Substance Abuse: Inpatient Rehabilitation Case Study

Brief History and Identified Problem

Sandra is a 32-year-old female of Caucasian descent. She has been using drugs and alcohol since the age of 15. She presents into inpatient rehabilitation appointed by court order after receiving a DUI (driving under the influence). She is in denial of needing any type of drug rehabilitation or treatment. She is an adult child of an alcoholic and has a limited family support system at this time.

She will need detoxification from alcohol abuse and will need to attend 28 days of inpatient rehab. A full psychological evaluation will follow after detox to determine any potential dual dx. She will be referred to sober living after her first 28 days in inpatient Rehab. Out-patient detoxification with AA/NA,1;1, and family therapy will follow.

Sandra grew up with parents who were preoccupied with their own lives. Although some of her basic needs like shelter, food, and education were provided, there was a lack of emotional and family support. Her parents were alcoholics so that by the time she was fourteen, she already had her first smoke and by the time she got a little older, she was drinking alcohol. Soon enough, friends and schoolmates have seen her hanging with a crowd that was involved in other substances, or drugs aside from cigarettes and alcohol.

Before she was eighteen years old, Sandra left home and tried to live on her working on fast foods and whatever may come along. At the same time, she has stopped schooling but continued to hang around with the crowd that introduced her to vices. Sandra has had other interests in life, such as moving to a better neighborhood. She crashes in with her friends’ flat and would sometimes share with the rent.

But as there are a lot of conflicts they have to address, such as overcrowding at some nights or days, Sandra would stay from one friend’s place to another until it has become a habit. However, her case has worsened when she was apprehended by the police for driving under the influence.

She had been recommended for rehabilitation but right from the start, Sandra has refused and denied she ever needed one.

There are several reasons why people like Sandra fell for abusing substances or drugs. It has been identified that her own family, specifically her parents were alcoholics. Alcohol is one of the more prevalent substances that are openly abused, or very acceptable in society, aside from nicotine or cigarette use. Other reasons include environmental influence, peer pressure, and the need to personally address conflicts.

The American Psychiatric Association defined substance abuse as First, a maladaptive pattern of substance use that leads to clinical impairment or distress manifested by one of the following:

• Recurrent use of a substance that fails to fulfill obligations at work, school, or at home. In the case of Sandra, she has escaped or walked away from home as well as stopped schooling altogether. She has looked for ways to earn but this is to support her vice, and just to keep on living.
• Repeated substance use has become physically hazardous such as her being caught driving under the influence.
• Presence of substance-related legal problems or her arrest.
• Persistence of substance use despite the presence or repetition of social or interpersonal problems much complicated by the effects of the substance use.

Women in substance abuse were generally less known and that their treatment needs were also less addressed. Aside from barriers, there is also the underrepresentation in the treatment setting (UNODC, 2004). However, other forms of treatment and solutions are available that could be provided for Sandra. While there exist private institutions that provide for clinical care, community settings may also be available, of which were also said to be effective and practical (Herbeck et al, 2008). Adoption, however, may vary from one institution to another, and external funding is needed to be able to sustain treatment (Roy-Byrne et al, 2003).

To efficiently address the case of Sandra, certain requirements need to be met. First of all, there must be self-acknowledgment, awareness as well as acceptance that she is abnormally using substances and needs rehabilitation. At this point, a barrier has been defined: Sandra denies having a problem nor the need to rehabilitate. The UN study (2004)m proposed a gender-responsive approach to addressing the case of Sandra. Educating her as well as providing gender-specific “treatment plans, facilitate access to treatment, improve treatment engagement and effectiveness and encourage the discussion of gender issues among treatment teams,” (p 29).

Likewise, it has been proposed that there is a need to:

• maintain a comprehensive as opposed to a confrontational approach, most specifically at the start of the therapeutic process
• maintain privacy especially in the treatment of traumatic experiences
• focus on her relationships such as family and relatives to restore social network and support
• focus on individual treatment
• provision of a long time for treatment to establish linkages and therapeutic bonding (UNODC, 2004).

While the above-given findings and suggestions of the UN study may be subject to individual cases. Further, as stated earlier, the early-stage treatment issues must be properly addressed, and these are:

• To make Sandra recognize, admit as well as move past ambivalence and denial
• Must be motivated by external pressure such as friends and social networks
• Internal motivation such as the drive to succeed in a career, as well as the adult responsibility to use substances or drugs appropriately
• Her emotional state of guilt, shame, depression, and anger.

On her part, Sandra has shown active resistance so that it is easier to identify her needs to be further educated to properly address her substance use. As identified earlier, there are emotional and mental conflicts in the case of Sandra where defense mechanisms may lead her to be perceived or self-perceived as:

• morally deficient
• a need to admit illness to lift her guilt, shame, or remorse
• the positive development of a realistic view of herself
• and recognition of her feelings to deal with the people around her including support groups.

Already, it was necessary from this stage onwards that support groups are present to provide necessary assistance in the rehabilitation of Sandra. While it was explicitly stated that she lacked family support, friends may serve the purpose, with health and social workers as well as others who may be within the community of Sandra, such as religious organizations.

It is also necessary that other important matters for Sandra be defined: such as career, the drive to excel into one thing such as a hobby (sports, crafts, arts, etc). Her access to realizing her positive goals must be supported.

Three types of interventions may be provided for Sandra to get her to seek professional help before irreversible damages occur: the medical or psychiatric setting, collective or guided effort by significant others in Sandra’s world, as well as conventional psychotherapy in a group format where she may be placed with fellow clients who are also reluctant for treatment or forced by the justice system.

Already, the principles as a result of the DUI are:

• early or timely detection
• creation of the crisis for emphasis
• and long-term counseling or care for Sandra.

The principles behind the group intervention with reluctant clients are:

• Inclusion of co-therapist in the form of embers of the group
• establish or maintain group goals
• lability to focus on obvious or existing data
• creation of a caring setting
• operation within a reliable or established treatment setting
• presence of consequences in refusal for treatment.

In addition, the goals of intervention are to provide a measured assessment of concrete data observed during group sessions, use of the group dynamic to break through denial through individual bonding, and motivation for the patient.

Evaluation

When compared to other cases, Sandra’s was still considered mild and the intervention was very timely. She has not undergone irreversible self-damage nor danger to people or property around her which all the more provided a more palatable image to return to.

She emerged in a group therapy program that soon saw her way through recovery: detoxification and self-reliance.

Conclusion

Sandra’s case is not unique and could be an ordinary occurrence in any local place, globally. The individual experiences, however such as cause, triggers, or processes in the development of abuse may be very individual.

However, as already pointed out, there are established clinical or group/community approaches that may address substance abuse such as the case of Sandra. Although she may have shown resistance from the beginning, the presence of other clients who were female, about her age, or similar situation has made her blend better with peers, or fellow clients. She soon was able to gap in reality and fantasy to fully accept that she needed rehabilitation.

Sandra’s recovery has taken a little while as it has also been a challenge to return her to the outside world or the place where she used to live and evolved in a rather unrealistic way through the blurry eyes and understanding of a frequently drunk adult woman. Her recovery with others like her made her built new friendships and a support group that encouraged her to develop a better view on life, get interested in things that she once only dreamt of (in her case, taking Acer of pet cats), and proceed anew with her life, with new friends.

Reference

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC.

Herbeck, Diane, Yih-Ing and Cheryl Teruya (2008). “Empirically supported substance abuse treatment approaches: A survey of treatment providers’ perspectives and practices.” Addictive Behaviors, 33, 699-712.

United Nations Office on Drugs and Crimes (2004). “Substance Abuse treatment and Care for Women: Case studies and lessons learned.” UN, New York. Web.