The client is a 38-year-old African American single woman who has been living with her mother on the south side of Monroe, Louisiana for 20 years. The client who is a mother of 4 children, is currently enrolled in an outpatient substance abuse program at the Cognitive Development Center. The client was born with drugs in her system due to her mother abusing drugs during pregnancy. Her choice of drugs is cocaine, marijuana, and prescription drugs, preferably opioids hydrocodone, and oxycodone. The client stated that the pills help numb her previous problems. The client did not graduate in high school and only has a 10th-grade education and solely dependent upon government funding to live and sometimes sell food stamps to purchase drugs or other needs. The client currently receives food stamps, low-income housing, and Louisiana Medicaid. The Department of Children and Family Services has been called on the client several times, and 2 of the children has been removed from the home due to being born with cocaine and marijuana in their system at birth.
When the client was ten years old, her father divorced her mother due to her substance abuse issues. The client stated that her mother would abuse her physically and emotionally throughout her childhood. The client had been in and out of several group homes and shelters most of her childhood. At the age of 13, she went to live with her 78-year-old paternal grandmother, who was too elderly to care for her properly. The client would elope for days without permission. At the age of 14, she started drinking alcohol and smoking marijuana and hanging out with older high-risk behaviour teens. She dropped out of high school at 16 and moved in with an older guy. She was then introduced to synthetic marijuana “mojo” but stated that she does not like it that much. The client said that she must have marijuana daily to help calm her nerves and keep her sane. During the last session, the client stated that she is currently ten weeks pregnant and don’t think she can stop using marijuana and cigarettes, but she believes she can go without cocaine and prescription drugs for nine months
Literature Review on Diagnosis
There were two types of assessments done to establish the symptoms of a client, which included a physical examination and psychological evaluation. The physical study assessed the visible signs that could be analyzed by vision, touch, and hearing process (Fiscella, 2011). More so, blood tests are done to establish the extent of addiction by the client (Helmbrecht & Thiagarajah, 2012). On the other hand, on psychological evaluation, the Hamilton Anxiety Scale may be used to gather more details from the client about the severity of the anxiety (Keegan et al., 2011). Some of the possible diagnosis recommended for the case study mentioned above include:
F12.10 Cannabis Use Disorder
This disorder refers to the problematic use of marijuana (Fiscella, 2011). This disorder highlights the possibility that an individual can exhibit some of the adverse effects of marijuana without necessarily being an addict. Some of the common symptoms include:
1. Taking more cannabis than was intended
2. Cravings on cannabis
3. Problems at work, family and relationships as a result of cannabis use
4. Withdrawal symptoms after discontinuing cannabis use
5. Continuing with the use of marijuana even if it threatens marriage and social relationships
F14.20 Cocaine Use Disorder
According to DSM-5, a diagnosis of cocaine use disorder can be affected if there is the continued use of the drug despite clinically significant impairment or distress in the person (Helmbrecht & Thiagarajah, 2012). This diagnosis is manifested by at least two of the following signs and symptoms for 12 months:
1. Cocaine is taken in more significant amounts or over long periods
2. There is a persistent desire to withdraw or control the use
3. There is a strong desire to use the substance
4. Recurrent use of cocaine despite physical dangers
5. Continued use despite psychological problems
Literature Review on Evidence-Based Treatment for Diagnosis- Cognitive Behavioural Therapy
This approach refers to a psychotherapeutic treatment approach that seeks to assist the clients in understanding their thoughts and feelings that influence individual behaviours. The underlying concept of Cognitive Behavioural Therapy (CBT) is that our thoughts and emotions play a critical role in determining our actions (Keegan et al., 2011). For instance, if a person spends most of his or her time thinking about motorcycle crashes, and other road disasters, then this individual may find himself or herself avoiding road travel (Fiscella, 2011). CBT is used in treating disorders, such as phobias, addiction, depression and anxiety. The goal of cognitive behavioural therapy is that while the client may not control every significant element around them, they can take control of how they interpret things in their environment.
One of the areas of focus for CBT is on dealing with the negative thoughts that increase emotional difficulties, such as anxiety and depression. The negative beliefs are usually comprehended by the mind and considered as true, and thus negatively influencing the mood of the person (Fiscella, 2011). Applying the CBT process, the client is encouraged by the therapist to examine the thoughts by looking at evidence that either supports or refutes the application of these feelings (Helmbrecht & Thiagarajah, 2012). For instance, when a person is aware of the thoughts and actions that lead to drugs and substance abuse, they are equipped better to overcome the problem of addiction. Through this approach, the client will be able to take both an objective and realistic attitude towards their thoughts and feelings, thus reducing anxiety and depression moods. By being aware of the negative thoughts, the client will be able to engage in healthier thinking patterns and conversations.
Literature Review on Theoretical Orientation
Therapy helps women to develop alternative ways of thinking and behaving, thus bringing in new thoughts and behaviour (Keegan et al., 2010). The main goal of the therapy is for these expectant women to develop new ways of thinking to reduce psychological stress and improve functioning. Some of the goals the client is expected to achieve include:
1. Learning how to both distract and delay some of the cravings to abuse drugs by participating in meaningful activities, such as writing, wellness, exercising and many others (Fiscella, 2011).
2. Developing ways of being assertive in giving out responses, especially those that turn down the offers for substance abuse (Kunycky, 2018).
3. Developing ways of solving problems both directly and effectively rather than drowning in the issue, which worsens the issue later (Helmbrecht & Thiagarajah, 2012).
4. Being aware of the pros and cons of abusing drugs and other drugs versus the advantages and disadvantages of being sober (Kunycky, 2018).
5. Inculcating behaviour good behaviours and attitudes that ensure self-respect, which includes overcoming beliefs that would undermine a person and lead him or her to hopelessness (Kunycky, 2018).
Role of the counsellor and client in CBT
The role of the counsellor is to help the client understand the source of the negative behaviours and thinking and to be able to change completely. On the other hand, the role of the client is to collaborate in the interactions so that the therapist can unearth the source of the negative behaviours (Fiscella, 2011). Overall, the therapist takes the leading role in communication since he or she listens and provides a solution by proposing new ways and assisting the client with better ways of thinking.