Assignment 1: Assessing Clients With Addictive Disorders

Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. For this Assignment, as you examine the Levy Family video in this week’s Learning Resources, consider how you might assess and treat clients presenting with addiction.

Learning Objectives

Students will:

Assess clients presenting with addictive disorders

Analyze therapeutic approaches for treating clients with addictive disorders

Evaluate outcomes for clients with addictive disorders

To prepare:

Review this week’s Learning Resources and consider the insights they provide.

Review the Levy Family video Episodes 1 through 5.

The Assignment

In a 2- to 3-page paper, address the following:

After watching Episode 1, describe:

What is Mr. Levy’s perception of the problem?

What is Mrs. Levy’s perception of the problem?

What can be some of the implications of the problem on the family as a whole?

After watching Episode 2, describe:

What did you think of Mr. Levy’s social worker’s ideas?

What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?

After watching Episode 3, discuss the following:

What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?

What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?

Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.

Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?

In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.

Discuss how you would have responded to this revelation.

Describe how this information would inform your therapeutic approach. What would you say/do next?

In Episode 5, Mr. Levy’s therapist is having issues with his story.

Imagine that you were providing supervision to this therapist, how would you respond to her concerns?

Support your approach with evidence-based literature.

Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

By Day 7

Assessing Clients with Addictive Disorders

Psychotherapy with Individuals

NURS 6640 Addictive Disorders

Substance use and addictive disorders are at an all-time high in the United States and unfortunately highly common in military veterans. The psychiatric mental health nurse practitioner must be prepared to properly assess and treat individuals that struggle with the disorder. The purpose of this paper is to assess clients presenting with addictive disorders, analyze therapeutic approaches for treating clients with addictive disorders and evaluate outcomes for clients with addictive disorders using evidenced based research.

Episode 1

To begin, it is apparent that Mr. Levy has a problem with alcohol. He is drinking alcohol nightly by himself and it is affecting his job, relationship with his wife and children and his mood. Mrs. Levy is aware of the issue and pleads with him to get help so he can be the person he was before the alcohol abuse began. Mr. Levy is attributing his drinking every night because of things that he experienced in Iraq while in the military. It seems as if Mr. Levy is using drinking to cope with his possible PTSD. Alcohol abuse a significant problem among our nation’s military veterans. If someone has both PTSD and SUD, it is likely that he or she also has other health problems (such as physical pain), relationship problems (with family and/or friends), or problems in functioning (like keeping a job or staying in school).

Episode 2

To continue, I agree with the social workers supervisor in this situation. The first thing any mental health provider should do before coming up with treatment options is to get to know the client first so you have a better understanding about that individual as a whole. Also the first line of treatment for PTSD in war veterans is Cognitive Behavioral Therapy (CBT). CBT is considered to have the strongest evidence for reducing the symptoms of PTSD in veterans and has been shown to be more effective than any other nondrug treatment (Reisman, 2016). If the social worker tries a new form of therapy with little evidence that it is effective, and it fails this could have a major impact on the client causing him not to adhere to treatment.

Episode 3

Moving forward, I believe that the way the therapist responded to what Mr. Levy had to say regarding his experiences in Iraq were very good. She did not speak much she only asked how many times he served in Iraq. When someone is opening up about a traumatic experience the therapist should provide supportive and active listening. In my opinion this was a great session the therapist provided supportive listening, taught the client a new relaxation technique with deep breathing exercise and gained his interest in participating in exposure therapy to treat his PTSD. Diaphragmatic breathing involves contraction of the diaphragm, expansion of the belly, and deep inhalation and exhalation, which ultimately decreases the respiration frequency and maximizes the amount of blood gases (Ma, et al., 2017). Deep breathing can trigger body relaxation responses easing a person experiencing anxiety.

Exposure therapy is a good option for this client for the treatment of his PTSD. Exposure therapy is an evidenced-based psychotherapy and a form of CBT. According to Reisman (2016), the most studied types of CBT are cognitive processing therapy (CPT) and prolonged exposure (PE) therapy and are recommended as first-line treatments in PTSD practice guidelines not only in the United States but around the world. Exposure therapy has shown to be effective in 60% of veterans with PTSD. The treatment will take approximately 12 weeks of weekly therapy and will include revisiting of the trauma and aids the client in how to overcome fear- and stress-inducing situations moving forward (Reisman, 2016). I agree with the therapist’s choice on this form of therapy

Episode 4

The client expressed a major trauma that he faced while in Iraq regarding watching his sergeant die. After the client told the story and reported that he cannot sleep at night due to flashbacks of his sergeants face I would inform him that in conjunction to this therapy that there are pharmacological options that can assist with his PTSD symptoms. The client has been very open to treatment options and has the desire to get better. Educating the client on different medications that assist with PTSD symptoms can give him hope and a stronger desire to continue treatment.

Episode 5

To conclude, the first line treatment for PTSD psychotherapies, but this involves the client sharing their past trauma to a mental health professional. Traumatized patients are encouraged to confront their associations, often by purposefully reliving the traumatic event to experience their full emotional and physical reactions. Secondary trauma also known as compassion fatigue and vicarious traumatization is defined as indirect exposure to trauma through a narrative of a traumatic event (Gil, & Weinberg, 2015). The vivid recounting of trauma by the survivor and the clinician’s subsequent cognitive or emotional representation of that event may result in symptoms mimic PTSD. Mental health professionals that work with individuals that suffered from traumatic experiences need to make sure they have enough time for self-care by maintaining a reasonable balance between work and their personal life.,

References

Gil, S., & Weinberg, M. (2015). Secondary Trauma among Social Workers Treating Trauma Clients: The Role of Coping Strategies and Internal Resources [article]. International Social Work, (Issue 4), 551. Retrieved from /orders/ezp.waldenulibrary.org/login?url=/orders/search.ebscohost.com/login.aspx?direct=true&db=edshol&AN=edshol.hein.journals.intsocwk58.54&site=eds-live&scope=site

Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., … Li, Y.-F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology, 8, 874. http://doi.org/10.3389/fpsyg.2017.00874

Reisman, M. (2016). PTSD Treatment for Veterans: What’s Working, What’s New, and What’s Next. Pharmacy and Therapeutics, 41(10), 623–634.

Sodeke-Gregson, E. A., Holttum, S., & Billings, J. (2013). Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients. European Journal of Psychotraumatology, 4, 10.3402/ejpt.v4i0.21869. http://doi.org/10.3402/ejpt.v4i0.21869

Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance Abuse and Rehabilitation, 8, 69–77. http://doi.org/10.2147/SAR.S116720

Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse : a how-to guide for evidence-based practice. New York, NY : Springer Publishing Company, LLC, [2014].