Introduction
The client system that this paper discusses is an individual. O. K. is a 22 years old woman with an alcohol abuse addiction. She is Hispanic, and O. K. grew up in a family with a history of alcohol abuse and child neglect. O. K. has been on probation, meaning that unlike individuals who are incarcerated, she had unlimited access to alcohol. Moreover, the probation process implies that a person stays away from any substances because the use of alcohol can increase the probability of relapse (Hyatt & Barnes, 2017). This means that O.K. was struggling with two main issues – having access to alcohol while dealing with substance abuse and adhering to her probation requirements.
The etiology of O. K.’s alcohol abuse is connected to her childhood and exposure to bad role models. Common reasons for developing this problem include wanting to satisfy a psychological need, for example, if a person does not have a support system or another source of consolation. Self-worth and identity problems are also a common factor predisposing people to substance abuse. In the case of a person on probation, it is further worsened by society’s stigma about probationers.
The social history of O. K. is connected to her alcohol abuse issue because she grew up in an underprivileged community, and her family has a history of abusing and neglecting their children. This was reflected in O. K.’s psychological assessment since, despite being physically healthy, she has shown some signs of psychological trauma. Both her parents have alcohol abuse problems, which affected her perception of the problem and her habits. O. K. left highschool and since then had several jobs, and at the time, she worked at Macy’s. Therefore, O. K.’s upbringing and the people surrounding her affected her perception of self, which developed into an alcohol abuse problem.
Generalist Social Work Process
The central premise of social work is to help client systems adjust their lives to ensure that their physical and psychological well being is not at risk and promote health by addressing the client system’s social and psychological issues (Scarnato, n.d.). In the case of O. K., the main target was to ensure that she does not relapse and begin consuming alcohol again, to ensure that she can lead a healthy lifestyle and adhere to her probation requirements. Additionally, from a social perspective, O. K. experienced difficulties because of the pressure and psychological problems associated with society’s perception of people accused of a misdemeanor or those who deal with substance abuse.
Engagement
There was an understandable issue with engagement at the first stages of working with O. K. because of her self-worth perceptions and belief that she is not worthy of receiving help and the shame she felt for her behavior. A senior colleague advised me to offer O. K. social work as a way of giving back to the community, which would help her receive the necessary help from me as her counselor. This helped O. K. with her self-esteem, and she began sharing more personal information about her behavior and background. At this stage, it was crucial for me to ensure that she understands the issues that alcohol abuse can lead to and agree on a mutual goal to work towards improving the situation.
Assessment
O. K.’s case was referred to me by another social worker due to concerns about a possible relapse. Hence, the initial assessment included looking through the information provided by the social worker and the client herself. At this stage, I tried to focus on the strengths-based perspective, mainly on the positive sides of O. K. ‘s behavior, skills, and aspirations to build a plan that can be sustainable for her.
Planning
The root cause of O. K.’s issues appears to be the environment she grew up in and the absence of a role model. Additionally, in the first stages of the assessment, it became apparent that O. K. is not aware of the causes of her alcohol abuse and lacks the motivation to address the problem. Hence, the planning process involved reviewing evidence to find the most effective evidence-based intervention to help O. K. recognize the problem and address it. Two primary options – CBT and family-based therapy were considered at this stage as the most commonly applied.
Implementation
At this stage, I offered O. K. to go through cognitive behavioral therapy (CBT) to bridge the gap between her feelings and actions.
Firstly, O. K. was asked to monitor her behavior and identify triggers that lead to her wanting to consume alcohol. Next, she was invited to participate in a community service project to help her improve her feeling of self-worth. Finally, we worked on goal setting and motivation to ensure that O. K. can successfully plan her life after the counsellings sessions are over.
Evaluation
Through CBT, O. K. was able to achieve several crucial goals. Firstly, her feeling of self-worth was supported through community work, and she understood the value of giving back to the community where she lives.
Termination
I no longer work with O. K. since she was able to reach a degree of success in managing her self-worth perception that led her to alcohol consumption.
Critical Reflection
Values and Ethics
When working with O. K., I encountered many stigma-related problems that affect the way ex-offenders perceive themselves. As I mentioned, substance abuse can begin or worsen due to feelings of shame and impaired self-worth, which is what O. K. experienced. She did not think she was a worthy person to receive help from others, and she felt shame for her actions that led her to probation in the first place. Another ethical concern that a social worker can encounter when working with a person of similar age is becoming too close to the client system, which would impair fair judgment. In my case, I avoided this issue because I was aware of the problems it could lead to.
Cultural Competency
Due to the fact that O. K. and I come from different backgrounds, I was very cautious about the fact that she may perceive counseling in a different manner. It is important to remember about human rights when working in counseling. While the main goal is to help the client system and improve their abilities to live in our society, the goal cannot be achieved without commitment and of the individual or people in cooperation with a counselor. That is why I made sure that O. K. wanted to get treatment.
Strengths Perspective
The strength perspective is a concept that allows social workers to point out the best in their client cases, help the individuals see these positive aspects, and use it to improve their lives (Scarnato, n.d.). In the case of O. K., it was evident that she is very compassionate and caring, despite her history of offenses. Hence, my goal was to help her see that she can contribute to her community as well through her work and by volunteering to help.
CSWE Competencies
In this case, I applied the competency of critical thinking, which helped me define the core issue that O. K. had and the causes of her alcohol abuse problem. This was done by carefully listening to her words and pointing out some inconsistencies in her thinking that may lead to her adverse behavior. Additionally, I engaged in research-informed practice and used the information I found to guide the intervention for O. K. There are several methods of addressing substance abuse problems. However, research shows that CBT is effective and provides results in a relatively small timeframe. Finally, I applied knowledge of human behavior and social environment, which helped me to understand the shame that O. K. was feeling and how it affected her perception of self.
Education Reflection
The practice of social work differs from the theory because, as the experience shows, social workers typically have to address complex client cases, with multiple layers of problems, for example, O. K. had issues with alcohol, underlying trauma, and probation. During my first years of education, I learned a lot about the theoretical pillars of social work and the variety of issues that people can face. In the case of O. K., I applied my knowledge to choose an intervention that would address the concern and provide a quick result.
Hence, though my education, I was able to understand the ethics applied to social work, the importance of having a professional relationship with the client system to be able to help. Additionally, I developed an understanding of the strength perspective as the main tool for addressing issues. Finally, I learned how to find and apply evidence-based interventions.
Research and Evidence-Based Practice
The following evidence-based sources provide other options for treating substance abuse, apart from CBT that was used in the case of O. K. – Allsop (2017), Antonelli et al. (2018), Batra et al. (2016), Epstein et al. (2018), and Haug and Schaub (2016). Mainly, the interventions outline two approaches to treating alcohol use disorders (AUD) – behavior modification and medication. Psychotherapy sessions can be used for treating substance abuse.
Medication can be applied as well, in severe cases of substance abuse, to help the person go through the process of reducing the cravings for alcohol. According to Antonelli et al. (2018), naltrexone and acamprosate are approved in the United States drug-based treatments for people with alcohol use disorder. The main issue with these drugs is that they have significant side effects, mainly for people who have liver illnesses or other health concerns.
Moreover, during the treatment process, it is vital for people to avoid drinking alcohol because the medication leads to the acetaldehyde in a person’s blood that results in major side effects. The underlying theory for medication-based treatment is that people with AUD struggle with cravings for alcohol, which often result in them binge drinking(Antonelli et al., 2017). The focus here is on the physiological craving for alcohol that a person has, not a behavioral issue or psychological implications of consuming alcohol as a method for finding comfort.
Regarding the compliance of drug-based treatment for AUD, several implications apply. Firstly, these drugs must be prescribed by a medical professional who is capable of assessing the O. K.’s health and objectively reviewing the possible side effects. In this case, the client has to be referred to a specialist. Additionally, as mentioned, this approach does not deal with the factors that lead to alcohol consumption in the first place. In O. K.’s case, these were negative role models, self-worth, and a habit of drinking when going out with friends. The latter was the trigger that, if not addressed, would continue to affect O. K.’s behavior even with medication that reduces cravings.
Family-based therapy is commonly used as part of counseling to help people overcome their substance abuse issues because one reason explaining why people turn to alcohol is a lack of a social support system. The substance they consume thus serves as a source of comfort, which can be substantiated with help and support from family members (Alson, 2017). However, in O. K.’s case, family therapy was not an option, since the indifference and neglect she experienced during her childhood persisted through her adulthood and her parents and siblings did not appear to care for her problems. Evidence by Epstein et al. (2018), also recommends group therapy, specifically for females who have AUD as an alternative to family-based therapy.
In both cases, the underlying theory is that an individual can obtain support from others and get social exposure that will help them overcome the addiction. Thus, although family therapy is effective, as the evidence suggests, it was not considered for O. K.’s case. This intervention complies with the ethics and values of social work because it helps the person build and sustain a support system that will aid them in overcoming their addictions.
Policy and Practice
Policies that help address alcohol abuse include projects directed at limiting access to alcohol and raising awareness regarding the number of people who have AUD and the available resources they can use for treatment, as well as fining people who drive under the influence. In the state of New York, about 2% of the population, including children over the age of 12, suffer from some form of alcohol abuse, which prompted the state authorities to address the issue through policies (Stephen, n.d.). In New York, the Office of Alcohol and Substance Abuse Services (OASAS) is responsible for addressing the problem of substance abuse and addiction.
This service was established to guide the process of increasing public awareness and educating the people who work with individuals with substance abuse issues. Allsop (2017) argues that the current theoretical and evidence-based approach suggests that using so-called “brief interventions” is the best method. CBT and other forms of psychological treatment, such as support groups, are a generally applied strategy that can help individuals deal with alcohol abuse problems. However, the treatment depends on the state of the individual and their level of conscientiousness regarding the problem.
The AUD was researched for many years, with different approaches and concepts applied to the treatment of this condition. For instance, in the 1970s, a more intense treatment process was applied. However, the literature review by Allsop (2017) suggests that “brief interventions,” including CBT, are the most commonly applied strategy that shows promising results. An important aspect is that individuals with AUD have to consent to the treatment in order for it to be successful, which implies recognizing that overconsumption or addiction is a problem in the first place. In this regard, OASAS’s efforts are helpful for raising awareness about substance use disorders.
Ideal World Reflection
Ideally, O. K.’s issues should have been addressed when she was a child since her addiction problems are connected to neglect, abuse, and negative role models of her parents, who also consume alcohol. She did not have a chance to grow up with a positive role model and a support system such as a counselor who would help her avoid developing the AUD in the first place. Hence, a policy tailored towards children whose parents have alcohol consumption problems would be helpful in reducing the possibility of these children having similar problems during their adulthood. This can include additional counseling for these children to help them deal with the trauma caused by witnessing addiction or state-wide policies that would address the question of whether parents with substance abuse issues.
Current regulations are tailored towards limiting the access and availability of alcohol, mainly by controlling the density of alcohol outlets per area, restricting the timeframe and days when they can be sold, and imposing similar regulations. However, little attention is dedicated to helping the 2% that are dealing with the problem on a daily basis, since access to alcohol is only one element of the problem, the other one being the psychological implications, which lead a person to indulge in substance abuse (Stephen, n.d.).
Thus, additional attention should be dedicated to encouraging people to seek treatment, since many of them, as was the case with O. K., are ashamed of their addiction. Hence, the proposal for improving the social conditions that would help address the AUD problem include more attention to children growing up with parents who have substance abuse issues and positive encouragement for people seeking help.
The implementation process of helping children who live with abusive parents would require some type of reporting system that would allow identifying families at risk and referring children to specialists. This can be a problem because it is unlikely that children themselves would report such behavior as they rely on their parents or may not be able to recognize adverse behavior. However, social workers can use some indicators to detect families at risk and arrange consultations with children to identify if they are in need of psychological help. In terms of resources, this would require an expansion of staff for local social services as well as specialists who are trained to work with children.
For the second proposal, an information campaign can be created to help people recognize the warning signs of their developing addiction. The case of O. K. highlights the fact that people often do not recognize this type of a problem or fail to see the underlying causes of it without outside help. This campaign would require input from local authorities and investment for the development of strategy and actual advertising. From this assignment, I learned about the various competencies and strategies that a social worker must apply when working on a client system case. I was able to review the stages of developing a case plan and recognize the value of the strengths-based perspective.
References
Allsop, S. (2017). Advancing alcohol research and treatment: Contentions and debates about treatment intensity, goals and outcomes in the 1970s and 1980s. Addiction, 113(6), 1149–1154. Web.
Antonelli, M., Ferrulli, A., Sestito, L., Vassallo, G. A., Tarli, C., Mosoni, C., Rando, M. M., Mirijello, A., Gasbarrini, A., & Addolorato, G. (2018). Alcohol addiction – The safety of available approved treatment options. Expert Opinion on Drug Safety, 17(2), 169-177. Web.
Batra, A., Müller, C. A., Mann, K., & Heinz, A. (2016). Alcohol dependence and harmful use of alcohol. Deutsches Arzteblatt International, 113(17), 301–310. Web.
Epstein, E. E., McCrady, B. S., Hallgren, K. A., Gaba, A., Cook, S., Jensen, N., Litt, M. D. (2018). Individual versus group female-specific cognitive behavior therapy for alcohol use disorder. Journal of Substance Abuse Treatment, 88, 27–43. Web.
Haug, S., & Schaub, M.P. (2016). Treatment outcome, treatment retention, and their predictors among clients of five outpatient alcohol treatment centres in Switzerland. BMC Public Health 16, 581. Web.
Hyatt, J. M., & Barnes, G. C. (2017). An experimental evaluation of the impact of intensive supervision on the recidivism of high-risk probationers. Crime & Delinquency, 63(1), 3-38.
Scarnato, J. M. (n.d.). The generalist intervention model for social work practice. Web.
Stephen, E. (n.d.). Alcohol dependence patterns and their impact on New York City. Web.