Brief Summary of the Client and Problem
The clients being addressed in this case are individuals with substance abuse problems. People with drug abuse issues have enhanced motivation to take drugs, increased probability of reacting to stress, emotional dysregulation, and impaired self-control. Drug use and abuse contribute significantly to mortality and morbidity rates in different set-ups. For instance, globally, alcohol abuse, the most commonly used psychoactive substance, is responsible for 4 percent of total disability and 3.2 percent of annual deaths (D’Souza & Mathai, 2017). Therefore, it is important to come up with intervention measures to address this public health problem.
The specific keywords used for the search included drug addicts, abuse, motivation, ambivalence, treatment compliance, intervention measures, angry outbursts, vulnerability, and insecurity. These keywords were meant to achieve specific outcomes. For example, as mentioned above, the clients, in this case, have drug abuse-related problems hence the use of the words “drug addicts and abuse.” “Motivation” was meant to address some of the factors that have been identified that improve the urge to change. The phrase “intervention measures” was expected to generate results about some of the approaches used to address the problem of drug abuse. Similarly, “treatment compliance” and “ambivalence” sought to establish what the available evidence shows about the role of ambivalence in following through with the treatment plan. The search results were limited to peer-reviewed articles published in the last five years to ensure the data used is up to date.
Research Topic and Research Questions
The research topic selected was drug abuse, intervention measures, and mediating factors to treatment compliance. The following research questions guided this case to inform the continuing assessment and intervention planning. i) Is there evidence that shows clients with drug abuse problems have angry outbursts because they feel insecure and vulnerable? ii) Are there some factors that have been identified that improve motivation to change and stop drug misuse? iii) What does the evidence show about the role of ambivalence in following through with the treatment plan? iv) Are there some treatment approaches that work better within specific conditions?
Summary of Evidence in the Literature Review
In their study, Tang et al. (2016) found that behavioral training could be used to reduce drug abuse. Specifically, this study focused on the role of mindfulness and meditation in improving emotional regulation as one of the strategies for addressing the problem of substance use and abuse. According to Tang et al. (2016), some of the major challenges that affect drug abusers include impulsivity and compulsivity, which means a lack of self-control, increased probability of reacting to stress, and emotional dysregulation or negative mood.
Therefore, this study was based on the premise that given that meditation and mindfulness have been shown to be effective strategies in improving emotional regulation, that attribute could be leveraged to address addiction. 46 randomly selected undergraduates were recruited for the study and given relaxation training on mindfulness and meditation (Tang et al., 2016). Brain imaging assessments were conducted before, during, and five days after the training session. Emotional regulation and stress management skills were assessed after the training. The results showed that both non-smokers and smokers had improved self-control abilities to manage their stress levels and regulate emotions after the training. Therefore, based on these findings, mindfulness and meditation are some of the treatment and intervention measures that could be used with drug abusers.
In another research, D’Souza and Mathai (2017) sought to study the role of motivation for change among hospitalized people with alcohol dependence syndrome (ADS). Readiness to change alcohol-drinking behavior is subject to various factors, such as self-efficacy, drinking severity, perceived stress, psychiatric comorbidity, and expectations for positive treatment outcomes among other related elements. The study was conducted in a treatment center dealing with alcohol de-addiction in a tertiary care facility. 100 inpatients in the hospital were selected for the study (D’Souza and Mathai, 2017). The results showed that the major motivational factors toward behavioral change included religion, level of income, and socio-economic class. For instance, those with higher levels of income or belonging to a higher socio-economic class were more motivated to change as compared with those from poor backgrounds.
Additionally, practicing Muslims and Christians were more ready to change as compared to their counterparts not affiliated with any religion. The mode of referral also had a significant influence – self-referred patients for treatment were more motivated to change their behaviors as compared to those referred by family members or care providers. Therefore, this study shows that the preparedness or motivation to change addictive behaviors is subject to various aspects, but religion, socio-economic status, and intrinsic motivation play an important role.
Walitzer, Deffenbacher, and Shyhalla (2015) aimed to study alcohol-adapted anger management in a group of alcohol-dependent individuals. The authors hypothesized that anger and alcoholism are causally correlated, and thus managing one could lead to better outcomes in the other. The working premise of this study was that alcoholism triggers anger, thus alcohol consumption was managed as the independent variable while anger was taken as the dependent variable. 76 alcohol-dependent participants from both genders were selected to participate in the study, whereby some were given intervention for alcohol dependence using Alcoholics Anonymous Facilitation treatment (AAF) and others were taken through an anger management (AM) program. The participants were followed for six weeks, and results concerning their anger patterns were noted.
The findings showed that the participants exposed to the AAF reported significantly reduced heavy drinking, mal-adaptive anger-related cases, and improved self-control and confidence as compared to AM group (Walitzer, Deffenbacher, & Shyhalla, 2015). From these results, it could be deduced that people become violent or have anger outbursts after becoming intoxicated with alcohol. As such, treating alcoholism could be used as a way of managing anger. The study did not indicate the underlying factors that make intoxicated people have anger outbursts. The search results did not yield any peer-reviewed article on the role of ambivalence in following through the treatment plan.
Application to Assessment
The information derived from this literature review is important and relevant to the clients being addressed in this case. First, the issue of effective intervention measures arises, and as Tang et al. (2016) found out in their study, mediation and mindfulness practices could be used to address this problem. This strategy seeks to empower the affected individuals to regain control of their lives. Tang et al. (2016) showed that mindfulness and meditation positively affect parts of the brain, specifically by improving activity in the anterior cingulate cortex (ACC), which is directly related to increased levels of self-control through emotional regulation. Therefore, in practice, these intervention measures could be applied to reduce impulsivity and compulsivity, which are major causes of substance dependence due to emotional dysregulation. From this study, I have realized that my clients are unable to control their emotions, but with the appropriate intervention, they could be helped to master their emotions and overcome this problem. Additionally, I could incorporate training on mindfulness and meditation into my practice, especially when dealing with drug users and abusers.
Similarly, from the article by D’Souza and Mathai (2017), it is clear that the motivation to change the behavior associated with substance abuse is subject to various factors. Specifically, the study found that religion, socio-economic status, and intrinsic motivation are important mediating factors in making the decision to change. The majority of my clients are from poor socio-economic backgrounds, and from this study, I now understand why they struggle with the problem of drug abuse. Therefore, in my practice, I will be careful to understand the different factors affecting motivation to behavior change so that I can apply the appropriate intervention strategies. The article by Walitzer, Deffenbacher, and Shyhalla (2015) is also insightful as it establishes the direct link between alcoholism and anger outbursts. I have learned that addressing the problem of alcoholism directly improves anger management, and this information is insightful and useful in my practice. Instead of intervening through anger management, I would rather work on the alcoholism problem, which, in turn, addresses the anger issue.
Conclusion
However, after going through this literature review, I have some unanswered questions. First, I did not get an article addressing the issue of ambivalence, and thus I do not know how it affects compliance with treatment plans among drug users. Second, I am yet to understand the underlying causes leading to anger outbursts after someone takes alcohol. Does this problem come from deep-running issues, such as feelings of insecurity and vulnerability?
References
D’Souza, P. C., & Mathai, P. J. (2017). Motivation to change and factors influencing motivation in alcohol dependence syndrome in a tertiary care hospital. Indian Journal of Psychiatry, 59(2), 183–188. Web.
Tang, Y. -Y., Tang, R., & Posner, M. I. (2016). Mindfulness meditation improves emotion regulation and reduces drug abuse. Drug and Alcohol Dependence, 163(1), 13-18. Web.
Walitzer, K. S., Deffenbacher, J. L., & Shyhalla, K. (2015). Alcohol-adapted anger management treatment: A randomized controlled trial of an innovative therapy for alcohol dependence. Journal of Substance Abuse Treatment, 59, 83-93. Web.