Case Study Formulation Drug and Alcohol

3. specific strategies Although it was previously thought that cannabis was not a drug of addiction, it is now recognized that cannabis use can lead to substance dependence, according to the internationally accepted DSM-IV definition of ‘substance dependence’ .

. With this knowledge in mind, Rick could possibly display withdrawal symptoms such as • Irritability • Frustration • Anxiety • Compulsion to smoke Cannabis 1 presenting problem Rick: Rick appears to have substance use disorder traits; his drug of choice is Cannabis. Rick appears to be in the stage of contemplation:Although Rick’s motivation is high and he indicates legitimately wants to cease his cannabis use, he is unsure that he will actually be able to stop. Rick appears to have a low self esteem and a lack of confidence in successfully remaining abstinence from cannabis. Prochaska & Prochaska (1999) argue that contemplators are very ambivalent about changing; they also evaluate the pros as about equal to the cons. This appears to ring true in Rick’s case.

Rick could also be hesitant about changing and appears to be unsure if altering his drug use will actually help his life situation at present.Rick fears he cannot cope without drugs. 2. stage of change How to help contemplators? Craving evidence.

Applying the process that is appropriate to ricks stage of change is important. Motivational interviewing techniques such as supporting his self- efficacy might be very useful as a specific intervention strategy. Helping Rick to believe that he has the potential to change may become a self fulfilling prophecy. (Miller & Rollnick,(2002) Behavior change tends to occur when the pros and cons (benefits and costs) of doing a particular thing are weighed up and the costs are seen to be too high.

But if the benefits outweigh the costs, the behavior continues. Sometimes a decision or resolution to change behavior is difficult to make and keep because of ambivalence. Rick will be better supported in making his decision regarding change if he is supported in weighing up the costs versus the benefits of his drug use. and sub-consciously made a decision to continue smoking. As previously stated Rick does want to stop his cannabis use, he just might not know how to.

When people struggle to grasp how to change, they may not recover from their extreme behavior problems. Prochaska& Prochaska, 1999) Intervention strategies may include: • Further assessment i • Refer to psychologist for further counseling and diagnosis. • Refer to a general practitioner Referring Rick to a medical professional may be appropriate for diagnosis and treatment for anxiety, depression and or significant mental health concern. • Marijuana’s Anonymous Self help group such as Marijuana’s anonymous may help Rick to identify with other Cannabis users. • Referral to drug and alcohol rehabilitation residential facility. Referral to alcohol and drug services re: harm minimisation programs.

• To elevate Rick’s concern with his partner relationship counseling may be in order. • According to Orford (2000) the excessive appetite model of addiction describes marijuana as the most used psychoactive drug in the world, and withdrawal symptoms are reported to be prevailing among cannabis smokers. With this in mind, this young man’s care plan may be more suited to one of an extensive nature. As opposed, to brief intervention.

Jim orford’s paper based on the excessive appetite model of addiction, describes cannabis as the most used psychoactive drug in the world and that withdrawal symptoms are prevalent among cannabis smokers. Case: Lesley This client is in pre- contemplation. Lesley does not see that her drinking may be affecting her health. For several months now Lesley consumes an average of 8 standard drinks per day. The NHMRC Australian Alcohol Guidelines recommend that to minimize harm: Females consume no more than two standard drinks per day, with at least 2 alcohol free days a week.

Considering this information Lesley’s alcohol consumption may well be considered harmful. The client’s appears to have no intention of giving up drinking or even to cut down. Leslie does not want to change her drinking habits. Specific Intervention Strategies: • Motivational Interviewing and Cognitive behavior therapy • Rolling with resistance • Develop discrepancy • Empathy • Identify and cope with high risk situation • Screening tools • Develop discrepency Miller (1983) describes self efficacy as a fundamental of Motivational interviewing.When considering this point of view Lesley should be to be responsible for deciding and implementing change, not the counselor. Building rapport with Lesley is significantly important, empathizing with the Lesley’s situation in regards to the potential difficulty in raising three children in a share accommodation.

Relapse prevention education; Helping the client to identify stressful situations, the desire to drink may be strong. Exploring with the client to determine if any significant issue has caused the escalation of alcohol use may be a strategy to implement.Lesley may be opposed to to certain interventions from a therapist, (Miller & Rollnick,(2002) argue that the best response to resistance is non-resistance. Acknowledging Leslies concerns and complaints may enhance the therapeutic alliance which is of prime importance in relating with a client. ++> Lesley is unaware that her behavior is a problem.

(Prochaska & Prochaska, 1999) state that people who are unaware that their behavios present as problems, and usually present for professional assistance intitually as they are pressured by family or signifant others. Clearly Lesley meets this criteria………………………..Case: Lesley | | |Lesley: We were just an average family living on a property near Cooktown when I was growing up. | |Probe:       Tell me more about your family | | | |Lesley: I did see a psychiatrist once when I was about twenty.

| |Illness | |Probe: |Tell me, what are your recollections about that? |Personality | |Lesley: You ask me about myself. I don't like talking about myself, it feels a bit embarrassing. | |Probe: It feels evasive to have your private matter talked about to a stranger | | | | | |Its hard talking to people you do not know about p private matters, Its intruding? | | Case: Sue Sue is a 19 year old amphetamine user. She comes to you reporting many symptoms, such as irritability, anxiety and sleeplessness.She says she is tired of feeling like this and knows that they are related to her use but every time she tries to stop using, she starts again within a week. She last used two days ago and says she is feeling fine, but wants help to prevent using again.

·       What areas are particularly important to assess with Sue? ·       What stage of change is she in? Why do you think she is in this stage? ·       Given her stage of change and other factors. what specific intervention strategies would you use with Sue? Why? Explain these in detail. Your answers will be rated on the following scales:                         Safe level of knowledge |Advanced level | |  |  |  |  |  | |1 | |  |  |  |  | 1 |2 |3 |4 |5 |6 |7 |8 |9 |10 | | Sue is in preparation stage; Jarvis, Tebbutt, Mattick and Shand (2005) verifies that a person who is in the preparation stage have already processed that the negative consequences of drug/alcohol taking outweigh the benefitsThey now need goal setting (Jarvis, Tebbutt, Mattick and Shand, 2005) (Prochaska& Prochaska, 1999) state that people who are looking to take action witin the near future (ie. One month) At this stage, clients have usually come to terms with the There is insufficient information to clearly assert which phase of change that Sue is. It can be argued that she borders between two stages.

Which are …… Only through further assessment and interviewing will this information be adequately probed. • Refer to treatment centre for young persons with substance misuse problems.