Which of the risk factors for substance use are present in your community of origin, or a community in which you currently live or work? Are there other factors that were left off the list?

An online search was conducted regarding risk factors for substance use, which are present in my community of origin. A youth survey was found for the State of Louisiana, Parish of Caldwell, of which I reside. The Louisiana Caring Communities Youth Survey Results for 2008 presents some information for Caldwell Parish regarding risks factors that consist of the main categories of demographics, social, behavioral, and individual. The chart given in the results of the youth survey involved the risk factors of community, the family system structure, school, and peer/individual, with demographics presented involving certain age groups of adolescents (Louisiana Department of Health and Hospitals, 2008). However, there were no demographics regarding gender given in this article. The information reveals that economic and social problems exist, which contribute to the substance abuse problem within the parish community. The community also suffers from a disorganized community structure that is causing a detachment in the neighborhood. This community a small rural area with very little funding for substance abuse prevention and treatment, which is a major concern for our community as the drug problem continues to escalate. The article shows that family problems exist within the community such as conflict and management of the family structure. Problematic behaviors in our parish such as alcohol and drug abuse are prevalent among the adolescent population. Such behaviors are family-oriented as many parents of the adolescents within this community are abusing substances. The Louisiana Department of Health and Hospitals (2008) also presents some evidence that show problems in the school system such as a lack of commitment, behaviors of an antisocial aspect, and failure in academic achievement, which contribute to substance abuse (p. 4). These problematic behaviors contribute to a high dropout rate. When examining the peer/individual risk factor listed in the youth survey, it shows that peer pressure is high with a favorable attitude toward using substances. Also, the information reveals that rebellion and withdrawal is a contributing factor to the drug use in my community. This information shows a strong need for more education and a greater awareness of the need for more funding and interventions before our community erodes even further.

There are other factors that interfere, which are not listed in this information. However, I have personally witnessed them, such as politics. This is a very political community that unfortunately, makes money off of our youth and adults who are using drugs by charging fines and putting them back on the street with no form of rehabilitation. As a past advocate for helping those abusing drugs, I witnessed the court system charge individuals $500.00 each and place them on probation for six months, knowing that these individuals would be arrested again so that $500.00 more could be charged. This is a major problem within our local court system.

Also, our local mental health behavioral health clinic does not have anyone on staff with a college degree other than a lady who represents a whole district of parishes. Most of her time is spent traveling from one clinic to another. While in a bachelor’s degree program, I wanted to take a class that required that I spend some time at a local facility to learn about how to conduct group counseling sessions. When I contacted this particular facility, I was told that they were too busy. This proves that our local parish has a disorganized structure, as indicated in the youth survey that was reviewed.

 

References

Louisiana Department of Health and Hospitals. (2008). The Louisiana caring communities youth survey results for 2008. Retrieved from http://dhh.louisiana.gov/assets/docs/BehavioralHealth/publications/CCYS2008-Parish/9162.pdf.

What are the unique challenges in treating someone with an anxiety disorder and a substance use disorder? 

There are unique challenges in treating someone with an anxiety disorder and a substance use disorder. I have personal experience with someone who had an anxiety disorder. She used to have panic attacks on a regular basis. If she had a few drinks, she would not have a panic attack The drinks would help her relax. She would also take xanex on a regular basis. The xanex or alcohol was a way to self-medicate. Therefore, after the medication would wear off, the anxiety would surface. Often times, the anxiety would be worse than it was prior to drinking alcohol. I also had to take this woman to the emergency room several times because she literally thought that she was dying. When I would take her to the emergency room, the doctors would look at her like she was crazy. She was obviously not the first person that came to the emergency room due to a panic attack. It is so interesting how a person can actually think that they are going to die even though everything is perfectly okay.

 

When treating someone with both anxiety and a substance abuse disorder, both disorders need to be treated. The client could have resorted to self-medicating the anxiety, which in-turn could have caused the substance use disorder. Or the substance use disorder could have caused the anxiety disorder.

Description and Purpose

The Drug Abuse Screening Test (DAST) is a self-report survey tool that was designed in 1982 by Harvey Skinner. The questions are modifications from the Michigan Alcohol Screening Test (MAST). It is used to determine if a person might have problematic drug use during the past 12 months. The classes of drugs tested are not limited too but include cannabis, solvents, tranquilizers, cocaine, stimulants, hallucinogens, barbiturates, and narcotics. Alcohol and tobacco are not included in the test. The DAST is used for purposes of screening and includes 28 binary (yes or no) questions related to prescription, over-the-counter, and illegal drug use. The test takes a total of 5-10 minutes. Each question yields a value of one point. Therefore, a total of 28 points are possible. A low score is an indication that a person does not have a problem with drugs. A high score is an indication that a person does have a drug problem (Yudko, Lozhkina, & Fouts, 2007). There are two other versions of the test, DAST-20 and DAST 10.

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In general, males have a higher risk of suicide. Jay is a male, which increases the risk of suicide. This risk of suicide increases as a person gets older. Jay is 56 years old, which increases the risk the risk of suicide. Not being able to see his family, being unemployed, and going through a significant amount of his retirement has sent him into severe depression. Being depressed increases the risk of suicide. Based upon the information given, Jay has not attempted suicide in the past. Jay’s alcoholism is at its worst. He cannot stop drinking. Even though his life is falling apart, he could not keep his job, and his friends want nothing to do with him, he is not able to stop drinking. Having a substance abuse disorder increases the risk of suicide. Based upon the information provided, it is not obvious that Jay is experiencing rational thinking loss. Jay has lost all of his social and family supports due to his alcoholism. His friends and family want nothing to do with him as long as he is active in his addiction. Having a lack of social supports increases the risk of suicide. Based upon the information provided, Jay does not have an organized plan to commit suicide. Jay is separated and his wife has filed for divorce. He lives by himself. Being single increases the risk of suicide. Based upon the information provided, Jay is not experiencing any sickness.

According to Assessment in Counseling, the higher an individual scores on the SAD PERSONS Scale the higher the risk of suicide. An individual with a score of 0 to 4 has a low risk of suicide, 5 to 6 medium, and 7 to 10 high. Jay’s score is a 7 out of 10 and the risk of suicide is high.

Risk Assessment (cont’d)

According to the SAD PERSONS Scale, Jay requires a risk assessment. The SAD PERSONS Scale provides a basic acronym for ten factors to be mindful of when determining if a client requires a risk assessment (Hays, 2014). The ten factors include Sex, Age, Depression, Previous attempt, Ethanol abuse, Rational thinking loss, Social support loss, Organized plan, No spouse, and Sickness. According to the SAD PERSONS Scale, an individual will receive a point for a positive answer to each of the following factors: sex is male; under 19 years-old or over 45 years-old; depression is present; previous attempt at suicide; ethanol or other substance abuse; rational thinking loss; social supports minimal; organized plan; widowed, divorced, or single; sickness.

Risk Assessment

The following questions would be a compliment to the information provided in the section above:

  • Do you think that you would be better off dead or do you wish you were dead?
  • Do you have thoughts of injuring yourself or others?
  • How often do you think about suicide?
  • Do you have a plan to carry out the suicide?
  • How would you commit suicide?
  • Do you have the weapons or items necessary to commit suicide?
    • What are the items or weapons?
  • Would you deliberately injure yourself without intending to die?
  • If you did commit suicide, would you hope to be rescued?
  • Have you ever attempted suicide in the past?
  • What do you think will happen to your wife and kids if you commit suicide?

Discussion

There are several reasons why Jay requires a risk assessment. Individuals who have psychological distress or mental disorders are significantly more likely than others to be vulnerable to suicide. Further, stressful situations are many times the precipitating cause of suicidal ideation (Hays, 2014). Jay is in a stressful situation as his wife has left him and filed a restraining order against him, he is unemployed, and he does not get to see his kids. Substance abuse significantly increases the risk of suicide for a client. The suicide risk for a person that abuses substances is fifty to seventy percent higher than normal individuals (Berman, 2006). Jay is an active alcoholic, and his alcoholism is as bad as it gets at this moment in time. Finally, Jay has recently had thoughts of wishing he were dead. As described above, several of the red flags for a person that might potentially commit suicide are present. Jay is definitely a potential suicide risk and he requires a risk assessment.

This post discusses the scenario of a guy that requires a risk assessment along with the reasoning behind why he requires a risk assessment. In the last section of the paper, the writer outlines how he would assess the client.

Scenario

Jay is a 56-year-old Caucasian man. Jay is slightly underweight and 6’4”. Jay has trouble maintaining eye contact. Jay also has a 5-year-old boy and a 10-year-old boy. Jay went to treatment for his alcoholism six months ago. He has since relapsed and his wife, Sue, has asked for separation. Sue has also filed a restraining order against Jay. Since Sue has filed a restraining order against him, Jay has only been able to see his kids on a limited basis. Further, Jay and his wife have burned through a significant portion of their retirement, as Jay has been unemployed for over a year. Jay was terminated due to his excessive alcohol abuse. His kids are his world and not being able to see them has caused him to go into a severe depression. Being unemployed and not having a purpose is making matters worse. Further, his close friends and most of the other people in his life want nothing to do with him until he can get his alcoholism under control. He admits to having frequent thoughts of wishing he were not alive. However, he denies having thoughts of actual suicide.

For the past several weeks, Jay has been living by himself in an apartment. He spends most of his time in isolation. He has gone to a few AA meetings. However, he is not willing to surrender to the program. Jay is only able to get a few days of sobriety at a time. He does not want to go back to treatment, because that will mean that he will not get to see his kids. However, Jay would desperately like to get back together with Sue. He desperately wants to be back living with and seeing his kids on a daily basis.

If Jay wants his wife and kids back, he needs to get and stay sober. The last treatment center he went to was across the country and most of the other patients were Heroin addicts in their twenties. Jay could not relate to these kids and he felt that the treatment was ineffective. He blames his relapse on the treatment center. Plus, treatment is a significant expense and he and his wife have already burned through a significant amount of their savings. Another option for Jay is sober living. However, Jay does not want to follow the rules and policies associated with the sober living home that he has looked at. He is open to sober living on his own terms. He wants his own room, he wants to come and go as he pleases, and does not want to be bound by rules. In other words, he wants his own apartment, which is a setup for failure.

Consider the physiological effects of the so-called “designer” drugs. Are these drugs any more dangerous than nicotine or alcohol?  

 

In my opinion, designer drugs or more dangerous than nicotine or alcohol. You don’t know what you are getting with a drug that was created in an underground or illegal lab. These drugs were created and not tested. You don’t know how strong the drug is, what is actually in the drug, or what the effects might be. Designer drugs are also known as “club drugs”. Take GHB for example. I was really into GHB back in the early 2000s. I cannot even count how many times I over-dosed and woke up in the emergency room. Every time I woke up in the emergency room, I was like, “f$%k, it happened again!” I used to take a cap of GHB, also known as “G”, and then take another cap, then another, then another, then a swig, then another swig. Next thing you know it was lights out and I was in the ER. While on G, I can remember losing things, losing my mind, not remembering where I lived, not remembering my door code. I remember a time when I was in a cab and I could not remember where I lived. The cab driver delivered me to a police officer, I was arrested for being under the influence in public, and I spent the night in jail. With alcohol, you know how much you are drinking and how potent the drinks are. You know what the effects of alcohol will be. It is much harder to drink so much alcohol that you end up in the emergency room. What makes designer drugs dangerous is the unknown factor. You don’t know exactly what you are taking, now much you are taking, and what the effects will be. Regulation and control make nicotine and alcohol much safer than designer drugs. 

There have been many legislative attempts at controlling the use of illicit drugs (whether prescription-type or otherwise). Why, or why not, have these attempts been effective? In your response, consider the root causes of illicit drug use. For follow-up discussion, respond to at least two of your peers.

 

There have been many legislative attempts at controlling the use of illicit drugs. Controlled substances or much more regulated today than they were even a few years ago. For example, physicians can see a patient’s prescription history very easily. They can log into a website and see which substances a patient has taken, when, how often, dosage, and they can see if a patient sees multiple physicians for the same prescription. In other words, a physician can tell based on a client’s history if he is a pill seeker. Also, all pharmacies are connected. A patient used to be able to go to multiple pharmacies to have the same prescription filled. This is no longer the case. A patient’s prescription drug use history is available to all pharmacies. This is a good way to minimize prescription substance abuse.