This paper examines a case of Miya, a 35-year-old Caucasian woman who has developed a chemical impairment, specifically, the misuse of alcohol and cocaine. The patient, who has undergone appropriate treatment, has also been showing the signs of a persistent depressive disorder. Even though Miya had been subjected to multiple healthcare professional interventions, she still struggled to take control over her craving for substances due to a lack of social support when the intervention described in this paper started. The patient believed that her drug addiction is the primary cause of her depression. She admits that she started taking alcohol since she was a teenager, and by the time when she was in her 20s, she had already developed substance dependency.
Being in her 30s at the time of receiving the therapy, Miya claimed that she desperately needed alcohol or cocaine to survive, and that she was aware of the detrimental impact of drugs on her mental state, particularly, the development of depression. The only person on whom she could rely for social support is her mother, yet the relationships between the two have been significantly impaired. Miya lacked a secure job and spends most of the time taking alcohol and cocaine. Due to unemployment, she did not have enough resources to support her lifestyle, which led her to engaging in ten activities that were borderline criminal and may have had long-lasting negative outcomes on her well-being.
The described situation might seem completely desperate; however, Miya had several strengths that might help her to manage the specified predicament. Miya’s desire to transform and be an active and responsible member of society was the main advantage that was likely to assist her in her fight against ten chemical dependency and the associated mental health concerns. The specified strength was evident from her statement of feeling sorry for her life choices and her willingness to transform her life. However, the fact that Miya’s social life had been quite questionable and that she had been struggling with depression made the possibility of a recovery rather doubtful. Unlike other clients, Miya continued her communication with me while staying at home, and attended all treatment sessions. Furthermore, she asked many questions regarding her opportunities for recovery, treatment options, and ten possible outcomes of the chemical dependency, which showed her awareness of her mental health status and her willingness to change it.
Goals and Objectives of the Client
Currently, the main priority for Miya’s case was to change the patient’s behavior and attitude toward the identified health problem by using cognitive behavioral therapy (CBT) techniques, psychotherapy, and motivational therapy. The management of alcohol and cocaine misuse was also one of the main goals since substance abuse served as the catalyst for mental health issues development and the main obstacle in shaping the patient’s behavior. Additionally, there are specific goals attached to the main goal, which included improvement in Miya’s relationships with her mother, overcoming the withdrawal symptoms, specifically, the craving for alcohol and cocaine, and recovery from depression.
Target Problems and Behavior
The interventions targeted specific behaviors that render Miya vulnerable to alcohol and drug abuse. These include maintaining relationships with friends who had a history of drug misuse, presence of idleness, lack of coping skills, unhealthy eating, failing to exercise, and refusing to participate in support groups. Therefore, among the established project goals, one should list the development of coping skills, promotion of a healthy lifestyle, and the behavioral change aimed at regaining social skills. It was expected that achieving the specified goals helped Miya to rebuild the relationship with her mother, control her addiction to substances, and, lastly, manage her depression.
Literature Review and Selection of the Interventions
The selection of the intervention in the case in point depended on the extent to which Miya has developed substance dependence. The interventions chosen for the patient included behavioral counseling and assessment of co-curricular activities (National Institute on Drug Abuse, n.d.). In this particular case, it was recommended to perform CBT for the patient to create an understanding of the reasons for her to have developed and have been following the identified destructive behavior patterns, as well as accept the necessity of an intervention. In addition to the CBT-based treatment, appropriate medications were administered to Miya. Namely, the use of Naltrexone or another FDA-approved treatment option, and identification other health issues that may have occurred as a result of the intervention, was required as an immediate action. The appropriate medications were administered in combination with CBT as the main tool for encouraging a behavioral change. In order to ensure that the patient’s motivation level remain high, Motivational Interviewing, Community Reinforcement Approach (CRA), and Guided Self-Change frameworks were used. These, in conjunction with the other treatments, will accelerate her recovery from depression.
In turn, the CRA model were utilized as the framework acceptable for clients facing social issues and mental health concerns associated with substance abuse disorder (Morin et al., 2017). Morin et al. (2017) cited Hunt and Azrin (1973) to prove that, according to a CRA-based randomized clinical trial with 16 participants, the application of a combination of a medicine-based and CBT based approach was vital. In the study, the CRA group was represented by eight participants, whereas the other 8 were included in the 12-intervention group. Six months after treatment, people who adhered to the CRA procedure showed certain improvements since they recounted drinking on 14% of the days, while the 1-step interventions reported drinking on 79% of all the days (Morin et al., 2017). It was also asserted that the CRA group frequently utilized the mental health procedures and had higher rates in employment as compared with the 12-step group (Morin et al., 2017). In addition to the therapy, Miya was provided with antidepressants, clonidine, and benzodiazepines. Benzodiazepine and clonidine have reduced withdrawal symptoms and irritability, while antidepressants have reduced depression (Addiction Center, n.d.). The dosage varied depending on the sobriety and the rate of withdrawal that Miya showed.
Applicability of the Intervention to the Client and the Practice Setting
The intervention was applicable since it recognizes drug abuse chronic condition and the challenges associated with its treatment. It took long-term and repetitive treatment to achieve sobriety since individuals cannot be cured for stopping to take drugs for few days. The recommended interventions were aimed at stopping Miya from using drugs and being productive in society.
Additionally, various principles lifted form a range of theoretical frameworks supported the treatment. One of the principles was understanding alcohol misuse as a complex and treatable problem, which motivated the doctors to pursue the cure for the best outcomes for the patient. The bulk work involved in the treatment is the detoxification and management of the withdrawal symptoms. Behavioral coaching helped the patient cope with the symptoms and the challenges of ceasing the rug abuse.
All treatments could be determinant for the failed or successful treatment. Early access to treatment by the client enabled the physician to manage the condition quickly and effectively. Setback on seeking medical treatment early rendered an individual vulnerable to exacerbations which can worsen the situation. Staying in the treatment for the recommended time improved patient outcomes. Behavioral therapies and cognitive treatment are the most recommended interventions for alcohol and drug addiction as they focus on eradicating problematic emotions and behavior. Medication is used as a secondary measure in conjunction with CBT with the help of licensed healthcare professionals. The most important thing is to review and modify the plans weekly depending on the patients’ outcome.
Methods
The primary intervention was CBT, for which motivation interviewing and guided self-change, which helped her cope with the depression episodes and accelerate her recovery, were used. CBT involved teaching individuals with substance use disorder how to find a connection between their feelings, action, and emotions and increase their awareness of their influence on recovery. In the case of Miya, it helped her maintain sobriety and be a responsible community member. Behavioral Couple’s therapy (BCT) and Community Reinforcement Approach (CRA) were integrated as two CBT techniques. As stated by (Camacho et al., 2020), BCT strengthens support for abstinence from drug abuse and rebuilds relationships among individuals seeking drug abuse. Evidence has shown that BCT increases the number of positive activities, improves their communication and negotiation skills, improves their expression of feelings, and active listening for substance abuse disorder individuals.
When combined with medication, BCT provided positive outcomes for an individual that considers both psychological and pharmacological perspectives. BCT allowed Miya’s mother to overcome resentment and enabled her to overcome fear and distrust feelings. Miya was able to express her emotions and past behavior, and the mother was able to listen and share her contemplations with the counselor actively. CRA is an intervention based on social learning theory to organize and personal and community reinforcements. CRA is effective for clients facing professional intimate and social issues (Morin et al., 2017). The therapy aims to help Miya find her ways of meeting her social and emotional needs in healthy habits, which reduced the chances of taking drugs.
The Extent of the Implemented Intervention
The evidence-based intervention was conducted by the evidence-based standard and the intended plan of care to a greater extent. Some challenges occurred in the behavioral therapy as conflict occurred between Miya and her mother. This would cause disruptions during sessions. However, the disputes were instrumental in realizing the influence of the drugs on their relationships. Miya was highly adherent to the BCT sessions and the medication prescribed for her condition. This showed implementation fidelity in the dose and participation responsiveness dimensions.
Fidelity Checks
In the testing of the interventions’ fidelity, repeated measures were implemented, and the same participant took part in each condition of the variable. I met with Miya three times a week for four weeks to assess her treatment for a quantitative purpose. We measured the number of difficult calls that Miya had with her mother with a counselor’s help per week. After the market, Miya would be requested to rate the ring on a rule of 1 to 10, where 1 represented no conflicts and ten extreme conflicts. This allowed the counselor to monitor the changes in her social interaction with the mother.
Independent Variable
Procedures
Data were collected after every Miya’s phone call with her mother. The counselor met with the client three times a week and recorded every conversation between Miya and her Mother. The counselor used Likert, as mentioned above, in rating the conversation. This helped in monitoring the CBT response.
Measures
The objective measured the fidelity of interventions through testing the consistency and adherence to the treatments as a signifier that the intervention was carried out to a full extent. Variable took into account the patient’s compliance to the medication schedule, level of adherence to behavioral treatments and self-care, and satisfaction with the treatment. Medication-assisted therapy and assessment of co-occurring health issues were also assessed as they are essential in determining interventions’ validity.
Research Design
Self-report measures and observation methods during calls were the data collection tools. Self-report is information that is required directly from the intervention client. The reports were directly obtained from Miya and her mother without using a checklist. A third was invited to assess the environment in which the interventions were being carried out. Miya was advised to keep a journal as a way of identifying the stress coping strategies. Qualitative data focused on how Miya’s behavior was influenced by the calls she had with her mother.
Procedures
All the calls were made through phone and Telehealth due to the restrictions of COVID 19. After completing the sessions, Miya and her mother were asked several questions regarding their current feelings, expectations alignments, and the intervention. The third-party personnel made an objective observation, four times with the Miya and three times with the mother. The words did not interfere with the sessions as the observer did not make any suggestions or ask questions. The primary purpose was to create a commentary on the feasibility of the procedures carried out.
Measures
The main objective of the qualitative assessment was to determine whether the client was getting all the benefits. In the qualitative perspective of the interventions, the attitudes of the mother and the client matter the most. The assessment also focused on whether the interventions achieved their goals or not. Self-reported data were recorded in each session, encouraging the client to be express her feelings and emotions. The data were analyzed using thematic analysis.
Results
Quantitative Results
Pre-Intervention Results
The Client and the Mother kept on having conflicts during the sessions. Miya was willing to stop drug abuse, but at times, she would go back due to severe withdrawal symptoms and lack of commitment. The client was not satisfied with the treatments since she felt they were not quenching her urge to abuse drugs, and her depression symptoms worsened.
Post-Intervention Results
The data was themed into four themes: patient adherence and compliance to the treatments, behavioral change, accountability to self-care, and patient satisfaction. The patient attended all sixteen sessions and strictly adhered to the medications given. Regarding the client-mother relationship, the Likert score was above 8 for the first six sessions and after which it reduced gradually up to 1. This showed that the objective of improving the client relationship was achieved. Miya was satisfied with the interventions, especially the BCT, and reported changes in her feelings and emotions; she was willing to look for work, her communications skills with the mother and other people improved, and how to navigate through requests (Breitenstein et al., 2012). However, she reported that she felt the urge to take drugs at times, but the diary-keeping helped her control her emotions by going out for physical exercise.
Present Analysis of Change
Miya’s relationship with her mother changed, and they would converse on the phone without conflicts at the end of the sessions. She learned practical communication skills as well able to negotiate for requests with courtesy. She was willing to work. The client’s self-care measures increased, and she broke friendships with the group of addicts. She was compliant with her treatment and the sessions, which led to a gradual decrease in drug abuse to less than four times a week.
Qualitative Results
Pre-Interventions
Miya was not sure whether the interventions would work. She had mixed feelings. The mother disliked her, and she was skeptical of the treatment. She felt the drugs had damaged the life of Miya. The interviews were done in a feasible environment as reported by the third party.
Post and Present Analysis
The interventions achieved all the goals. Miya’s relationship with the mother was restored. She was able to cope with her emotions, and the signs and symptoms of depression were reduced. In addition, she reduces the number of times she would take drugs three times a week which was an outstanding achievement.
Discussion
Since it was a single case scenario, the study lacks generalization to a difference in patient characteristics. The self-reporting methods may be biased as the client may please the counselor and single studies lack scientific rigor. One threat to internal validity is subject variability, given that this was based on one client. The population is no enough to warrant inner truth, and time for the experimentation was too short.
The next step was monitoring the client by reducing the number of BCT sessions to two times a week. The counselor focused on reducing the episodes of drug abuse to zero and managing the withdrawal symptoms. As for the depression, the antidepressants were introduced gradually as Miya continued taking them for at least six months. The study has significant implications in managing substance abuse disorder and being used as a foundation for more lessons and managing other clients.
References
Addiction Center. (n.d.). How medications help with addiction treatment. Web.
Breitenstein, S. M., Gross, D., Garvey, C. A., Hill, C., Fogg, L., & Resnick, B. (2012). Implementation fidelity in community-based interventions. Research in Nursing & Health, 33(2), 164-173. Web.
Camacho, K., Page, A., & Hooke, G. (2020). An exploration of the relationships between patient application of CBT skills and therapeutic outcomes during a two-week CBT treatment. Psychotherapy Research, 2020, 1-11. Web.
Morin, J., Harris, M., & Conrod, P. (2017). A Review of CBT Treatments for Substance Use Disorders. Web.
National Institute on Drug Abuse. (n.d.). Treatment approaches for drug addiction Drug Facts. Web.