The next presenting issues and goals that my client Rachel could address after completing the last one – measured in the single-subject design (SSD) paper – revolve around alcohol and drug addiction. The goal is based on objective setting and the realization that good health comes from being deliberate about it. With negative thoughts out of the way, Rachel could now tackle her alcohol and drug addiction problem. Typically, people with drug addiction have general medical, employment, alcohol, drug, legal, family, and psychological problems.
For example, she presented with the employment-related issue of joblessness, the legal-related problem of sentencing, family-related challenge of conflict and separation, and psychological issues that include depression, hallucination, suicidal thoughts, and anxiety. With specific, measurable, achievable, realistic, and time-bound (SMART) objectives, Rachel might completely eradicate alcoholism and drug addiction. If Rachel quits alcohol and drugs, her health, relationships, and finances will improve. She will also manage personal hygiene better if she achieves sobriety.
Various goals and objectives that Rachel could focus on are measurable using goal attainment scaling (GAS). Notably, a relationship between the main goal and specific objectives exists to simplify the effort needed for their attainment. In this particular case, the main goal is to reduce, with the ultimate aim of eradicating, drug and alcohol abuse. One of the GAS-measurable objectives tied to this goal is to minimize alcohol consumption to one glass of beer or three tots of spirits per day (down from the current unlimited amount). The other one is to restrict the use of crack cocaine to only once a month from the current rate of almost weekly usage. Quitting cocaine should be simpler because the drug is illegal and not necessarily easy to find.
A GAS Chart with the Two Objectives
As noted earlier, if I were to try this technique with the client, the goal would be to reduce alcohol and drug abuse with the ultimate aim of finally quitting them completely. The two objectives based on this goal are to reduce alcohol use to about three pints a day and to limit cocaine use to once a month. The idea is to ensure that Rachel consumes less and less alcohol and drugs on her path to recovery. The approach is appropriate because abruptly quitting alcohol and drugs can lead to severe withdrawal symptoms that may complicate the recovery process. It is also important to have a progressive reduction in alcohol consumption to eradicate relapse, which commences as a series of patterns formed by individual attitudes and thought processes. A doctor or qualified social worker can help a recovering addict avoid relapse by creating an effective path to recovery and recognizing and managing early relapse warning signs.
No matter how good a treatment regimen is, it is unlikely to work if there is no collaboration with the patient. Therefore, I would scale the first objective by collaborating with Rachel in developing her daily routine. I will help her identify various activities she can engage in daily to earn a living and ensure that she is not idle to reduce thoughts about looking for alcohol and drugs. I will also meet Rachel daily and supervise her as she takes the limited daily amounts of alcohol. I will use the same approach and strategy to collaborate with Rachel to attain the second objective. I will supervise Rachel closely for two months and scale up the objectives if the assessment at the end of the second month reveals positive gains. We will continue scaling the objectives until our primary goal is 100 percent abstinence from drugs and alcohol and continued monitoring to prevent relapse.
GAS Chart: Goal Attainment Scale
Client Name: Rachel McCoy
Symbol for initial raw score: ___ ? ___
Symbol for follow-up raw score: __ ?____
Length of Treatment: Eight weeks
Evidence Base and Treatment Fidelity
The recommended intervention – gradual quitting of alcohol and drug use – has the best potential for being effective with this client as existing evidence support it. According to Horowitz and Taylor (2019), tapering drug use – including prescription drugs – is the best mechanism for reducing withdrawal effects. When an individual is addicted to alcohol or cocaine, their bodies are used to these substances; they cannot function effectively without them. Therefore, putting an abrupt stop to the use of these drugs is not recommended. Tapering gives the body time to adjust its dependence mechanism leading to better recovery.
However, Attilia et al. (2018) and Airagnes et al. (2019) contend that gradual quitting is effective when accompanied by detoxification and drug treatment. In this regard, Rachel will undergo detoxification treatment followed by alcoholism medication, sedation, and vitamin treatment. Rachel will also receive cognitive-behavioral, aversion, and family therapy to supplement the other practical strategy of reduced alcohol and drug consumption. The well-known alcohol and drug withdrawal syndrome occur after an intentional or unintentional abrupt cessation of heavy consumption of the substances (Jesse et al., 2017). Because Rachel has been a heavy alcohol and drug user, abrupt cessation of consumption is not recommended as it will negatively impact her life.
For Rachel’s treatment to work, we will employ various measures and approaches from the beginning. The main strategy will entail reducing the number of drinks consumed gradually until this number gets to zero. It is recommended that it gets to zero because people with former alcoholism may find it difficult to maintain their drinking habits within acceptable levels. The second approach would be to space out the length of time between drinks.
The time between each drink will increase until Rachel finds it difficult to recall the last one she had. Third, the patient will take juice, lemonade, or a glass of water between drinks and substitute for alcohol and drugs. It will ensure she remains hydrated to fight off any possible symptoms of withdrawal. I will implement the intervention during the week that the client and I do the GAS by convincing Rachel to change from using her favorite drink to consuming the one she hates the most. We will also develop the weekly reduction schedule and designate a stop date.
Determining Current Level and Computing Change Scores
At follow-up, my client and I will decide what level we have reached by looking at performance until that day. At the beginning of the treatment, we will introduce a notebook to record her daily and weekly alcohol and drug consumption activities. We will then meet and evaluate performance every two weeks, converting the scores into percentages. If the percentage scores per week are 90 or more, it means that the client is ready to proceed to the next level. If the scores are below 80 percent, we will review the strategy and create a better one. A score between 80 and 90 percent means that the client will proceed to the next stage but with greater monitoring and supervision.
In the weekly assessment, the client and I will compare our records to verify the results and ensure they are accurate. Notably, my client and I believe that other family members will also help Rachel in her sobriety journey.
As noted earlier, the scores based on the new treatment objectives range from -2 to 2. Since the maximum daily score for alcohol consumption reduction is 2, the weekly maximum is 14 (2 multiplied by 7). Similarly, the least score per week is given by -14 (negative 14). My client and I will not compute the daily scores for drug addiction as this will happen only once a month, with the maximum monthly scores being two and the minimum being -2 (negative 2). Notably, the maximum weekly score of 14 means that the client has restricted her daily alcohol consumption to one glass of beer or three tots of beer. The lowest score means that the client has not been able to restrict her daily consumption of alcohol. It is the worst possible outcome that implies that the employed strategy is not working. My client and I will convert only positive scores to percentages.
Any negative scores imply that the client is doing poorly and that the strategy needs to change. The formula for converting positive scores into percentages is given by the current score divided by the maximum score (that is 14) and multiplying the result by 100. That is:
Percentage score = (current score/maximum score) * 100
As seen from the hypothetical score, Rachel scored 100 percent in the first two weeks, representing significant performance. The percentage is calculated as follows:
Percentage score = (current score/maximum score) * 100
(14/14) * 100
1 * 100 = 100%
Conclusion
Quitting alcoholism is not easy, but it can happen with a well-designed strategy and commitment from both the patient and the interventionist. The main research limitation of this work is that there are no recommended lengths for quitting alcohol gradual; the duration depends on personality and other factors. If this outcome had occurred during my work, the next step with the client would have been to monitor change and watch out for any signs of relapse for up to two years.
References
Airagnes, G., Ducoutumany, G., Laffy-Beaufils, B., Le Faou, A. L., & Limosin, F. (2019). Alcohol withdrawal syndrome management: Is there anything new? La Revue de Medecine Interne, 40(6), 373-379. Web.
Attilia, F., Perciballi, R., Rotondo, C., Capriglione, I., Iannuzzi, S., Attilia, M. L., Coriale, G., Vitali, M., Cereatti, F., Fiore, M., & Ceccanti, M. (2018). Alcohol withdrawal syndrome: Diagnostic and therapeutic methods. Rivista di Psichiatria, 53(3), 118-122. Web.
Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538-546. Web.
Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben‐Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A., & Ludolph, A. C. (2017). Alcohol withdrawal syndrome: Mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4-16. Web.