COUNSELING
Counseling: Case Conceptualization
Substance use disorder is not a healthy life activity that should be continued at any stage of life. There are only risks associated with this condition since the individual and his family suffer from this addiction. It leads to physical harm such as chronic pains, heart diseases, mental disturbances, physical disabilities, loss of mobility, etc., and creates severe and adverse negative reactions on cognitive functioning. Not only this but, the social connections and income possibilities are also adversely affected. This paper aims to develop a hypothetical case study of a diverse client and explain how the ASAM dimensions model of addiction can address a clients specific clinical needs.
A 62-year old African American has been addicted to alcohol and his hypertension and diabetes prevalence for the past ten years. He drinks alcohol daily and repeatedly, sometimes in larger amounts. Along with these conditions, his doctor has prescribed that he has to strictly abandon alcohol since it can lead him to suffer from heart diseases. He has been prescribed some psychotherapy sessions and felt abstinence for five to six months. He still mentioned that whenever he was under stress due to family stressors, such as his wife suffering from Alzheimers and only one son who lives away and never talks to them, he starts binge drinking again. He mentioned that the days when he stopped alcohol use were when his wifes doctor told him that she might be showing signs of betterment. However, the alcohol drinking returned when he experienced stress coming from his wifes one of the risky episodes of Alzheimers illness after a long time. Along with his medical conditions, the African American 62-year older man started drinking alcohol. He found that he could not keep himself away until his problems were solved, which seemed impossible.
ASAM Dimension 1: Acute Intoxication and Withdrawal
The risk associated with the patients current intoxication is the combination of his medical conditions of hypertension and diabetes and alcohol addiction. Research has shown that 65% of the adults who binge drink, which means that drinking five or more glasses at the same time for men, have an extremely high risk of health problems similar to the African Americans case here (National Institute of Drug Abuse, 2020). High blood pressure, heart failure, diabetes, liver problems, bone issues, memory difficulties, mood disorders, etc., are some of the common ones. These risks aggravate up to 107% in alcohol use disorder of the age is above 65 years since their metabolism reacts slowly and their sensitivity to drugs or intoxications like alcohol is higher than adolescents or middle-aged people. In such a case, as in the given African Americans alcohol substance disorder, there are greater chances of falls and difficulties occurring in memory, coordination, or sometimes reaction time when the intoxication of extensive drinking is severe (National Institute of Drug Abuse, 2020). Investigations about old age alcoholism have suggested that posture mechanisms could be problematic once elderly people suffering from alcohol substance use disorder fall (Rigler, 2000). If falls are severe, they might result in hip fracture or dislocation of bones due to age factors. Their bones have become weak with age, and their recovery could be slow. Alcohol impairs and imbalances are common risks associated risks with this disorder that cause dietary hardships and orthostasis. Some old and chronic alcoholics do have the strength to fight with their condition and likely develop myopathy. The sensory functioning start to decline f treatment is not diagnosed on time and can continue to result in peripheral neuropathy in addition to neural damage. Osteoporosis is not new to these circumstances since...
…cannot be relied upon.There are no legal, vocational, social service agency, or criminal justice mandates that may enhance the patients motivation for engagement in treatment. Further, there are no transportation, child care, and housing issues that need to be clarified and addressed. There are employment issues since he needs to be financially strong for his wifes and his treatment. He retired a few weeks ago but is still looking for employment to carry on with his wifes and own treatment. He constantly remains in search of employment assistance so that his continuous source of income could lessen some of his worries and stress.
Suggested Treatment Plan
Considering all of the above six ASAM dimensions of the patient, the suggested treatment plan would be guided self-change for mixed substance abuse or dependence. A great emphasis on this self-change model would be deemed better for this patient since he does not have strong social support at the moment that could help him adhere to his treatment plan (Cordaro, 2006, p. 31).
He needs to elf-regulate and self-monitor on his own since he has the willpower to do so. He wants to get better for his wife and look after her. For this, the suggested treatment plan, the self-change intervention, would be on an individual level, though previously they have been used on group levels. However, men in a group do not exhibit their alcohol problems openly as they are uncomfortable and fear social stigma (Sobell & Sobell, 2005).
Individually targeted self-change intervention for this patient is predicted to produce positive results in reducing alcohol dependency to reduce his stress. The patient complained that stress reduction is the sole reason for his alcohol use disorder, could be treated with mindfulness-based stress reduction (MBSR), which is successfully targeted towards elderly people, particularly those suffering from memory problems (Berk et…
References
Assari, S., Smith, J., Mistry, R., Farokhnia, M., & Bazargan, M. (2019). Substance Use among Economically Disadvantaged African American Older Adults; Objective and Subjective Socioeconomic Status. International Journal of Environmental Research and Public Health, 16(10), 1826. https://doi.org/10.3390/ijerph16101826
Berk, L., Hotterbeekx, R., Os, J. & Boxtel, M. (2017). Mindfulness-based stress reduction in middle-aged and older adults with memory complaints: A mixed-method study. Aging and Mental Health, 22(9), 1113-1120. https://doi.org/10.1080/13607863.2017.1347142Cordaro, M. (2006). The use of treatment process variables to differentiate between completers and dropouts for a guided self-change adolescent substance abuse intervention [Florida International University]. FIU Electronic Theses and Dissertations. https://digitalcommons.fiu.edu/cgi/viewcontent.cgi?article=3829&context=etd
Mullins, C. D., Blatt, L., Gbarayor, C. M., Yang, H. W., & Baquet, C. (2005). Health disparities: a barrier to high-quality care. American Journal of Health-System Pharmacy : AJHP: Official Journal of the American Society of Health-System Pharmacists, 62(18), 1873–1882. https://doi.org/10.2146/ajhp050064
National Institute of Drug Abuse. (2020, July). Substance use in older adults drug facts. https://www.drugabuse.gov/publications/substance-use-in-older-adults-drugfacts
Rigler, S.K. (2000). Alcoholism in elderly. American Family Physician, 61(6), 1710-1716. https://www.aafp.org/afp/2000/0315/p1710.html
Sobell, M.B. & Sobell, L.C. (2005). Guided self-change model of treatment for substance use disorders. Journal of Cognitive Psychotherapy, 19(3), 199-210. https://doi.org/10.1891/jcop.2005.19.3.199Spruill T. M. (2010). Chronic psychosocial stress and hypertension. Current Hypertension Reports, 12(1), 10–16. https://doi.org/10.1007/s11906-009-0084-8
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