence: she experiences harrowing physical symptoms as a result of withdrawal, cannot think straight, cannot cope physically, and needs more and more of the substances to get the desired effect. She is not just an abuser of the substance, as her abuse of the drugs and alcohol has continued for quite some time in her life.
Mental Health Issues
In Tanya’s case, her mental health has been devastated by her physical and sexual abuse, which has undoubtedly caused her to experience childhood trauma (Ekinci, Kandemir, 2015). Seeking to escape this trauma and its associated depression, she has turned to drugs and alcohol. This, however, has resulted in a negative feedback loop that only exacerbates the original problem. Instead of effectively applying a safe and effective intervention to address her abuse as a child, she has attempted to self-medicate, which has resulted in a life-long addiction to drugs and alcohol and her current incarceration. She has no support system and has never obtained the proper mental health treatment needed to help her cope with the physical and sexual abuse she has endured.
Factors Impacting the Case
The genetic factors involved in this case are unknown and cannot be known without an assessment of Tanya’s family history to see if there is any heredity associated with her depression. Biologically, further assessment must also be conducted to see how her drug use has impacted her brain’s development. Environmental factors are evident: she comes from an abusive home, has lived on the streets, has been abused on the streets, and is now incarcerated. She has no social support system, has lasting psychological need for substance use, and has no evident positive philosophical elements in her life, as she has constantly sought help only from drugs and alcohol and has been unable to appropriately address her depression and trauma.
Treatment Recommendations
Tanya should be enrolled in group therapy so that she can be provided with a support system, since she has no family or friends upon whom she can rely. She will also benefit from a pharmacological treatment, with naltrexone or methadone as possible interventions to help deal with her withdrawal. Cognitive behavioral therapy (CBT) should be prescribed to address her behavioral patterns and the negative impulses that steer her towards substance use. Recognizing these impulses and implementing a plan of behavior to overcome them would benefit Tanya immensely. Tanya’s most basic needs according to Maslow’s hierarchy of needs have never been met, so these must also be met initially before implementing any further intervention.
Main Techniques
The main techniques of the treatment options for a case like Tanya’s are to stabilize the patient through a detox program, help provide support for the cravings via pharmacological intervention, and ensure that a strong support system is in place. Group therapy can help introduce Tanya to a support network and CBT can assist Tanya in recognizing the patterns of thought and action in her own life that have caused her to suffer. Trauma-focused therapy is one technique that can be used for patients who are substance-dependent as a result of childhood trauma (Giordano, Prosek, Stamman, et al., 2016).
Risk Factors
Tanya’s risk factors include lacking an adequate support system, overcoming her years of mental and physical abuse, and helping her body to rebalance after years of drug and alcohol dependence.
Preventing Relapse
Relapse prevention should be structured by having Tanya’s treatment occur in a highly-controlled environment, with post-intervention follow-ups conducted in the environment into which she is released, post-incarceration. She will need support from her halfway house and work that will provide her with stability and a positive environment from which she can obtain the strength and vision to persevere.
Ethical Issues
As Tanya is currently incarcerated, the legal issues surrounding her case are assessed by the prison and her care workers must abide by the parameters enforced in the prison.







References
Ekinci, S., Kandemir, H. (2015). Childhood trauma in the lives of substance dependent
patients: The relationship between depression, anxiety and self-esteem. Nord Journal Psychiatry, 69(4): 249-253.
Giordano, A., Prosek, E., Stamman, J. et al. (2016). Addressing Trauma in Substance
Abuse Treatment. Journal of Alcohol and Drug Addiction, 60(2): 55-71.
Gorelick, D. & Baumann, M. (2016). The pharmacology of cocaine. Retrieved from
https://basicmedicalkey.com/the-pharmacology-of-cocaine-amphetamines-and-other-stimulants/#head8
The Louis de la Parte Florida Mental Health Institute (2002). Co-occurring disorders
treatment workbook. Retrieved from: http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=1593&context=mhlp_facpub 
Martin, P. & Patel, S. (2016). Pharmacology of drugs of abuse. Retrieved from
https://basicmedicalkey.com/pharmacology-of-drugs-of-abuse/
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370.
Sacks, S., & Ries, R. K. (2005). Substance Abuse Treatment for Persons With Co-
Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42. Substance Abuse and Mental Health Services Administration.
Samet, S., Waxman, R., Hatzenbuehler, M., & Hasin, D. S. (2007). Assessing addiction:
Concepts and instruments. Addiction Science & Clinical Practice, 4(1), 19.
Signs and Symptoms of Polysubstance Abuse. (2015). Buppractice. Retrieved from
https://www.buppractice.com/node/12376