Assessment and case formulation of the client

Reggio is an aboriginal individual who is addicted to heroin and alcohol. This assignment will show the various aspects that must be considered by the professionals to develop a healthcare plan for him so that he can live better quality lives by overcoming addiction and substance abuse.

The patient named Reggio is of the aboriginal origin and is 40 years old. He has lost his job because of his absence at work. He used to be absent because he felt unwell after abusing heroin. He had now realized the negative aspects of heroin use on his employment and income and now he wants to overcome the addiction so that he can get another scope from his employer. He is highly upset from the incidences that took place with him a year ago where a renowned person of the town had assaulted him physically. All these had affected his mental stability and in order to overcome the depression, anxiety as well as stress, he had started using heroin again after 20 years. This had again affected the client negatively by making him sick and remain absent from work. This had made him lost his job.

Therefore, Reggio might suffer from financial instability. Poor income and unemployment often associate with poor quality life (Strang et al., 2015). People belonging to this cohort cannot afford important objects like food, clothing and maintenance of proper shelter that are important for leading healthy and fulfilling lives (Hamacher et al., 2018). Hence, he might suffer from depression and anxiety. Although he had realized that his association to heroin and alcohol are affecting his life, he might also start abusing drugs at higher level. Studies suggest that poor income and unemployment results in frustration as well as stress for which people starts abusing drugs to overcome the feelings of pain and suffering (Csiernik et al., 2017). Moreover, they are also seen to have enough time for themselves which makes them bored and increases their chance of abusing drugs in the free time (Luongo et al., 2017). All these might result in huge psychological as well as social impacts on the client affecting his quality of life. Therefore, it is very important for the therapist to sequentially counsel the patient in ways by which he can get over his urge of abusing heroin and renew his life by getting good opportunities in employment sector.

Studies are of the opinion that most of the problems that had resulted in higher rates of alcohol and substance abuse among the aboriginal people in comparison to that of the non-native individuals in the nation are mainly generational. Problems, which are set in motion several of the generations ago had unknowingly inherited by the descendants. Consequently, the emotional as well as spiritual deprivation, alcohol, poverty, drug abuse and violence as well as despair head become predictable outcomes to the different types of systematic, multigenerational oppression. Therefore, oppression, torment, destruction of culture, land and many others are intricately associated with their increased addiction towards tobacco smoking, alcohol and many other drugs (Carr et al., 2018). All these historical contexts of excessive adduction to substance are an integral part of culture and needs to be kept in mind while handling the patient. Moreover, alcohol use and tobacco use are part of their cultural traditions. Hence, while communicating and involving the client named Reggio, these cultural factors and sensitive issues need to be kept in mind.

Factors relevant to the cultural aspects of clients

Other important cultural factors are very important to maintain when the therapist needs to communicate with the client. The aboriginal people do not prefer eye contacts with people when they communicate. Such gestures are taken to be rude although such aspects are accepted in western culture of communication. Hence, such gesture needs to be avoided. Moreover, their culture supports silence during the times of communication whereas silence during communication is not accepted in western culture (Day & Mitcheson, 2017). Therefore, the therapists should respect the maintenance of silence of the patient and should not interrupt the patient during that time. Moreover, aboriginal people do not feel comfortable with strangers and they never discuss personal stories with strangers. Therefore, therapists should first try to develop rapport with the patient through informal and light discussions. These would help in developing rapport and then the intervention session should be initiated. All these cultural factors need to be maintained by the professional who managed Reggio’s case so that he feels that his cultural his respected and cared by the therapist. This would increase his compliance with the treatment procedure.

The world Health Organization had developed one of the best assessment-screening tools that can be extensively used by healthcare professionals to develop an idea about the degree of addiction of patients towards various substances. This tool is called Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). This is mainly a questionnaire that screens for all the different levels of problems as well as the risky substance use in the adults. This tool is mainly seen to contain eight important questions that cover tobacco, alcohol, cocaine, cannabis, sedatives, amphetamines, hallucinogens, opioids and other types of drugs (Solis, 2018). A risk score then follows this, which is particular for each substance. Following this, the scores are seen to be grouped into any of the three important categories that are known as “low risk”, “moderate risk” and “high risk”.  This score would be helpful in the determination of the level of intervention that would be recommended to the client. In case of the patient namely Reggio, it is seen that he is abusing heroin and is addicted to alcohol use. Therefore, filling up the form by him would be helpful to the therapist and depending upon the score, he would devise the intervention plan for Reggio.

In the initial meetings, it is important for the professionals to develop rapport with the patient through informal discussions. Once, the patient gets comfortable, the therapist should try to encourage the patient to participate in a narrative or personal story telling session. Such sessions are extremely important for the professionals as these sessions make the patient reveal important information, sequential occurrences of different situations, their values, beliefs, their motivation level and many others (Dunn et al., 20150. Narratives and personal stories thereby help professionals to develop chronological orders of the scenarios and enable them to understand the values and beliefs of the patient that needs to be maintained. It also helps in understanding the different contributing factors that had made the patient develop their present ill health and hence planning interventions become easier.

Appropriate screening tool

Once the narratives have been successfully completed, the next intervention should mainly contain inclusion of the patient in health behavior change model like that of the stages-of-change model or the trans-theoretical model. Prochaska and DiClemente and their “stages-of-change” model had been extremely helpful for the clinicians to tailor different types of brief interventions for the needs of the clients. This model usually comprises of five important stages of change that represents the different processes that the people go through when they are thinking about or are beginning and trying their best to maintain a new set of behaviors (Riper et al., 2014). This model can be successfully applied for the substance abuse cases of the client named Reggio. In each of the five stages that people go through while they are trying to change their behaviors, motivational support from professionals (appropriative to their state of change) is important. If the professionals fail to use the strategies that are appropriate to the stage the client is in, treatment resistance as well as non-compliance might result.

To ensure change, clients who would be at the pre-contemplation stage must have their awareness raised. Therefore, in order to resolve their ambivalence, clients in the contemplation stage must be helped in choosing positive changes over their current circumstances. Clients who are in the preparation need help in the proper identification of the potential change strategies and thereby help in choosing the most appropriate ones. Clients who remain in the action stage need help in carrying out and complying with the change strategies. This is followed by the maintenance stage where the behavior of the client has been changed and this continues to be maintained in long run (Everitt et al., 2016). The patient named Reggio us seen that he had already recognized the ill impacts of his drug addiction behavior and its consequences. Therefore, he is found to be in the contemplation stages. Therefore, the professional would counsel him on the cost and benefit of the various changes of the stage and thereby help in to move forward in the preparation stage by helping him with different evidence based strategies that he can adapt to overcome the drug abuse sessions. Constant motivation by the professional through the forthcoming stages for Reggio would enable to him to align with the interventions developed by the professional and overcome addiction to heroin and alcohol.

Cognitive behavioral therapy is one of the most effective and research based treatment modality that had been found to be effective for substance abuse, eating disorders and many others like specific mental health diagnosis. CBT is present-oriented; problem focused as well as goal-directed and provides the following benefits. This model of counseling helps the affected individual in helping people to address their problematic thoughts and feelings for overcoming addiction. Studies have found that when an addicted person can understand why they feel or act in particular way and how their feelings and actions lead to substance use, they would be found to be better equipped for overcoming their addiction (Moore et al., 2016). Cognitive behavioral therapy mainly helps individuals in identifying their negative automatic thoughts. An automatic thought can be based in impulse and often may come from misconceptions and internalized feelings of fear and self-doubt. Individuals try to self-medicate these painful thoughts and feelings by abusing drugs.

Intervention used in initial meetings

In case of Reggio, it is seen that he had been physically assaulted once and since then he had started using drug heroin once again which he had stopped twenty years ago. Researchers are of the opinion that individuals who undergo physical assaults might get traumatized. Trauma among individuals often urges them to escape from the reality in search of a better recluse where they hope to overcome the pain, suffering and anxiety that result from depression, loneliness and hopelessness. Automatic negative thoughts are often considered to be the root cause of depression as well as anxiety disorders which are actually quote common with disorders and addiction. This means automatic thoughts can make someone more likely to abuse drugs and alcohol. Use of drugs provides them with pleasure where they can escape into alternate reality to overcome the feelings of pain (Spada et al., 2015). Reggio also wanted to overcome the memories, pain, and anxiety that resulted from the physical assault and started using drugs. Hence, cognitive behavioral therapy would be extremely useful.

The cognitive behavioral therapy would be extremely helpful for Reggio.  It would help him by helping him to dismiss all types of false beliefs and other insecurities that had made him to develop substance abuse habits. It would also help Reggio by providing him with self-help tools that would make his mood better. It would help him to develop effective communication skills. This therapy would help him to learn three skills that would make him overcome the addiction habit (Tang et al., 2015). The first would be to recognize the important circumstances that would lead to using of drugs as well as drinking. Secondly, he should learn to remove himself from the triggering behaviors whenever possible or appropriate. Third, he would use the techniques of CBT for addressing and alleviating emotions and thoughts that are leading him to heroin and alcohol abuse.

Apart from the counseling and therapy sessions, Reggio can be also referred to a number of other healthcare professionals to ensure development of better quality lives. He needs to visit the primate healthcare professionals to undertake a physical assessment and screening sessions to find out whether his excessive use of heroin had caused any physiological impact or not.  Stomach issues, including constipation, liver and kidney disorders, clogged blood vessels in brain and many others are very common and therefore he needs to carry out physical an assessment. He may also need the help of dieticians who need to develop a proper diet for him so that he can undertake a nutritious diet, develop his ability and become physically strong to carry out his occupation as a ground man. He may also visit community-nursing professionals who can help him with different contacts of services where he can get financial aids and unemployment schemes and aids (Luitzen er al., 2014). He also needs to involve in different entertaining activities and keep himself busy and community nurses can arrange all such activity classes for him.

Relapse prevention is one of the aspects of the cognitive behavioral treatment and mainly focuses on the maintenance stage of the Trans-theoretical model of change. The main goal that would be set in this step is to prevent the occurrence of the initial lapses after the commitment to change has been made. The second goal would be to prevent any lapse that does occur from escalating into a full blow relapse. The professional should set goals that would be easily achievable. When goals become difficult to achieve, it might result in loss of motivation and despair (Davis et al., 2015). Relapses can be prevented when individuals remain highly motivated not to get back in previous behaviors. Therefore, professional of Reggio would ensure easy set up goals. Moreover, he should also ensure that he remains away from any situations that trigger him negative thoughts. Therefore, his counseling plan also needs to teach him to cope with such thoughts successfully. This would prevent relapses.

The patient had been physically assaulted but he does not want to reveal the name of the person who acted as the perpetrator. However, it is also important for the professional to understand the entire experience of the patient to develop an idea about the interventions. However, it might happen, that the patient does not want to reveal all information about it. Hence, it might become a problem for the professional. In order to provide best evidence based care or to maintain beneficence, all information is important. Therefore, there might be a conflict between saving autonomy and dignity of the patient and in maintaining beneficence. However, he should never force Reggio to reveal information and encourage him to speak up as much as he is comfortable (Scott, 2015). This would prevent development of stress in-patient. Moreover, patient wants to maintain confidentiality and this can be understood from the way of his not mentioning of perpetrator. This decision of him should be respected.

Conclusion:

From the above discussed areas, it can be understood that the professional should use the stage-of-change model as the first set of interventions to motivate the patient to change his habits of drug abusing and live better quality of lives. The cognitive behavioral therapy can then be applied to help the individual overcome his negative thoughts that make him undertake drug abusing steps and develop positive thoughts.

References:

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