Substance Use Disorder: Challenges and Interventions

The given assignment discusses the critical issue of substance use disorder in high-risk populations. It emphasizes the importance of education and awareness to prevent such practices and involves not only healthcare providers but also families, communities, and educational institutions in prevention and treatment efforts. The assignment references various studies and research papers on social cognitive predictors of treatment outcomes, solution-focused brief therapy, specialty substance abuse treatment barriers among Latinos, changes in substance abuse treatment use among individuals with opioid use disorders, medical family therapy in alcohol and drug treatment, and smoking cessation interventions for adults in substance abuse treatment or recovery.

Case analysis

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
CASE ANALYSIS .........................................................................................................................1
1. Case study brief and biopsychosocial assessment ..................................................................1
2. Issues and diagnosis for treatment ..........................................................................................1
3. Treatment management plan using MATRS ..........................................................................2
4. Components of the appropriate intervention for treatment.....................................................3
5. Cultural and agency level adaptations to interventions ..........................................................4
6. Ethical and legal issues ...........................................................................................................4
7. Countertransference / transference issues ...............................................................................5
CONCLUSION ...............................................................................................................................5
REFERENCES ...............................................................................................................................7

INTRODUCTION
Substance use disorder (SUD) or substance abuse is defined as excessive or repetitive use
of specific drugs and alcohol which affects cognitive, behavioural as well as control ability of an
individual (Moos, 2018). The use of both legal and illegal drugs as SUD is increasing among
young people affecting their routine life and health efficiency.
CASE ANALYSIS
1. Case study brief and biopsychosocial assessment
Mr. David is 30 year old Caucasian male who has been presented to rehabilitation facility
and outpatient detoxification. For the last 3 weeks he has being using 4 cans of beer, 10 bags of
heroin and heavy dosage of cocaine as well. Due to substance over dosage patient has limited
control on behaviour and thus has been indulged in various activities of violence. Instead of
going to jail for the law violations patient and his family desire to go for probation treatment
program. Mr. David is married and lives with his wife and has been referred by his probation
officer. He is unemployed and thus he spends most of time with his friends.
David stated that for 5-6 years he was also addicted of marijuana but due to
unemployment stress and regular issues with his wife he started taking heroin. When he first
started taking drugs his wife was aware but she did not support him. For the financial support he
used to take help from his parents who are also well aware of this addiction. David does not have
any past history of hospitalisation but few days ago due to overdose of heroin his wife found him
unconscious and thus he was admitted to hospital. It has been also reported by David that he has
been continuously struggling with mild anxiety, sever depression from adolescents. He even had
suicidal thoughts but never attempted.
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With the drug consumption he feels relaxed and then he also stopped taking his anti
depressants like benzodiazepine and antipsychotic which was prescribed to him. At present he
does not seek any psychiatric medication and support. On physical examination it is observed
that his heart rate is regular and lungs sounds are clear. His skin is cracking and he often feels
itching. The patient is alert, talkative and easily gets irritated and angry. His body temperature,
blood pressure and heart rate is normal.
2. Issues and diagnosis for treatment
Issues: Mr. David informed that since from the last 4 hours he has not taken heroin, he is not
well. Though he is not feeling any visual issues or inflammation but he is feeling high level of
anxiety. He has been also suffering from diarrhoea, nausea and back pain. He denies of any kind
of history of breathing shortness, joint or skin issues and urine incontinence. David informed that
from last few years is appetite has decreased and constipation is very frequent issue. Though he
does not take any medication for it.
Diagnosis: In the initial assessment breathalyser and urine test are performed. For the
detoxication patients urine toxicology helps to identify substance use while breathalyser
measures the alcohol amount in breath. After these tests the blood count, metabolic panel and
plasma reagin test are also performed. The patients having abnormal blood test or the chronic
medical conditions are not admitted for rehabilitation units. Suboxone or methdone is used to
treat opioid abuse dependence with withdrawal while same for the alcohol dependence is treated
by Ativan or Librium irrespective of breathalyser tests (Thurgood & et.al., 2016). For the alcohol
treatment protocol CIWA score and alcohol abuse reported by patients is also used.
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3. Treatment management plan using MATRS
The following treatment interventions based upon MATRS approach can be used to
provide the effective care and treatment to David.
Cognitive and solution focused therapies:
These therapies are specific and aims at controlling the psychological perspective
contributing to substance abuse. During therapies therapist try to determine the real life factors
which encourages the craving and availability of such substance. Thus, regular therapies for 4-6
months can help David to minimise the psychological issues causing addiction. Through the
therapy the behavioural pattern and emotional issues are controlled and managed so that drug
usage can be reduced.
Family based therapies:
David feels lack of emotional support from the family thus through this therapy care and
attention will be provided to him. It will specifically address the emotional needs of the patients
so that his will power can be strengthen in overcoming the drug addiction. David may need this
therapy for long run to avoid chances of relapse but it gives valuable outcomes in terms
eliminating addiction. The family based therapies emphasis on assuring that patient receives
equal support and care from the family members so that moral support can be increased and it
becomes more easy to manage post withdrawal challenges and complexities during treatment
(Pinedo, Zemore & Rogers, 2018).
Use of medications such as methadone, Buprenorphine and Naltrexone:
Along with the personalised care and coordination David also need medication so that
post withdrawal complications can be managed. In addition to the therapies the use of
medications treat the physiological changes due to drug consumption. This may take few months
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and attainable changes are observed through physical and psychological assessment of the
patient. The main aspect of this intervention is to address physiological aspects instead of mental
aspects.
4. Components of the appropriate intervention for treatment.
Cognitive behavioural theory: This therapy is used for addiction treatment as it helps
addicts from recovering in order to find connections between feeling, thoughts, actions, feelings
which in turn affects the impact on recovery process. The substance misuse of alcohol has led to
positive enforcement in order to attain better results and outcomes. This theory helps David in
distressing the emotions and harmful behaviour (Gullo & et.al. (2017)). The cognitive behaviour
therapy helps in providing effective treatment in relation with eating disorders, mental health
diagnosis, substance abuse, etc. This theory helps client in overcoming the drinking problem.
This also help David in changing behavioural response in order to overcome negative emotions
and thoughts. This theory helps patients in coping up with the various problems and behaviours
which in turn helps in healthy living of life. It is mainly classified into two components:
functional analysis and skills training. Functional analysis helps in identifying the reason of
consuming opioid and alcohol. This will help in identifying the reason to cope up with
difficulties. David needs to learn to cope with difficulty and effectively develop healthier habits
(How Cognitive Behavior Therapy (CBT) Is Used to Treat Addiction, 2019). Some social skills
training methods which helps in recovering alcoholics are focused instruction, modelling, role
playing, feedback, etc. Social skills training helps in treating David by avoiding situations where
other people are drinking.
Solution focused therapy: this theory will help David to change the behaviour which in
turn helps in taking into consideration various factors which adversely affect the health of the
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individual. This study helps in developing new solution to the problem which affects the
functioning of the individual (Kim, Brook & Akin, (2018). It is very useful in treating the mental
health disorders. It helps in building strength and developing skills to resolve the difficulties to
cope up with Opioid and alcohol. This helps theorist in treating opioid and alcohol addiction
which helps in addressing various mental and emotional issues.
Family therapy: this is an outpatient behavioural treatment which will help David in
reducing drugs and alcohol due to some common problems such as depression, work attendance,
family disorder, etc. The family therapy will help in using the strengths and resources of the
family to find an effective way for David to live without Opioid and alcohol. It helps in
developing a positive surrounding which in turn helps the patient in overcoming the use of
alcohol and Opioid in order to live healthy and prosperous life (Addiction Treatment Should
Include Family Therapy, 2019). This theory involves family members to effectively understand
the addiction and it helps therapist to develop a better support system which in turn helps in
attaining better results and outcomes (Soloski & Pickens, (2018). A full rime family therapist is
devoted to recover opioid. Family members take part in various educational programs which in
turn helps in better understanding of the substance use inn order top best support and give better
treatment.
5. Cultural and agency level adaptations to interventions
The cultural adaptions can enhance the quality of treatment interventions especially for
the indigenous people. Mr. David belongs to caucasian community and thus the integration of
traditional care approaches can help him to recover quickly and to quit from the practice of
substance abuse. For instance the drug and alcohol control programs must integrate the language
and cultural values of the indigenous culture as well. This will make patient comfortable and to
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develop trust on health care professionals (Pinedo, Zemore & Rogers, 2018). Similarly, the
spiritual aspects associated with the culture can also have positive impact upon psychology of the
individuals and thus it must be incorporated in the health care interventions. The cultural
activities such as dance, social interactions and social-spiritual practices can be used to
encourage patient so that their control ability and mental willingness can be increased to
cooperate with the treatment interventions.
6. Ethical and legal issues
Ethical and legal issues are significant part of the treatment of substance abuse. For
instance the individuals may not prefer to share their experience and details with the therapist. In
such situations the service providers must respect the privacy and dignity of the patient. Since the
medications given for the treatment of substance abuse it is the ethical responsibility of the care
provider to ensure that during treatment no harm is caused to the patient. The patient must also
be provided with all necessary information or the adverse impacts associated with the treatment
procedure.
It will help patient and his family members to take better decisions related to care. Since
the opioid usage is also limited to legal prohibitions it must be assured that all fundamental and
safety rights of the patient are protected and not violated. One of the factor which makes
substance abuse evident is the availability of the restricted drugs (Swensen, 2015). Thus, it must
be assured that patient and other community members are able to access such drugs only with the
valid prescription from the health care practitioners. Without prescriptions such drugs must not
be accessible to individuals so that substance abuse can be prevented and regulated.
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7. Countertransference / transference issues
Transference is defined as emotional entanglement of feelings of patient towards
therapist while the countertransference is known as the redirections of emotional attachment of
therapist towards the patient. These issues affect the health outcomes of the patient as well as
quality of care services. For instance when David has good emotional connectivity with the
therapist or service providers then he can share his experience and needs with more honesty and
comfortably. It helps in developing better care interventions.
Contrary to this the excessive countertransference can have adverse impact upon therapy.
For instance on many occasions of relapse patient may demand for the heroine pleading on the
basis of health. In such circumstances the if therapist becomes emotional and provide substance
to the patient then it can have adverse outcomes. Another transference issue which may emerge
is that since patient does not receive emotional support from the family thus the regular care and
love from the service providers can significantly help to improve the health condition (Saloner &
Karthikeyan, 2015). However, if therapist is changed or after treatment when patient is required
to discontinue interaction with the therapist then it may trigger the higher possibilities of relapse.
CONCLUSION
It can be concluded that substance using disorder is very critical in high risk involving
population. The education interventions and increasing awareness must be created among
individuals to prohibit such practices. It has been also analysed that along with the health service
providers, families, community and educational institutes must also participate in prevention and
treatment of substance abuse.
REFERENCES
Books and Journals
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Gullo, M. J & et.al. (2017). Social cognitive predictors of treatment outcome in cannabis
dependence. Drug and alcohol dependence. 170. 74-81.
Kim, J. S., Brook, J., & Akin, B. A. (2018). Solution-focused brief therapy with substance-using
individuals: A randomized controlled trial study. Research on Social Work
Practice. 28(4). 452-462.
Moos, R. H. (2018). Evaluating treatment environments: The quality of psychiatric and
substance abuse programs. Routledge.
Pinedo, M., Zemore, S., & Rogers, S. (2018). Understanding barriers to specialty substance
abuse treatment among Latinos. Journal of substance abuse treatment. 94. 1-8.
Saloner, B., & Karthikeyan, S. (2015). Changes in substance abuse treatment use among
individuals with opioid use disorders in the United States, 2004-2013. Jama. 314(14).
1515-1517.
Soloski, K., & Pickens, J. C. (2018). Medical Family Therapy in Alcohol and Drug Treatment.
In Clinical Methods in Medical Family Therapy (pp. 321-354). Springer, Cham.
Swensen, I. D. (2015). Substance-abuse treatment and mortality. Journal of Public
Economics. 122. 13-30.
Thurgood, S. L., & et.al., (2016). A systematic review of smoking cessation interventions for
adults in substance abuse treatment or recovery. Nicotine & Tobacco Research. 18(5).
993-1001.
Online
Addiction Treatment Should Include Family Therapy. 2019. [ONLINE]. Available
through:<https://www.verywellmind.com/addiction-treatment-should-include-family-
therapy-67293>
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How Cognitive Behavior Therapy (CBT) Is Used to Treat Addiction. 2019. [ONLINE]. Available
through:<https://www.verywellmind.com/cognitive-behavior-therapy-for-addiction-
67893>
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