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1 Theories and Models of Addiction Case Study Treatment Plan Regene Best Capella University COUN5260: Theories of Addiction Treatment Professor Scott Rasmus September 10, 2023

2 Theories and Models of Addiction Case Study Treatment Plan This paper explores the dynamics of alcohol addiction. Connor Gannon, a 45–year–old man, will be the center of focus as the paper narrows down to address the impact of alcohol abuse at different levels. According to Wang et al. (2020), alcohol addiction is a condition that causes a person to drink impulsively despite the adverse consequences to the individual’s health and their normal functioning at large. Consistent use, also called alcohol reliance or dependency leads to several problems that include alcohol use disorder, a mental health that is characterized by a person’s impaired ability to stop alcohol use. Alcohol addiction impacts different populations as much as some communities are more affected based on their vulnerability and cultural expectations of leisure. This paper will deliberate on client description and analysis in section one where the client evaluation using the transtheoretical model of change and from a biopsychosocial model perspective will be captured. Consequently, the paper will focus on the therapeutic approach where provisional diagnosis based on the DSM-5-TR, description of client strengths, and description of challenges to be addressed will be explored in detail. Lastly, the paper will debate the treatment plan that incorporates theory selection, cultural considerations, short-term goals, long-term goals, and a description of the strategies for interfacing with the legal system and working with court-referred clients before a conclusion. Section 1 — Client Description and Analysis Connor Gannon is a 45–year–old man who is court–ordered to treatment following his second conviction for drinking under the influence (DUI). His drinking has caused a variety of problems in his life. Based on the case study, Connor is Irish. He is a Catholic Caucasian who lives alone after divorcing his wife. His two children aged 20 and 18 also live away with the

3 younger one living with the mother while the older one attending a local college where he lives. It is reported that Connor has an older brother and father who abuse alcohol and live in the same city. He earned a high school diploma and served in the military with a honorable discharge. He maintains gainful employment in the construction industry. Connor’s lifestyle embraces alcohol and women. He dates the ladies he meets in local bars. His brother and father are equal addicts who drink relatively more than him. Alcohol is involved in all social situations making it look like his way of life. He, however, participates in social church during major religious events. Connor began drinking as a teen with peers, a habit that intensified after enlistment in the military with episodes of extreme alcohol abuse which he faced sanctions. He has, however, managed to stay on the safe side in the construction industry despite his excessive drinking. Connor received court-ordered treatment after his first DUI conviction three years ago. He was required to complete months of abstinence from alcohol and had to provide random urine screens to verify his abstinence. He completed the treatment program without incident. Despite this criminal conviction and treatment, he does not perceive himself as an “alcoholic.” He received his second DUI conviction in three years due to a severe automobile accident with minor injuries to himself and severe injuries to the driver and passengers in the other car. He has been courting–ordered to treatment after serving time in jail. He will also have to see a probation counselor, submit random urine screens, and lose his driver's license for one year. Following the report, Connor presented for therapy because he was overwhelmed with the frequent arrests. Alcoholism is impacting his life negatively. The series of accidents exposes the client to more risks if not handled appropriately. Evaluation of client using the transtheoretical model of change

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4 Connor presents with AUD symptoms which are compromising the brain function making him unable to limit the amount of alcohol he consumes after attempts to stop the behavior becomes futile in the long run. A transtheoretical model of change incorporates six stages that initiate health behavior change including precontemplation, contemplation, preparation, action, maintenance, and termination (Hashemzadeh et al., 2019). Based on the fact that the first treatment was part of the requirements when he was in jail for a DUI incident, Connor’s current condition can be associated with the first stage, precontemplation. The court- influenced counseling after his first DUI showed that every involvement was not from his point of view. The random urine screening to detect if he is staying sober was initiated after he was put in jail. All this time, Connor feels that he is not an alcoholic. The mentioned analogy hints at the lack of self-acceptance which retards self-esteem to face treatment from within. He stopped consuming alcohol after his first Dui because he did not want to be monitored closely by the authorities. Otherwise, at a client level, Connor was not willingly receptive to the counseling and all the activities incorporated in the wake to stop his drinking spree. Therefore, Connor is in the pre-contemplation stage. Other stages will be integrated afterward. Evaluation of client from a biopsychosocial model perspective Connor has a history of alcoholism. His brother and father are reported to consume it more than him. The biopsychosocial approach systematically considers biological, psychological, and social factors and their complex interactions in understanding health, illness, and healthcare delivery as stipulated by Nimbi et al. (2021). These factors apply in Connor’s case. This is the second time he has appeared in court after the second DUI that led to severe injuries to the other driver and passengers. This was the second DUI in three years. This shows

5 how insignificant the client takes into account his drinking habit. As he loses his license and is on probation, Connor shows a lack of self-control to start therapy. It is possible to assume that once his case is closed as it was in the previous court directives, Connor would happily resume his drinking behavior because it seems part of the family lifestyle. He inherited the habit from his father. The family history reveals alcohol use that impacts all the family members at almost equal magnitude. The client’s social niche also magnifies his addiction. The case study reports that on several occasions, Connor drinks with friends and job associates. Social and economic factors such as income, education, employment, community safety, and social support are significant risk factors in Connor’s drinking habit. According to Nimbi et al. (2021), the availability of social support and adequate income bolsters a given lifestyle making it difficult to stop it. Biopsychosocial evaluation integrates social determinants of health. These include the conditions in which a person is born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life (Grossman et al., 2017). Connor’s income and social protection are significant. This is in addition to good housing, food security, and a befitting social inclusion and non-discriminative environment. As much as the client’s childhood development is not explored in the case study, it would be assumed that he grew up in a middle-class family with financial stability. Social health determinants influence health inequities which also include access to healthcare and socioeconomic position. Biologically, Connor’s drinking spree is in the family genealogy. It is a trait that is inherited from generation to generation. As much as his elder brother and father drink relatively more than him, the outcome of this trait is impacting them equally. The biological domain of the biopsychosocial evaluation should focus on the inherited traits that go beyond the nurturing a child gets as they grow up in a given community. Connor is resistant to self-awareness which would be a very important therapeutic tool. Understanding that

6 his drinking is inborn will influence a good start to therapy. Therefore, it would be appropriate to recognize the relationships he has with his family members, friends, and workmates. The mentioned analogy will echo the psychological domain of the biopsychosocial evaluation as well as the social aspect of Connor’s life. The psychological aspect of Connor’s condition is significant. The support he receives from his family and friends is destructive because instead of building his need to change, the social support is compounding the AUD symptoms. Alcohol use disorder is a psychological condition that occurs over time when a person fails to control their drinking lifestyle. Two DUIs confirm the mentioned analogy. Over time, Connor experiences cognitive, and emotional setbacks that are attributed to his irrational behavior. For example, the latest accident he caused was traumatizing because the driver and other occupants of the vehicle involved sustained severe injuries as reported in the case study. Based on the DSM-5 criteria for AUD, it would be appropriate to associate Connor’s separation from his wife with his alcoholism. Moreover, his eldest child is staying away from yet he attends a nearby college. The mentioned analogies present Connor as an irresponsible parent who has been compromised by alcoholism. Section 2 — Therapeutic Approach Integrating appropriate therapy will help Connor overcome his drinking woes. Before this, identifying the major defining symptoms and the primary diagnosis is imperative. Drinking is associated with different stressors that determine the magnitude, hence the symptoms realized during the alcohol screening.

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7 Provisional Diagnosis Based on the DSM-5-TR: The provisional diagnosis is 303.90 (F10.20) Severe Alcohol Use Disorder because Connor meets the DSM-5 criteria for AUD (DSM-5, 2022). Over a record of three years, the client presents with symptoms such as consumption of alcohol in large amounts and, persistent desire for alcohol use as seen in Connor’s lifestyle on different occasions. Additionally, a relatively longer time is spent to obtain alcohol. Connor is always craving for alcohol. This has prompted the separation of his wife and children. He has failed in his obligations as a husband and a parent. He has continued consuming alcohol despite sanctions in the military and a jail term after his first DUI. The client started using alcohol as a teenager and continued to adulthood even after joining the military. His employment was compromised in the process. It is imperative to note that Connor has been drinking and driving. The two DUI incidences affirm this situation. From the case study, it is noted that the client served a jail term during which he was forced to attend counseling sessions to make him sober. Despite his awareness of the recurrent physical and psychological problems caused by his excessive drinking, he continued the behavior until his latest accident. The client has also shown tolerance because of his consistent increase in the amount consumed every time he consumes alcohol. In the diagnosis process, it is imperative to identify possible medical conditions. The case study reports no medical condition under treatment or treated in the past. The client is reported to use alcohol only. No other substances are used. This bars away the possibility of other substance use disorders (SUDs) such as Marijuana and opioids among others. No other psychological problems. Connor consumes alcohol as a lifestyle. This analogy bars away the possibility of using alcohol as a coping mechanism to deal with an existing mental health condition such as depression and anxiety. Therefore, the primary diagnosis for Connor’s condition is Alcohol use

8 Disorder because he meets the criteria set by the American Psychiatric Association’s DSM-5. No other psychological condition is notable. However, the client is exposed to other factors within his social nest. Primary Diagnosis: 303.90 (F10.20) Alcohol Use Disorder, Severe Other Factors: Z63.5 Disruption of a family by separation and divorce Estrangement Z63.3 Absence of family member Z60.2 Living alone The case study explores Connor’s lifestyle. His children and wife are not within his social niche, this analogy is a reflection of a person who once had a family and now lives all by himself. He dates the ladies he meets in bars during his drinking spree showing that he is lonely and needs company. Living alone is traumatizing as reflected in Connor’s excessive drinking. Additionally, the absence of his wife and children attributed to the unceasing drinking. The divorce caused a significant disruption in the family unit. Description of Client Strengths Connor had been in the military for some time before the sanctions. He is currently having a stable job that has been affected by his drinking as much as no sanctions were reported. Conor is determined. His success in the construction industry is amicable. This analogy defines his first major strength, commitment. The client is committed to the tasks allocated to him and this may form a great consideration during therapy. Secondly, the client has a passion for whatever things he does. His passion for a drinking lifestyle summarizes the mentioned analogy.

9 As much as his current passion has negative outcomes, tapping into this strength would be significant in the long run. Thirdly, Connor is independent. He has managed to survive all alone without remarrying after his marriage fell apart. Being independent would improve his decision- making skills if he manages to restore his confidence and self-esteem. Description of Challenges to Be Addressed With the talents and power speaking points that define his strengths and abilities, Connor has serious challenges that have prompted an escalated condition of alcoholism. The client lacks appropriate problem-solving abilities. After the first DUI, where he was arrested, jailed, and put into forced counseling therapy, it would be expected that the client would have a permanent behavioral change because he was released upon realizing his soberness. However, this was not the case. Instead, Connor resumed his drinking habit immediately after regaining his freedom. Barely three years later, he is at loggerheads with the authorities after another DUI. However, he caused serious injuries to other people making him lose his license among other punishments he is yet to face. Secondly, the client lacks situational awareness. He has taken relatively a long time to acclimatize with his irrational behavior. According to the case study, the client claims to be non-alcoholic. The mentioned analogy retards self-acceptance which inhibits the onset of a viable therapy in the long run. Thirdly, the client is stalled on content. He believes that he is on the right track. He fails to realize that his excessive drinking is not only hazardous to other people but also to him. His backward thinking has inhibited him from seeking or embracing the therapies presented to him. Despite recovering from alcoholism, he resumes drinking immediately. This shows a lack of internal motivation and readiness to embrace a problem. Lastly, Connor has the hero syndrome based on his previous experiences. While addressing the AUD, it will be imperative to also check on these negative attributes. His lack of significant self-

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10 esteem has allowed room for imposter syndrome to control most of his thoughts and behavior. For example, when he does not perceive himself as an “alcoholic” it means that he is a hero in his world of alcohol users. Maybe, he has a right to consume excess alcohol while becoming an alcoholic. However, his addiction is detrimental. Treatment Plan The treatment plan must focus on the client as an addict whose condition is partially inherited from the father. The family harbors three individuals including a father and two sons. As much as Connor’s mother is not mentioned in the case study, it would be assumed that she divorced his father because of the alcoholism Connor is currently impacted by. Connor presents with alcohol use disorder. Implementing the best treatment plan to avert the condition is imperative. Theory Selection Addiction treatment involves several insights such as individual counseling, group counseling, educational services, mental health treatment, life skills, and vocational services among others as stipulated by Miller (2015). Irrespective of the methods chosen by the professionals to help a person offset their irrational behavior, a specific theory must be integrated to determine the treatment process. Connor is suffering from alcohol use disorder, a condition that has an impulsive bearing that compromises critical decision-making skills. Therefore, Cognitive Behavioral Therapy (CBT) will be incorporated to manage the client’s case. According to Breuninger et al. (2020), Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including

11 depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. Connor will benefit from the constructs of the therapy if he accepts and consistently embraces the recovery guidelines. CBT believes that the psychological problem is in part associated with faulty thinking or unhealthy behavior, hence the respective clients can relieve their symptoms by avoiding irrational values while learning better ways to cope and live a normal life. CBT is effective in the treatment of alcoholism. According to Wang et al. (2020), most clients suffering from AUD are victims of cognitive or behavioral challenges. Such people embark on drinking to kill the distress they encounter while attempting to uphold a normal life. Conner’s case is different since he is not suffering from any other condition. Rather, AUD is the main problem that calls for an effective solution. CBT reduces relapse rates for alcohol use disorder hence providing a more consistent treatment front in AUD patients (Breuninger et al., 2020). The theory projects significant treatment considerations. For example, Connor will recognize his distortions in thinking that is creating the drinking problem other than the fact that the behavior could be inherited. This will allow him to reevaluate the stressors and focus on the reality. Consequently, the client will gain a better understanding of his situation making it easy to highlight his weaknesses and areas of strength. The theoretical expectations compel the client to use problem-solving skills to cope with the difficult situations arising as stipulated by van Amsterdam et al. (2022). The mentioned analogy will facilitate the client to develop a great sense of confidence needed to actualize the CBT techniques in the treatment plan. The CBT model focuses on three levels of cognition based on the magnitude of the symptoms presented. Firstly, the therapy explores the core beliefs and schemas of a client.

12 Connor believes that he is not an alcoholic. This perception has escalated his drinking habit to alarming rates making him have DUI charges in less than three years. Secondly, the CBT model focuses on cognitive distortions which are irrational beliefs people maintain to keep a certain ego that identifies them in a given social niche. Connor feels that drinking is a lifestyle associated with his family since his father and brother are also alcoholics. Lastly, the model exploits the negative automatic thoughts (NATs). Such thoughts are always brought on in certain situations unintentionally. According to Breuninger et al. (2020), NATs intensify problematic behavior. This is reflected in Connor’s situation. From the case study, it is evident that with AUD, his NATs have made him underestimate his ability to cope with situations and instead influenced him to further engage in problem drinking after the first DUI leading to another DUI with more severe implications. For alcohol addiction, CBT will be effective if carried out for over 5 to 20 sessions based on the magnitude of the symptoms. The progression of Connor’s condition is alarming raising the need to uphold as many as 20 sessions for full recovery. It is imperative to note, however, that CBT is a relatively shorter therapy compared to others. It is self-driven and aims to help a person solve their problems amicably (van Amsterdam et al., 2022). Various interventions will be effective to help in Connor’s recovery. Exposure therapy will ensure the client learns a different perspective of healthy lifestyles that excludes alcoholism. Motivational interventions will be used to restore confidence as the client attends the therapy sessions especially the Alcoholics Anonymous (AA) which embraces group therapy but with a consistent recovery plan as stipulated by Breuninger et al. (2020). Additionally, the client will benefit from contingency management. In contingency management, Connor will be reinforced over time with frequent rewards of observable behavioral change during therapy. More importantly during CBT for

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13 alcoholism, avoiding relapses is imperative. The client will benefit from the alcoholism relapse prevention strategies such as positive self-talk, practicing relaxation, changing his lifestyle, and planning how to cope with external influence and pressure. Self-care is as important as the therapeutic interventions upheld to restore normal self. Cultural Considerations Connor is a 45–year–old Irish Catholic Caucasian male. Considering the cultural perspectives of alcoholism will make the interventions adopted more effective. Cultural sensitivity promotes a sense of belonging while barring unnecessary prejudice, bias, and discrimination. Binge drinking is considered the norm in Ireland, with over 58% of men partaking in the activity, and over a third of all women (Mauger, 2021). The mentioned analogy affirms Connor’s lifestyle which associates every important event with heavy drinking. Alcoholism has impacted the Irish medical system making it difficult to manage deaths associated with alcohol-related diseases and mental disorders. Therefore, observing a cultural tone while helping the client to recover from his drinking problem is imperative. During therapy, creating a stereotypic mentality with the client is possible. This is because several insights into the exaggerated portrayal of drinking habits in Ireland have made it easy to provoke unnecessary prejudices. For example, the Irish saying “A man takes a drink, the drink takes a drink, the drink takes the man” urges those experiencing drinking problems to stop drinking before they fall in the long run (Mauger, 2021, p.72). Observing cultural perspectives bolsters therapy. Culture affects alcohol use as well as the beliefs and views people hold about it. According to Miller (2015), upholding cultural sensitivity when assessing for and treating alcohol use disorder is

14 imperative because the clients’ experiences of culture precede and influence their clinical experience. Short-Term Goals Short-term goals are achieved faster to ensure the client builds trust with the methods used. Therefore, it would be appropriate if the severity of the symptoms decreases over time to ensure consistency in therapy. Firstly, Connor will attend individual therapy sessions at least thrice a week where he will learn coping strategies needed in the recovery process. Adjusting to the therapeutic context is needed to achieve this. The coping strategies will include relaxation techniques and a change of lifestyle among others. The second goal would be closely related to the first goal since the target is a quicker reflection of the methods used. Therefore, the client will benefit from the group therapies used alongside CBT such as Alcoholics Anonymous (AA) to help him restore his self-confidence and self-esteem. According to Breuninger et al. (2020), AA benefits therapies integrated to help clients with AUD by providing a network of support. AA meetings are free, retain anonymity, have no obligations to join, and are not culturally biased. Another short-term goal would focus on relapses. Connor will use at least three relapse prevention strategies every week to prevent current and future risks of relapse. Relapse prevention is a key area of consideration when dealing with alcohol addiction. The previous treatment plan that was initiated through court order did not provide a lasting solution to Connor’s drinking spree. Therefore, it would be appropriate to focus on the possible relapse prevention strategies such as self-care, mindfulness meditation, and grounding techniques as stipulated by van Amsterdam et al. (2022).

15 Long-Term Goals Long-term goals are a sense of direction allowing the patient and therapist to take their time unpacking, troubling and at times traumatic issues, whose ramifications may have plagued the patient for a great deal of their lives (Miller, 2015). Connor will experience a reduction in symptoms of Alcohol Use Disorder when exposed to Cognitive Behavioral Therapy. CBT is the main therapeutic intervention that integrates different approaches and techniques. The therapeutic focus is full recovery at the end of the treatment period. Various techniques will be applied in the wake to achieve the mentioned analogy. Among others, the therapist will integrate exposure therapy that will create new insights about new lifestyles that are healthy. Secondly, the mentioned goal will be achieved by the integration of relapse management techniques to ensure consistency is achieved in the long run. Additionally, cognitive restructuring will help the client in seeing things differently. It will remove the distorted thoughts that make him feel that drinking is the most fashionable lifestyle in their family. Coping strategies will be paramount for this course. If Connor achieves his therapeutic goals, he will be compelled to find various ways to sustain his new lifestyle. Coping strategies mean he will live a new life free from alcohol intoxication. Strategies for Interfacing With the Legal System and Working With Court-Referred Clients Connor’s case after the second DUI will be another court proceeding. Previously, he was compelled to attend counseling sessions meant to help him regain his soberness. He was also subjected to frequent urine screening to establish the progress of his recovery. For the second time, the legal proceedings must take place in the right order. As much as the court might order a

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16 similar therapeutic platform for the client, the professional ideologies upheld within the jail structures must be consistent with those explored outside to avoid the breakage of the treatment plan. dealing with involuntary clients requires concerted efforts. Mainly, learning communication is crucial to that effect as stipulated by Miller (2015). Communication helps the counselors to make clear the kind of engagement and purpose to be realized afterward. This is because, once in custody or jail, the client might not interact directly with the therapist. Clear communication will allow the counselor to explain the counseling obligations versus the client’s obligations to ensure the therapy is achieved in the long run. Conclusions This paper focused on alcoholism. Connor is of Irish descent. The paper explored his struggles with alcoholism, a condition he assumed was the best lifestyle. He experienced two DUIs within 3 years. According to the client, alcohol consumption is normal. He drinks on all occasions and events. Therefore, the primary diagnosis revealed that Connor meets the criteria for AUD. This has informed the best therapy for Connor which includes CBT alongside other coping skills and relapse control strategies. CBT is an effective treatment consideration because it is short with a friendly client interface.

17 References Breuninger, M. M., Grosso, J. A., Hunter, W., & Dolan, S. L. (2020). Treatment of alcohol use disorder: Integration of Alcoholics Anonymous and cognitive behavioral therapy. Training and Education in Professional Psychology, 14(1), 19. Diagnostic and statistical manual of mental disorders. (5th ed., text rev.). (2022). American Psychiatric Association Publishing. https://dsm-psychiatryonline- org.library.capella.edu/doi/book/10.1176/appi.books.9780890425787 Grossman, M., Chaloupka, F. J., & Sirtalan, I. (2017). An empirical analysis of alcohol addiction: results from the monitoring the future panels. In Determinants of Health: An Economic Perspective (pp. 604-619). Columbia University Press. Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A. M., & Daei, A. (2019). Transtheoretical model of health behavioral change: A systematic review. Iranian journal of nursing and midwifery research, 24(2), 83. Mauger, A. (2021). A great race of drinkers? Irish interpretations of alcoholism and drinking stereotypes, 1945–1975. Medical History, 65(1), 70-89. Miller. (2015). Learning the language of addiction counseling. (4th ed). Wiley. Nimbi, F. M., Galizia, R., Rossi, R., Limoncin, E., Ciocca, G., Fontanesi, L., ... & Tambelli, R. (2021). The biopsychosocial model and the sex-positive approach: an integrative perspective for sexology and general health care. Sexuality Research and Social Policy, 1-15. van Amsterdam, J., Blanken, P., Spijkerman, R., van den Brink, W., & Hendriks, V. (2022). The Added Value of Pharmacotherapy to Cognitive Behavior Therapy And Vice Versa in the

18 Treatment of Alcohol Use Disorders: A Systematic Review. Alcohol and Alcoholism, 57(6), 768-775. Wang, S. C., Chen, Y. C., Chen, S. J., Lee, C. H., & Cheng, C. M. (2020). Alcohol addiction, gut microbiota, and alcoholism treatment: A review. International journal of molecular sciences, 21(17), 6413.

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