Substance abuse is a public health concern that has continued to have a detrimental effect on the community. It is one of the grave humanitarian problems and complex human phenomena destroying the basis and foundation of the society. Psychotherapy plays a vital role in the management of substance abuse disorder among users. One technique of treating substance abuse and alcohol use disorder is narrative therapy, which is a process of helping people overcome the psychological problem through talk therapy. Narrative therapy is based on the assumption that individuals construct reality through conversations with others ( Duvall & Béres, 2011) . The treatment involves holding interviews and discussions with the client using a stance of respectful, questioning, and curiosity that prioritizes the person’s knowledge and resources. This paper demonstrates the efficacy of using narrative therapy in a client with substance use disorder to help them improve and recover. The article describes the client, formulation of the client situation, diagnosis of the condition, and the intervention method selected.
Description of Client
The client for this narrative treatment model is a 39-year old male of Hispanic ethnicity. John is a middle-aged man in his late 30s who is a single man living with his mother. He has three children aged 17-years, each with a different mother, and has a good relationship with each of them. In presenting his history, the client described having come from a crazy family where his parents were all drug peddlers. As a young man, John engaged in the business of selling drugs to make a living. The cultural factor that includes migrating from Puerto Rico also plays a role in the development of the situation.
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The client has a history of drug and substance abuse as well as episodes of extreme drunkenness. This history defines his life, where he has frequently been arrested and sent to prison for the same. He entered therapy complaining of depressed mood, hopelessness about life, and concerns about his drug use. John reported using cocaine and PCP in the last few months due to stress and pain of his son and his son’s mother being involved in a severe car accident
The client has come for evaluation and treatment of the substance use disorder that has been a significant part of his life. He reported the onset of the substance use disorder to have begun when the client was 17 years old, which was a period when he started drinking alcohol and smoking bhang. This behavior has led to the client repeatedly found in the wrong hands of the law due to drug peddling and use. His criminal history includes being incarcerated numerous times due to the same and being released. The last time John was found on the wrong side of the law, he was put under probation to help in recovery.
Furthermore, the client reported using drugs, including drinking alcohol and smoking marijuana, except while in prison. He was also an avid user of PCP and had started experimenting with cocaine. Similarly, the client reported having been arrested severally for driving under the influence, which has led to a suspension of his driving license. In essence, the client had a drug and substance use disorder that was impacting his whole life. Apart from using the drugs, John was engaging in the peddling and drug trafficking, and reports difficulties are quitting the business. Despite having the qualifications to get a legal job, the client prefers engaging in the illegal activity of drug peddling due to the luxury of its quick money.
Another crucial information about the client is the fact that he is a religious person who attends church service regularly and takes his family to the church as well. However, his involvement with drugs often makes him doubt whether he is doing the right thing attending religious services while selling drugs at the same time ( Watts, Tetzlaff-Bemiller & McCutcheon, 2017) . He often prays to God for protection whenever engaging in illegal activities instead of praying to stop the addiction. At the same time, the client has a good relationship with the priest, family members, and other members of the community who supports his efforts to recover from the addiction.
Agency Context
The agency is an addiction treatment center known as “Door into the Future,” which focuses on catering to the needs of people suffering from addiction and mental health problems. The mission of this agency is to provide patient-centered, comprehensive, and quality addiction treatment services to individuals with substance abuse disorder in a supportive environment. It focuses on using individualized-goal-driven treatment to support clients cost-effectively and achieve recovery and hope for patients. Furthermore, the agency has the mission of delivering services that provide ease of access and improves the social and occupational functioning of an individual and his family.
The job of a mental health professional in narrative therapy is to help clients achieve recovery through evidence-based practices and patient-focused care. The therapist recognizes the stage of a client’s recovery and adjusts treatment sessions that fit them and allows the client to improve. The treatment involves using motivational interviewing, psychoeducation, family systems, and solution-focused therapy, as well as CBT ( Miller & Rollnick, 2013) . The responsibility of the treatment also entails developing a curriculum for group sessions for expected clients, touching on the areas of recovery skills, goal setting, dealing with stress and anxiety, as well as how to prevent relapse when functioning.
Formulation of the Client Situation
Despite being 39 and having three sons, John reported by a single at the time of intervention and living with his mother. He was jobless without formal employment but was primarily involved in the selling of drugs. John does not have a mental health diagnosis except for episodes of depression whenever feeling stressed that pushes him into using drugs. He is calm, makes good eye contact, and has regular motor activity. At the same time, the client seems alert and oriented with a coherent thought process and thought associations. He has a moderate intellectual ability with good judgment, and no hallucinations or delusions reported. The client has never had suicidal or homicidal ideas/
The probation referred the client for treatment due to violating a random positive urine drug screening. John was reportedly involved in cocaine use and abuse of PCP until the last week before falling under trap by probation. The act of finding him using the drugs was distressing the client since only a few weeks were remaining to end his probation period. As a result of this violation of the law, the client had a scheduled court date in a few weeks. He came for the treatment to prove to the judge that he is changing his behavior away from drug use and abuse.
At the same time, the client reported being affected by the injury sustained by one of his sons. The accident left the son and his mother with a long and hard recovery process, and has pushed him into using drugs again. He is also uncomfortable with the distress shown by his mother, who continually asks him to stop dealing with the drug. He is willing to stop the habit, but he is deeply addicted that a little trigger sees him using the drugs. John revealed that his involvement in selling drugs is the luxury of making easy money in illegally as opposed to getting a formal job that pays peanuts ( Watts, Tetzlaff-Bemiller & McCutcheon, 2017) .. He reports being afraid of the consequences associated with this illegal job and will do everything to get sober again and get a well-paying job that does not have risks of arrests.
The genetic predisposition of the client seems to play a role in the situation, as he grew up in an environment of drug abuse and peddling. His background entailed growing up with a family that sold drugs for a living. He witnessed his father and uncles serving prison sentences for the same but still has not managed to walk away from the behavior. He has an addiction to the use and selling of drugs due to the environment, genetic, and neurological factors ( Rylaarsdam, 2018) .
Diagnosis of the Condition
From the formulation of the client situation, John can be diagnosed with substance abuse disorder. The client uses alcohol and marijuana regularly and has recently started using cocaine and PCP. This is a red sign for substance use disorder as the client does not show signs of stopping despite being aware of the consequences that come with using and selling drugs ( Watts, Tetzlaff-Bemiller & McCutcheon, 2017) .. As such, the client is struggling with some compulsion disorders and an inability to control drug addiction. The primary diagnosis of an alcohol use disorder, cannabis use disorder, phencyclidine use disorder, as well as automatic control and conduct disorder.
The differential diagnosis for this case study can be depression, such as major depressive disorder that is associated with the issues surrounding his family and personal life. It is always essential to get a distinction between a preexisting mental disorder and an acute drug effect in an individual.
Narrative Technique
Using the sequential treatment model is the best intervention to help the client into recovery. Narrative therapy is a psychological approach that seeks to adjust the stories of a client to bring about positive change and better mental health. It is based on the assumption that patients are experts in their personal lives and are separate from their problems ( Duvall & Béres, 2011) . Therapeutic conversations can help clients adjust to tell stories about their lives to match who they want to be, thus leading to a positive change. The therapists ask non-blaming and non-anthologizing questions that allow the client to express what they want to do with their lives. Therefore, the client is treated as brave and responsible instead of viewing him as deficient and inherently problematic.
The narrative technique selected for this case study is that of telling one story as well as the externalization technique. The first technique will involve the client re-authoring his story by expressing himself regarding the problem ( Lee & DeMarco, 2016). The therapist will help the client telling the story of his life and helps the client re-author the story. This would help John to find expectations of the time he failed, and the times he succeeds, and we both experience to determine the best method of avoiding trouble. Narrative therapy entails individuals crafting stories from events of their lives to confront them ( Duvall & Béres, 2011) . This involves helping treatment helping the client to re-author his story of pain and past events. Individuals with substance abuse disorder have their identities shaped by the stories they tell about their lives.
Secondly, narrative therapy will entail using the externalization technique to help the client towards achieving their problems as external instead of a part of themselves. It is a substantial positive therapy towards self-identity and confidence for the client since it is easy to change the behavior that a core personality characteristics. The externalization encourages individuals to find meaning and purpose by separating the individual from the issue instead of internalizing it. The technique of externalizing problems facilitate positive interaction and help the client see the problem objectively
During the therapeutic conversation, the therapist looks to expose the identity of the problem and delineate its boundaries. People often speak about their challenges as if the problem is inherent to them. As a result, there is a need to externalize the problem and conversations to disconnect the problem from the person’s identity and minimize its iatrogenic effects. The goal of externalization is to change the perspective of the client so that he does not see himself as problematic. As a result, he will not feel superior or unable to change from the condition. The idea behind this technique is that the client will develop more control over the issue after perceiving the problem as something outside of their personality.
Reason for Choosing the Technique
The narrative therapy as a technique for treatment was selected for this case study as it would help the client find expectations of the different times that he had engaged in drug use and abuse, as well as reflect on the different ways h can change. The therapy was also chosen because it was the right choice when working with individuals from different cultural backgrounds ( Duvall & Béres, 2011) . This intervention is focused on allowing the client to express himself and separating the person from the problem. It is more of a dialogue between the therapist and the client that enables the client to minimize the existing issues in his life by relying on his skills
This model is empirically grounded on a solution-focused therapy where it looks to deal with what is currently happening with his life. This entails asking John how his problems can disappear when he makes a list to always remind him of the right thing to do ( O’Connell, 2005) . The client needs to believe in himself, and the narrative therapy empowers him to take steps towards recovery ( Duvall & Béres, 2011) . Evidence has shown that the treatment has the most reliable scientific support that can help deal with substance abuse. Therapies based on meaning, nonjudgmental self-acceptance, and enhanced self-awareness can be crucial in curtailing future episodes of substance use and disorder. The therapist will look towards helping the client author and re-author his story of life problems dealing with substance abuse and help him find the positive aspect of life as well. The therapy will involve using motivational interviewing skills to assist the client in reaching the next step of change ( Lee & DeMarco, 2016) .
It is possible to find meanings and healing through telling stories, allowing the client to separate from the past and gain a broader perspective. The personal experiences become personal stories for the client who uses them as an inspiration to walk away from substance use and sell. He therapist will seek to help the client see that his problem does not exist inside of him but was a narrative created by social limits, family dynamics, and culturally enforced notions of drugs as an escape from pain and anxiety. In this regard, John needs to externalize the problem and see the script of drug use and abuse as an antagonistic alien narrative that can be defeated.
Evaluating the Effectiveness of the Narrative Technique
The evaluation of this narrative treatment technique will be facilitated by setting up a follow-up meeting with the client. The session will focus on understanding the effectiveness of this intervention and how the client is progressing with the condition. From the standpoint of narrative therapy, John’s substance abuse has been incorporated into a maladaptive script that is activated in moments of extreme anxiety. Using cocaine provides a meaning structure that instantiates a course of action and protection from despair and self-loathing.
The success of this treatment model is determined by the client reducing the use and selling of drugs and prove that he has changed ( Watts, Tetzlaff-Bemiller & McCutcheon, 2017) . The therapist will gather information from the client regarding the situation and understand whether there is any progress. Whenever the client fails to make the anticipated growth, the therapist will look to conceptualize the barriers and modify them accordingly. The treatment of substance abuse disorder begins with questions based on motivational interviewing and self-monitoring. Through this narrative therapy, the client will keep a log of cocaine use and choose to set a limit on how much he is involved in drug-related activities ( Duvall & Béres, 2011) . After managing this routine for about four weeks, the client will reach a point of walk away from the habit and adopt a new lifestyle.
The evaluation will also be based on whether the depression symptoms within the client improve after the narrative therapy. The treatment will improve the mental health condition, such as stress and depression. The effectiveness of this program is when the client shows progress and improvement in mental health as well as physical health and can take care of the situation without any temptation to use alcohol.
Furthermore, the effectiveness of the narrative technique will be determined by assessing the satisfaction level of clients on the therapy. It will measure whether the client is satisfied with the results of the treatment in helping him deal with the problem of drug use and selling of drugs ( Watts, Tetzlaff-Bemiller & McCutcheon, 2017) .. The therapy will assess the occurrence of specific target behaviors and success towards achieving the goals. For example, it will entail determining the number of attempts a client has tried to get rid of drugs in his possession.
Cultural Sensitivity of the Narrative Practice
The cultural sensitivity of this narrative technique is to recognize the sensitivity of mental health conditions and the culture of a person. Since the client will show patches of depression and psychological issues, the client should be sensitive to the mental state and handle the client with care. At the same time, the therapy will consider the cultural background of the client. John grew in an environment and culture where he learned and developed many of these behaviors, and is now having a problem changing them. In this case scenario, the client is an immigrant from Puerto Rico, with this situation playing an essential role in the existence of this psychological condition. Numerous things can be considered due to his association with the culture of Puerto Rico
Cultural sensitivity also includes an aspect of spirituality since John appears to be a spiritual man who attends church and prays occasionally. The therapist will focus on driving the client into visiting religious services more often and using them as a motivation to stop engaging in the problem. Furthermore, the cultural sensitivity of this issue is to ensure the treatment is patient-centered and addresses most of the problems while considering the cultural backgrounds. Therefore, the therapist will answer questions and engage in motivational interviewing using a patient-centered approach ( Miller & Rollnick, 2013) . There are risks of unintended harm that can affect the recovery process if issues of cultural sensitivity are not considered. The therapist will look to avoid any problems that touch on why the client still lives with his mother, why they left Puerto Rico as well as the using of drugs for cultural purposes.
Ethical Implications for the Client
Several effects may arise from the use of narrative therapy in treating substance abuse disorder and mental health conditions. The field of psychotherapy always has concerns for ethical action that entails doing the right thing and avoiding unethical issues ( Duvall & Béres, 2011) . The crucial ethical factors include confidentiality of client information, respect to his privacy as well as seeking consent before doing anything. The therapist in the narrative technique acts as a guide to provide support for the client as he walks through the journey of self-discovery, and should put these factors into consideration.
The ethical consideration is also to ensure the medication is appropriate for the client considering his history and cultural aspects. Deciding the most appropriate therapy for compulsivity an addiction requires an understanding of side effects, among other ethical considerations. The client should agree to the treatment before the session starts and agree to be part of the process until the end.
Imperatives for Advocacy towards Change
The narrative therapy will help the client with substance abuse disorder to have control over his life and choose to change the behavior. During the therapy session, the client expressed a desire to change his practices and develop into a better human being who respects the law. He has been under probation for drug-related offenses as well as serving prison time. The narrative therapy has a significant effect on the recovery of the client by allowing them to stop engaging in drug use and abuse ( Duvall & Béres, 2011) .
The advocacy for change involves getting family support and getting closer to his sons as a way of dealing with the problem. The client lives with his mother and is closer to his children, who will play a crucial role in supporting his treatment and recovery from the condition. Family support is a protective factor for recovery due to encouragement and well-wishing.
At the same time, advocacy towards change can entail advising the client to become more spiritual and attend weekly services in the church as part of the rehabilitation. The client confessed to being a religious man, which means he can benefit from heeding to the word of God. Furthermore, the therapist should focus on providing patient education on how to deal with the situation and its side effects. It is necessary to equip the client with knowledge on what to expect during and after the therapy. The therapist should also provide options for referral to another counselor in case the client continues to engage in drug use addiction.
Conclusion
Narrative therapy offers new conceptions of psychological distress and therapeutic change and can be useful in treating mental disorders. It operates on the identity of re-development through the practice of a client telling a story of his experiences ( Lee & DeMarco, 2016) . This aspect of story-telling allows the client to realize his knowledge and skills that form the current conceptualization of self-identity. It will enable the client to create new meanings while integrating the medical history of the condition. The therapist uses this therapy to explore the client’s knowledge of himself and establish self-identity to help deal with the situation. In this case, the focus is to have the client stop engaging in drug use and selling using externalization, and help him get close to his family for support.
References
Cowden, J. D., & Kreisler, K. (2016). Development in Children of Immigrant Families . Retrieved from The Pediatric Clinics of North America, 63(5), 775–793.: https://doi-org.ezproxy.simmons.edu/10.1016/j.pcl.2016.06.005
Czachesz, I. (2018). Evolutionary theory on the move: New perspectives on evolution in the cognitive science of religion. . Retrieved from Filosofia UNISINOS, 19(3), 263–271. : https://doi-org.ezproxy.simmons.edu/10.4013/fsu.2018.193.08
Duvall, J., & Béres, L. (2011). Innovations in narrative therapy : connecting practice, training, and research. W.W. Norton. Retrieved from Retrieved from https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=cat01806a&AN=sim.b2164757&site=eds-live&scope=site
Lee, H. F., & DeMarco, R. (2016). Storytelling/narrative theory to address health communication with minority populations. Retrieved from Applied Nursing Research, 30, 58–60.: https://doi-org.ezproxy.simmons.edu/10.1016/j.apnr.2015.09.004
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing : helping people change. Guilford Press. . Retrieved from Retrieved from https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=cat01806a&AN=sim.b1886247&site=eds-live&scope=site
O’Connell, B. (2005). Solution-focused therapy. Retrieved from Sage Publications.: Retrieved from https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=cat01806a&AN=sim.b1374956&site=eds-live&scope=site
Rylaarsdam, R. P. (2018). The Genetics of Addiction. . Retrieved from Perspectives on Science & Christian Faith, 70(4), 232–241: Retrieved from https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=asn&AN=133231132&site=eds-live&scope=site
Watts, S. J., Tetzlaff-Bemiller, M. J., & McCutcheon, J. C. (2017). MAOA, Drug Selling, and Violent Victimization: Evidence of a Gene x Environment Interaction . Retrieved from Criminal Justice Review, (Issue 4), 368.: https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=edshol&AN=edshol.hein.journals.crmrev42.40&site=eds-live&scope=site
