Treatment Plan for Heroin Abuse

Demographic Information
Jodi is a 22-year-old Hispanic female. She is a single mother but does not live with her daughter who enrolled in the foster care system. She completed her general educational development (GED) tests, but her Certified Nursing Assistant Training Program is still pending. Her past medical history indicates that she gave birth prematurely but has no known allergies.
Assessment of Data
Jodi became pregnant and gave birth to a daughter after a raped ordeal. She patient has a five-year addiction to treatment. She administers the drug five to six times a day through the intravenous route. She enrolled in both the outpatient and inpatient detoxification programs but did not finish. She was treated with Suboxone for one month before she abandoned the pharmacological therapy and has a history of marijuana and alcohol abuse. Moreover, Jodi has depression that has led to a suicide attempt. Despite being diagnosed with post-traumatic stress disorder (PTSD), no treatment or remedies have been administered. She visited the emergency department in the past month for treatment of an abscess; it was unpacked and an antibiotic administered. However, she did not complete the dose and noticed some recent redness and swelling in the area.
Additional Data Needed by Counselor to Plan Treatment
Jodi is noncompliant to her pharmacotherapy treatment. She has failed to finish her detoxification sessions on two occasions. Moreover, she did not complete her antibiotics that were administered after abscess treatment. She has basic education and can understand medication instructions regarding the duration, dose, and frequency. Jodi has recently been arrested for prostitution; she should be advised on using condoms to protect herself from HIV/AIDS and other sexually transmitted diseases. A medical examination revealed that she was underweight and had irregular menses.
Standardized Screening Measures
Before the screening, it is essential to note down all the relevant historical information about a patient whether medical, hospitalizations, social or family. The goal of screening is to identify any drug-related problems. Testing of drug-related issues is mainly done by conducting interviews with the patient or asking them to fill in a questionnaire. The Alcohol Use Disorder Identification Test (AUDIT) can be used to identify any complications resulting from her alcohol use. It contains ten questions that are highly related, and there is a scoring guideline used to determine the severity of a case. The Beck Depression Inventory-II can be used to identify any changes in her mental health. It covers any short terms changes that include depression, anxiety, somatic signs, and social dysfunction of any kind. There is no specific tool for safety screening of suicidal thoughts and para-suicidal attempts and the questions a clinician asks only act as a guide to avoid underestimating the risk of Jodi injuring herself.
PTSD can only be appropriately screened by asking relevant questions regarding the history of a traumatic event in the life of Jodi. Additionally, symptoms that have persisted for longer than 30 days should be noted that have led to her decline in how she relates to people, and avoidance of questions regarding the trauma. The use of heroin can be screened using the use of the NIDA quick screen test and the NIDA modified assist. It asks questions that check for the use of illegal drugs and prescription drugs for nonmedical uses. A resultant score chart is used to identify the risk level of the patient. If the total points are more than 27, a patient can be considered as being at high risk, and the clinician should offer the relevant support for the condition. However, a score between 4 and 26 puts the patient at medium risk, and the doctor should consider referral based on the clinical judgment. Finally, a score of less than four is low risk, and the patient should be advised to abstain from drugs. She should also be subjected to bacterial cultures to determine the specific strain of bacteria that has affected her and whether it has become resistant to antibiotics or not.
Potential Relevance and Biases with Multicultural Populations
The instruments and screening methods used should have been tested and on women of specific culture and others from special populations before being adapted for use. The step helps to ascertain their effectiveness. Jodi needs advice regarding the screening and methods to ensure that she does not find the process to be threatening, scary or intrusive (Straussner, 2012). The screening should be approached in a way that establishes cultural relevance and winning the patient’s confidence so that she can open up. The questions asked should be replaced with an in-depth discussion with the patient to help in understanding the extent of drug abuse from her point of view. Screening staff should be trained efficiently about the ethnic groups that they will be serving. Additionally, they should be prepared for practical communication skills and ways of creating interpersonal relationships (Kaminer, 2013). This step will help in reducing the possibility of clinicians having preconceived ideas about a particular ethnic community about substance abuse.
Reason for Choosing Screening Instruments
The decision of choosing the particular screening methods and instruments is based on the following criteria:
· The tools have passed various quality control tests and have shown reliable results in the diagnosis of different conditions among women of diverse cultural backgrounds and special groups with minimal margins of error.
· These methods are reliable in producing results without making the patients feel victimized or uncomfortable. The questions asked are prepared by professionals to ensure that all the patients can answer without feeling shy.
· The instruments offer reproducibility in results, which makes them reliable.
Differential Diagnosis
· Addiction to the heroin- Jodi depends on heroin on a daily basis taking the drug up to six times daily via the intravenous route.
· Depression. Jodi experiences the feeling of guilt, helplessness, and irritability. She has even attempted to commit suicide once. Additionally, she has presented with weight loss.
· Post Traumatic Stress Disorder- Jodi has PTSD from a rape case that resulted in her being pregnant. She still recalls the events that occurred to her and feels shy to talk about the specific actions of the trauma.
· Staphylococcal bacterial infection- bacteria is the most prevalent cause of an abscess and cultures should be done to determine whether or not it is present.
· Pregnancy- Pregnancy test should be done to exclude it as a cause of irregular menses.
· Stress- it might be a possible cause that leads irregular menses.
· Polycystic ovarian syndrome- should be excluded because of the irregular menses.
· Hyperthyroidism- the levels of thyroid hormones should be measured to exclude the condition because Jodi mentioned having irregular menses and weight loss.
Co-Occurring Medical Or Psychological Conditions
Jodi has been engaging in prostitution in the past few months. Moreover, Jodi is also a subject of substance abuse, which may impair her judgment leading to her engaging in unprotected sex. Therefore, she should be asked to visit the nearest HIV/AIDS testing center to determine whether or not she might have contracted the condition. Additionally, she should be tested for sexually transmitted diseases. In case she tests positive, she should she should be put on antiretroviral therapy (post-exposure prophylaxis) or the necessary antibiotics. Subsequently, the clinician will develop a plan that will guarantee her compliance to the medication given her history of abandoning drugs midway. Another potential issue is the possibility of her committing suicide because of depression.
Identification of Stage and Defenses Used By Client
Jodi is at the acceptance level (Connors, 2013). She knows that she is suffering from depression and addiction to heroin. She has also agreed to attend therapy sessions twice every week to get help for her medical condition. Her acceptance has made her seek medical assistance as a precursor to her reunion with her daughter.
Short-Term Goals
An individual suffering from addiction always feels like it is a near-impossible task. However, having immediate goals can make the process to appear less intimidating. The following are the short-term goals for Jodi to ensure she can smoothly overcome her addiction:
· The first step will involve discarding all the heroin and substance abuse-related items. The items include syringes, the drug products, empty bottles, and needles. The materials always serve as a reminder of the past life and having them will prevent her from attaining her objectives. Therefore, destroying them will prevent her from relapsing in her weak moments when she feels a craving for the drugs.
· Finding a local support group is also an essential step in the process of recovering from substance abuse. This will ensure that she feels supported and will find encouragement from others going through a similar situation to what she is feeling.
· Restoring positive relationships should also be a critical agenda for Jodi. She should strive to reach out to her family especially the parents who she has not been able to see for several years. This might require her to invest a lot of time and commitment but will lead to her smooth recovery.
Long-Term Goals
Jodi should also be in a position to remain sober in the long term. It is essential to set goals, which will help her achieve this step. The following are the long-term goals:
· Jodi should be able to finish all her medication. Pharmacotherapy will help to prevent the withdrawal symptoms and relieve any craving that she might face thus preventing her from backsliding into using heroin again.
· Jodi should also focus on restoring her relationship with her daughter and aim to live her.
· The third goal for Jodi is to ensure that she exercises on a daily basis and to avoid stressful situations that might exacerbate her depression and PTSD.
Treatment Plan
The treatment plan for should contain a pharmacological and a non-pharmacological patient. The pharmacological treatment should include:
· Enrolling Jodi in an outpatient detoxification program
· Administration of suboxone strips which contains naloxone and buprenorphine to help her to reduce the opioid withdrawal symptoms that she might suffer and relieve cravings.
· Administration of an appropriate selective serotonin reuptake inhibitor like sertraline, fluoxetine or citalopram for the management of depression and PTSD.
· Administration of the antibiotic depending on the susceptibility test carried out.
The non-pharmacological treatment is also an important aspect to ensure that patients can recover fully. Jodi should be encouraged to:
· Nutrition modification is essential for both mental and physical health. She should be encouraged to eat small meals that are well balanced while avoiding sugary foods (Longmore et al., 2014). This will keep her energy up and help her prevent mood swings.
· Exercise can be as useful as using the different medication in the treatment of depression, heroin addiction, and PTSD. It heightens the serotonin levels in the brain as well as other feel-good chemical mediators. Moreover, it will trigger the growth of brain cells.
· Social support is also a vital aspect as it helps to reduce isolation. Patients who stay on their own have higher chances of backsliding into substance abuse and feeling depressed (Whiteford et al., 2013). Jodi should be encouraged to reach out to her family members and join a local support group.
· Jodi should also be encouraged to take part in activities that help her reduce her stress levels. Stress might precipitate depression. Such actions include visiting friends and relatives, volunteering for community service, planting trees, and visiting homes for the elderly.
· The clinician should also schedule follow- up meetings to ensure that she is compliant to the drugs provided and that she does not skip her therapy sessions. Jodi should be educated on the importance of adhering to the specified dose, frequency and duration specified for every medication that has been administered (Dart et al., 2015).
Ethical, Family or Cultural Considerations Influencing Counseling
Racial identity is an ethnic issue that should be considered as it affects counseling. Some people cannot speak English and should be incorporated in groups where people they can understand the ethnic language. Additionally, some people might feel comfortable to share information with other familiar individuals. Family history and dynamics is also a crucial factor (Lewis, Dana & Blevins, 2014). The family members of an individual play a significant role in their sense of ambition. This will determine how determined a person will be towards attaining sobriety about drug abuse. A counselor should also be aware of the cultural values and biases. To be successful in engaging patients, counselors should acknowledge that cultural heritage has an interaction with discrimination and stereotyping. Therefore, they should learn to improve their understanding of different cultures to be able to communicate effectively with their clients.
Potential Counselor Bias or Counter Transference Issues
The counselor-client relationship is a crucial aspect of all forms of therapy. It is instrumental in providing Jodi with the basis to sail through the issues related to the drug abuse while maintaining healthy relationships. Countertransference occurs when the counselors impose their reactions and unresolved feelings (Galanter, Kleber & Brady, 2014). It is mostly in situations where the counselor has failed to remain objective, and they may end up feeling overwhelmed or angry just by listening to the story from their subject.
Additionally, counselors who are handling clients with chronic health conditions might suffer from burnout. The capacity of the counselors to remain focused in treatment might be impaired as they as their morale for work is eroded and their work begins to interfere with their private life. Some counselor might find the experiences of the clients to be incomprehensible because of the level of cruelty the stories contain. They may end up experiencing mild trauma, difficulty in maintaining healthy relationships, weird dreams, and anxiety. Thus, they might end up losing morale to work with their patients.
Final Observations
Jodi’s abuse of drugs can be linked to her pregnancy after a rape ordeal. This has predisposed her to addiction to heroin, which she administers to herself intravenously. However, she is committed to reuniting with her daughter and has committed herself as seen from the help she has sought from the doctor. For success, the clinician should carry out a proper diagnosis as the study outlines after which a treatment plan will be formulated. Both the short-term and long-term goals will guarantee Jodi’s recover because she has accepted her situation but is committed to changing it.

References
Connors, G. J., DiClemente, C. C., Velasquez, M. M., & Donovan, D. M. (2013). Substance abuse treatment and the stages of change: Selecting and planning interventions. Guilford Press.
Dart, R. C., Surratt, H. L., Cicero, T. J., Parrino, M. W., Severtson, S. G., Bucher-Bartelson, B., & Green, J. L. (2015). Trends in opioid analgesic abuse and mortality in the United States. New England Journal of Medicine, 372(3), 241-248.
Galanter, M., Kleber, H. D., & Brady, K. (Eds.). (2014). The American Psychiatric Publishing textbook of substance abuse treatment. American Psychiatric Pub.
Kaminer, Y. (2013). Adolescent substance abuse: A comprehensive guide to theory and practice. Springer Science & Business Media.
Longmore, M., Wilkinson, I., Baldwin, A., & Wallin, E. (2014). Oxford handbook of clinical medicine. Oxford University Press.
Lewis, J. A., Dana, R. Q., & Blevins, G. A. (2014). Substance abuse counseling. Cengage Learning.
Straussner, S. L. A. (Ed.). (2012). Ethnocultural factors in substance abuse treatment. Guilford Press.
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., ... & Burstein, R. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1575-1586.