Combating Alcoholism and Addiction

vignette pertaining to addiction. Ethical and legal factors will be considered. Also discussed will be cross cultural matters related to the topic. Possible solutions to the issue at hand will also be considered.

Middle-aged couple, Anna and James, drops in for an appointment as Kevin, their son aged 16 years, faces suspension from school because of 'drug paraphernalia' found in his school bag. While James is Native-American, Anna is Japanese-American. James goes on to say that it is all Anna's fault, stating that she has smoked pot on a daily basis for the most part of their married life. Anna is of the view that she at least isn't a slobbering drunk like James, further elucidating that James over-indulges in drinking alcohol on weekends. It is discovered, in the course of assessment that James as well as Anna come from alcoholic homes.

Session one

Much is to be taken into consideration with Kevin and his parents. Firstly, both James and Anna need to describe their addictions, or possible addiction behavior to see whether it is a problem.

Certain instruments can be found that assist counselors in determining whether or not further evaluation is warranted, whether the client has any mental disorders, nature as well as extent of substance abuse, kinds of traumatic events experienced by the client and their consequences, and factors related to treatment, which influence client reaction to interventions. No specific screening recommendations and evaluation instruments for women are necessitated by this Treatment Improvement Protocol (TIP); it doesn't aim to raise a comprehensive analysis of this multi-faceted topic (Screening and Assessment). Instead, it gives a brief description about several tools often used by providers to study aspects of the lives of female clients. Preconceived beliefs may be held by intake personnel and counselors regarding the occurrence of drug abuse in women belonging to specific ethnic groups, which is the case highlighted in this vignette. Counselors may, for instance, neglect the need for screening and assessing Asian women. Every assessment staff member must be trained with regards to the ethnic and cultural groups they work with which in this case is Native American and Japanese; the right communication and interpersonal styles to be used for successful conversations with both the clients; and cultural practices and beliefs regarding use and misuse of substances, physical and mental health, trauma and violence in their own homes and lives in general. Counselors can, by way of training, learn the cultural factors that should be taken into account for accurate testing of the two clients in this vignette. Level of acculturation may influence assessment and screening outcomes. Counselors might need to substitute standard approaches for assessment and screening with in-depth talks with both clients and, possibly, also their 16-year-old son, for understanding substance usage from the cultural and personal viewpoints of all the clients involved. Migration experiences should be examined; some immigrants might have faced ordeals in their native countries and will require a sensitive assessment of trauma (Screening and Assessment).

Another point to be investigated is whether there is any family history of neuro-cognitive illnesses like Prion disease or Huntington's. Common symptoms that signify these diseases comprise delusions, paranoia, and probably hallucinations. Another quite common symptom can be agitation (DSM-5).It can emerge as a highly combative behavior, especially in case of caretaking tasks, that include combing hair, bathing, and dressing as well. Behaviors observed in these diseases could take one towards addiction and alcoholism as a means to cope. This is why it is imperative to examine both parents' family histories to determine its root cause.

It is definitely traumatic to grow up in alcoholic families. Children, in such homes, are faced with a routine environment of fear, inconsistency, chaos, denial, abandonment, and potential or real violence. Surviving in such environments is a round-the-clock job. Post-Traumatic Stress Disorder (PTSD) also gives rise to a 'psychic numbing' condition, experienced in the form of an estranged feeling, and a sense of detachment to the extent of believing that no group or place exists where one truly belongs (Helping Children From Addicted). Emotions get constricted, particularly in areas of affection, intimacy, and sexual involvement. It is no wonder that such kids are eight times more liable to becoming addicts or marrying a drug addict / alcoholic. In case of Anna and James, the above-mentioned behavior is observed to some extent, as they both hail from alcoholic homes.

It appears as if the cycle has now passed on to their son. Judging from the information we possess, this cycle is carrying on. Issues that should be investigated include whether or not the boy is using those drugs found in his possession, how did he access it, reasons why it was needed and whether the cycle can be ended.

Session 2

Diagnosis: James, Anna, and their son all have addiction behaviors attributed to alcoholism and drugs.

An assimilated model is required to combine treatment of substance abuse with family therapy. For this Treatment Improvement Protocol's (TIP) purposes, this term denotes a group of interventions taking into consideration (1) issues of every family member related to substance abuse (probably a spouse overindulging in drink, another who permits drinking, and a kid who imitates in response to parent's drinking habit), and (2) impact of every family member's problems on family structure (Integrated Models for Treating Family Members). Another assumption of this TIP is that though a substance use issue is exhibited in a person (for example, one individual who smokes crack cocaine); its solution will also be present in the family structure (such as new interactions which are in favor of not smoking crack cocaine).

Specialized addiction and addiction-recovery knowledge has been acquired by counselors for substance abuse. They may also make use of personal experiences of recovery. They may, however, be unfamiliar with the techniques and theories linked to family interventions. Although they are generally knowledgeable with regards to the influence exerted by family on a member's alcohol / illicit drugs use, counselors may, at times, perceive family problems as being a threat to client recovery, especially if the individual, who abuses substances, feels overpowered and incapable of coping with family reactions to treatment, as well as the strong emotions aroused as a result of treatment (Integrated Models For Treating Family Members). The goal of the counselor is patient recovery, and issues like family pressure, which threaten goal attainment, shouldn't be permitted to distract clients. On the other hand, family therapists are well-aware of family system operations. They may, however, not completely understand the stresses and needs of individuals suffering from substance abuse conditions. Clients themselves might perceive a family therapy recommendation as going back to repetitive conflicts within the family, and emotional tumult.

Ethical and Legal Considerations to Take Into Account

Two legal/ethical issues come to mind when looking at this family:

When it comes to dealing with any addiction or dependency and coming up with a treatment plan there are many ethical and legal considerations to be taken into account. Confidentiality is a big concern in regards to addiction treatment plans. The Substance Abuse and Mental Health Services Administration (SAMHSA) has given many reports in the past explaining confidentiality requirements (NIH-Legal and Ethical Issues). Major parts of these requirements do apply to direct practitioners. However when it comes to treatment program administrators nothing is set in stone. Considering that this family will be doing a treatment program run by administrators instead of a practitioner confidentiality concerns could be a big issue to crop up.

Alcohol treatment programs as well as others have standard policies against working with patients who relapse. Furthermore, sobriety is considered to be a behavior needed in order to continue treating the patient. A number of programs are additionally recognized to have rules against conversing with intoxicated patients. These standards have been founded on the notion that drinking patients ought to not be provided social support that might cut down their level of sorrow (hitting-bottom) as well as weaken their desire to be sober (NIH-Legal and Ethical Issues). Treatment providers do have obligations to treat the diseased and therefore they should tolerate the manifestations that can come with it. Denial is sometimes seen as a part of alcoholism and therefore it would be unethical to terminate any treatment of a patient who is manifesting those symptoms.

Treatment Plan:

The initial step for addressing addiction that involves alcohol, nicotine, and other drugs is, usually, assisting the individual in quitting substance use (Designing an Addiction Treatment Plan). This should take place prior to beginning treatment. In some instances, hospitalization or medical supervision is needed to clear the system of toxic substances, a process termed as stabilization or detoxification.

- Thus, if any presence of alcohol or drug traces can be identified in parties during the meeting, a 3- day detox plan will be devised.

Addictions are also treated by using medications. These medications work by diminishing withdrawal symptoms and cravings, diminishing rewards or highs linked with substance usage, and/or acting as less harmful substitutes.…