Many say that acknowledgment of an issue is the first step to its resolution. However, merely recognizing the issue is not sufficient for healthcare services to construct a suitable intervention. A concrete plan for a disorder treatment process is the key to its success, yet it is impossible to compose one without knowing all the relevant factors. Patients with multiple disorders present an even more formidable challenge, requiring an individually tailored approach with the most thorough assessment. Gerard, a 57-year-old miner, presents a challenging case that includes several long-term substances uses and behavioral disorders, chronic depression, and incidental aggression. This paper will examine the multimodal approach to patients with complex co-morbidities in the example of the case of Gerard by outlining a probable assessment process and three ways to intervene in this situation.
Screening and Assessment Process
The information that specialists will receive is vital for Gerard’s speedy recovery, the safety of the selected treatments, and the overall quality of care. Initially, all psychiatric history must be immediately requested from all past treatment facilities and thoroughly analyzed for the purpose of determining past and present conditions, efficient and inefficient approaches, and the client’s preferences and medications (Atkins, 2021). Gerard’s current state must be well-documented via both a personal interview and a questionnaire that captures his contemplations and causes of adverse behavior.
The possible approach to analyzing this case is the stages of change model by Prochaska and DiClemente. This method involves analyzing a patient’s thought processes that lead to undesirable behavior through a cycle of plan-action sequences (Atkins, 2021). All of the patient’s issues must be analyzed from their initial occurrence to the most recent relapse. Behavioral addictions often share symptoms and methods of their alleviation with substance addictions, as both falls under the definition of “craving” (Sancho et al., 2018). These cravings, their causes, and targets must be clearly outlined during the assessment, putting statements by the patient in comparison with the intended goals. Treatment is as efficient as a patient’s will to participate in it since a physician’s efforts are insufficient without motivation (Atkins, 2021). Therefore, the assessment process must identify factors that cause Gerard to use and abstain from substances and gambling.
It is crucial for healthcare personnel to contact Gerard’s relatives and confirm any information relative to the case. It is not unusual for patients with coexisting disorders to fail to report or misinterpret their actions or perceptions, making an outside view of the presented case a vital source of information (Atkins, 2021). Their input will not only increase the validity of the data but also keep Gerard’s motivation at a required level later on.
Applicable Therapeutic Approaches to Treatment
There are many possible solutions that have been developed for the treatment of patients in such situations. However, some of them may be less applicable to this case. First of all, the patient’s desire or the severity of the issue may call for an inpatient option for treatment. There are hints in Gerard’s behavior that he may agree with this treatment, as he is already seeking help. Residential treatment programs that are capable of dealing with co-occurring disorders provide fewer restrictions on a patient’s personal freedom while efficiently dealing with their physical and mental issues (Atkins, 2021). Such facilities nullify patients’ exposure to triggers, making them a valuable opportunity for Gerard to self-reflect and learn how to abstain from adverse behavior via individual and group therapy sessions with a psychiatrist. However, without a strong motivation from Gerard, this option may have limited efficiency due to a high possibility of relapse (Atkins, 2021). Therefore, other options may be preferable and must remain on the table.
Another possible solution to Gerard’s issue can be outpatient therapy with frequent visits from an appointed healthcare worker. This method allows a highly individualized treatment plan to be as comfortable and accommodating as possible while remaining grounded in the facts (Atkins, 2021). Non-standardized care is preferable for co-occurring disorders as it eases the acceptance of treatment (Wieczorek & Dąbrowska, 2019). Scheduled visits from a specialist are an efficient solution to cases where a patient does not require constant monitoring and has support from other sources (Atkins, 2021). In this case, motivational interviewing can be implemented to promote changes in Gerard’s lifestyle and adherence to daily routines. The level of motivation is sufficient for the application of this method. The setting for treatment is already set, as Gerard’s family appears to be ready to move in for a prolonged period to help him deal with addictions.
The last therapeutic approach that will be reviewed is a mindfulness-based intervention. This method increases self-awareness through meditation which helps a patient to achieve peace of mind and focus on the present (Atkins, 2021). For example, mind-body practices may help Gerard alleviate pain, bring order to his thoughts, and allow him to shift attention to a more suitable subject by himself. Substance use disorders and behavioral addictions may be efficiently controlled via self-regulation, given sufficient training was provided to a patient (Ketcher & Black, 2020). Mindfulness training may be suitable for Gerard if he expresses interest in this subject and shows improvements after the initial course.
It must be well understood that this case requires a continuous assessment, with multiple stages marking each goal and changing on the fly to support any possible developments in Gerard’s state. Motivational interviewing must always remain a possible option during any stage of intervention, despite the selected approach, as it decreases the chance of a patient dropping out of the process (Abbott, 2019). Overall, a selected approach must be feasible, agreed upon by both healthcare personnel, a patient, and their family, and remain open to adjustments.
Potential Scenario
For Gerard, the realization of the faults in his way of living presents an excellent opportunity for change. His motivation will be the focus of the treatment plan, and upholding his desire to cease addictive behavior will be supported via all possible channels. Outpatient therapy is a likely scenario for this case, as Gerard has a supportive family at home and a strong desire for self-improvement. Since the involvement of the family is already in process, the initial part after the assessment will begin with consulting Gerard’s relatives and involving them directly in assisting a physician’s efforts. Their input will lie in the success of this intervention, as Gerard alone is unlikely to prevail under duress and his decreasing health status. It will be vital to monitoring Gerard’s condition continuously and document any changes in his behavior. Alas, gamblers with co-occurring disorders drop their treatment 2.5 times more often, making monitoring essential (Wieczorek & Dąbrowska, 2019). Therefore, a physician needs to appoint a case manager to keep track of the patient’s progress and provide advice or seek specialists’ assistance if necessary.
Goals for the patient must be set to realistic, desired by Gerard himself, and measurable by his doctor and, for some parameters, his family as well. The structure of the proposed treatment must be straightforward and well-understood by all stakeholders through a doctor’s consultation (Atkins, 2021). A specialist will meet with the patient to discuss, analyze, and improve upon recent experiences related to substance use and gambling addiction. Without any judgment, this worker will assist Gerard with overcoming resistance to change via advice and suggestions, avoiding any coercive statements. Eventually, Gerard is expected to experience discomfort when thinking about factors that cause undesired behavior. The patient will accept change and eventually become self-conscious regarding his choices and how they affect his and his relatives well-being.
Conclusion
In conclusion, the presented case poses a necessity for healthcare services to utilize a multimodal approach, which includes efforts from all stakeholders and Gerard himself. After a long journey to his current state of mind and body, Gerard is open to assisted self-improvement. His motivation will be used as the initial step toward abstinence and control, yet it must be supported by outside sources. His family is the key stakeholder in this process and can become an efficient unit for keeping the patient’s motivation high. Pushing through several disorders will be challenging, but it is manageable with a clear treatment plan and knowledge of a patient’s current condition. These methods should bring order to Gerard’s and his family’s lives through the gradual eradication of the patient’s destructive behavior. Additional control over possible relapses will be secured by a case manager who will monitor Gerard’s state via interviews and assessments and provide assistance on this path to recovery.
References
Abbott, M. W. (2019). Professionally delivered interventions for gambling disorder. Current Opinion in Psychiatry, 32(4), 313-319.
Atkins, C. (2021). Co-occurring disorders: A whole-person approach to the assessment and treatment of substance use and mental disorders (2nd ed.). PESI Publishing.
Ketcher, A., & Black, D. S. (2020). Mindfulness-based interventions applied to addiction treatments. In S. Sussman (Ed.), The Cambridge handbook of substance and behavioral addictions (pp. 409-416). Cambridge University Press.
Sancho, M., De Gracia, M., Rodríguez, R. C., Mallorquí-Bagué, N., Sánchez-González, J., Trujols, J., Sánchez, I., Jiménez-Murcia, S., & Menchón, J. M. (2018). Mindfulness-based interventions for the treatment of substance and behavioral addictions: A systematic review. Frontiers in Psychiatry, 9.
Wieczorek, Ł., & Dąbrowska, K. (2019). Difficulties in treatment of people with comorbid gambling and substance use disorders. Journal of Substance Use, 25(4), 350-356.