SoCW-6202-WK4-Discussion

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Discussion: Over-Treatment and Under-Treatment of Addiction

The term levels of treatment refers to a continuum arranged by intensity of treatment. The levels of treatment range from the least to the most intense and aggressive approaches. The American Society of Addiction Medicine’s Patient Placement Criteria (PPC), the most frequently used and studied treatment levels classification system, divides the intensity continuum into four levels (Mee-Lee & Gastfriend, 2008). The PPC starts with Level I, outpatient treatment, which includes the least aggressive approaches. The system increases incrementally in intensity ending with Level IV, intensive inpatient treatment.

The appropriate level of treatment is determined by many factors, including the severity of addiction, prior treatment history, and the unique needs of the individual receiving the services. It is often desirable to try the least intrusive and restrictive level of treatment appropriate, as long as the individual’s safety is not jeopardized. Other important factors must also be considered when determining the appropriate level of treatment, such as the need to continue earning a living or raising a family and the individual’s stage of readiness for treatment (Prochaska, DiClemente, & Norcross, 1992). Knowledge of the levels of treatment may help an addiction professional determine the most appropriate levels of care based on the unique needs of each individual. Over-treatment and under-treatment of addiction can interfere with a client’s progress on the path toward recovery and result in adverse consequences.

For this Discussion, review this week’s readings. Then review the media and reflect on how the counselor employed the continuum of levels of treatment in the counseling session with Marge

(PDF attached).

Consider potential consequences of over-treating or under-treating Marge.

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Post


an example of potential over-treatment and an example of potential under-treatment for Marge.

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Explain the possible consequences of your chosen example.

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As a helping professional, explain how you would mitigate the potential for over-treating or under-treating clients.

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Support your response using the resources and the current and seminal literature regarding such factors as levels of treatment, patient placement criteria, and client’s stage of readiness.

  • Needs to be 1 page in length or more

References (use 3 or more)

Doweiko, H. E. (2015). Concepts of chemical dependency (9th ed.). Stamford, CT: Cengage.

Mee-Lee, D., & Gastfriend, D. R. (2015). Patient placement criteria. In M. Galanter, & H. D. Kleber (Eds.), The American psychiatric publishing textbook of substance abuse treatment (5th ed.). Arlington, VA: American Psychiatric Publishing.

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102–1114

Laureate Education (Producer). (2012c). Counseling session 2. [Multimedia file].

SoCW-6202-WK4-Discussion
Counseling Session 2 Counseling Session 2 Program Transcript Welcome to Marge’s second counseling session, where you will ask ques tions to determine the level of treatment needed to address her addiction and her engagement level with her treatment. Before you begin, please carefully read through the paperwork that contains information obtained from team membe rs. After reviewing this information, click the “continue” button to begin Marge’s first counseling session. Using your cursor, rollover buttons A and B to revie w your question options. Click what you think is the best question to ask Marge out of the two options offered. If you ask an effective counseling question, yo u will receive more information from Marge. If you ask an ineffective question, you will receive an equally unhelpful response. Choose wisely, because the better you counsel Marge, the better her treatment experience. *Please keep in mind that the video has been made in a way that gives you a realistic vantage point from where you would sit and counsel your client in real life. A close up view of the individual has not been added because you, as a counselor, will not have varying angles of your client to work with. Paperwork: • Marge C. • Sixth day of detoxification treatment • Patient is experiencing residual physical withdrawal symptoms. Patient is shaky and groggy, has been given a mild sedative to keep her calm during withdrawal • Patient is cooperative and still open to treatment. Patient expressed feelings of loneliness and concern for her children • Patient exhibiting signs of depression [About six days later, Marge is going through detoxification, which mean s she may be a little groggy from sedatives and slightly shaky due to residual physical withdrawal. Her appearance is plain but more kempt than on her admission; she has no makeup, the bandage is removed, her abrasions are healing, and th e black eye is almost gone. She is composed, rather down, but cooperative and still open to treatment.] Question #1: Option A: © 201 4 Laureate Education, Inc. 1 Counseling Session 2 Counselor: Marge, when we last met, you expressed resentment toward your family and friends after the intervention they held with you. We left th at as unfinished business. Share with me your thoughts and feelings toward the m now. Marge:. Yeah, I was furious, but not so much now. I’m more ashamed than mad and concerned that I let things get that bad. They all had written down examples of some of the things I had done while I was drinking that concerned the m, and they read those things out to me. Ethel, my older sister, said that my sons told her they were embarrassed when I came to their soccer games because I’m always staggering around and f alling all over everyone. My best friend, Emma, told me she found me passed out one day in the house when she came by to check on me when I hadn’t answered my phone. You know, I don’t even remember that, but why would she make i t up? Their examples got worse, especially when my husband Ken began reading h is. I don’t want to talk about what he said right now; I’m too ashamed a nd afraid to face the facts right now. I need time and help before I can do that. I’m glad I’m here now; I just hope I can stop drinking for good an d live a normal life. I just hope I can, but I don’t know… And even if I would be able to stop, there’s all the damage I’ve done in my life in the meantime, to all those who care about me and need me, and to myself. If only I could ever get sober and live a normal life like most people, if only….. Option B: Counselor: Marge when we last met you expressed resentment toward your family and f riends after they held the intervention. We left that as unfinished business. Do you still feel that resentment? Marge. No, not anymore. Question #2 Option A: Counselor: Why do you think you’re here? Marge: You ask me “why”? You’re making me wonder if I’ve done too much damage to repair. Don’t you think I’m asking myself that same ques tion every minute that I’m here anyway? Or you’re making me feel as if I need to own up to ever other single bad thing in my life before I can get better. Well, we co uld be here a while! © 201 4 Laureate Education, Inc. 2 Counseling Session 2 Option B: Counselor: I hear you saying that you think your drinking may have cause d too much damage to repair and because of that you won’t be able to stop d rinking for good. Tell me more about the damage and how it affects your ability to stop drinking. Marge. It would take me days to tell you all the damage my drinking has done. For starters, though, there’s my family. My children have done the be st they can to carry on without a real mom; I’m never there for them, never pay t hem any attention. I’m an embarrassment to them. They never bring their friends home. They have their problems like any growing kids, and their dad does the b est he can to help them. But he has to moonlight to pay the bills since I got f ired from teaching, so he isn’t able to give them the attention they need by himself. Because I lost my income, our finances are in a mess. Now there’s thi s DUI facing me when I return home. I’ve totally ignored my health. I’m a d iabetic, and my drinking is always causing complications. And on top of all that, I’m so tired and so depressed. I’ve always been depressed, and sometimes it’s l ike a dark tunnel with no light at the end. I could go on and on, but it just depre sses me more. I don’t know how I can return to all that when I leave here, and how I can stay sober with all that facing me? I realize I’ve got a lot to work to do, the more I talk about it, and the more I know I need to be here. Question #3 Option A: Counselor: Marge, look at me; I’m a recovering alcoholic myself. I took my last drink 15 years ago, and if I can do it, you can do it. So I know exactly what’s going through your mind. Until I admitted I had a problem and needed hel p, I wasn’t able to get sober. Can you understand that? Marge: I admire you for that, I really do (she’s sincere). I wish I could do it like you, but I don’t think I have whatever it is you have to be able to d o it. Option B: Counselor: What changes your mind about needing to be here? Marge: That darn intervention; whether I liked it at the time or not, th e truth is, that’s what changed my mind! I didn’t think so at the time, but it brought reality © 201 4 Laureate Education, Inc. 3 Counseling Session 2 home to me. I needed to hear everything they said to me that day. I realize now my children haven’t had a mother; they’ve had a drunk who hasn’t been there for them. The DUI helped change my mind, too, I guess. I’ve never even had a sp eeding ticket, and now I get stopped for drunk driving. My name was in the pape r, and I have to go to court, just like a criminal. If I had kept on doing what I was doing, there’s no telling what would have happened. My family and friends’ intervention pointed out that I’ve hit my r ock bottom, I guess you could say, before I hit a worse rock bottom than I want to ima gine. I could have never done it on my own. Like I told you, I tried. There are too many triggers to drink and distractions out there in the world to just up and stop drinking on my own. I don’t have the tools inside of me to cope with it all on my own right now; I need someone to help me help myself when I go back out there in the real world again. I’m tired; I want to live a normal life. I just hope I can do it, I m ean really stop…for good…I wonder though. Question #4 Option A: Counselor: Marge, I strongly believe that unless you have a sound belief in a higher power or sense of meaning, you will never get sober. People who h ave faith can do it; people who don’t have it can’t do it. That’s m y firm belief. Do you believe in God enough to get sober? Marge: (starts sobbing). No, I try so hard to believe, but I feel so s inful. No God would have anything to do with me. Option B: Counselor: You said you need the “tools.” Let’s start identifyi ng some of those tools for developing goals for your treatment plan. What are a few of those tools and personal goals that come to mind right now? Marge: It seems like whenever I run up against something unpleasant, I don’t have the inner resources to cope with it, so I reach outside myself to t he bottle to take care of it. I want to learn to relax without drinking. And then there’s anger. I get so mad at the littlest thing and become a bundle of nerves. Another thing I can’t cope with on my own is my lack of self-confidence. I can’t go out in public without a drink; I’m too self-conscious. © 201 4 Laureate Education, Inc. 4 Counseling Session 2 But more than any of that, I think my depression is the main thing that drives me to drink. I’ve been depressed since I was a teenager; I can’t reme mber a happy moment since my childhood. I can’t imagine me being able to ever stop drinking and live a normal life as long as this depression hangs over me, ever. If I am stressed, angry, or depressed, I want to drink, and it seems lik e I am feeling those things almost constantly. I need to learn to recognize whe n I am experiencing those feelings, and do something besides drinking to reliev e them. I used to enjoy running, a long time ago. Maybe if I get outside and walk? That seems like a good way to handle those feelings instead of drinking. Question #5 Option A: Counselor: Before we end today’s session, Marge, there’s one question I want to ask you. Are you ready to stop drinking? Marge: I’m here, aren’t I? I never said I didn’t want to try. I just don’t think you can help me do it. I can do it on my own. Option B: Counselor: Marge, several times today you’ve questioned your ability to stop drinking for good and have a normal life. Picture yourself living that n ormal life when you stop drinking and describe it to me. Marge. Well, to begin with, I see myself being a good mother and a good wife; that’s the first thing that comes to mind. (Ponders the question a m oment longer) And having a sense of meaning in life, yes, that’s important…a sense of meaning…(displays a hint of pleasant anticipation on her face) I would be in better health, too, so that I feel confident when I go out in public. I would be able to help my kids and Ken instead of relying on them all the time to help me. I would be the adult, you know? Not another kid that Ken has to take care of, but a partner. Final Text: Congratulations. You have now completed your counseling session with Mar ge. © 201 4 Laureate Education, Inc. 5

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