There are different ways to describe substance abuse. Every substance abuse case is individual and requires a unique assessment and intervention plan to best help a client. Alcoholism is injurious to health and is a prevailing plague which requires professional medical assistance, detox and long-term planning to facilitate client to heal and recuperate in a healthy environment. The continuous abuse of alcohol not only deteriorates health but also destroys ones sense of balance. Here, is a case study of an individual, Mark, an employee of a government organization, operations department, is analysed to help create a futile intervention plan for him to achieve a desirable outcome of his alcohol abuse.
Marks recent divorce is the primary trigger to his present problem of alcohol addiction. Now, this is taking a toll in his career as he is constantly absent from work and arrives late to work, dons an ungroomed demeanour as well as cold attitude which is perturbing his performance at work and relationship with colleagues.
Marks operation manager has given him four weeks to reform, otherwise he has to leave the organization. As such, this essay explores the counselling techniques which are formed appropriately to provide Mark a comprehensive healing and relapse prevention plan.
CASE INTERPRETATION AND ASSESSMENT
In accordance to the Transtheoretical Model, and using this model as a relevancy in this case study, the transtheoretical model postulates that peoples behavioural change doesnt happen swiftly and resolutely however it occurs perpetually in a cycle. As the model suggest, there are six stages, namely, precontemplation, contemplation, preparation (determination), action, maintenance and termination. Presently, Mark is at precontemplation stage, In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behaviour is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behaviour and place too much emphasis on the cons of changing behaviour, as it is in Marks case (“Transtheoretical Model (Stages of Change),” n.d.).
Initial interviews with Mark disclosed that he started off with one can of beer in a night to more than a dozen of cans over a span of two weeks. There are five stages of alcoholism, which are occasional abuse and binge (stage 1), increased drinking (stage 2), problem drinking (stage 3), alcohol dependence (stage 4) and addiction and alcoholism (stage 5). Presently, Mark is at stage 3, classified as a problem drinker. Over a span of 4 weeks of time crunch given by the operations manager, Mark has to procure determination and take action within thirty days, he first needs to take small steps to change his behavioural attitude towards alcoholism. Using the Transtheoretical Model, Mark has to progress from stage 1 (precontemplation) to stage 2 (contemplation) and to stage 3 (preparation), which should be achieved within the first three weeks.
Progressing from stage 1 to stage 3 would mean that he would need to start recognising the problem of alcoholic dependence to start taking small steps to reduce alcoholic use. The desirable outcome for Mark would be to completely quit drinking and find functional ways to cope with divorce and potential triggers of pain. Moreover, finding functional coping strategy to overcome the crisis would also help him to concentrate at work, change his attitude at work such as finding purpose at work, restoring healthy bond with his colleagues and increasing his productivity due to less frequently falling ill.
To strengthen Marks self-motivation and to drive his commitment to reform, Motivational Interviewing would be a key technique as it cores on evaluating and determining uncertainty and focus on motivational processes within the individual to enable change. Motivational Interviewing also serves as an essential approach to behaviour change. The initial description, by William R. Miller in 1983, developed from his experience in the treatment of problem drinkers as it is in Marks case (“MI Definition Principles & Approach V4,” n.d.).
Initially in counselling, the process of assessment and interviewing techniques would be exercised to better build rapport with Mark. As such techniques in motivational Interviewing would be used, would be OARS, namely, open-ended questions, affirmations, reflective listening and summaries. Expressing empathy through reflective listening, engaging in respectful conversation, acceptance of clients and their feelings as well as prompting open-ended questions allows clients, in this case, Mark to have the opportunity for self-reflection and evaluation of is drinking behaviour. By emphasizing sincere affirmations and listening than telling boosts Marks strength to sustain hope and have confidence to make the needful change. Also, as an additional technique to aid the interview, Mark can be prompted to discuss a typical day or week related to drinking behaviour, this technique is suggested by Bell and Rollnick whereby A typical day and recent day or session is carefully pinpointed and the interviewer begins as follows: Can we spend the next 5-10 minutes going through this day from beginning to end. What happened, how did you feel, and where did your use of fit in? Lets start at the beginning (Rollnick, Heather, & Bell, 1992, p. xx). This would encourage Mike to make positive behaviour change at a more moderate pace.
Another technique to be used is Reflective Listening, which plays a vital role in motivational interviewing. Reflective listening aids the counsellor to self-check whether one is able to understand the client, also it closes the loop in communications to ensure breakdowns dont transpire. Reflective listening is a technique that allows empathy to be expressed as well as to understand the clients potential hesitancy towards taking steps to change. For example, understanding, understanding how alcohol fits into Marks life and being able to acknowledge this, conveys that one can understand and acknowledge hesitancy and difficulty Mark may face in adopting a change in behaviour. Hence, reflective listening is an essential intervention to guiding Mark towards making change as well as to support goal-directed aspect of motivational interviewing.
Lastly, Summaries, which are unique applications of reflective listening. This technique is most ideal at transition points, for example, after client has narrated a particular topic or when the session is nearing an end. Not only it enables a clear communication between the client and the counsellor but also provides a stage of progress towards change. In Marks case, summarising will help end the session with his plan of action.
In accordance to the Transtheoretical Model, another alignment is also applied to the model which is known as the relapse or regression stage. Interventions should be in place to allow the counsellor and client to address each step of the relapse process When looking at relapse or relapse prevention, there are many approaches to attain recovery and treatment. The intervention in Marks case, if he were to regress to the previous stage, would be to guide him back to the initial stage of the cycle to reinforce self-efficacy and to renew his confidence. Relapse stage is a common stage for substance abusers to fall back and forth on hence, when tis happens it is imperative to counsel the client back to contemplation stage to renter the cycle of recovery again. External factors such as work-induced emotional stress and repeated failure at work even could serve as triggers that could lead to the regression. Also, cognitive reasons such as negative thinking patterns such as over-generalisation or personalisation where there could be distortion in their way of thinking and making sense of a situation could result in going back to unhealthy coping habits. Moreover, lack of support system to encourage him with recovery could also potentially harm him. This could include work colleagues, friends and family. Also, it is essential to explore the meaning and reality of a relapse as a learning opportunity and assist Mark in seeking alternative strategies as well as to sustain supportive contact. The future of relapse prevention seems focused on the addition of Mindfulness-based relapse prevention strategies, which complement the theory underlying Marlatts Cognitive Behavioural Model. The cognitive behavioural therapy teaches clients how to identify distorted cognitions through a process of evaluation. In Marks case, he would learn to differentiate between his own thoughts and reality. Once, Mark is able to learn the influence that cognition has on his feelings, he is then able to recognize, observe and monitor his thoughts on regressing back to abusing alcohol. This in return identifies Marks unhelpful beliefs resulting them to change and retreat to recovery.