Advanced Clinical Practice : Final Paper Essay

The definitions have progressed from tolerance or withdrawal symptoms from a specific drug to chronic intoxication, continued use with increased dosage, dependence, and damaging effects to user (Reinarman 2005). Both of these definitions proved to be too restrictive because all drugs do not have the same effects on every user. The current definition used by physicians and the criminal justice system is based on seven criteria (Reinarman 2005). The constant evolution of how the professional world views drug dependence mirrors society’s change in the understanding of addiction. Historically, “the drink” was viewed as the devil and drugs were often thought to be the cause of many criminal acts (Schneider 2003). After the medicalization of addiction and dawn of decriminalization of drug abuse, public opinion of deviant alcohol and drug use has changed. For the family unit, it is much simpler to accept and approach treatment for addiction if it is classified as a medical disease. In society, drug users can be framed as patients instead of criminals based on current standards. By looking at addiction as a treatable set of signs and symptoms instead of holding the individual accountable for actions they committed while intoxicated, the disease concept releases a lot of the stigma that goes along with

According to Gardiner and Kosmitzki (2008), most recently the ecological perspective has become a leading approach towards addressing the relationships among persons and environment. In Essentials of Human Behavior, Hutchinson (2013) uses a multidimensional approach to better understand social work practice. Using this approach, one can analyze the connection between a client’s person, such as psychologically or biologically, a client’s environment, such as families or communities, and a client’s time, such as their linear time in past, present, or future. Specifically analyzing the environmental component, Uri Bronfenbrenner’s (1999) ecological perspective identifies four levels of systems a client may be associated with: microsystems, mesosystems, exosystems, and macrosystems.

This paper explores the scenario of a client and looks at the presenting problem from an ecological and strengths perspective. It will also explore advanced clinical skills, intervention strategies and ethical dilemmas encountered. Methods for evaluating progress will be discussed within the social context of the case. Termination and follow-up approaches, and any ethical dilemmas will be included. Any problems with oppressed populations will also be discussed. Finally, the limits of the chosen model and limits of the practitioner, evolution of client and practitioner identities, any ethical or social justice issues for the agency, and an evaluation of the practitioner’s effectiveness will conclude the paper.

The participant is a 49 year old African American male who began using substances at the age of 13. He was diagnosed with severe alcohol, cocaine, and opioid use. The participant has been incarcerated over the past 32 years. He was recently paroled after completing eight years of a sixteen year sentence in the Illinois Department of Corrections for burglary and theft. The participant is on medications to treat HIV/AIDS and has been diagnosed with Major Depressive Disorder. He was referred to Healthcare Alternative Systems residential program through TASC as a condition of his probation.

In the United States, we have a culture that accepts the use of some substances over others, regardless of the negative affects of the “acceptable” drugs. For instance, it is socially acceptable to drink alcohol, eat sugar, and, while no longer as in vogue, smoke cigarettes. From a public health standpoint, these substances are also dangerous and can have debilitating affects on both children and adults. What is more, while narcotics use during pregnancy can lead to NAS at birth, there has been no conclusive evidence of lasting negative effects across the lifespan (Goldensohn & Levy, 2014; Miller, 2015). However, the use of other substances, such as alcohol, can be devastating and carry much more risk, leading some reporters to believe that the law has more to do with the people using these substances than the substances themselves (Todd, 2014). In any case, the punishment of mothers who suffer from addiction when they should be receiving support and treatment is a large moral failing on the part of policymakers. Arguments around whether the woman should be held responsible for her addiction overlook possible systemic barriers that led to her substance use as well as the fact that drug addiction is a treatable illness (Todd, 2014). In creating and invoking this law, policymakers are essentially turning their backs on some of the most vulnerable people in our society, expectant mothers, and using their resulting arrests as evidence of corrupt principles, deserving of punishment and

Until recently, there was a dramatic disconnect between this research and drug court operations. The consequences of this disconnect included relapse, overdose, and death. While drug courts were designed to accommodate those in need of medical care, most operated under the misguided and dangerous practice of requiring defendants, as part of their successful program completion, to stop taking life-saving addiction medication prescribed by their physicians. This practice, which is at odds with decades of scientific and medical research, put individuals with opioid addictions in the precarious position of either having to stop taking their effective medication and risk relapse or use their medication and face incarceration. To compound matters

In the past, law enforcement was taught to arrest anyone distributing or using opioids. The state believed that jail was the best method to get addicts off the streets and to stop using drugs. The issue with this method was when these addicts were released from jail, they went right back to using. United States President Barack Obama, has been working on a plan to reform the nation’s criminal justice program. He proposed that drug courts, which are fundamentally substance-abuse boot camps, are the best way to help treat addiction (Redmond A3+). Obama’s plan involved getting rid of mandatory minimum sentences, which he believed would also be a very cost saving solution. Obama stated, “We should invest in alternatives to prison, like drug courts and treatment and probation programs which ultimately can save tax payers thousands of dollars each year” (Redmond A3+). The problem with Obama’s method is that he does not seem to be concerned about the mental health of these

Nonmedical Prescription-Opioid abuse in the United States and Michigan has continued to rise, and with it, the devastating results that accompany it. Research has shown that increased opioid abuse leads to an increase in overdose and death, increases in crime and increased incidences of costly blood borne diseases like HIV, AIDS and Hepatitis. It also leads to increased societal costs, such as an increasing number of children in foster care and increased healthcare, workplace and criminal justice costs that can decimate communities and local budgets. Many communities were caught with their heads in the sand, as they were overwhelmed by the influx of prescription opioids into their communities. When policies were finally implemented to curb the amount of prescription opioids in their communities, rates of heroin use (also an opioid) began to skyrocket and people began realizing they had an opioid epidemic on their hands. How to combat this heroin epidemic has been the topic of many debates. This article will attempt to examine the relationship of nonmedical prescription-opioid abuse and its effects on heroin use.

Rosa Cunningham (full name is Rosa Lee) is a 53 year old African American female client of average height, slight build, and is appropriately groomed. She has 8 children, 2 of them being female and 6 males, all adults. Rosa is a widow and reached this status after being separated from her deceased husband for many years. Rosa is currently hospitalized for pneumonia, and has been hospitalized several times in her life for diferent illnesses. Rosa’s medical history as self-reported is HIV and seizures. Rosa is a heroin addict and has been this way for several years. Rosa is involved with the local methadone clinic and receives 55mg of methadone daily. Even by receiving this daily dose of methadone, Rosa continues to use heroin. Rosa has several legal and health issues that are present also, despite which she continues to use heroin. Rosa has a lengthy criminal history to include arrests for prostitution, larceny, and selling drugs. The reason for today’s assessment is a referral made by the social worker at the hospital in which Rosa is a patient at and discharge planning is to be made for aftercare.

Opioids and opioid addiction obviously effect those who find themselves abusing such drugs both legally and illegally. Arguably one of the worst effects of opioids is the destruction of the family unit. One thing that holds true is, no matter what type of family structure one lives in, every person in the family (both immediate and sometimes extended) is effected by the trauma of a family members abuse. Abuse can diminish a family’s financial, physical, and mental well-being.4 Any family of an opioid abuser is traumatized; however lower class families suffer the most. The financial instability and often nontraditional unit structure of lower class families renders them venerable to the negative constructs of opioid addiction.

Opioid abuse is extremely prevalent in today’s society. Many public health professionals are calling it the worst drug crisis in the nation’s history. (DeGarmo, 2017) Opioid abuse and addiction is an issue that goes beyond adults, it is plaguing juveniles as well. Juveniles are feeling the negative effects of this issue in many different ways. Some are watching their friends or family go through addiction, some have lost loved ones, and some juveniles are addicted themselves. I volunteered at the EB HOPE drop-in center which is located in East Bridgewater. The mission of the drop-in center is to provide resources to those affected by opioid addiction. They have an abundance of resources including retreats, rehabilitation centers, support groups, as well as faith based healings. They also have various support groups for family and friends of those addicted to opioids.

Case Study: Sheila's Substance Use and Crisis Treatment Plans Sheila is a single 35 years old mother who lost two sons to child welfare authorities and currently lives in a shelter (Confederation College, 2018). She has been dependent on alcohol for about 20 years (Confederation College, 2018). She has a track record of offenses, such as shoplifting and selling illegal drugs (Confederation College, 2018). At this present time, she has a court case coming up for stealing and assaulting a police officer while under the influence of alcohol (Confederation College, 2018). In the past, she was taken advantage of sexually by her father, who physically abused her brother and her mother (Confederation College, 2018).

Drug abuse is shown to be connected to all different kinds of crime in the United States, and in many circumstances, crime is inspired by drug abuse and addiction. In fact, 80% of criminal offenders abuse drugs or alcohol (National Association of Drug Court Professionals). Also, 60% of those who are arrested test positive for illicit drugs when they are arrested, and 60-80% commit another crime, typically drug-related, after leaving prison (National Association of Drug Court Professionals). And, even after these individuals put in the time in prison that would allow them to go through the uncomfortable process of detoxing, 95% of them will chose to go back to drug abuse after prison (National Association of Drug Court Professionals). Given these overwhelming statistics, it is clear that drug abuse, and repeated or continued drug abuse, are a serious problem facing the criminal justice system.

Today, in society, there has been a huge rise in the amount of deaths due to heroin overdose and addiction. Heroin and opiate addiction is something that needs to be recognized within our society in order to help protect one another. In this essay, I will explore the different methods of treatment, health insurance issues, and how the addicts affect the society. Information involving treatment for heroin and opiate addicts needs to be more prevalent in society because we do not hear much about how to treat addicts until something goes wrong. With knowing that there are these issues in society, information about treatment and help needs to be addressed more affectively in order to prevent death and other health issues from occurring. Insurance is also a major factor that goes along with treatment, and I believe that treatment and other rehabilitation programs should partially be covered by health insurance in order for the whole process to be affordable. All of the educational parts of these issues go untouched because it is not talked about in many societies; in a news article by Dan Dearth he discusses the concerns of many police officers within the area of Washington County, MD. The police officers believe that Heroin is the up and coming drug that is going to affect many citizens, and there is no education about how Heroin affects an individuals body and mental stability. Therefore, the educational part of this situation needs to be introduced more within the society

Clinical practice guidelines (CPG) are designed to improve the quality of healthcare services, decrease unwanted, ineffective and harmful interventions for patients. CPG are used to facilitate treatments for each individual patient’s by maximizing the benefits, minimizing the risk of harm and obtain treatment with an acceptable cost. Researchers had proven that CPG is a bridge for change and improving health outcomes. The effectiveness of CPG is perceived to be helpful in clinical decision making. CPG are developed to assist healthcare providers such as doctors and nurses in decision making for specific clinical outcomes (Vlayen, et. al. 2005)