The current conceptualization, recovery, and relapse prevention plan focuses on counseling Allan for alcohol abuse. It incorporates operant conditioning theory to conceptualize the substance abuse problem, intervention plan, and strategies. Alan's alcoholism problem is most likely being influenced by his current difficulties that include disability as a result of leg amputation, delayed benefits, and frustration caused by both emotional and psychological pain. The inability to continue working for the army is also a contributing factor to his alcoholism problem. A recovery and relapse prevention plan comprise of positive support strategies and the use of education and other resources to prevent a relapse. Alan's recovery and interventions results will show improvement in cognitive ability, conduct, general wellbeing as well as social responsibility.
Intake Summary
Alan is an African American Army Veteran aged 25 years. During the last year, he has been on one year of service in Iraq as part of an infantry company to provide security to Iraq citizens. Alan has undergone a leg amputation as a result of an explosion that left him severely wounded. Although he is proud of his service, it is difficult for him to express his feelings to other people. He is experiencing pain and has PSTD symptoms, such as nightmares and anger. He is currently using medication for pain and antidepressants. He is also abusing alcohol as he states that he is drinking as much as is needed. He feels that his wife does not understand the psychological and physical pain that he is experiencing. He is also worried that because he does not know how he is going to provide for his family because his benefits have been delayed. An analysis of his drinking problem indicates that he is addicted to alcohol, and there is a need to stop the addiction.
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Interrelationships/Conceptualization
Conceptualization refers to understanding the relationship between the inner life of an individual and the person's outer life. It further explains the current difficulties that an individual is experiencing and guides therapy. Alan is experienced difficulties related to the trauma he suffers as a result of the event that led to his disability. He is suffering from both emotional and physical pain and is unsure of how he is going to take care of his family. All these factors contribute to his alcohol use disorder/alcoholism. Alcoholism is characterized by a compulsion to look for and take alcohol and loss of an individual's control to limit its intake (Ghodse, 2011).
Alan states that he takes as much alcohol as is needed indicating that he has no control over the limit. Besides, a person who has the disorder develops a negative emotional state in situations where access to alcohol is denied (Ghodse, 2011). Alcoholism affects several motivational ways and can, therefore, be conceptualized as a condition that progresses from positive reinforcement to negative reinforcement. The negative reinforcement related to alcoholism can be developed from several neuroadaptations. In the case of Alan, the disorder is a result of negative reinforcement. Negative reinforcement in alcoholism refers to taking alcohol to get rid of a specific negative emotional condition (Langwith, 2010). The emotional effects of the traumatic event that Alan went through are the most probable causes of his drinking problem.
Alcohol use disorder, just like drug addiction, is a disorder that is related to reward deficit. The development of an adverse emotional condition has a crucial role in the perpetuation of the disorder. The neuroadaptations are beyond acute withdrawal. They cause a relapse and deficit in cognitive abilities that can lead to compulsive alcohol consumption. The key deficit that can make an individual vulnerable to a relapse and a deficit in cognitive ability is reduced reward function.
Operant conditioning theory can be used to explain Alan's alcoholism problem. The theory puts into consideration the environment in which an organism lives and proposes that behavior is influenced by the consequences (Blackman, 2017). A subject learns the relationship between a stimulus, the reaction, and the outcomes. The response is implemented with more or less frequency, depending on the consequence. This is referred to as reinforcement. Secondary reinforcement enhances the frequency of a certain behavior through increasing or incorporating a pleasant encounter (positive reinforcement) or getting rid of an experience that is not pleasant, which is also known as negative reinforcement (Lagwith, 2017). According to this theory, Alan's alcoholic behavior is influenced by the outcomes of consuming alcohol. It is as a result of the relationship between alcohol, response, and the results thereof. For Alan, alcohol produces a pleasant outcome (temporal happiness), which makes him repeat the action of drinking more frequently to the extent that it becomes an addiction.
A common negative reinforcement framework used in drug addiction is the self-medication theory. According to the model, a person uses drugs intended to treat some psychological problems that they are experiencing. In the case study, Alan is most probably abusing alcohol to manage the psychological issues he is experiencing related to trauma and pain. The "high" feeling after consuming alcohol gives him a temporal feeling of happiness and tends to make him temporarily forget his current problems. This is repeated over and over again to make him experience the "good feeling."
Recovery and Relapse Prevention Plan
The recovery and relapse prevention plan will comprise of six essential elements which are:
The rationale for developing a plan
The rationale will include the response of the therapist to how Alan will react towards planning a recovery intervention. Individuals who misuse substances and alcohol in most cases do not have the structure in certain parts of their lives because most of their time is spent in alcohol (Marsh et al., 2013). As a result, Alan will be offered assistance in setting realistic goals, a workable plan and maintain motivation.
The problem that needs to be addressed
Once Alan agrees to collaborate on developing a plan, the problems that need to be addressed regarding alcoholism will be specified. The problems to be addressed are evidenced by signs and symptoms (Marsh et al., 2013). Alan's problems include the inability to stay sober because of constant drinking, depression, and PTSD symptoms. Withdrawal symptoms also are a problem that will be included in the list.
Clarifying of goals
The identification of what Alan will have to do to resume normal functioning will be done after a list of problems is generated. Alan needs to stop his drinking problem and must, therefore, learn the skills needed to live a sober life. The goal's for Alan's recovery and treatment plan are:
Develop a recovery program that corresponds with a sober life.
Learn to cope with trauma and stress adaptively.
Learn how to handle unpleasant feelings without using alcohol.
Learn how to express his negative feelings to his wife
Quit alcohol consumption.
Desired outcomes
The therapist, together with Alan, will identify and define the expected outcomes of the plan. The desired outcomes for Alan are the ability to live a sober life, quitting alcohol, ability to manage stress and trauma without using alcohol.
Setting strategies to work on the objectives/goals. These include interventions to help Alan complete the identified objectives and realize the goals set. The interventions ought to be objective and also measurable (Marsh et al., 2013). Interventions for Alan will be chosen based on what he needs. A close family member will also be part of the recovery team. In addition. The interventions will include strategies to prevent a relapse after recovery. The intervention strategies for Alan include cognitive behavioral therapy techniques such as:
Have the patient come up with a list of the negative outcomes of alcoholism
In a conjunct period, have Alan share the relationship between drinking and his current challenges.
Encourage Alan to share his anxious feelings
Graded exposure assignment
Help him create a recovery plan that incorporates all the activities that he intends to attend.
Timeframe to achieve the objectives
A period to achieve the identified objectives will be set. The recovery and relapse prevention plan will last for 12 months.
Ethical or Legal Considerations
Ethical issues surrounding Alan's treatment of substance addiction revolve around confidentiality, autonomy, and professional boundaries in making decisions regarding interventions. Ethical dilemmas may arise in cases where certain information regarding the client has to be shared. In addition, the patient has a right to make decisions on how to live his life, and this may come into conflict with some interventions (Isaac, 2016).
Referral Sources
The patient will be referred to a social support group that he can easily access to help in his recovery process through interaction with others. Alan will be referred to AA meetings where he will receive further support in overcoming his alcoholism problem.
Follow-up plan and other support
Alan will need support from his family, especially the wife, who he currently feels that she does not understand his pain and agony. Support from other close family members and friends will be required to ensure that he recovers from the addiction. Follow-up will be conducted for 12 months after recovery to ensure that he does not fall into a relapse and address any signs of a relapse.
References
Blackman, D. (2017). Operant conditioning. Operant Conditioning , 38–53. doi: 10.4324/9781315083735-4
Ghodse, H. (2011). Substance abuse disorders . Chichester, West Sussex, UK: Wiley-Blackwell.
Isaac, R. (2016). The Ethical Private Practitioner. Ethical Issues in Counselling and Psychotherapy Practice , 19–36. doi: 10.1007/978-981-10-1808-4_2
Langwith, J. (2010). Alcoholism . Detroit: Gale/Cengage Learning.
Marsh, A., Dale, A., & OToole, S. (2013). Addiction counseling: content and process . East Hawthorn, Vic.: IP Communications.
