Alice is a 26 year old woman who was in the recent past discharged from the military because of some medical reasons. She is a mother to two girls aged two and four years. She divorced her husband of four years two years ago citing infidelity and abuse. Her mother takes care of her two children while Alice is away on duty. She previously worked as a janitor in one of the local schools but quit in order to help raise her grandchildren. Alice sees them once in a while. Her parents divorced when she was 15 years old hence has been single-handedly raised by her mother. While in the army for a period of six years, Alice suffered from very high levels of stress and anxiety. The divorce and work related issues caused her stress. Alice reports that she drinks more as is needed
Alice is waiting to receive her final benefits which she believes are taking long. She fears that she might not be able to provide for her children and mother. She is the sole bread winner in the family. Alice was recently diagnosed with cervical cancer which is at an advanced stage; she is currently under chemotherapy and is scheduled for radiotherapy sessions. She is also under antidepressants. She reports that she is that she may not be able to provide for her family in the future because of losing her job in the army. She only has a high school diploma and is worried that even if she survives the cancer it might be difficult for her to find a well-paying job to take care of herself, her mother, and children. In addition, she states that she feels that her mother does not understand the psychological and physical pain that she is currently experiencing in her life.
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Counselling and/or Case Management
A week ago, Alice presented herself at the clinic. After an assessment of the issues presented, it was identified that she was battling alcoholism. Taking alcohol was identified as her way of dealing with the stress and anxiety she has been experiencing. As a result of her current medical condition, her doctor advised her to quit drinking and referred her at the clinic for treatment and rehabilitation. The fact that Alice stated that she consumes as much alcohol as is required indicated that she did not have control over the amount consumed. Individuals with drinking disorders/alcoholism experience a negative emotional feeling when they are denied alcohol ( Ghodse, 2011 ). To assist Alice in overcoming the addiction problem, counselling was offered. As a substance abuse counsellor, my role was to give the client the needed and appropriate support system in order to recover from the addiction problem and prevent a relapse.
A substance abuse counsellor forms a relationship that is based on trust with patients. They offer assistance, resources, and sound guidance which can be applied by patients in their journey towards addiction recovery. In addition, they help addicted individuals with crisis and long term solution addiction problems (Reading & Jacob, 2003). These may include support as well as medical treatment. The roles played in counselling Alice include developing a therapeutic relationship with the patient, encourage patient recovery and prevent a relapse, help the patient create a relapse prevention plan, meet family members to give guidance for support purposes, and refer the patient to a support group. A strong therapeutic relationship with a patient helps ensure that a patient trusts the counsellor which in turn ensures effective collaboration throughout treatment (Lewis et.al, 2014). Encouraging recovery is a key role played during counselling sessions with Alice. Addiction recovery is a not easy because most addicted people do not recognize their personal patterns of abuse (Reading & Jacob, 2003). A substance abuse counsellor has a duty to motivate patients and identify strategies that effectively meet a patient’s needs. Despite the fact that change is in the hands of the client, the counsellor can modify the style used in order to promote motivation during the recovery process (Lewis et.al, 2014).
D.A.P. Note
D (Data): Alice reports that was recently discharged from the military because of medical reasons. She has been experiencing anxiety and stress while in the army. Alice has been drinking as much as is needed. She is a mother of two, divorced and is the sole bread winner in the family that includes her mother who has been taking care of her children. Alice is worried that she may not be able to provide for her family in the future because of job loss.
A (Assessment): Alice is starting to trust and began opening up today. She expressed how she feels towards her mother whom she feels does not understand her pain. She began addressing the frustrations she feels and indicates her willingness and determination to recover from alcohol addiction.
P (Plan): Alice will attend a session on April 15 at 10.am. She will be assisted in identifying the goals of treatment and a recovery plan.
Counselling Framework
The Adlerian theory will be used in Alice’s addiction recovery process. This theoretical framework was chosen for this case because it addresses motivation issues which are essential in the patient’s recovery and relapse prevention. The patient reported that she felt her addiction problem was beyond her ability to handle because she had tried quitting but failed. As a result, she needs to be encouraged. According to the theory, when people feel encouraged, they tend to feel able and appreciated ( Carlson, 2006 ). Consequently, individuals behave in a way that is not only connected but cooperative too. When a person is discouraged, he/she is likely to behave in a way that is not healthy by either trying to compete, withdraw, or give up ( Carlson, 2006 ). In the case of Alice, applying the framework would encourage the patient to overcome her feeling of insecurity and have a deeper sense of being interconnected. Constantly encouraging the patient will stimulate Alice to attempt what she initially perceived as impossible. Increase in confidence, and gratification causes more desire and ability to become cooperative ( Carlson, 2006 ).
Ethical Concerns
The ethical concerns that arose while working with Alice include confidentiality and autonomy issues. There arose situations that required sharing of patient’s sensitive/confidential information with her family in order to help with the recovery process. The patient’s consent was sought before sharing any of this information. Furthermore, a client has the right to make their own decisions regarding the way they want to live which may conflict with some aspects of therapy ( Isaac, 2016). The patient was guided to make decisions without coercion by giving adequate information to the patient and ensuring that it was understood.
SMART Goals
Learn how to cope with stress and anxiety in an adaptive way by the end of the program.
By the end of the recovery plan, learn strategies and techniques needed to manage unpleasant and negative feelings without taking alcohol.
Quit taking alcohol and recover from addition by the end of the plan.
Community Agencies in Windsor-Essex
To help Alice with her recovery and relapse prevention, working with community social support groups is important. Agencies such as Alcoholics Anonymous and Medical Wellness Centre of Windsor can help Alice deal with her alcohol addiction problem. The education sessions offered and interaction with other individuals battling or who have battled alcoholism can help Alice overcome her alcohol addiction problem. I would refer the patient to the group sessions and a sponsor in the agencies. Sponsors offer encouragement and enhance accountability required in achieving and maintain sobriety.
Evidence-based Assessment Measure
DAST (Drug Abuse Screen Test)-10 can be applied with Alice. The tool is used to screen populations, assess clinical casers, and evaluate treatment. The instrument provides a quantitative index of the level of outcomes related to abusing drugs. It takes around 5 minutes to apply it either as an interview or self-reported (Koob, 2011). The measure will be used assess the patient in order to identify the best way to deal with the problem and determine the plans effectiveness.
DAP Notes (Final Session)
D: Patient reported that she is has for the past three months managed without alcohol. In addition, she stated that she feels that her stress levels have significantly reduced and experiences less anxiety. Furthermore, Alice explained how she has been implementing the strategies learned and asked to state any challenges that she needs addressed.
A: Alice has been able to implement the developed plan in an effective way. She has recovered from the addiction. However, follow-up is needed to prevent a relapse.
P: Refer Alice to Alcoholics Anonymous for further social support and follow up for a period of three months, one session every month.
Evaluation Strategy
The recovery plan will be evaluated based on achievement of the SMART goals identified by the patient and the substance abuse counsellor. Also, the effective implementation of all the activities, steps, and actions will be used to evaluate the effectiveness of the recovery and relapse prevention plan developed at the beginning of the sessions.
References
Carlson, J., Watts, R. E., & Maniacci, M. (2006). Adlerian Therapy: Theory and Practice . American Psychological Association.
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
Koob, G. F. (2011). Theoretical Frameworks and Mechanistic Aspects of Alcohol Addiction: Alcohol Addiction as a Reward Deficit Disorder. Behavioral Neurobiology of Alcohol Addiction , 3-30. https://doi.org/10.1007/978-3-642-28720-6_129
Lewis, J. A., Dana, R. Q., & Blevins, G. A. (2014). Substance Abuse Counseling . Cengage Learning.
Reading, B., & Jacobs, M. (2003). Addiction: Questions and Answers for Counsellors and Therapists . Wiley.
