Addiction and adolescent
Case Study: Maria C.
According to the case study of Maria C, the key developmental issues include chemical dependence, depression, and lack of personal development, unsafe sexual behaviors, cognitive impairment, and lack of personal relationships. Chemical or substance dependence is an issue of concern in that Maria has continued to use marijuana from twice per week to a daily routine, and she uses cocaine, alcohol, and cigarette at large amounts on regular basis. Despite the negative effects of substance abuse, she has increased amounts of substance and time spent rather than decreasing the use. This has resulted in psychological problems such as poor educational attainment, unsafe sexual practices, and lack of companionship with her parents and her younger brother, and deviant behaviors such as staying out late. Hammong, Mayes, & Potenza (2014) assert that during the adolescence stage, young people experience behavioral and psychological changes, and they are also vulnerable to the risk of substance use. Factors that may motivate adolescents to continue abusing drugs include changes in the neural circuitry, stress, and changes in cognitive control. The authors argue that in order to understand the substance abuse behavior and offer the best treatment, it is important to consider the neurobiological basis (Hammong, Mayes, & Potenza, 2014). For example, Maria's addictive behaviors have affected the brain's reward system and as a result, the brain is responsive to the drug of abuse. Note that the neural circuitry is a pathway of reward and repeated exposures to substance abuse affect the neurocircuits, the neurotransmitters, and other brain regions. Thus, understanding the neurobiology is important in order to target the neurotransmitter systems and neural circuitry.
Using the DSM-V, Maria meets conditions such as substance-related and addictive disorder. Specific examples that show she is suffering from substance use and addictive disorder include alcohol intoxication, cannabis intoxication, cocaine intoxication, and cigarette intoxication and other unknown substances (American Psychiatric Association, 2013). For example, Maria smokes marijuana and cigarette on a daily basis, she consumes 3-4 beers every weekend, and use cocaine 3-4 times during the weekend. The DSM-v criteria disorder show that a person suffering from this disorder has a variety of problems such as using the substance in large amounts, unable to stop using the substances, unable to do constructive things such as reading, continuing to use despite its effects in life, and failure to engage in recreational activities (American Psychiatric Association, 2013). According to the DSM-v, Maria has severe substance use disorder since she expresses more than six symptoms including behavioral change, irritability, change in daily routines, tolerance and withdrawal, social impairment, and cravings.
One symptom of mental health disorder that appear from Maria's history and description is schizophrenia. For example, Maria expresses symptoms such as substance use, withdraw from family, poor education performance, lack of social life, and depression. Another symptom that I would want the mental health professional to evaluate further is a personality disorder. This is because, according to the case study, Maria has substance abuse issues, she finds it difficult to create and maintain relationship especially with family members, and she cannot control impulses (American Psychiatric Association, 2013). These behaviors are the criteria for personality disorder it is important to evaluate this condition in order to help her change behaviors. It is also important to note that many adolescents develop personality disorders due to factors such as family history and neurological factors (American Psychiatric Association, 2013). These might be the factors that have made Maria engage in drug abuse behavior and neglect her physical health.
As a mental health practitioner, I would use various techniques to engage Maria to talk to me, and I would also use approaches to form an alliance with her parents. To engage Maria, first I would focus on establishing a therapeutic alliance (Center for Substance Abuse Treatment, 2005). Since my aim is to offer treatment and help her change behaviors, a therapeutic alliance will bring counseling effectiveness and more important, positive treatment outcome. To establish a therapeutic alliance, I would use an empathetic counseling style. Note that by being empathetic, I will motivate the client to talk to me, pay attention, and maintain contact during face-to-face interaction. As a result, we will build productive relationships, help her make life transition and more important, adhere to treatment (Center for Substance Abuse Treatment, 2005). In addition, an empathetic style will allow the client to express herself, and a result of listening keenly to her problems and needs, I will compliment, persuade, provide support, and more important, maintain a collaborative relationship. After building a therapeutic alliance, I would like to know the background or rather, her cultural group. The purpose of learning about the background is to understand the communication style, her expectations as well as her family expectations, and her concepts of drug abuse in relation to culture (Center for Substance Abuse Treatment, 2005). The cultural knowledge will help use a culturally sensitive approach in providing treatment, and more important, meeting the basic needs. After forming a therapeutic alliance and learning about the cultural background, I would structure on how to offer support. This means that individuals like Maria create time to engage in drug abuse and they rarely have time for constructive activities (Center for Substance Abuse Treatment, 2005). Thus, I would help Maria manage time and engage in meaningful activities so that she can heal from mental illnesses. I would also ensure that rather than spending time with peers especially her husband who abuses drugs, I would encourage her to spend most of the time with family, relatives, and friends.
After engaging Maria and ensuring that we have established a productive relationship, I would also engage her parents through family behavioral therapy. In this method, I would involve the parents to discuss the substance abuse behavior. Note that family and in specific the parents have a significant role in substance abuse treatment (Center for Substance Abuse Treatment, 2004). This is because, the parents will give an overview concerning Maria's substance abuse behavior and addiction, and the parents and the mental health practitioner will establish a relational pattern where the parents will be the source of help and reduce the substance dependency. Thus, using the family behavior therapy, I will encourage the parents to focus on the behaviors of the teenager and, I will train them on how to help her change behaviors (Center for Substance Abuse Treatment, 2004). I would also encourage the parents as well as the teenager to set behavioral goals to ensure that Maria changes the maladaptive behaviors. The family behavioral therapy will promote interaction between the parents and the teen, improve communication, solve problems together, provide the needed resources, improve communication, and more important, help the teen avoid substance abuse and also prevent the remaining family members from engaging in abuse problems (Center for Substance Abuse Treatment, 2004). Thus, the family behavioral therapy is an important approach parent as it will create a healthy family structure that will not only prevent Maria from engaging in drug abuse but it will also ensure that other siblings will not abuse drugs in future.
The best approach that would be the most effective with Maria is the Motivational Interviewing (MI). This is because the approach is client-centered or in other words, the mental health practitioner provides intrinsic motivation so that the client can explore herself and engage in enjoyable and interesting behaviors, and more importantly, engage in activities that are internally rewarding (Center for Substance Abuse Treatment, 2005). The main purpose of choosing this method is to help the client establish achievable goals and make a commitment. A client-centered approach means that the mental health practitioner should avoid confrontation and focus on building a positive rapport. In addition, to avoid confrontation, the mental health practitioner allows the client to make the argument or rather express her thoughts. With respect to the case study, I would help Maria to express herself, choose the change, employ her personal beliefs, show resistance, come up with a new perspective, and identify the problem and find answers (Center for Substance Abuse Treatment, 2005). After giving the client time to talk, the specific technique that I would employ to engage her is Motivational Enhancement Therapy (MET). The purpose of this technique is to engage the client in treatment by employing difference stages of change. The first stage of change that I would use is pre-contemplation- I would express concern on how substance abuse have ruined her life and the need to change behaviors. The second is contemplation- after ensuring the client has taken the issue of substance abuse seriously, I would provide her with relevant information and incentives so that she can make change statements to changing the behavior. The third stage is preparation- in this stage, I would encourage the client to weigh both pros and cons of substance abuse, make a firm commitment, and identify and eliminate the barriers that may hinder her from taking action (Center for Substance Abuse Treatment, 2005). The fourth stage is action- at this stage, the client is fully aware that substance abuse ruins the life and she changes the behavior. I would provide encouragement and support, strengthen the commitment, and engage her in meaningful activities such as group work. The fifth stage is maintenance- at this stage, the client has developed a new pattern of behaviors but she may encounter a crisis. I would be at the forefront to help the client address difficulties (Center for Substance Abuse Treatment, 2005). The last stage is relapse- after the client has made positive changes, she may become sick since her body was used to substance abuse. I would support her to hasten her recovery and help her understand the substance-related relapse.
In addition to using the MI method, another counseling technique that I would consider using in working with Maria is cognitive restructuring. This counseling technique comes from the approach known the cognitive-behavioral therapy (Center for Substance Abuse Treatment, 2005). The main aim of this counseling technique is to help the client change her thoughts. For example, Maria may think that she cannot feel uncomfortable until she smokes marijuana. I would help her change the negative thoughts and instead use positive thoughts such as “one can be comfortable without using Marijuana and other drugs”. This will help her challenge the irrational thoughts and view the world around her in a positive way. As a result, she will reduce stress and adopt positive thoughts.
Regarding Maria's behavior, the area that I could use the harm/ risk reduction approach is sexual behavior. Note that Maria is infected with genital Herpes due to unprotected sexual activities. The purpose of harm/risk reduction, in this case, is to reduce the harm that may occur due to sexual behavior. The specific technique that I would use to reduce risk is ‘discouraging the behavior' and educate her on the importance of safer sex (Leslie et al, 2008). First, I would encourage Maria to reduce sexual behaviors and inform her about the benefits and demerits of sexual activities at an early age. Second, I would educate her on condom use and as a result, she will be safe from sexually transmitted infections and unwanted pregnancies (Leslie et al, 2008). Even though substance abuse is a risky behavior that can bring harm, sexual activity is the first behavior that Maria need to avoid to stay away from infectious diseases such as HIV.
Other strategies that I might suggest to work with Maria and her parents include connecting her with programs or educational institutes that offer substance abuse prevention education. Maria and her parents should join such centers to gain knowledge concerning the harm of substance abuse such as alcohol and marijuana (Center for Substance Abuse Treatment, 2004). The parents will gain knowledge on substance abuse and related harms and positive parenting. As a result, they will help the teenager change behaviors. Maria will not only gain knowledge in alcohol abuse but she will learn the acceptable social behaviors and as a result, she will modify behaviors and behave in a positive way (Center for Substance Abuse Treatment, 2004). Another prevention strategy in both sexual activities and substance abuse is to avoid peer pressure. It is important to understand that teens are motivated by peers to engage in deviant behaviors such as drug use. Thus, Maria should make relationships with better groups that engage in constructive thing to avoid being in tempting situations.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-
5®). American Psychiatric Pub.
Hammond, C. J., Mayes, L. C., & Potenza, M. N. (2014). Neurobiology of adolescent substance use and
addictive behaviors: prevention and treatment implications. Adolescent medicine: State of the art
reviews, 25(1), 15.
Center for Substance Abuse Treatment. (2004). Substance abuse treatment and family therapy. National
Center for Biotechnology Information
Center for Substance Abuse Treatment. (2005). Substance abuse treatment for persons with co-occurring
disorders. National Center for Biotechnology Information
Leslie, K. M., Canadian Paediatric Society, & Adolescent Health Committee. (2008). Harm reduction: An
approach to reducing risky health behaviours in adolescents. Paediatrics & child health, 13(1),
53-56.
