Interventions for Drug Addiction: Case Study

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Many attempts have been made to arrive at a universally acceptable definition of addiction and what causes addictive behaviour but the matter still remains unresolved. People often define addiction as drug abuse and misuse. To Krivak (1982,p.83), ‘Addiction will be defined as a behaviour pattern characterised by an ongoing and overwhelming preoccupation with the used of a drug and the securing of its supply.’

This definition could also say the addict is, ‘Someone who is involved with an activity to such an extent that it the major focus of his or her life’, (McAllister et all., 1991,p.5).

For my assignment, I have chosen a client within the criminal justice system that has an addiction problem with drug misuse. He has been involved with the criminal justice system because of his offending behaviour relating to illegal drugs. I am basing my assignment on this client. I am going to discuss in my assignment, drug users and the criminal justice system, the psychology of addictive behaviour, Care planning and different options of planning and assessment, the initial referral and the in-depth assessment, methods of intervention and models of care and drug problems in prisons within the criminal justice system.

Where there is an addiction to drugs, most drug users at some time or another come into contact with the criminal justice system. This is how my client got involved with the system. Some drug users spend periods of time in prison as a result of drug-related offending behaviour. There is an alternative to custody and these include fines, community service, probation and bail, which is subject to certain conditions such as participation in drug treatment programmes. My client is subject to certain conditions that he participates in a drug treatment programme.

Criminal justice orders can be subject to conditions of residence for the offender. For drug service workers, close liaison with practitioners in the criminal justice field of work is normal practice. Joint care plans are carefully and sensitively devised to help both services work with the drug user in collaborative and constructive ways. Criminal justice practitioners are expected to work with offenders to achieve specific objectives and these are not always compatible with drug service objectives, for example, reducing drug-related offending behaviour rather than getting rid of it altogether (Robertson, 1998, p.389).

My client has an addiction to drugs. The psychology of the addict involves behaviour that takes a repetitive form and is associated with increases of anxiety. Some behaviours that take a repetitive form are associated with increases or decreases in anxiety and these are considered compulsive behaviours. These types of behaviours can include drug addiction, gambling and exhibitionism. However there are important distinctions between these types of behaviour and action and true compulsive behaviour. Firstly addictive behaviours involve a pleasure-seeking component, which is not in compulsive behaviours. Secondly, the anxiety involved with the performance of criminal activity is appropriate in light of social sanctions. Obsessive-compulsive patients experience anxiety that is inappropriate to the situation (Oltman, 1995,p11).

There are different options of planning and assessing with substance misuse offenders in the criminal justice system. For social workers, assessment is a key task and it will determine whether or not a care plan is needed for the offender of if a management service is needed. The NHS and Community Care Act (1990) provides guidance on procedures for assessment for people who are entitled to community care services. The assessment process includes, the initial referral, the initial assessment and the in-depth assessment. The assessment process should be needs led and not service-led. Community care services are greatly in demand and the screening process is used to determine who needs the treatment the most. Drug agencies undertaking assessment may receive referrals from the criminal justice system or other agencies. Basic referral forms are filled in with the details of the service user, such as factors and the reason for referral. My client has been referred from the criminal justice system to a drug agency for assessment.

The initial interview with the service user will determine whether or not they need a more in-depth assessment or a formal care plan. Most local authorities have certain criteria and priority levels to which they can base their response on. The service user is told what is involved in the assessment, is told about confidentiality policies and whether or not there will be any participation of others. The service users are told what to do if they want to use complaint procedures or appeal if they are against any decisions made at or after the assessment. The initial assessment will determine the seriousness of the problem and the level of need required.

My client has more complex needs with his addiction problems so he would require a more in-depth formal assessment so that a care plan can be made for him. This assessment will include personal details, family and relationships, social details, significant life events, social supports and networks, comprehensive history of addictions and associated problems. The assessment will also include, treatment history, risk behaviour, criminal history and current offending behaviour, financial status, physical health, mental health problems, past and present, self concepts, perceived needs and the level of motivation to address these needs, personal resources and abilities, resources and abilities of partners and carers, other agency assessments and specialist assessments and the conclusions and suggested interventions of the assessment.

Robertson (1998,p.376) suggests that care planning should involved developing a package of care, which will meet the client’s needs. Care plans are systematic approaches and include all the care and treatment that will be provided and the desired outcome. Care plans are monitored measured and reviewed and will involve the client, service provider, an assessor and a care manager. The care plan will involve information gathered at the assessment in an easy to monitor format and will illustrate the behaviours that need to be addressed and it will have separate sections for identifying the needs of the problem.

Partnerships between the criminal justice system and the treatment agencies direct substance-misusing offenders to the appropriate services. There are many initiatives aimed at encouraging substance misusers to take part in appropriate treatment that will help them. In the UK there are twelve step agencies that are also know as the ‘Minnesota method of treatment’. These agencies are funded through statutory sources. The aim of these agencies is to treat the dependence on drugs to help reduce drug misuse and to help the client give up drugs completely when they feel ready to do so. Three intermediate aims are to help resolve the underlying problems that contribute to drug misuse, to help the client gain more control and minimize harm also known as harm minimization (Keene, 1997,p.223).

The Government produced a drug strategy in 1998 in the UK called, ‘Tackling drugs to build a better Britain.’ This was updated again in 2002. The strategy sets out the range of interventions and policies to help reduce harm caused by using illegal drugs by the year 2008. The drug intervention programme used to be known as the criminal justice interventions programme. The government aims to cut crime related to drug use. This strategy uses the criminal justice system to help direct offenders who used drugs out of crime and into treatment.

There are different kinds of interventions used by drug service workers. Psychological interventions are very useful when it comes to help treat someone with a drug addiction. Professional psychotherapy is very effective and good quality drug counselling can also be very effective. Psychological interventions are, cognitive behaviour therapy, motivational interviewing, and the twelve-step treatment program that I discussed earlier and relapse prevention. Some people think that complementary and alternative therapies are useful, but there is not enough evidence in the population to back up this claim.

The model of care, introduced by the National Treatment agency (NTA), is a framework that is used by Drug Services to ensure that the services provided are consistent and meet the needs of the service user. The framework is categorised by easy to understand tier levels and treatment levels. Tier one, includes primary care by health care professionals and general practitioners that provide medical services along with probation and housing services. Tier two (Open Access Services) offers a range of drop in street agencies that offer advice and support for stimulant users and substance misusers are able to drop in when there is a crisis. Tier three (Community prescribing services) is mostly geared towards opium user. Tier three, (Structured day programmes) are geared into providing education about drug misuse, and provide training for work skills and give advice about practical issues. Tier four, (Residential Care) has different systems in place for entry in different areas for entry into residential care. The social services community care assessment team usually deal with the funding.

Another option for the substance misuse offender is motivation to change. Motivational interviewing is based on using the motivational change model. The model consists of five stages with stage one being the pre-contemplation stage, stage two the contemplation stage, three the action stage, four the maintenance of change and five the relapse stage. Prochaska and DiClemente are two best-known authors on the importance of individual motivation in dependency treatment. The authors developed the motivational change module from their work with smokers. They use a

Cognitive behavioural approach method and their interventions are concerned with cognitive and behavioural change (Prochaska and DiClemente, 1983,p.390).

The control of drug misuse is a big problem in prisons. People are much more likely to use drugs in prison because of stress, anxiety and boredom. These levels are higher for substance misusers in prison so they would be more likely to take health risks. Drug treatment in prison could be approached the same way, as it is in the community with regimes to reduce drug related harm, rather than prevention.

Because of the extent of my client’s addictive behaviour he has had a formal in-depth assessment done so that we can meet his needs. This has resulted in a care plan being made up for so that we can provide services for him and carefully monitor his progress. We have liased with other professional health services and we have had a full mental health assessment done for him. We have considered his past history of using drugs and the amount of offending he has done in the past and the length of time he has been involved in the criminal justice system. We have noticed that he has also had mental health problems in the past and that he suffers from depression. The client did not go into custody this time because of his substance offending behaviour instead he was given a probation order subject to certain conditions that he participate in a drug treatment service. We contacted drug service workers who were happy to help my client as long as he was willing to accept help. My client says that he does want to change his behaviour and put an end to his substance misuse. He has tried in the past to give up but this has always lead to a relapse. After careful consideration and after weighing up all the options of treatment for my client I decided that psychological intervention along with drug therapy was the best way forward to help reduce his drug dependency. I have decided that professional psychotherapy and relapse intervention would be the best option for him because other options have not helped him in the past. We are also going to offer him good quality counselling. My client has told me that spending time in custody has not done him any good. He told me that he gets very depressed when he is inside and this leads to more dependency on drugs. Our goal is to help him stay out of custody and reduce his dependency on drugs. We will continue to monitor, measure and review the clients care plan and see whether or not his dependency and addiction are getting better. As substance service workers our goal is to meets the needs of the service user and in this instance it is to reduce substance addiction and the long term goal is to eradicate substance misuse altogether.

In order to intervene effectively where there is addictive behaviour, social workers need to be able to assess and plan appropriate treatment. For my assignment I have chosen a client within the criminal justice system that has an addictive behaviour. He is a drug misuse offender and he has been involved with the criminal justice system for a few years now. I have discussed a bit about the psychology of addictive behaviour and how my client was referred to me through the criminal justice system. I have discussed the methods of assessment and the different options available. I have discussed the most suitable option for my client who I feel has deeper problems to address than some other substance misusers I have encountered. In this instance I felt that my client would benefit from a psychological form of intervention that would include psychotherapy. There are different types of psychotherapy; these are behaviour therapy that helps the client put an end to undesirable habits or certain fears that they have. Cognitive therapy is a method that tries to show the client that certain thoughts that they are having are not good for them and that they are negative. The therapist will then try to get the client into thinking more positive thoughts in order that the persistence of negative thoughts will eventually fade away.

Drug therapy is also called by the name of pharmacotherapy and it is a part of psychotherapy. The approach here with this method of intervention is to calm the person down using certain anti-anxiety drugs so that they permit the other therapies to have effect. The negative side is that sometimes these drugs encourage psychological dependence and the anxiety that was there before might return again. Some addictions such as obsessive – compulsive disorder have been successfully treated using certain antidepressant drugs.

The types of interventions I have discussed do not always work for everyone. Social workers need to analyse the situation very carefully and sensitively when working with addictive behaviours. This is because it is a very sensitive area and if treatment goes wrong the client could go back to their old habits of substance misuse and become a part of the drug culture again. The aim is to reduce offending and minimise the number of substance misusers by putting carefully controlled care plans into place to address their needs. The intervention method that was used on my client was very successful and I am happy to say that my client has cured his addictive behaviour. It is important that assessments are done very carefully and to take into consideration all the important facts of the client. It is also important for social workers and other drug service workers to gain the trust of the client because without this there is less change of the client willing to accept treatment.

References

Barber, J. (2002) Social Work with addictions, 2^nd ed. Basingstoke: Palgrave Macmillan.

Keene, J. (1997) Drug Misuse; Prevention, Harm, minimisation and treatment. London: Chapman & Hall.

Krivanek, J. A. (1982) Drug Problems, People Problems: Causes, Treatment and Prevention, Sydney, Allen & Unwin.

McAllister, I., Moore, R. and Makkai, T. (1991) Drug users in Australian Society: Patterns, Attitudes and Policies, Melbourne, Longman Cheshire.

Oltman, T. F. (1999) Case Studies in Abnormal psychology, New York: Chichester. John Wiley & Sons.

Prochaska, J. O. and Diclemente, C. C. (1983) Stages and Processes of self-change of smoking: Towards a more integrative model of change. Journal of consulting and Clinical Psychology.

Robertson, R. (1998) Management of Drug users in the community, a practical handbook. Arnold publishers.