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A Treatment Approach in Counselling the Family
Depending on the patient’s overall health and the degree of addiction, a variety of treatment options may be used while addressing drug misuse. Recently, Antoine has been linked to drug usage, mainly drinking alcohol with colleagues after work. His addiction causes the family much distress, particularly Martha, his wife, who is directly and negatively affected. Motivational enhancement therapies (MET), including motivational interviewing (MI), constitute a viable intervention option for Antoine to assist him in overcoming his addiction disorders and engaging in the necessary treatment procedures.
Motivational enhancement treatments are a sort of client-centred therapy that addresses ambivalence and increases an individual’s drive to participate in behavior change. The assumption behind motivational enhancement treatments is that motivation is continuous and that individuals are at various levels of motivation with regard to resolving addictive habits. The rationale of MET is to elicit change discourse in a supportive and collaborative setting and to encourage the client’s intrinsic drive to participate in change. According to DiClemente et al. (2017), motivational enhancement and interviewing are effective for several addictive behaviors, such as alcohol, marijuana, tobacco, and gambling. MET is typically included in a short intervention style, in which a counselor meets with the patient for a limited time, ranging from a 10-minute to 1-hour session.
Motivational enhancement treatments provide a client-centered, non-confrontational strategy to aid clients in examining the many parts of their usage patterns. Clients are urged to evaluate their usage’s benefits and drawbacks and set goals for a better lifestyle (Winters et al., 2018). In this situation, Antoine might be challenged to examine the repercussions of his behavior on his children, who live in a stressful environment. For example, Martha and Antoine are reported by their neighbors due to their unruly conduct, which the neighbors characterize as “a lot of screaming.” To facilitate successful behavior and emotion regulation, it is essential to have adaptive and attainable objectives. Moreover, in treating addictive illnesses, setting explicit goals to lessen or end addictive participation is essential (Kim & Hodgins, 2018). The therapist delivers customized feedback and preserves the client’s autonomy over their conduct. Although the connection between the counselor and patient is more of a collaboration than an expert/recipient one, the counselor is directive in helping the client to analyze and mitigate ambivalence and in promoting the client’s responsibility for choosing and implementing healthy behavioral changes.
The community reinforcement and family training (CRAFT) strategy is the most suited therapy approach for Antoine’s family. The technique with the strongest evidence is CRAFT, a behavioral therapy that, in addition to increasing the well-being of concerned significant others (CSOs), teaches them how to adjust their conduct in order to favorably motivate the identified patient (IP) who refuses treatment to seek therapy (Hellum et al., 2022). This relates to Antoine’s unwillingness to see a therapist or counselor regarding his increasing drinking habits. In fact, he does not recognize that he has a problem until his neighbors call the police to report excessive screaming in his home, which reignites the interest of the local child protection agency.
Community reinforcement and family training are among the most effective methods for addressing drug misuse among those who do not recognize their need for treatment. The rationale for this approach is to concentrate on three crucial objectives. Two of the three objectives are primarily focused on the IP, while the third objective is centered on the CSO (Canadian Centre on Substance Use and Addiction, 2017). In this situation, the primary and ultimate purpose is to persuade Antoine, who has lately engaged in alcohol misuse, to seek medical care or therapy. A second important objective is to limit his alcohol use, and the third objective is to enhance the lives of his CSO. In this instance, the CSO is Martha, and the children are directly or indirectly affected by Antoine’s heavy drinking. For example, Martha has been immediately and negatively affected by Antoine’s present conduct since he was the family provider, and his license has been revoked due to excessive alcohol use. In addition, Antoine moves out of the therapist’s premises. At this point, Martha begins weeping loudly, reveals bruises on her right arm, and admits she has been suffering from “all of Antoine’s behavior.”
Adopting the CRAFT technique is a guaranteed way for Martha to achieve tremendous outcomes; typically, the CSO is responsible for learning and implementing this strategy. Information and comprehension relate to increased mutual comprehension and self-awareness and a greater understanding of the drug abuse habit adopted through psychoeducation and transparent communication. Martha and Antoine may avoid creating a chaotic atmosphere that directly influences their children if they engage in good communication rather than commotion and shouting at one another. Research indicated that those who got communication and coping skills training among heavy drinkers reported a larger decrease in problematic drinking for up to one year than those who got a control treatment (Kim & Hodgins, 2018). In addition, professional social services would be essential by concentrating on enhancing couple relationships’ mutual support (Edgren et al., 2022). This excellent treatment inside the family will persuade Antoine to seek therapy and counseling and eventually stop drinking.
However, depending on therapy approaches, not every client is ready for assistance. This pertains to abusers who, despite the CSO’s efforts, refuse to seek help. It has been observed that the majority of abusers seek therapy as a result of external coercion from a partner, other family members, the judicial system, or doctors. Among the indicated external pressures, the family-based intervention has been the most effective in compelling drug addicts to undergo treatment (Hellum et al., 2022). Martha is lucky since her situation attracts the attention of the child protection agency, and Antoine is ready to attend the counselor about his ongoing alcohol usage. In addition, the CRAFT and MET techniques may be integrated. These two techniques are primarily used to treat individuals with drug use disorders. These two are critical in addressing Martha and Antoine’s situation since all the impacts on their family are apparent, from domestic violence to financial difficulties and a strained relationship with Natalie.
Adoption of the Harm Reduction Ideas
Harm reduction pertains to the policies, programs, and strategies that aim to minimize the negative health, social, and legal consequences of drug use, drug regulations, and drug laws. It emphasizes positive transformation and working with individuals without judgment, coercion, discrimination, or mandating drug usage cessation as a prerequisite for receiving help. The primary objective of harm reduction techniques is to assist persons with substance abuse problems. This emphasis is intended to limit the damage caused by drug misuse or usage, which generally involves abstinence-based therapy. Minimizing harm emphasizes the importance of abstinence in treating or limiting damage.
Several essential characteristics must be addressed within a harm reduction approach. These include embracing self-determination and respecting client autonomy (Vakharia & Little, 2017). The therapist’s objective is to promote the client’s development, self-discovery, and decision-making. They seek and emphasize their customers’ abilities and encourage self-efficacy development. Depending on the cases of Antoine and Martha, it is evident that individual members have difficulties with their daily responsibilities, support responsibilities, and relationships. They are putting in so much effort to keep going, with the worry that the circumstances will worsen over time if they do not establish substance use limits.
The family of Martha must take immediate action to curb the arising concerns caused by drug abuse. In this situation, Martha and Antoine must consider options that may assist reduce drug abuse while preserving their survival. This involves freedom from the drug use disorder and uncertainty of Antoine’s addiction. Therefore, it is necessary to guarantee that these two maintain their principles and refrain from engaging in actions that are detrimental to themselves and their neighbors. This is a method for teaching Antoine the value of remaining sober and avoiding drug usage. The harm reduction component of the family therapy framework would aid in concentrating on efforts to improve the efficiency and motivation of individual family members, therefore producing permanent improvements within the family.
In addition, harm reduction approaches are compatible with the phases of the change model, which assumes that individuals are competent in making choices about their essential needs. Hence, this allows them to handle them when they are prepared. While undergoing change, motivation and anticipation are crucial factors to consider. Motivations may include the desire to treat physical or emotional suffering, improve pleasure, change consciousness, or a blend of these (Vakharia & Little, 2017). Self-medication for co-occurring mental health issues is a frequently cited reason for usage. Assessing the patient’s stage of change, preparedness to approach their substance-use objectives, and self-efficacy may also contribute to motivation. Expectation demands investigation into the client’s anticipated use, for example, their intended effects. Substance-related expectations may be highly potent and substantially impact how individuals experience intoxication (Vakharia & Little, 2017). Incorporating the harm reduction concepts into family-involved work is thus crucial since it would aid in defining how each of these concepts contributes to family-involved work.
Nonetheless, the execution of the damage reduction strategy presents a number of obstacles. Among these obstacles are problems in achieving and preserving abstinence from alcohol. The ideal goal of harm reduction is complete cessation of use, that is, abstinence. The majority of programs emphasize a continuum of outcomes, including prompt access to safer drug alternatives and support for clients to minimize their alcohol use (Ulaş&Ekşi, 2019). In addition, this program depicts unfavorable outcomes for those unable to regulate their substance use outside of highly organized surroundings.
In addition, implementing a harm reduction strategy would need considerable paradigm change among practitioners and treatment organizations. Many argue that a therapist’s readiness to deal with actively abusing clients is inherently immoral since practitioners treat clients participating in high-risk drug use rather than enforcing the safest choice, abstinence. In the meanwhile, therapists may defend the ethical validity of their method by arguing that the enforcement of abstinence may discourage a prospective client from seeking therapy entirely.
The Message Conveyed by Showing the Bruises on a Client’s Arm
Martha has already covered her husband’s actions in the first report. During an inquiry conducted by the child protection agency, she said that Antoine did not have a substance abuse problem and that this most recent incident was due to bad luck. She also states that he only has a few beers with colleagues after work and is not aggressive when intoxicated. Martha adds that the conduct has not impacted the children’s everyday activities. However, it does not take long for the narrative to shift once Sam is introduced. Martha begins sobbing as Antoine characterizes Sam as an indolent and unintelligent person. She explains why Sam lives with them and his challenges in obtaining employment. Eventually, when Antoine asks to leave and add more money to the parking meter, Martha starts sobbing and admits that it has been hard to deal with Antoine’s recent conduct.
Martha pulls her right arm sleeve up, which reveals her bruising. Therefore, it is evident that Antoine has engaged in a violent brawl with Martha. Perhaps her previous report was merely a means of disguising their domestic issues, or maybe she was certain that Antoine would change based on how she treats him at home, even when intoxicated. Now that he is unaware of what Martha has been doing since his absence, she chooses to speak up. It may seem that Martha weeps because her husband is unwilling to remain with his brother, Sam, who has been unemployed for a long time, or because she fears that her husband will not change his present behavior. Martha explains while sobbing about their difficult relationship as a couple.
As a counselor, it is critical to approach these situations with the utmost competence. The case study shows that Martha has had a difficult life; she is abused and conceals it from the public. Perhaps, the screams heard by the neighbors that prompted the police to be called resulted from a fight involving Antoine and Martha. In this framework, counseling begins by discussing their circumstances, beginning with Antoine’s perspective on his wife’s injuries after being beaten by him. The consequence of this discussion would be the development of measures to eradicate Antoine’s alcohol addiction. In this instance, Martha and Antoine can be categorized as any-stage spouses affected by alcoholism. As anticipated, alcoholism has significantly impacted their marriage, establishing conflict characterized by hidden dependency, competition and imbalance. Now that Antoine is no longer employed, he and his family rely on his wife Martha, causing Martha to experience an excessive workload while Antoine rests and drinks.
A counselor needs to approach this situation in a critical manner. This may be accomplished by using vigorous efforts to ensure that Antoine abstains from alcohol use. Utilizing the Al-Anon self-help technique will enlighten the non-drinking family member about alcoholism and maintain a firm focus (Klimas et al., 2018). In addition, as a counselor, it is essential to track any domestic violence, harassing and intimidating conduct towards the partner and refer to the appropriate program. Since Martha is alone after Antoine left, advising her is easier since AI Anon is inappropriate until the spouse’s safety is ensured. If the brutality is not resolved, it would be better to recommend that she seek out a legal women’s organization based entirely on her legal rights.
References
Canadian Centre on Substance Use and Addiction. (2017). Community Reinforcement and Family Training. Web.
DiClemente, C. C., Corno, C. M., Graydon, M. M., Wiprovnick, A. E., & Knoblach, D. J. (2017). Motivational interviewing, enhancement, and brief interventions over the last decade: A review of reviews of efficacy and effectiveness. Psychology of Addictive Behaviors, 31(8), 862. Web.
Edgren, R., Pörtfors, P., Raisamo, S., & Castrén, S. (2022). Treatment for the concerned significant others of gamblers: A systematic review. Journal of Behavioral Addictions, 11(1), 1–25. Web.
Hellum, R., Bilberg, R., Andersen, K., Bischof, G., Hesse, M., & Nielsen, A. S. (2022). Primary Outcome from a cluster-randomized trial of three formats for delivering Community Reinforcement and Family Training (CRAFT) to the significant others of problem drinkers. BMC Public Health, 22(1). Web.
Kim, H. S., & Hodgins, D. C. (2018). Component Model of Addiction Treatment: A Pragmatic Transdiagnostic Treatment Model of Behavioral and Substance Addictions. Frontiers in Psychiatry, 9. Web.
Klimas, J., Fairgrieve, C., Tobin, H., Field, C.-A., O’Gorman, C. S., Glynn, L. G., Keenan, E., Saunders, J., Bury, G., Dunne, C., & Cullen, W. (2018). Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews, 2018(12). Web.
Ulaş, E., & Ekşi, H. (2019). Inclusion of family therapy in rehabilitation program of substance abuse and its efficacious implementation. The Family Journal, 27(4), 443-451. Web.
Vakharia, S. P., & Little, J. (2017). Starting where the client is: Harm reduction guidelines for clinical social work practice. Clinical Social Work Journal, 45(1), 65-76. Web.
Winters, K. C., Botzet, A. M., Stinchfield, R., Gonzales-Castaneda, R., Finch, A. J., Piehler, T. F., Ausherbauer, K., Chalmers, K., & Hemze, A. (2018). Adolescent Substance Abuse Treatment: A Review of Evidence-Based Research. Adolescent Substance Abuse, 141–171. Web.
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