Introduction
The present paper provides a case presentation of Olivia Kerr (further referred to as O.K.), a 22 year old woman on probation in need of substance abuse counseling. The motivation for presenting this particular case is that individuals who are not incarcerated at the moment of substance abuse relapses have greater access to alcohol and may aggravate their situation. Therefore, this circumstance adds an extra layer of difficulty to resolving issues of such kind.
This paper contains a detailed theoretical overview of relevant approaches to practice with a focus on cognitive and family-based therapy. The case itself is presented in great detail, including reasons for referral, present concerns, assessment as well as engagement, contracting, and other aspects. An intervention plan is also enclosed with a description of potential ethical issues, constraints, and limitations. The case analysis is based on my experience with counseling O. K. as a social work intern assigned to a probation unit.
Theoretical Approach to Practice
Alcohol and drug abuse is not a rarity among probationers. In fact, according to statistics provided by the Centers for Substance Abuse Treatment (2005), in the United States of America, more than two-thirds of probationers have had a history of uncontrolled alcohol or drug consumption. For incarcerated individuals, this rate is even more concerning: the Centers for Substance Abuse Treatment (2005) reports that as many as 74% of them are dependent on alcohol or drugs. The issue is worth more attention due to the fact that staying clear off substances is one of the prerequisites of successfully passing the probation period (Hyatt & Barnes, 2017).
Probationers who avoid temptations have a decreased likelihood of recidivism and reincarceration. Moreover, staying away from drugs and alcohol allows for forming new positive habits and changing the entire lifestyle for the best. Unfortunately, being on probation often means greater access to substances as opposed to prison where it is much more restricted (Centers for Substance Abuse, 2005). In some cases, relapsing is preventable; others, however, need an intervention before the situation derails beyond repair.
At present, cognitive behavioral therapy is widely used for treating addiction. The purpose of cognitive behavioral therapy is to help a patient find connections between their feelings, thoughts, and actions (Leahy, 2015). In the case of substance abuse, this type of therapy can help to pinpoint the root cause of a habit and substitute it with a healthier pattern. Overall, cognitive behavioral therapy hinges on the premise that intention to change alone cannot make much of a difference. Action is the key to breaking the vicious circle and recovery (Leahy, 2015).
A patient is assisted in defining the circumstances that lead to relapsing: particular triggers, events, or people. By becoming more aware of these triggers, an individual empowers themselves and can now respond thoughtfully instead of mindlessly reacting (Garland, 2016). Another idea that may be used to help a patient is that of providing a reward of some other kind. For instance, if by abusing alcohol, a person meets their emotional needs, he or she might find it useful to do it in a different way, for example, by reaching out to their support system.
As much as cognitive therapy has proven successful in treating substance abuse, some issues are still likely to arise and should not go unaddressed. First and foremost, probationers with a history of substance abuse suffer from identity and self-worth issues. Namely, they may be suffering from the stigma that society puts on them due to their criminal record and alcohol and drug consumption (Jewell, Malone, Rose, Sturgeon & Owens, 2015).
This results in intense feelings of shame that often impede intervention and treatment. Another common problem that should also be addressed by social services and in therapy is financial barriers. As Barnes, Hyatt, and Sherman (2017) state, high-risk probationers often have to handle multiple financial responsibilities, which leaves them with little to no resources to seek help. Their family well-being and debt took a higher priority over their mental and physical health.
Lastly, according to Caroll (2014) individuals in therapy may be lacking genuine motivation to work on themselves. If a person does not quite understand why they need a change, even the most qualified specialist might be unable to help. In summation, an efficient approach to tackling substance abuse in high-risk probationers should draw on theoretical foundations of cognitive behavioral therapy and address real-life issues that may arise in the process. This combination should prove effective in the long run and avert relapse and reincarceration.
Case Presentation 2.5
Reason for referral
O. K. is a young 22 year old woman who is on probation for robbery from local supermarkets. This is not her first offence as O. K. has quite a history of misconduct spanning from middle school till present times. O. K. grew up in an unstable, underprivileged family with two siblings. The client’s parents were abusive and neglectful of their children. It is safe to say that O. K. was not given enough chances to receive proper education and come into contact with role models outside of her community. As of now, she is on probation for a year, during which she is obliged to abide the law and meet with her probation officer on a regular basis.
Present concerns
O. K. was referred to my social work institution due to her unhealthy drinking habits. It was previously established that her history of misconduct was closely tied to her substance abuse. In particular, she was caught stealing from the supermarket while being under the influence. As of now, she is at high risk of relapsing and sabotaging her probation and return to normal life. It seems that O. K. understands the importance of tackling this destructive habit, and yet, her reasoning might be not exactly on point. First and foremost, quitting alcohol for her means not being caught again and avoiding reincarceration. However, O. K. fails to realize that substance abuse has a detrimental effect on other aspects of her life as well.
Assessment
During the medical and psychological examination, I was able to conclude that O. K. is physically healthy. It seems that despite having spent her childhood and early years in an underprivileged community, she did not have any health problems, which surely does not mean that they cannot manifest themselves later on. However, her psychological assessment has shown that O. K. might have some problems that need to be addressed in order for her to accelerate recovery and avoid relapsing.
First and foremost, it seems that O. K.’s drinking habit stems from two different factors, which she seems to be unaware of. Firstly, O. K. grew up in a family where both the mother and the father drank excessively. In a conversation, O. K. mentioned that she would never want to grow up like her parents, and yet, she seems to have adopted their behavior patterns. Another factor that shaped her addiction is the need for emotional gratification (Berking et al., 2011). For O. K., being intoxicated means going to a happy place where she does not have to worry about her problems.
Relationship with the client
It appears to me that over the course of our work relationship, O. K. and I have managed to build quite a good rapport. I will not lie if I say that at times, relating to O. K.’s issues was difficult. Moreover, given that I am not that experienced with working for social organizations, sometimes I was at sea about what I was supposed to do. However, over time, we got to know each other at a more personal level, and O. K. started to confide in me much more than at the beginning of the counseling.
Engagement
Overall, O. K. was engaged in the process, even though it did not happen right away. The biggest obstacles to total engagement included her feelings of shame for her life situation, lack of motivation, and unawareness of the impact that her habit had on her life.
Contracting
I made sure that O. K. was not in therapy against her will and she was aware of the purpose of her being here. I reassured my client about confidentiality and anonymity. Among other things, I mentioned that if I ever decide to use her case for research purposes, I will make sure that her personality is non-identifiable and her name is changed. Apart from that, it goes without saying that I asked O. K.’s permission to use the information that I obtained from her for writing academic papers.
Issues of diversity
Probably the only parallel I could draw between me and my client is our age. We belong to more or less the same age group, and we may relate to each others’ experiences at some level. For example, O. K. mentioned that she worries a lot about what people think of her, and apparently, she is quite susceptible to peer pressure. I admit that this is an issue for me as well, even if we have quite different social circles to compare ourselves too. The biggest difference that I think I am not able to bridge is our upbringing. I grew up in a family that was quite well-off; my parents had stable jobs and cared about me. I cannot even imagine what it is like to grow up in a house where your needs are constantly neglected and where you do not have any positive role models.
Intervention
The intervention started off with giving O. K. tasks within her cognitive behavioral counseling treatment. O. K. was encouraged to determine triggers for her addiction and find healthier ways to provide herself with an emotional relief. Apart from tasks outlined within the scope of cognitive behavioral therapy, O. K. and I worked on eliminating the barriers to recovery described in more detail in Section II “Theoretical Approach to Practice.” As it has been mentioned, being an ex-offender and dependent on substances makes a person extremely vulnerable to public opinion.
Since O. K. often felt unworthy of help and getting back to normal, we found a way to restore her identity and make her feel better. Together with another specialist from our social work institution, we offered her to participate in community service. This idea may be not exactly obvious, but psychologically, it is quite powerful. When O. K. realized that she had the capacity to “give back” to the community through quite simple tasks, she started feeling better about herself. At this point, O. K. started seeing the relationship between her and me as a fair exchange.
Another task for her was supposed to increase her self-agency and motivation. As it has already been mentioned, one of the reasons why ex-offenders are reluctant to address issues such as substance abuse is because they do not quite understand how it will change their life. Together with me and other specialists, O. K. was able to put together short-term and long-term plans for the future, given that she takes control of alcohol consumption. O. K. has grown more aware of the positive impact that being clean will have on her life. For instance, in the short-term perspective, she will be able to show up for work on time, uninterrupted by alcohol binges. In the long run, O. K. will be able to have healthy kids and have a loving family.
Ethical issues
In the process of working with O. K., I did not encounter any ethical issues. However, I can readily imagine what kind of struggles I could have been confronted with in a similar situation. One of the possible unwanted scenarios would include becoming too close with O. K. and crossing the line between worker and client into a grey territory. In this case, I think I could have become more biased toward O. K. I would start relying on my own perception of her rather on what is prescribed based on theory and evidence.
Constraints / Limitations
The greatest constraint that I encountered when I was working with O. K. was the total indifference of her family to her issues. Family-based therapy is the type of counseling that is often used to tackle substance abuse issues. In the case of O. K., it could have been beneficial if she had a support system at home (Lanza, Garcia, Lamelas & González‐Menéndez, 2014). For instance, her family could have been encouraging her not to give up as well as expressing their concerns and sympathy with her struggles (Sexton, 2017). Given O. K.’s life circumstances, it was not exactly the case. I still think that some form of family-based therapy could have been possible for O. K., but perhaps, with her friends instead of her relatives. In any case, I would focus on involving people that she deems significant in the process.
Conclusion
Like many other probationers, O. K. struggles with alcohol abuse, which diminishes her chances to reform her life and avoid recidivism. The main concern as of now is her unawareness of the roots of her issue and the lack of motivation to tackle addiction once and for all. To help O. K., cognitive behavioral therapy was chosen, during which the client succeeded in pinpointing her personal triggers that led to relapses and binges. The process was not smooth: O. K. showed reluctance that was later explained by her feelings of unworthiness. Overall, O. K. seems to be in a more stable situation now than she was before.
References
Barnes, G. C., Hyatt, J. M., & Sherman, L. W. (2017). Even a little bit helps: an implementation and experimental evaluation of cognitive-behavioral therapy for high-risk probationers. Criminal Justice and Behavior, 44(4), 611-630.
Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive–behavioral therapy for alcohol dependence. Journal of consulting and clinical psychology, 79(3), 307.
Carroll, K. M. (2014). Lost in translation? Moving contingency management and cognitive behavioral therapy into clinical practice. Annals of the New York Academy of Sciences, 1327(1), 94.
Center for Substance Abuse Treatment. (2005). 10 treatment for offenders under community supervision. Web.
Garland, E. (2016). Restructuring reward processing with Mindfulness-Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. Annals of the New York Academy of Sciences, 1373(1), 25.
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.
Jewell, J. D., Malone, M. D., Rose, P., Sturgeon, D., & Owens, S. (2015). A multiyear follow-up study examining the effectiveness of a cognitive behavioral group therapy program on the recidivism of juveniles on probation. International journal of offender therapy and comparative criminology, 59(3), 259-272.
Lanza, P. V., Garcia, P. F., Lamelas, F. R., & González‐Menéndez, A. (2014). Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women. Journal of clinical psychology, 70(7), 644-657.
Leahy, R. L. (Ed.). (2015). Contemporary cognitive therapy: Theory, research, and practice. New York, NY: Guilford Publications.
Sexton, T. L. (2017). Functional family therapy. The Encyclopedia of Juvenile Delinquency and Justice, 1-7.