Dual Diagnosis Paper

Step two: List triggers or high risk situations that increase relapse risks. (These may include) It is important for the client to realize this list will serve as a guideline.

Jed, a 38 – year old welder, enrolled in the treatment center after his arrest resulting from drunken driving (DUI/DWI) (National Institute on Alcohol Abuse and Alcoholism, n.d.). His lawyer has advised him to stop drinking and get treatment until his trial date, which is in approximate two months. Jed does not believe that he will serve any jail time, but feels that treatment could help strengthen his court case (National Institute on Alcohol Abuse and Alcoholism, n.d.). In this paper, I will create a relapse prevention plan that will aid Jed as he enters into his treatment program. This paper will also show

First, the recovery model prioritizes individual life goals, which are developed by the person seeking treatment, not the provider. On the other hand, the medical model is focused narrowly on treatment goals which are developed by the provider or treatment team. The recovery model encourages high goal-setting. They facilitate hope through providing resources and education, and help to develop steps to achieve personal goals, whereas the medical model has low expectations of the client and does not facilitate positive outcomes that will increase one’s quality of life. While the recovery model is holistic and sensitive to the issues that encompass stigma, the medical model is reductionistic and identifies individuals by their illness. The recovery model is strengths based, which is focused on improving self-efficacy, whereas the medical model is focused on symptom management; the overall goal is to reduce symptoms and stabilize the client. The recovery model recognizes that relapse does exist, whereas the client would be considered non-compliant if treated under the medical model. The medical model is focused on systematic processes, undervalues the therapeutic relationship, and is less focused on the individual. With the recovery model, providers understand the importance of a strong therapeutic relationship and encourage clients’ self-direction and right to make decisions regarding treatment. Recovery based therapy values the impact that hope and empowerment can have on individual treatment. The provider maintains a facilitator role with the client, which helps to encourage and foster positive change. With the medical model, providers control all aspects of treatment and client involvement is not as stable as it may be in recovery based treatment. (National Association for Social Workers West Virginia,

a. In therapy Jane learned that Recovery isn’t going to happen all at once. With that she understands that there will ups and down in her recovery but she know that as long as she stays strong she can stay on the path of recovery

(James, p. 74, 2012). Pre-contemplation is when the person is not considering change and denying they have a problem. Contemplation is when the addict is sitting on the fence about if they have a problem or not. Preparation/ready for action is described as when they are making a mental plan for how and when they are going to act. Action is practicing the new behavior for three to six months. The maintenance stage is continuing to maintain the new behavior for more than six months after the action plan. Relapse occurs if the old behaviors happen again, (James, 2012).

Differential diagnoses are developed by a clinician upon learning of the chief complaint. One must begin to develop the possibility of potential diagnoses mentally to guide the care provided to the patient. These potential diagnoses are developed by the care provider and are often based on one’s past clinical experiences, awareness of the illness and a clear understanding of the patient’s complaint (Goolsby & Grubbs, 2014). The care provider with experience may develop these diagnoses independently and others with less experience may utilize evidence-based resources and clinical guidelines to aid in this process (Goolsby & Grubbs, 2014). The process for reaching a final diagnosis requires further investigation and use of physical assessment

The learning outcome I have chosen to focus on for this literature review is section 4.2, the reason I chose this learning outcome is because when people are not aware of the prevalence of concurrent disorders, they may not be at all drawn to assess them for it in the first place. Comorbidity is so common that concurrent disorders should be expected rather than considered an exception (Minkoff, 2014). The reason I have choose these specific articles, is because one shows the importance of using the most beneficial assessments, and the second one is why it is so important that a greater interest in the need for best practices at the system level (Minkoff, 2014)and is also shown in all aspects of treatment with concurrent disorders, at all levels including assessments.

Second, a plan in place goal is to prevent any lapse from turning into full relapse. Next, educating an individual with addiction on relapse prevention, so that the individual understands each step of the relapse process, with resource and tools. To clarify,the relapse plan, educates the client with skills training, cognitive restructuring, and lifestyle changes, in order to be proactive.

PROCEDURE: Patient was taken to the OR where she was given spinal anesthesia. She was then prepped and draped in the usual fashion for cesarean section. A Pfannenstiel incision was made carried down to the fascia. The fascia was (__) lateral and was directly separated from the rectus muscle. Rectus muscle was divided, the peritoneum cavity was entered. The O access ring was placed,

The third and final stage of recovery is known as late recovery, and involves a client finding growth and meaning in life. In this stage, relapse may be less frequent as a sense of purpose is found. As this stage is found only by enduring great challenges, a client may not be as tempted by relapse and the act of back tracking in their recovery may seem tiresome and unworthy of their time. However, though a deep awareness of the consequences of substance abuse is profound, relapse is still possible if an addict forgets that he or she has a disease that is incurable and succumbs to the enticement of “just this one time can’t hurt” or has the thought that “I have been clean for so long. I am cured.” Bill W. stated in his book Alcoholics Anonymous that “This is the baffling feature of alcoholism as we know it-this utter inability to leave it alone, no matter how great the necessity or the wish” (pg. 34). Complete abstinence is the only choice for those with the disease of addiction, and so many recovering addicts forget this simple realization in the late recovery stage.

DATA: Today’s group has been facilitated by Kirsten again, and includes relapse, what it is, and how each client can prevent it. Being that relapse is a process, it is an ongoing situation that can be interrupted, rather than a static event that is over and cannot be changed. It involves the individual reverting to old attitudes, beliefs, values, and risk behaviors. These are part of a progressive pattern, and will worsen until the process is interrupted or changed. Relapse is not a sign of failure, and, at times, may be part of the recovery process. There are times when individuals are more vulnerable to relapse, specifically, when they are too hungry, angry, lonely, or tired (HALT), and need to be aware of this vulnerability, and take

Providing better outcomes in substance abuse treatment involves improving the quality and delivery of evidence based practice. One way to potentially achieve this is in continuous quality improvement (CQI)— “a planned approach to transform organizations by evaluating and improving systems to achieve better outcomes.”(Hunter, Ober, Paddock, Hunt & Levan, 2014). There are various approaches used in CQI interventions but most commonly used in substance abuse treatment settings is the Plan-Do-Study-Act (PDSA) cycle. The PDSA cycle is “a method in which individuals, drawn from the organization, make small, repeated and rapid changes to organizational function, test their impact and then decide whether to incorporate the change permanently.”

The second part of the problem is when multiple disorders that are currently considered separate and very similar. Having people with seemingly very different patterns be classified as having the same disorder was something I also saw frequently at my work. In the case of substance dependance we would have some patients who felt they could quit a substance if not for withdrawal, and other who felt the substance controlled their life. To me these seem like different problems, and I wouldn't think of treating them in the same way. I feel the same way about persons entering treatment for major depression that began with a specific event but lasting unreasonably long compared to a person who didn't have a clear event that started the episode. For the first example it could be a lack of coping strategies, yet for the other it may be cognitive distortions, yet both would be listed as the same disorder. As I previously stated, the opposite also seems problematic. Using the previous example, the cognitive distortions resulting in a major depressive episode could also result in dysthymia. Biological theories of disorders also don't seem to support these separations, with similar neuro-chemical problems being associated with ranges of disorders. Together, these two issues call into question the accuracy in our current system of categorical diagnosis in finding discrete clusters of symptoms.

Addiction is a “chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” The initial decision to take drugs is voluntary for most individuals, but frequent drug use can lead to brain alterations that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain alterations can be persistent, which is why drug addiction is considered a "relapsing" disease. People in recovery from drug use disorders are at increased threat for returning to drug use even after years of not taking the drug. It's common for an individual to relapse, but relapse doesn't mean that treatment doesn’t work. As with other chronic health conditions, treatment should be constant and should be adjusted based on how the patient answers. Treatment plans need to be reviewed often and modified to fit the patient’s changing desires.

In Counseling for Alcohol and Drug Abuse, the need to use different techniques is an integral part of the process. Working with an individual that is either entering into recovery or actively in recovery, the clinician must take their time with introducing the 12 Steps. The individual may not be open to the 12 Step philosophies at the onset. Addiction is very complex and actively affects the person on a daily basis; therefore, it is so important to start from the beginning of counseling to create a structured program.