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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.

The text (pg. 108) describes the phenomenon of “therapeutic index.” Addiction to barbiturates can be critical in terms of lethality as measured by the therapeutic index. Provide an example, which explains how this phenomenon might lead to an accidental overdose. Why is this factor more critical with barbiturates than with other classes of depressant drugs?  For follow-up discussion, respond to at least two of your peers.

 

The therapeutic index is the lethal dose for 50% of mice/the effective dose for 50% of the mice. Because the lethal does should always be higher than the effective dose, the therapeutic index should always be higher than 1 (Hart, 2012). The higher the therapeutic index, the safer the drug is. For example, valium can have a therapeutic index of 770. That means that a person would have to take 770 times the amount it would take for sedation in order to take a lethal dose.

 

Barbiturates alter central nervous system activity. According to Barbiturates Overdose, barbiturates have a very narrow therapeutic range. In other words, the drug can be dangerous if you take an amount not much greater than the standard dosage amount (Barbiturate Overdose, 2013). This makes it much easier to overdose.

 

For example, let’s say a person takes a Nembutal to calm his anxiety down. He also has a couple of drinks. Then he is still feeling anxious so he takes another Nembutal. Then without giving the Nembutal enough time to kick in, he takes another four because he is impatient and wants it to start working. The standard dosage was one pill and he took six. This was six times the standard dosage amount and the therapeutic index was six. This leads to an overdose.

 

References

 

Barbiturate Overdose. (2013). Retrieved from http://www.drugaddictiontreatment.com/types-of-addiction/prescription-drug-addiction/barbiturate-overdose/

 

Hart, C. L., & Ksir, C., (2012). Drugs, society, and human behavior (15th Ed.). New York, NY: McGraw-Hill. Retrieved on February 28, 2015

There are numerous screening instruments available to help counselors assess and diagnosis substance use disorders. What are the advantages and disadvantages of using standardized instruments to assess and diagnose clients?

There are several advantages and disadvantages of using standardized instruments to assess and diagnose clients. Because information gathered from a standardized test can be compared to the normal population, a counselor can use the information as part of the clinical decision making process. The information can also be useful when working with a client that is in denial or is in resistance to their substance abuse addiction. For example, a client could debate that drinking a liter of vodka per day is normal because his parents both drink a liter of vodka per day. However, compared to the normal population, drinking a liter of vodka per day is a strong indication of alcoholism. Data gathered from a standardized test has the benefit of objectivity. A client cannot accuse a counselor of being biased or opinionated just because he wants the client to go to treatment because that is how he gets paid. Substance abuse addicts often minimize their drug use. Therefore, there are standardized tests which indirectly screen individuals for substance abuse. (Capuzzi, 2012). Standardized tests are good for many reasons as mentioned. However, a standardized test cannot be customized to better suit the needs clients. Standardized test can also become outdated.  

 

Capuzzi, D., & Stauffer, M. (2012). Foundations of Addictions Counseling. Upper Saddle River, NJ; Pearson Education.

Transitioning to Closure

There are several tasks that will need to be accomplished with a member that will be terminating membership of an open group. First, members of the group should fully understand how to give notice and what steps need to be taken in order to appropriately terminate themselves from the group. Second, the member that is leaving will need adequate time to prepare emotionally for their departure. Next, other members of the group should have the opportunity to say goodbye. Different cultures view endings differently, and this should be taken into consideration. Lastly, a final individual session or follow-up call should be discussed and potentially scheduled. The group leader will need to get consent for this final session or phone call. Specifically, the group leader will want to review what the member learned during group counseling and how he will implement those things into his life moving forward. Referrals will be made when appropriate (Corey, Corey, & Corey, 2010).

Third and Fourth Sessions

Checking in with the members of the group kicks off the third session. During the check-in, one of the members, Jesse stated: “I am not feeling very good about myself today.”

Group Leader: “Do you want to tell us why you are not feeling good about yourself today?”

Jesse: “Not really.”

Group Leader: “Jesse we are here for you and we want to support you. We can only support you if you are open and honest with us. Tell us what is going on?”

Jesse: “I used meth over the weekend. I put myself in a vulnerable situation and I relapsed.”

Group Leader: “Ok, do you want to share with us what happened?”

Jesse: “I went out on Saturday night with a few of my friends. We ended up at a party and before I knew it, I was high!”

Group Leader: “Does anyone have anything to say to Jesse?”

Jackie: “Jesse what were you thinking? You should have called me. I told you that I would be here for you if you were ever in a vulnerable situation!”

Jesse: “I know Jackie, I think that deep down I knew that I was going to come across meth if I went out with my friends.”

Jackie: “Why do you think that you put yourself in that situation?”

The group leader’s responsibility was to dig deeper and find out what was bothering Jesse. After further questioning, Jesse opened up and shared to the group that he had relapsed. The members of the group must be willing to share and be open with the group in order to have meaningful interactions with other members (Corey, Corey, & Corey, 2010). Jesse getting honest with the group continues to build group cohesion. Jackie stepping in and offering support shows that group cohesion is getting stronger.

Also during the check-in, another member, Michelle stated, “I was sexually abused as a child.”

Group Leader: “Do you want to share with us what happened?”

Michelle: “When I was 13 years old, my uncle Tom sexually abused me. He used to take care of me when my parents were out of town. He would get drunk and sexually abuse me.”

Group Leader: “I am really sorry to hear that Michelle. How are you feeling right now?”

Michelle: “I’m angry!”

Jackie: “I was also sexually abused as a child, so I can relate. I too was angry. I did not trust men until I finally was able to work through the trauma.”

Michelle: “How were you able to work through the trauma?”

There are many fears that the group members could potentially have including the fear of being vulnerable, the fear of rejection, the fear of self-disclosure, or the fear of being judged (Corey, Corey, & Corey, 2010). Michelle opening up and sharing such a thing shows that she is feeling trusting and comfortable with the group. It is the group leader’s job to make Michelle feel safe, to fully recognize what happened to her, and to assist her in working through the event (Corey, Corey, & Corey, 2010). Depending on how severely Michelle is affected, it might be best to refer her to individual therapy to work through this traumatic event.

The third session closes with homework being given, to complete a Relapse Prevention Plan, which will be due in one week.

During the fourth session check-in, Mike states, “I got wasted at the game on Sunday. Not only did I get wasted, but I also drove home.”

Group Leader: “Wow Mike! That came out of the blue. Do you want to share with the group what happened?”

Mike: “I went to the game with a bunch of guys from work, and they were all drinking. I didn’t want to tell them that I didn’t drink. Therefore, I thought it would be okay to have a couple of beers. Next thing you know, I was wasted. I drove home after the game because I did not want to have to call my wife to come and pick me up.”

Group Leader: “So how are you feeling about yourself right now?”

Mike: “I feel like a loser. I let myself down, I let my wife down, and I let you guys down.”

Group Leader: “Mike we are here to support you and love you. Does anyone else want to say anything to Mike?”

Jesse: “Mike, I am here to support you in anyway that I can. I wish that you would have called me prior to taking that first drink.”

Jackie: “You could have called me Mike. I would have given you a ride home.”

Michelle: “How were you feeling prior to the game? What was going on that you were in a vulnerable place?”

The group leader’s job is to provide a balance between confrontation and support. It is the group leader’s job to support Mike in taking a risk and opening up to the group. Getting him to reflect on his behavior will promote a deeper level of self-exploration (Corey, Corey, & Corey, 2010). The members of the group want to love an support Mike as well. The group leader does a good job getting the members of the group to speak up.

Second Session

Because the group will composed of recently clean and sober adults, it is going to take more than one full session for the level of trust and comfort to be at a place where productive group work will take place (Jacobs, Masson, Harvill, & Schimmel, 2011). During the first part of the second session, the beginning stage will come to an end as the trust and foundation of the group are still being formed. An activity designed for the members to get to know each other individually will be next. The group will break up into dyads, and select a new partner every 10 minutes. Questions asked of each member will include:

  • Why do you want to be clean and sober?
  • What do you expect to get out of the group counseling experience?
  • What is your biggest fear about the group counseling process?
  • What is your level of trust in the group? What is contributing to your trust or mistrust?

During this session, one of the members, John stated: “I am uncomfortable being with groups and I really do not want to be here.”

In response to this statement, this writer herein described as Group Leader stated: “John, tell me more about why you are uncomfortable being with a group?”

John: “I do not know the other members of this group. Why would I want to open up and share with complete strangers?”

Group Leader: “If you got to know the other members of the group, would you feel comfortable being in this group and would you want to be here?”

John: “I guess so.”

Group Leader: “Does anyone else have anything to say to John?”

Jackie: “You and I have had several conversations and I feel comfortable opening up to you. I have learned from you and I think that you are an important member of this group.”

Michelle: “I think that you are an important member of this group and I too am glad that you are here.”

Group Leader: “What do you think about that John?”

John: “Wow, I had no clue. Knowing that other members of the group like me makes me feel more comfortable already.”

It is important here to get John to open up and express how he is feeling and what he is thinking. This will promote group cohesion and trust will start to be established if the facilitator can get him to share (Corey, Corey, & Corey, 2010). Getting other members of the group involved in the discussion helps John see that he is an important part of the group and it makes him feel more comfortable.

Checking in with all of the group members closes the session.

Group Goals

There are many goals that I can think of that individuals with a substance condition might have. However, I have narrowed the list down to five goals:

  1. Each member will confront difficult issues in his life and learn a technique to handle the issues more effectively.
  2. The members of the group will provide a supportive network for the other members of the group. Members of the group will support each other by listening, caring, opening up.
  3. The members of the group will learn more effective ways to handle difficult social situations. Difficult social situations will be discussed during the sessions.
  4. Each member will complete a relapse prevention plan and share it with the group.
  5. Members of the group will provide constructive feedback to other members of the group.

According to the information at http://samhsa.gov/, the United States substance abuse policies are geared towards creating communities that promote emotional health to reduce the likelihood of substance abuse. The policies are focused on education and prevention. For example, National Prevention Week is a SAMSA-supported event dedicated to increasing public awareness of substance abuse and mental health issues. The event is an opportunity to promote prevention, educate about behavioral health issues, and create and strengthen community partnerships. Other programs, events, and resources focused on prevention include Stop Underage Drinking, Too Smart to Start, Communities That Care (CTC), Drug-Free Workplace, and many more. The economic costs of drug use are gigantic in the United States. Furthermore, drug-induced overdose deaths now surpass homicides and car accident deaths in the U.S. The Obama Administration’s plan to reduce drug use in the U.S. includes a science-based plan, the National Drug Control Strategy. According to Dr. Nora Volknow, a person addicted to drugs has lost the ability to exercise free will. According to Gil Kerlikowske, Director, National Drug Control Policy, “drug policy reform should be rooted in neuroscience- not political science. It should be a public health issue, not just a criminal justice issue. That’s what a 21st century approach to drug policy looks like.” Science has demonstrated that addiction is a disease of the brain that can be both prevented and treated. The National Drug Control Strategy is focused on education and prevention.

Because the chemical processes that occur during the activities of a process addiction are similar to the chemical processes that occur during substance abuse, it is challenging to differentiate between the two. Although there are similarities, there are also clearly defined differences. Substance addiction occurs from the abuse of alcohol, drugs, or any mind altering substance. Process addiction occurs from engaging in activities or behaviors and is not dependent upon substances.

A process addiction is a condition in which a person is dependent upon an activity or behavior, such as sexual activity, overeating, gambling, or shopping. The reward or relief a person gets from engaging in one of the activities listed above is what he compulsively pursues, despite negative consequences. Process addiction does not involve any addictive chemicals or substances. However, there are chemical processes which occur during the activity which are similar to chemical changes that take place during substance abuse. (Smith, 2012). Process addictions are often overlooked or overshadowed by substance addictions as not being “real” addictions. This is unfortunate as the negative consequences of process addictions are no less than the consequences of substance addictions. Negative consequences include everything from loss of significant other, home, or family to loss of self-esteem, confidence, job, or money.