Introduction
The literature notes the significance of protective and risk factors concerning substance abuse. According to Nawi et al. (2021), risk factors of drugs refer to those circumstances or conditions that increase the possibility of a person abusing drugs, while protective factors reduce this possibility. Some common risk factors of drug abuse include a family history of substance abuse, poor parental monitoring, association with delinquent peers, childhood sexual abuse, low academic achievement, and many more (Nawi et al., 2021). On the other hand, protective factors of drug abuse are family support, parent and family engagement, school connectedness, parental monitoring, and much more (Centers for Disease Control and Prevention, 2022). Assessing drug abuse’s risk and protective factors contributes to finding appropriate interventions.
Case Scenario
In the case study involving a 22-year-old, Sarah, some risk and protective factors can be identified. One risk factor for Sarah’s drug abuse behavior is her family’s dysfunction. From the case study, Sarah’s father left and never came back when she was 12, and her mother also cut her off and does not speak to her anymore. She has never had any family member take care of or monitor her for drug abuse. Other risk factors include dropping out of school, early exposure to drugs and alcohol, and living around people who abuse and drink alcohol. On the other hand, the identified protective factors include her friend, who keeps advising her on the right thing to do, and her desire to seek advice.
Substance Abuse Pattern
Primarily, Sarah uses heroin, which she started at 17 when she was introduced to her boyfriend. At age 22, Sarah says she injects around $300-$400 to help her function properly throughout the day. She says that she has to inject heroin about 2-3 times a day, and the last time she used it was the previous day after work. Sarah also notes that she smokes cigarettes and drinks wine or alcohol before she sleeps daily. When she cannot access heroin, Sarah occasionally uses opioids and benzodiazepines.
Out of all the drugs that Sarah uses, heroin poses a significant risk of harm if to withdraws from it. According to an article from WebMD, heroin is significantly addictive, and people who regularly abuse it develop some tolerance (Peri, 2022). This means they frequently need more or higher doses of heroin to get the desired feeling, a condition called substance use disorder (SUD).
SUD is “when continued use of the drug causes issues, such as health problems and failure to meet responsibilities at work, school, or home” (National Institute on Drug Abuse, 2022). This condition can range from mild to severe, which is the worst part of addiction. People who frequently use heroin can also develop severe withdrawal symptoms if they stop using abruptly (Peri, 2022). In the case study, Sarah needs heroin to function and would opt for other dangerous drugs like opioids when it is not available. She has developed SUD for heroin, and when she stops using abruptly, she can experience severe withdrawal.
Other Potential Harms
Apart from the effects of heroin, which are significantly severe, Sarah is also exposed to some potential harm. These harms include an abusive relationship with his boyfriend, Nick, financial instability, possibly being evicted from their house, and physical health issues. Her dependency on heroin is affecting her financial stability and increasing the chances of her being fired from her job.
If Sarah is pregnant, her current condition will expose the baby to various potential harms. These potential harms include an increased risk of premature birth, congenital disabilities, low birth weight, prenatal exposure to alcohol and drugs, developmental issues, and much more (Mburu et al., 2020). All these other effects add to the severe impacts of frequent heroin usage.
Recommendations
Sarah’s friend’s advice that she should not stop using heroin if she is pregnant is correct. When a woman uses heroin while she is pregnant, it is significantly dangerous and can sometimes prove deadly. Both the mother and the baby stand a higher chance of being affected by the effects of heroin during pregnancy. For instance, according to Mburu et al. (2020), prenatal exposure to heroin is dangerous to the baby and can lead to an elevated risk of low birth weight, neonatal abstinence syndrome (NAS), and stillbirth. Others include developmental issues, miscarriage, sudden infant death syndrome, placental abruption, and more (Peri, 2022).
Therefore, the best advice for Sarah, if she is pregnant, is to seek medical treatment before stopping to use heroin. This is because if she quits the drug suddenly, it will lead to severe issues for the child, which can even cause death (Mburu et al., 2020). The healthcare provider will offer Sarah drugs to help her reduce her dependency on heroin more safely for the baby.
Stage of Change
James Prochaska and Carlo DiClemente’s transtheoretical model (TTM) of change can be used to assess Sarah’s stage of change. Hashemzadeh et al. (2019) note that the TTM of behavioral change states, “changing a behavior is not a coincidence but instead is a process and different people are in different stages of change (SC) and readiness” (p. 83). In this behavior change process, a person goes through five stages: contemplation, precontemplation, preparation, action, and maintenance (Hashemzadeh et al., 2019).
At the pre-contemplation stage, a person is not yet considering change and sometimes does not understand how damaging their behaviors are. Secondly, when a person is in the contemplation stage, they are aware of their behavior and why they need to make efforts towards change. However, these people are still battling the cost of changing their negative behavior (Eshah, 2019). Additionally, while a person in the preparation stage has begun to make small changes, the one in the action stage has begun taking direct action to eliminate the problematic behavior (Eshah, 2019). The maintenance stage involves successfully avoiding problematic behavior and adopting a new one.
In the case study, Sarah is in the contemplation stage of behavioral change. As mentioned earlier, a person in the contemplation stage has become more aware of their problematic behavior and its damage. They always have a conflict of whether to choose the benefits of making a change or avoid the costs that come with it (Eshah, 2019). In Sarah’s case, even though she has expressed a desire to change her behavior and realized how it affects her current situation, she seems conflicted and doubtful about the next step. She is weighing each side’s pros and cons, which is causing her an internal struggle.
Counselling Approach
Motivational interviewing (MI) is the best counseling approach for engaging Sarah. According to Martino et al. (2019), MI is “an evidence-based behavioral intervention that can capitalize” on reachable events, such as patients who abuse drugs and have come to seek treatment in a healthcare organization (p. 2520). This approach is often patient-centered, collaborative, and goal-oriented, aiming to elicit and support the client’s argument for change and resolve arguments that prevent them from choosing to change. Utilizing this approach, the therapist adopts blended fundamental patient-centered communication skills and a nonjudgmental and empathetic stance to help elicit an individual’s motivation to change (Oveisi et al., 2020). Additionally, this approach requires the counselor to listen to what the client is saying and respect their right to make decisions.
Over the years, strong evidence has indicated that MI is an effective approach to intervening in substance use and supporting individuals through changing their behaviors. For instance, Oveisi et al. (2020) found a positive correlation between MI and changes in alcohol and substance abuse. In their study, the reports suggested “motivational interviewing can decrease desire (urge) to use and reported probability of use (i.e., improve self-efficacy)” (Oveisi et al., 2020, p. 6). Martino et al. (2019) add to their conclusion, “given the success of enhancing motivation, as shown through the change talk findings, this is a missed opportunity” (p. 2525). This approach effectively elicits and supports the clients’ need to change and how to go about it.
One specific strategy that one would use in this approach is asking open-ended questions. In this strategy, the counselor has to ensure that the client is the one doing most of the talking. Sarah will offer the counselor enough information about his condition. For instance, the counselor would tell Sarah, “I understand your Heroin-using behavior is disturbing you lately, tell me about it?”
The other strategy is the use of reflection while in session with Sarah. While using this strategy, the counselor will try to rephrase a client’s statement to understand it better. It encourages clients to offer the counselor more in-depth information and motivates them much more. For example, “heroin helps you attend to your daily tasks and function properly, but you are now saying it is worrying you. You realize you might be pregnant, and it is even disturbing you more.” This can help reinforce or amplify Sarah’s desire for change.
Treatment Options
If Sarah is pregnant, the first appropriate treatment option is prenatal care and support. This treatment involves the healthcare provider monitoring the health of Sarah and the unborn baby and determining how to support her and prepare for giving birth (Krull, 2022). Therefore, it would be important for the counselor to refer Sarah to an obstetrician and a specialized prenatal program. Another treatment option for Sarah is medically assisted treatment (MAT).
Over the years, strong evidence has indicated that MAT is effective in addressing opioid use, enhancing behavior change, and decreasing overdose risk (Deyo-Svendsen et al., 2020). It involves the combination of counseling, behavioral therapies, and medication to influence behavior change. Individual counseling approaches like cognitive behavioral therapy have proven effective in influencing behavior change (Martino et al., 2019). Through these treatment options, Sarah will successfully change her behavior, and her unborn child will be safe from the effects of heroin.
Other Issues in the Case
One other issue that is evident in the case is domestic violence. At the women’s drop-in center, Sarah reveals that her relationship with Nick has many issues, and nowadays, they are not having sex as much as they used to. She adds that Nick always wants unprotected sex, and she cannot advise her to use condoms because she fears he will beat him again. Another issue in the case is mental health concerns.
Sarah needs to be referred to a domestic violence support agency that offers her the required services (Shaheen et al., 2020). As the case study begins, it is evident that Sarah has a history of substance abuse, trauma, and current emotional distress caused by her abusive boyfriend and the fear of being pregnant. Therefore, Sarah must be referred to a mental health institution to be assessed.
Different attitudes and stigmas can negatively affect Sarah’s treatment and change of behaviors. For instance, according to Zwick et al. (2020), negative attitudes and stigma about alcohol and drug abuse can lead to discrimination against people with an addiction, judgment, and less access to the required care and support. When people start perceiving drug addicts as bad influences in the community, they discriminate against them and deny them access to appropriate support.
Conclusion
Therefore, when treating Sarah, it would be important to consider offering her care in a nonjudgmental and compassionate manner. She has to feel like she has someone listening, understanding her issues, and treating her with respect and dignity. Abuhammad et al. (2022) note that educating and training healthcare providers, social workers, and the public on substance abuse would help mitigate the attitudes and stigma around it. By implementing this knowledge, these professionals can offer a conducive environment for care.
References
Abuhammad, S., Hatamleh, R., Alrawashdeh, M., Mukattash, N. A., Abuhammad, M., & Howard, K. (2022). Personal attributes and attitudes to substance use disorder: A study among Jordanian undergraduate medical majors students. PLOS ONE, 17(2), e0263442. Web.
Centers for Disease Control and Prevention. (2022). High-risk substance use among youth. Web.
Deyo-Svendsen, M., Svendsen, M. C., Walker, J., Hodges, A., Oldfather, R., & Mansukhani, M. (2020). Medication-assisted treatment for opioid use disorder in a rural family medicine practice. Journal of Primary Care & Community Health, 11. Web.
Eshah, N. F. (2019). Readiness for behavior change in patients living with ischemic heart disease. Journal of Nursing Research, 27(6), e57. Web.
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. Web.
Krull, E. (2022). Treatment for substance use and addiction while pregnant: What you should know. Web.
Martino, S., Zimbrean, P., Forray, A., Kaufman, J. S., Desan, P. H., Olmstead, T. A., Hayden-Gilstad, K., Gueorguieva, R., & Yonkers, K. (2019). Implementing motivational interviewing for substance misuse on medical inpatient units: A randomized controlled trial. Journal of general internal medicine, 2520-2529. Web.
Mburu, G., Ayon, S., Mahinda, S., & Kaveh, K. (2020). Determinants of women’s drug use during pregnancy: Perspectives from a qualitative study. Maternal and Child Health Journal, 24, 1170-1178. Web.
National Institute on Drug Abuse. (2022). Heroin Drug Facts. Web.
Nawi, A. M., Ismail, R., Ibrahim, F., Hassan, M. R., Manaf, M. R., Amit, N., Ibrahim, N., & Shafurdin, N. (2021). Risk and protective factors of drug abuse among adolescents: a systematic review. BMC Public Health, 21(1), 1-15. Web.
Oveisi, S., Stein, L. A., Babaeepour, E., & Araban, M. (2020). The impact of motivational interviewing on relapse to substance use among women in Iran: A randomized clinical trial. BMC Psychiatry, 20, 1-7. Web.
Peri, C. (2022). Heroin. Web.
Shaheen, A., Ashkar, S., Alkaiyat, A., Bacchus, L., Colombini, M., Feder, G., & Evans, M. (2020). Barriers to women’s disclosure of domestic violence in health services in Palestine: Qualitative interview-based study. BMC Public Health, 20(1), 1-10. Web.
Zwick, J., Appleseth, H., & Arndt, S. (2020). Stigma: How it affects the substance use disorder patient. Substance Abuse Treatment, Prevention, and Policy, 15(50), 1-4. Web.