Treatment Intervention and Challenges
Part 1
Identify and provide an explanation of one treatment approach to engage Antoine and one treatment approach you consider to be most helpful in counseling this family. Please provide a description of the treatment approaches, as well as your rationale for why these approaches are the most helpful one to use.
When dealing with treatment on substance abuse, various approaches can be used depending on the condition of the patient and the level of addiction. Antoine is a family man who has been lately associated with substance abuse, especially taking alcohol with friends after work. His addiction raises concern majorly to the family, especially Martha, who is directly and adversely impacted. For Antoine’s case, the most appropriate approach to engage in the Community Reinforcement and Family Training (CRAFT) (Kirby et al., 2017). This is an empirically-based therapy program, which has proved a significant success when dealing with family members or friends diagnosed with substance abuse disorder but has, by all means, refused to get treatment. Just like in the case of Antoine’s who is not ready to visit any therapist or counselor over his recent drinking habits. Indeed he does not accept that he has a problem until the neighbors call the police about excessive screaming in their house, which attracts the concern of the local child protection agency.
CRAFT is one of the sure ways to address substance abuse with individuals who do not appreciate that they need some therapy. The reason for this selection is first to focus on three essential goals. Of the three goals, two of them have a primary focus on the individual who is abusing alcohol, and the third focusing on the concerned significant other (CSO). In this context, the first goal and the final objective is to influence Antoine, who has recently been involved in alcohol abuse, to seek medical attention or treatment. Secondly, a very significant goal is to ensure that the amount of alcohol he takes is reduced, and thirdly, is to improve the lives of the concerned significant other (Dutcher et al., 2009). In this case, the CSO is Martha, and the children who the alcohol abused by Antoine has directly or indirectly impacted them. For instance, Martha has been directly and adversely impacted by Antoine’s current behavior, to start with, he was the breadwinner for the family, and due to alcohol, his license has been suspended. Additionally, in the therapist's place, Antoine happens to move out, and immediately Martha starts crying loudly, showing bruises on her right arm, and also confesses that she has been struggling with “all of Antoine’s behavior.”
Primarily, I would prefer CRAFT over any other method when addressing alcohol addiction. Martha, embracing this method will be a sure pathway towards achieving great results; generally, the direction of this approach is for the CSO to learn. This knowledge gained is essential to avoid using behavior, reward non-using behavior, and discontinue enabling. Understanding enabling in conjunction with alcohol addiction and other substance use is a well-intended elimination of negative natural consequences that decreases the identified patient (IP) behavior (Kirby et al., 2017). A good example is when Antoine comes home drunk, and Martha does not help him addressing the complications associated with drunk people, such as help in vomiting, take them to bathrooms and clean their mess. In the following days, the husband might recognize that he has become a burden to the wife and family and thus needs to change. The wife can also help in this by dealing with the morning hangovers and even reporting to the boss that the husband is not capable of attending to his jobs the following day, which Martha had already started doing. This great treatment within the family will fully convince Antoine to seek treatment and counseling and later on quit alcohol.
However, not every individual is ready for help based on treatment interventions. This is for the case of abusers who refuse to get help despite the efforts of the CSO. It has been noted that the majority of the abusers take action for treatment as a response to external pressure from either spouse, other family members, legal systems, or physicians. Among the stated external forces, a family-based intervention has proved more successful, forcing substance abusers to enter treatment (Lam et al., 2012). Martha is one of the lucky women as her case gets the attention of the child’s protection agency, and Antoine is willing to see the therapist and counselor about his recent alcohol use.
Additionally, various treatment approaches are used to address substance abusers. One of the most helpful approaches that reward good results is the behavioral approach, primarily referred to as behavioral family therapy treatment, which is based on social learning theories and operant to gather knowledge about the substance abusers within the family context. Based on this approach, substance use is a learned behavior from the social interaction, which fits well in Antoine, whose alcohol consumption starts after he starts visiting pubs with friends. The family concern in this prospect is designed to reward sobriety, reduce drug use and promote prosocial behaviors, which have been seen to fade out with the substance use. This method suits best in treatment interventions because the abuser and the family members get trained on helpful methods that would increase positive interactions, increase problem-solving, and foster communication skills. The ultimate result of these skills is to help the family members reduce continued drinking by using family members.
This capability has been used commonly with alcohol and drug-abusing couples. Just as in our case, Antoine is a victim of alcohol abuse, making this treatment approach appropriate in addressing his condition with Martha. Commonly, three strategies are used to reinforce patterns observed with drug users' families. These include the reinforcement for substance-using behavior taking the form of his drug abuse. Secondly, it is to shield the substance user from experiencing adverse consequences on substance use and punishing drinking behavior (Dutcher et al., 2009). The family's primary focus in this approach, as stated, is to change the spousal interactions, which are the main stimuli for abusive substance use. Interactions are good as they would help in improving communication and problem-solving abilities, as well as coping skills that promote sobriety. Martha needs to make sure that her interaction with Antoine is, at best, sharing on the impacts that alcohol has cost the family, losing his job, and poor association with Natalie; thus, he can change the mind and focus on stopping this alcoholic abuse.
More importantly, the CRAFT and behavioral treatment approaches can be intertwined. These two approaches are essentially treating people with substance-use complications. Additionally, the community reinforcement approach (CRA) was found to have a significant influence over the drinking decisions. The majority of members were reported to get convicted and go for treatment based on pressure from their family members and friends. Besides, the CRA was found to work with CSO perfectly. The latter's primary concern is on their wellbeing as they have suffered when dealing with stressors associated with the identified patient substance use. Common stressors felt include violence, verbal aggression, marital conflict, financial problems, social embarrassment, and disrupted relationships with children. These two suits exactly in addressing Martha and Antoine's case are because all the effects are evident of their family, ranging from violence to financial problems and disrupted relationship with Natalie.
Part 2
- Consider Martha and her family. How might the harm reduction ideas be helpful to your work with them? Identify what might be some challenges to adopting this philosophy to working with families?
The treatment methods present have a central focus to support individuals abusing substances. The reason for this focus is to minimize harm from substance abuse or use which primarily includes abstinence-based treatments. The latter treatment highlight that abstinence is the priority towards addressing or reducing harm. In this program, there are some key attributes that need to be addressed; these include embracing self-determination and promoting ideas that individuals decide on specific harms to address and the order that they need to follow (Denning, 2010). Based on Antoine and Martha’s case, it is clearly pointed out that individual members are struggling with their daily duties, support, and love affairs and instead strains so much to keep going, with a fear that the situation might get worse with time if they happen not to set limits with substance use relativity.
This family needs to take immediate mitigation. In this case, Martha and Antoine need to ask themselves questions on possibilities that might help mitigate substance use while at the same time ensuring that they protect their survival. This includes freedom from chaos and volatility that the alcoholism addiction had created. Therefore, it is essential to ensure that these two keep their values and engage in counterproductive behaviors to themselves and the neighbors (in this case, avoiding activities that might attract the attention of the neighbors in the future, such as screaming). This is a way of making Antoine appreciate the importance of being sober, avoiding the abuse of drugs. The harm reduction in the family treatment framework would be helpful in refocusing on efforts to enhance individual family member efficiency and motivation, which creates long-lasting changes within the family.
Additionally, harm reduction principles fit adequately with the stages of change model, with assumptions that people are capable of making decisions on important needs. This means that they can address them when they are ready. These practices are generally designed to help people move across the stages of change at their own pace (Denning, 2010). Also, the practice offers a wide path honoring all the stages in the change process. It is, therefore, essential to incorporate the harm reduction principles in working with families, as it would help in describing how each of these principles helps in family-involved work.
However, some challenges are associated with the implementation of the harm reduction approach. A variety of these challenges include issues with achieving and maintaining abstinence from alcohol. The most desirable outcome of the harm reduction process is the total elimination of use, which is although goal to achieve a majority of the programs focus on a continuum of outcomes which include swift to safer substance alternatives and encouragement of clients to reduce their alcohol use (Mancini et al., 2008). Also, this program portrays negative consequences for individuals who are unable to control their use unless they are in highly structured environments.
- As noted in the new case study information, Martha shows you the bruises on her arm. What is the message that Martha is trying to convey in her action? What are some initial thoughts that come to your mind? What are your next steps? Answer the questions and provide an explanation of the steps you would take to address the issue(s).
In the previous report, Martha has been covering his husband’s behavior. In an investigation with the child protection agency, she expressed that Antoine did not possess any drinking problem and that this latest experience was bad luck. She also adds that he only takes a few drinks with friends after work and that he is not violent when drunk. Martha also states that children have not been affected by the behavior and continues with their daily scheduled activities. However, it does not take long for the story to change when Sam is introduced to the story. Antoine describes Sam as a lazy and uneducated fellow, which makes Martha start crying. She points out why Sam is living with them and the difficulties of finding a new job. Suddenly, when Antoine requests to get out and put more money in the parking meter, Martha cries loudly and confesses that she has been struggling and finding it so difficult to cope with Antoine’s current behavior.
She pulls her sleeve on the right arm showing bruises. So, simply this means that Antoine has been violent fighting Martha. Perhaps, her former report was just a way of concealing their home affairs as every woman would do, or maybe she was just sure that Antoine would change with the kind of treatment she gives her while at home, even when drunk. Now that he does not realize what Martha was doing and that he is not ready to accept Sam in their home, he decides to open up for good for worse, and immediately he leaves out for the payments, Martha speaks it all. Initially, I thought that Martha cries that his husband is not willing to stay with his brother, who has been jobless for some time now, or maybe he is worried that his husband would not change his current behavior.
As a counselor, I need to address these issues with the highest level of competence. From the look of things, life has been so tough to Martha; she is even beaten up and hides it from the public, perhaps even the screaming herd by the neighbors that led to calling of police was a fight between Antoine and Martha. In this context, therefore, I would address both of their situations, first listening to Antoine’s take on beating his wife to even development of bruises. The outcome of this talk would be to come up with strategies that would help completely eliminate the alcoholism behavior with Antoine. For this case, we would consider the case of Martha and Antoine as couples at any stage who have been influenced by alcoholism. Just as expected, their marriage has been greatly affected by alcoholism, creating symmetrical conflict where covert dependency and competitiveness and imbalance. Now that Antoine no longer works, he and the family relies on his wife Martha, which makes her overwork while he relaxes and drinks.
As a counselor, it is essential to address this challenge critically. This can be achieved through dynamic efforts to make sure that Antoine abstains from drinking alcohol. The use of the Al-Anon self-help program will educate the non-drinking member of the family on alcoholism on keeping a strong focus. In addition, as a counselor, I would trace all cases of domestic violence, threatening and intimidating behavior on the spouse, and referrals made to batterers program (Wormer & Parker, 2018). Now that Martha is left alone, I would advise her alone, as AI Anon is not appropriate until the partner is safe. I would advise Martha, solely of her legal rights, to seek a legal women’s group if the violence is not settled.
References
Kirby, K. C., Benishek, L. A., Kerwin, M. E., Dugosh, K. L., Carpenedo, C. M., Bresani, E., ... & Meyers, R. J. (2017). Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient?. Psychology of Addictive Behaviors, 31(7), 818.
Lam, W. K., O’Farrell, T. J., & Birchler, G. R. (2012). Family therapy techniques for substance abuse treatment. Treating substance abuse: Theory and technique, 256-280.
Wormer, K. & Parker, L. (2018). 15. Substance Abuse Treatment: A Field in the Midst of Change. In R. Rooney & R. Mirick (Ed.), Strategies for Work with Involuntary Clients (pp. 418-433). New York Chichester, West Sussex: Columbia University Press. https://doi.org/10.7312/roon18266-017
Dutcher, L. W., Anderson, R., Moore, M., Luna-Anderson, C., Meyers, R. J., Delaney, H. D., & Smith, J. E. (2009). Community Reinforcement and Family Training (CRAFT): An effectiveness study. Journal of Behavior Analysis in Health, Sports, Fitness and Medicine, 2(1), 80.
Denning, P. (2010). Harm reduction therapy with families and friends of people with drug problems. Journal of clinical psychology, 66(2), 164-174.
Mancini, M. A., Linhorst, D. M., Broderick, F., & Bayliff, S. (2008). Challenges to implementing the harm reduction approach. Journal of Social Work Practice in the Addictions, 8(3), 380-408.
