According to Li’s history, I believe he has opioid use disorder as per DSM-V. He reports that he has been using heroin secretly for several months now and is unable to stop since he thinks that he is hooked. Li also reports that he has tried to stop taking the drug several times but has failed to do so since he gets so sick that he is forced to use it. To have a diagnosis of an opioid use disorder, a patient should be taking the opioid in larger amounts over a long period, has a craving for the drug, and a desire to stop the use of the drugs but is unable to (APA, 2013). Before he started using heroin, Li was a hardworking student who was honest with his parents. However, since he started using heroin, he has spent a lot of his time indulged in activities to get money to buy heroin and hanging out with his friends who also use the drugs. Due to his heroin use, he cannot do well in school and cooperate with his parents at home. This information shows that the drug has led to his failure to fulfill his roles and has caused him to have recurrent social problems (APA, 2013). Li's heroine intake has increased over time, and to fund this addiction, he has resorted to stealing from his mother to buy his drugs
Evidence shows that cognitive-behavioral therapy is effective for managing substance use disorders such as opioid use disorder. It is recommended that larger treatment sizes are particularly more useful for the treatment of opioid use disorder (McHugh et al., 2010). Cognitive-behavioral therapy (CBT) for substance use disorders can be used alone or in combination with other modes of treatment. One of the key elements of CBT in opioid use is the analysis of a patient's motivation for treatment (McHugh et al., 2010). A higher motivation predicts the likelihood of adherence to treatment. A therapist should assess a patient's motivation to change and address any indifference or ambivalence to treatment. Motivational intervention is often used as individual therapy for patients and can be used on its own or in combination with other treatment modalities.
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Another type of CBT effective for opioid use disorder is contingency management. This type of treatment is based on providing options to the reinforcing effects of the opioid in use (McHugh et al., 2010). An example would be providing another option such as a goods voucher after an individual demonstrates a willingness to abstain from drug use. Research shows that the higher the monetary value of the incentives given, the higher the success rates of treatment, leading to longer durations of abstinence. Most of these contingencies are connected to drug screening results, such that for Li, a negative drug screening for heroine would mean an incentive. Another treatment used in CBT for opioid use disorder is relapse prevention treatment. This treatment aims at analyzing any cues for opioid use and finding alternative responses to these cues (McHugh et al., 2010). This approach helps a patient identify high-risk situations and find ways of not responding to the prompts. This approach has been shown to improve the general psychosocial adjustment of a patient addicted to opioids. However, this treatment is not entirely effective in reducing substance use and has to be used in combination with other treatment methods.
One of the ethical implications in counseling adolescents is the inability of people in this age group to consent. However, for Li, he is already 18 years and is legally able to consent for treatment on his own. Also, he has the right to privacy and non-disclosure of information to his parents (Winters, 1999). Hence, if the counselor divulges information to his parents without his consent, there would be legal and ethical implications. The counselor is bound to keep private Li's information on assessment, diagnosis, counseling, and treatment. The counselor may disclose any information only after the adolescent has signed a comprehensive consent form.
References
APA. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) . American Psychiatric Pub.
McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics , 33 (3), 511-525.
Winters, K. C. (1999). TIP 32: treatment of adolescents with substance use disorders: treatment improvement protocol (TIP) Series 32.
