Psychotherapy for Addictive Disorders
The client in this practicum was a 24-year-old female who was in her freshman year in College. The client arrived to the clinic due to her concern about are alcohol use, and how drinking affects her health. He has recently noticed changes in her sleeping patterns, family problems due to her obscure drinking habit, frequent headaches, recent trauma, and motor vehicle accidents that led to the death of her grandparents. During an integral therapy session with the 24-year-old client, at first, the client appeared excited. Per the client’s statement, “So, help me get this out”. My response to her was, since you are exhausted of hassles and demand a life without troubles, but on the other hand, you were advice to come this clinic due to the of the drink-driving charges, and your employer has threatened to terminate you if you are once found to be drunk at job. I am contemplating how continuing in this manner with alcohol will help keep your life problem-free. Psychotherapy for Addictive Disorders
During the diagnosis process, the primary responsibility of the counselor is to respect the dignity and promote the welfare of clients. Using DSM-5 was useful in this mental diagnosis as it provides standards for clinicians able to communicate about psychiatric disorders as a result of substance addiction (Fisher, 2016). Basing on the client’s complaints which is related to DSM-5 Category Substance Related and Addictive Disorders, the client presents with symptoms of Substance Related and Addictive Disorders based on the classifications of the Diagnostic and Statistical Manual of Mental Heal Disorders 5th Ed. (DSM-5) (Wheeler, 2014). The client have had several episodes of slurred speech, poor balance, dizziness, headache and nausea, was recently admitted to the hospital for alcohol intoxication. The most common symptoms of alcohol Psychotherapy for Addictive Disorders
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intoxication are slurred speech, impaired coordination, trouble with balance and walking, involuntary eye movement, impaired attention or memory and loss of consciousness (American Psychiatric Association, 2013). Intoxicated individuals may also experience nausea, vomiting, vertigo, headache and present with bloodshot eyes (Vonghia, et al., 2008). However, it is crucial to know that the DSM-5 also explains that alcohol intoxication can produce problematic psychological or behavioral changes such as impaired judgment, unusual mood changes, inappropriate sexual behavior, and aggression (Wheeler, 2014). Psychotherapy for Addictive Disorders
Effectiveness of Motivational interviewing to the client
As a nurse practitioner student, I was at lookout for motivational statements the client may make. These may recognize the problem in a cognitive way, however during the therapy, she expressed some optimistic stance when she said, “I’m pretty sure that I can do it if I try.” Recent research has proven that psychoanalytically qualified general practitioner operating in rehabilitation programs for addictive patients has hypothesized that integrating psychoanalysis practices to dependence management would improve the results (American Psychiatric Association, 2013). Clinical studies have shown a consistent improvement when psychotherapy programs are efficiently applied. It has been helpful to patients with addictive disorders, with an effect size ranging from mild to moderate. The baseline of starting this programs for addictive patients is to review their background information on psychotherapy and drug counseling presentation. Psychotherapy for Addictive Disorders
Moreover, Motivational Enhancement Therapy (MET) strives to induce from clients their own enthusiasm for change and to combine an individual decision and strategy to adjustment
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(Wheeler, 2014). This therapy program is used by experts entirely centered onto patients with planned directions. It is based on principles of cognitive and social psychology. Work of the counselor is to elicit and consolidate the client’s intrinsic motivations for change. Most of the substance dependence according to many research has identified a range of behavioral therapies that have been recorded to be most effective. This review highlights the roles played by behavioral treatments discussed below as compared to pharmacotherapies. Behavioral therapies that will be considered are the family and interpersonal approaches, clinical management, coping skills management, as well as motivational interviews.
Behavioral approaches such as contingency management (CM) are based on the formed standards of behavioral pharmacology and operant training and therefore have a founding principle that behaviors that are strengthened are more expected to be repetitive (Albrecht et al., 2017). Behavioral approaches help people engage in drug abuse therapies, provide incentives for the patients to remain abstinent, modify their attitudes and behavior related to addiction. Psychotherapy for Addictive Disorders
Contingency Management (CM) as a therapy functions under the conviction that substance use is significantly influenced by societal, environmental, and biological causes. Clinicians who are using psychotherapy treatment method make the patient move away from substance use so as to enter into a recovery process (Wheeler, 2014). The recovering process must face a much-stressed relation, poor financial conditions, and ill mental and physical health consequential from the drug misuse.
Another form of therapy is the cognitive behavioral therapy which works under the principle of non-twelve phase recovery plan which focuses on the notion that overcoming dependence and maintaining long-term sobriety is based on abandoning the unhealthy behaviors Psychotherapy for Addictive Disorders
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and moving on without considering the illicit substances to initiate positive changes (American Psychiatric Association, 2013).
Legal and Ethical Implications
The legal and ethical considerations a counselor has to maintain is to ensure there are proper and safe records keeping and documentation (Fisher, 2016). A counselor must have an informed consent in the counseling relationship to safeguard the welfare of the clients. A counselor must avoid imposing harm and values to the clients especially beliefs and behaviors. In essence maintaining and managing boundaries and professional relationships is the primary goal of ensuring there is the protection of client’s rights and exploitation from the counselors. Following the APA ethics of measures will help the counselor maintain the confidentiality of the client which promotes the therapeutic association and reveals the professional’s respect for the privacy and self-respect of clients. Psychotherapy for Addictive Disorders
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Psychotherapy for Addictive Disorders
Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. German Medical Science Psycho-Social-Medicine, 4, 1–11. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/
Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. Doi: 10.1037/14860-002 Psychotherapy for Addictive Disorders
Vonghia, L., Leggio, L., Ferrulli, A., Bertini, M., Gasbarrini, G. & Addolorato, G. (2008). Acute alcohol intoxication. European Journal of Internal Medicine. 19(8): 561-567
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company Psychotherapy for Addictive Disorders