The intention of evaluations are to develop a depiction of the client’s substance abuse problems, substance abuse history and behavioral patterns; to identify the client’s strengths and weaknesses; to identify the client’s spirituality/religious beliefs/morals; to help determine the client’s social and psychological functioning; to observe the client’s attitude and behavior during assessment; and determine how treatment will address the client’s issues and needs. The evaluation process confronts the client about the consequences of their substance abuse; and both the client and clinician determine what behavioral changes are needed; and what changes the client is willing to make, or wants to make (Miller, 2011). In addition, the clinician also puts together a summary statement (that includes all of the detailed information) of recommendation for appropriate treatment.
Most clinical evaluations require preliminary screening for reason such as: sorting out
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clients who have medical, legal and/or psychological issues that need to be addressed before treatment; to ensure that the client can fully benefit from treatment; and to identify the client’s needs in order to develop an appropriate individualized treatment plan. “An evaluation consists of gathering of all of the detailed information from the screening process and reviewing the information” (Miller, 2011). There are multiple purposes involved in evaluations, including: • To determine the extent and severity of the individual’s drug and alcohol abuse problem: Identifying the type of substance or substances used; how often the substance(s) are used; amount used; history of substance use; age of initiation; and withdrawal potential are all factors that help determine the appropriate type and level of care. In Donovan’s case, he states that he has experimented with marijuana and alcohol in the past but that he didn’t like either of them. He also states that he first used cocaine with a friend in college as a boost to get through is exams. Donovan continues with how much he liked cocaine and that knew immediately after his first use he was hooked. He has been using from the time he was in college to present – presumably a considerable amount of time. And lastly, as cocaine is associated with withdrawal symptoms, medically assisted detoxification is recommended. • To determine the client's motivation for receiving treatment: Salvaging his marriage, improve physical, mental and emotional health, save money, reduce the risk of being involved with law enforcement, develop healthier coping skills to counteract urges and stressors that result in substance use; to improve relationships with friends, family and most importantly his wife; and increase work productivity. • To determine any other co-occurring problems (i.e. depression, multiple drug use, anxiety, and other health complications): Screening and addressing co-existing disorders and emotional stability is crucial to Donovan’s recovery; as well as an ethical requirement to ensure that he receives the most appropriate treatment and support. Symptoms of substance abuse often mimic psychiatric disorders and overlap with each other. It is already known that Donovan has high blood pressure. Symptoms of high blood pressure are similar to physical symptoms of cocaine abuse – anxiety, sweating, nose bleeds, sleep disturbances and severe headaches. Chronic stress weakens the immune system that would make him susceptible to disease. Dealing with chronic stress and using cocaine both contribute to his high blood pressure which warrants a complete physical examination to test for other health complications; as well as administering screening tools that will detect if there are any other problems present such as depression or anxiety. As an example, when Donovan states at the end of the session that he wasn’t convinced that his marriage was worth salvaging, and that he wasn’t sure why he made the appointment to get help for his addiction may indicate that he was ready to leave. His comments and behavior may indicate that he is experiencing cravings, urges or anxiety about using or treatment. Additionally, Donovan is under extreme stress for an extended period of time. His wife is threatening divorce which is often associated with depression for many reasons. Divorce is similar to a funeral in that there are powerful emotions involved for losing a loved one who shared similar dreams, hopes and experiences; and it can also be financially draining. As his wife, she may be entitled to half of everything he has worked for – retirement, pensions, property and other assets. Donovan may be also suffering from emotional duress.
He mentions that he comes from a good family and that his biological parents are still married. The term ‘good family’ and ‘ideal childhood’ symbolizes that they do not support or tolerate drugs or alcohol. He may feel as a failure for possibly going through divorce and not being able to meet his parent’s standards.
Sleeping disturbances (i.e. sleeping too much, or too little) was not indicated during the initial assessment and should be screened for. Sleep deprivation has been linked to substance abuse, irritability; physical complications such as heart attack; obesity, insomnia and depression. Public health hazards such as accidents and work injuries; poor academic and work performance; decreased energy levels; dramatic mood changes; weakened immune system; and cognitive impairment (i.e. memory loss, concentrating, problem solving, attention and reasoning) have also been linked to sleeping disorders.
• Functional analysis of the client’s substance
use: People use drugs or alcohol for various different reasons despite the potential adverse affects. The domain of functional analysis is to investigate what role or function drugs and alcohol play in that person’s life. This type of information can also be gathered via interviews, administering questionnaires and/or requesting Donovan to provide a self monitored journal of his drug and reasons (situation, feelings of pain, unpleasant emotions or thoughts, cravings or social pressures, etc) for their use (Miller, 2011). Generally, a person uses their substance(s) of choice after exposure to ‘trigger’ (stimuli that are stressful) and the consequences from using substances (reaction to stressors that typically reinforces the behavior of using to be continued). Donovan states that he uses cocaine to meet the high demands of his job. There may also be other reasons why he uses that he may not even be aware of such as repressed emotions; peer pressure or to relieve a physical ailment for example. • To evaluate the client’s risk and protective factors that will either assist or deter client’s recovery: Risk and protective factors are interrelated and often play devil’s advocate on an individual as both variables can be environmental, emotional, financial, social, and biological and so on. Protective factors are understood to be positive individual and environmental conditions or behaviors that reduce the negative effects of stressful life events such as the individual’s skills, strengths, resources, family and peer support, coping strategies that help avoid risks or hazards; to promote social and emotional competence; and are also called upon when developing a treatment plan to encourage treatment compliance. Risk factors are considered to be any negative exposures or components that increase the risk of harming a person’s mental and/or physical health such as substance abuse, unprotected sex with multiple partners or driving too fast or under the influence as an example. Identifying risk factors is a process that takes time; but it’s crucial to identify them because they also help shape the client’s treatment plan. Protective Factors: • Peer Groups: Married couples are generally invested in each other. The fact that she is only threatening divorce if he doesn’t stop using drugs implies that she does not necessarily want a divorce; and is giving him a second chance to clean up his act before she has to resort to divorcing him. As an intimate partner, Donovan’s wife can be considered to be an exclusive peer group. He identifies with his marriage, their dreams, their goals, interests, family, preferences, experiences that they’ve shared and the like. For this reason, she should be considered to be a protective factor. Involving her in his treatment would benefit Donovan in that she could provide support at home; and help monitor his behaviors, emotions, aid in relapse prevention, etc. Interviewing her would provide valuable information that Donovan may not want to reveal. Friends and family are important weapons against the damaging effects of stress, treatment outcome and other health related complications. Social support is a well documented phenomenon in health psychology that has been shown to be most beneficial to treatment and recovery. How social support systems protect health is still unclear; but it is assumed that positive feelings associated with socializing allows the individual to perceive stress as manageable because it allows the person to confide and seek alternatives to dealing with their problems (Pomerantz, 2012). • Characteristic traits Donovan has demonstrated are intelligence, competence and hard working. He graduated college and is managing a corporation even while high on cocaine. (Listening to his wife to get help or get out was also a wise decision). College students and managers are two occupations that require hard work and dedication. These strengths can be applied throughout treatment which will increase his chances of success. • Not being involved in the judicial system has its pros and cons. The pros are that Donovan does not have the stress of reporting to probation, financially responsible for penalties, child support or history of violent behavior. Risk Factors: • Donovan’s weaknesses include his colleagues and coworkers who are a deviant peer group that dangerously threatens his successful recovery because he identifies with them and relies on them for his social support. that his peers understand him and can relate as they share similar success and achievements. This statement also places them before his wife. • Physical dependency involves intense cravings and urges to use are more. • Potential co-occurring disorders that may interfere with his treatment outcome. Screening test will be administered to screen for depression and anxiety as he is under extreme stress ranging from the threat of divorce, financial issues, health complications and high demands from work. • The negative of not being involved in the judicial system is that Donovan will not have as much structure. For example, if he was court ordered or on probation he would be randomly drug tested that would monitor his drug use. • To determine the type of intervention suitable to address his issues while simultaneously engaging him to participate in developing their treatment plan, goals and objectives:
Jovan is a 23year-old African-American male, who has voluntarily admitted himself for inpatient treatment at a local non-profit agency due to abuse of alcohol and other drugs. Jovan has been unemployed for the past 9 months; his employment position with Dollar General was terminated due to charges of embezzlement. He admits that he took money from the register but planned to replace it when he got paid. So, Jovan is currently unemployed, homeless, and has charges pending due to embezzlement and for writing a number of "bounced" checks written over the past year.
Predictors of Treatment Outcome in a Drug Court Program. American Journal Of Drug & Alcohol Abuse, 31(4), 641-656.
...determination, action, and maintenance. Harm Reduction therapy implements strategies of therapy dependent upon the stage of change the client may be experiencing at the time. The therapist should always take a position of non-judgment as this will encourages the individual to proceed through the different stages of change at a pace that is comfortable and suitable for the client personally. Pre-contemplation has been described as the stage where an individual is still in the process of actively abusing recreational chemicals. The mission of the therapist during this stage is to help to educate the client of the different risks involved with their particular type of substance abuse issue. During contemplation, the client begins to show ambivalence towards their continued drug use, this is the therapists cue to initiate and buildup the client’s motivation for change.
The Addition Severity Index is a well-known and widely used tool for use in treating alcoholics and other addicts. It is an approximately 45 to 60 minute long interview comprised of questions about the patient’s life. The interview covers eight subscales focusing on many different parts of a person’s life which helps to provide a comprehensive understanding of their life. The severity is scored on a ten point scale ranging from no problem or treatment indicated to extreme problem, treatment absolutely necessary. The scale helps the interviewer determine the seriousness of a client’s problem and to plan an effective course of treatment. The ASI can also be found in a self-administered paper-and-pencil form and an interactive CD-ROM multimedia version for the computer (Maleka, 2004). This test has been found to be reliable by most but some others do not agree. It is difficult to say whether or not the test is a reliable and valid measure of treatment due to the complexity of the questions. Once a client’s psychosocial needs are identified it is easier to find treatment suitable for that client. There are some problems with the test such as it is not properly designed to cover such a wide population (Maleka, 2004). Other problems include irrelevant questions for alcoholics and other drug users, difficulty remembering relevant information, and lying and exaggerating information for the best interest of the patient (Maleka, 2004). Use of the ASI can be found to be particularly problematic when used with the homeless or double-diagnosis patients. The ASI can be used in a wide range of treatment settings including clinical, research, and administrative. This comprehensive evaluation is a useful tool that helps professionals understand the
The article "Causes and consequences of sleep deprivation in hospitalized patients" written by Stephanie Pilkington is exploring the causes and consequences of sleep deprivation in hospitalized patients. The author provides a brilliant summary of factors that affect the level of sleep experienced by patients in hospitals and the effects of sleep deprivation on the health and the wellbeing of these individuals. The article goes on to state that for sleep-deprived patients, there were bio-cognitive consequences for their health and recovery, with particular effects on immune functioning, inflammation, parasympathetic equilibrium, carbohydrate metabolism and cognitive performance.
A biopsychosocial spiritual assessment is a commonly used assessment tool used to discover underlying problems or issues that an individual may have. This assessment tool can be used in many different areas of practice. They can also be used on individuals who have mental illnesses as well. The biopsychosocial spiritual assessment works well with individuals who have anxiety and depression. In the case of Marcel, the client I am working with. He has stated that he has some issues with depression and this may be factor that is causing him to drink and to use illicit drugs in the manner that he uses them. The article “Perceptions of Biopsychosocial Services Needs among Older Adults with Severe Mental Illness: Met and Unmet Needs” has some information
Chronic sleep loss is becoming more common in modern culture and less restricted to sleep-deprived diseases such as insomnia. Suggested to be the result of a number car, industrial, medical, and other occupational accidents, sleep deprivation is beginning to be recognized as a public concern. As a result, the Centers for Disease Control
Therefore, when I work with substance abusers I will show empathy, encourage and validate their successes and their feelings about any failures. In addiction, I will help the person learn from their failures and normalize the situation. Furthermore, I would attempt to ensure that the person had several coping strategies in place, to help when he or she finds themselves in a difficult situation. Moreover, I intend to ensure the client has all the tools he or she needs to succeed while getting to the root of their problem through counseling.
It was the late 19th century when a lot of conflict for families from the Industrial Revolution and illegal drugs had easy access to anyone in the United Sates. These illegal drugs like morphine, cocaine, and alcohol were available through manufacture, delivery, and selling. It was proved that the over use of alcohol and violence in families’ homes were linked together around the 1850’s and that women and children were being abused by the father and husband from the letters and journals that were wrote. These were times when women were stay at home mothers and it was the man’s responsibility to be the provider for the wife and children. Because of the abuse in the household it led up to the temperance movement. The purpose
Health is a complex concept, and when we talk about health we refer to body health and to the health of the mind, the health of relationships between us and those around us, the spiritual health. Looking online on one of the additional resources recommended, www.nimh.nih.gov, I have noticed that one of the symptoms of most diseases that affect a person's mental health is lack of sleep. Lack of sleep not only worsens man's mental health, but also causes serious imbalances in metabolism, immunity, general mood, and last but not least, affects the ability of learning and memorizing among students. The sleep fulfills a number of vital functions for both our mind and body. We spend about a third of our lives sleeping, which is a valuable and useful
Client education is also a process by which clients are educated as to the course that alters health risks and behaviors associated with alcohol and other drug use and abuse primarily by abstinence but in some cases with medication to improve client health status. “Client education provides culturally relevant formal and informal education programs that raise awareness and support substance abuse prevention and the recovery process” TAP 21, competency 99 (www.samhsa.gov). Clients and family members are often unaware of the initial root cause (s) of the health impairment that led to or became the issue (s) (beyond presenting situation) of the impairment. Educating the client in a variety of forms is an essential part of the healing process and will aid in the overall wellness of the client. Some forms of client education are addressed in a class or group setting but can be significantly addressed in a one on one setting with a counselor however; the advantage of peer on peer feedback, or interaction is lost.
Nobody denies that every client and situation is unique, but there is a general layout out of a treatment plan that can be used thought out the facility to ensure success for the client. The first step in the treatment plan is to screen clients to determine if he/she meets the criteria of the facilities drug, or alcohol program. The facility will use the standard CAGE, of the Substance Abuse Subtitle Screening Inventory questioner as a screening tool. These two screening tools are consist of few questions and require only short answers to determine (American Society of Addiction Medicine, 2012). These tools are easy to use and can be done by any qualified staff according to the ASAM. If more through information is needed then the client will go under an assessment.
According to Wilson (2005), sleep deprivation can cause not only traffic accidents, but also medical conditions such as: obesity, type 2 diabetes, metabo...
College students are no exception to the rule and are often at a greater risk of suffering from conditions that accompany sleep deprivation. Regardless of the time period, a college student must be well rested in order to perform at his or her best in terms of physical performance, memorization capabilities, and test-taking abilities. Also, without adequate sleep, the person will be more susceptible to illnesses, both mental and physical. In conclusion, I believe that sleep deprivation among college students is extremely common and has a direct effect on how well that student performs or feels.
Wells, M., & Vaughn, B. V. (2012). Poor Sleep Challenging the Health of a Nation. Neurodiagnostic Journal,52(3), 233-249.