Levi has begun to withdraw from much of any social interactions, he has also avoided telling is family about his illness and avoids interactions with most of his friends. He has been able to obtain a variety of medications for anxiety, and often takes more than the prescribed dosage. In addition, he has had a cocaine habit that he views as his one area of excitement in life. His pattern of use is on weekends, or sometimes as a pick-me-up to get to work. He tends to use the anti-anxiety medications in the evening to help him relax and sleep. He sees his life slipping away in what has come to feel like an increasingly empty lifestyle.
In his initial interview Levi reports that he has been feeling more own lately. He claims that he enjoys work because he can escape into what he is working on and references himself as if he were a robot even during this time. He struggles with being alone and feels like the world crashes down on him when he leaves work. He claims that all though he made a vow to be celibate after his diagnosis that he still has the desire to feel love. He has tried multiple hobbies to occupy his mind but feels as if they are just ways of passing time as his life goes by.
He expresses a desire to somehow have a normal pre diagnosis life and that dreams of such keep him awake at night. He also admits that he has not been honest with his therapist over the last 10 years. He has been using tranquilizer to get through the weekdays, and then cocaine for a little excitement on the weekends. He says he feels as if he has a relationship with the drugs and that the relationship is not working for him any longer. He no longer is getting the same feelings from the drugs and admits that he now feels anxious, jittery and even paranoid on occasion post use.
He says he feels weak at times and has been losing weight. Levi feels that he may need help with his drug use. “Treatment planning involves identification of the specific problem areas that need changing and the intervention strategies that are best suited to a given individual” (Carrey & Correct, 1998, p. 742). Most importantly, it builds trust. Van Wormer and Davis (2013) posit that it is as simple as telling the client that “you are interested in what brought them in to see you and what they want to get out of your time together” (p. 389).
Treatment planning also sets a “standard” and a “plan” so that the client and therapist are on the “same page. ” For the therapist, it provides an outline needed to treat the client so that therapy can o smoothly. It also provides the therapist with time-management. For the client, it provides them with set goals in writing so that they understand the process. It also provides them with a detailed plan of what is to be expected. In order to meet Levies needs in the areas of improving, a clinician will most likely find that cognitive behavioral therapy and residential treatment may be beneficial to use.
Cognitive behavioral therapy (CB) is one of the primary techniques in psychotherapy. The aim of CB is to address problematic thought processes, maladaptive behavior and dysfunctional emotions via hysteretic methods and processes that are anchored in achieving goals. In the case of addiction, CB treats addiction and substance abuse as having resulted from dysfunctional development in behavior, management of behavior and thinking and this manifests in an addictive and dependent personality. The theory proposes that doing away with addiction and controlling addiction impulses and problematic behavior can be learned.
While going through CB, Levi will be able to identify her problematic behavior, the causes of his addiction and abuse, and having clarified and zeroed in on them, learn to correct them. Essentially, CB is a collection Of strategies learned step by step which allows the individual self-control, mastery over impulses and desires. By using CB, Levi will learn coping mechanisms, come to understand the negatives of continued drug use, and learn self-monitoring techniques to identify and curb risky behavior.
Residential treatment (ART), which is currently recommended, actually places the substance abuser in a facility where care staff and experts who oversee their treatment monitor them. For Levi, this is a combination of medication, psychotherapy, physical activities, social activities, and counseling. The target is to support, guide, and monitor the client in completing this treatment plan, wherein the target is for the client to be rid of said addiction through the course of the plan. The continuum of care for addictive and compulsive behavior will be an important element in the plan.
Additionally, the plan will take consideration Of the particulars Of the client to fit the plan to the client’s needs, situation, and personality. Wendell, Brown and Beck (2009) suggest that “in the first session of counseling with suicidal patients, the following strategies should be used: (1 ) discuss structure and process of treatment, (2) emphasize compliance by the client to the treatment intervention, (3) complete risk assessment, and (4) complete a safety plan” (p. 132). The basic suppositions fundamental solution-focused therapy is that there are positive changes and outcomes.
The goal is to counter problems presented by the client by stipulating them with incremental, sensible and achievable changes, and new opportunities. Treatment planning would be based on the solutions focused therapeutic approach. The assessment process in solution-focused therapy centers around five focus-based questions that include: (a) goals, (b) calling, (c) miracle questions, and (d) exception (Van Wormer & Davis, 2013). The goal-directed question focuses on what will be accomplished in the therapeutic sessions. Scaling involves drawing out feelings, moods and other attitudes that are not openly communicated.
An “exception to the problem guides the client to think of how her life would be if and when there were no problems. Finally, the miracle question requires the client to hypothetically envision if a miracle happened and the problem was solved, what he or she would be experiencing (Bliss, 2009). This combined intervention of a person- entered and solution-focused approach as a treatment plan is to focus on the “here and now” meant to bring about client knowledge of self (which is person-centered) and knowledge of client ability (which is solution-focused therapy).
In the preceding therapy model discussion described, I suggest the Motivational Interviewing Model as the most effective way to correct his troublesome conduct, and deal with the tragedy of a life threatening illness and drug addiction. Levi must be placed in a rehabilitation centre where he can be given all proper attention and care, as well as medical intervention, ND psychological and psychiatric counseling. Loneliness seems to be the biggest trigger for Levi; learning to deal with isolation and not hiding from his diagnosis is at the forefront of treatment for him.
To achieve an overall positive change in Levi, he must undergo a complete rehabilitation program, which will help palliate his sufferings during that entire period of intervention. During the rehabilitation program, Levi would be educated about the evils of drug abuse, and exposed to other positive activities which will help rebuild his life. During this time he should address his illness with his family and begin to ark on building a support system within them.
He will be helped to either make arrangements to take a leave from his current job or to find jobs from which he could earn a living when he completes his treatment. After discharge from the rehabilitation center, would suggest frequent follow-ups, interviews and visits be arranged for him. The whole family should be supervised and counseled for the next few months to help them all deal with the diagnosis of a terminal illness. Levi should have very defined treatment Goals to motivate him throughout his recovery. Levi should be taught to understand the concept of addiction.
His illness is not one which will disappear so he will need to find ways to alter life aspects that will lead to drug-free lifestyle. It is suggested that he gain insight regarding the impact of addiction on self and family relationships and begin the healing process. Reestablish family relationships so that he does not feel so alone and has a support system to go through his illness with him. Everyone needs a shoulder to lean on and with a terminal diagnosis he needs his family by his side for himself and for their benefit as well.
This connection will establish a positively influencing sobriety-centered support system. Levi should find ways to have a social outlet as well. It is unhealthy for him to withdrawal from friends and family. He needs to live life to its fullest and not be scared to share his love with others. The objectives for Levies treatment are to attain an increased knowledge of the addiction/disease concept. He should be able to gain and verbalize increased insight regarding the severity and negative impact of addiction on self, family, and society.
A major objective is for Levi to share his diagnosis tit his family and reestablish family relationship as a means of support through both his recovery from addiction as well as his HIVE diagnosis. Before he is released from the facility he should gain and implement knowledge obtained regarding relapse prevention process. In doing this he should be able to learn and verbalize plans to live a chemical-free lifestyle. Levi must learn to not keep within himself and recognize that loneliness will be a trigger for his recovery.
He would benefit from associating with productive and sober persons. When we talk of relapse, we are referring to the possibility of Levi ailing back into cycles of social withdrawal and drug use. To prevent a relapse means identifying the signs of relapse and preventing the high-risk situation it brings back from taking form. It is suggested that Levi follow Marital & Cordon’s relapse prevention model, as well as Gorse’s relapse prevention model. Marital and Cordon’s model lists a taxonomy factors that can lead to relapse.
The taxonomy is a detailed description of factors and elements that can lead to relapse that fall into two categories: immediate determinants, I. E. Coping skills and high-risk situations and covert antecedents, I. E. Urges, compulsions, and imbalances in the lifestyle (Laramie, Palmer & Marital, 1999). Treatment for relapse begins with an analysis of the environment and situation of the individual whereby the counselor is assessing the context of the lifestyle and environment of the person to determine the presence of the factors and elements that can likely lead to relapse (Laramie, Palmer & Marital, 1999).
The idea is to target weaknesses and devise ways of coping and spotting by providing the client with cognitive- behavioral skills and instruments to help prevent a relapse. Following cognitive-behavioral models, Levi can be armed with understanding his symptom stresses and other high-risk situations. Marl and Gordon focus on the cognitive aspect of relapse, Gorse’s approach is biophysically approach. Family origin issues, brain dysfunction, personality disorientation and social dysfunction are incorporated in this approach to relapse prevention.
