Week 8 Integrating Theories Discussion
Week 8 Integrating Theories Discussion
Integrating Theories Discussion
Now that you have studied 11 therapy models, what criteria could you develop to create your own integrative approach to counseling? What basis do you have for including or excluding certain major concepts of the various approaches? How could you evaluate the effectiveness of your approach?
Integrating Theories Discussion
Please no plagiarism and make sure you are able to access all resource on your own before you bid. Main references come from Van Wormer, K., & Davis, D. R. (2018) and/or American Psychiatric Association. (2013). You need to have scholarly support for any claim of fact or recommendation regarding treatment. I have also attached my discussion rubric so you can see how to make full points. Please respond to all 3 of my classmates separately with separate references for each response. You need to have scholarly support for any claim of fact or recommendation like peer-reviewed, professional scholarly journals. If you draw from the internet, I encourage you to use websites from the major mental health professional associations (American Counseling Association, American Psychological Association, etc.) or federal agencies (Substance Abuse and Mental Health Services Administration (SAMSHA), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), etc.). I need this completed by 04/19/19 at 7pm.
Expectation: Integrating Theories Discussion
Responses to peers. Note that this is measured by both the quantity and quality of your posts. Does your post contribute to continuing the discussion? Are your ideas supported with citations from the learning resources and other scholarly sources? Note that citations are expected for both your main post and your response posts. Note also, that, although it is often helpful and important to provide one or two sentence responses thanking somebody or supporting them or commiserating with them, those types of responses do not always further the discussion as much as they check in with the author. Such responses are appropriate and encouraged; however, they should be considered supplemental to more substantive responses, not sufficient by themselves.
Read a your colleagues’ postings. Respond to your colleagues’ postings.
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Respond in one or more of the following ways:
· Ask a probing question.
· Share an insight gained from having read your colleague’s posting.
· Offer and support an opinion.
· Validate an idea with your own experience.
· Make a suggestion.
· Expand on your colleague’s posting.
1. Classmate (N. Pra)
Strengths
One major strength with an integrated treatment approach is that a client may receive services at one location. Typically it is much more difficult to treat a client who struggles with a co-occurring disorder, whether that is because they do not attend treatment regularly, relapse, or another perceived obstacle. Having a treatment facility that tackles all areas does make it significantly easier for a client to maintain their mental health and sobriety. A second strength is that this approach is not only holistic in nature, but it strengthens the continuity of care between the treatment team and client. Being all-encompassing, a client can work with their therapist in individual counseling, attend a recovery group with another, and/or see a psychiatrist for their medications (Van Wormer & Davis, 2018).
Weaknesses
One weakness of the integrated treatment approach (and counseling those with dual-diagnoses), is that many have a high probability of being homeless, and unemployed. Without a steady flow of finances, and reliable transportation, showing up to scheduled appointment times can become nearly impossible. Case-management services could be used to link the client up with local and federal resources, but sometimes these will fall short, especially if the client suffers from a severe mental illness, such as schizophrenia (Moore, Young, Barrett, & Ochshorn, 2009). A second weakness is how difficult it is to utilize an integrated approach with untrained staff. Many therapists and psychiatrists are untrained with co-occurring disorders, and provide inadequate treatment. It can be very costly, and time-consuming to train, and get every staff member on board, and many organizations simply do not have these finances or resources (Van Wormer & Davis, 2018).
Conceptualize
My client’s name is Pete, a thirty year old, white male. He has been struggling with depression since he was fourteen, and after his parent’s divorce at sixteen, he began abusing prescription pills. By the time he was twenty, he had graduated to heroin, and cocaine. At twenty-three he overdosed on a speedball, and after recovering at the hospital, he entered a rehabilitation clinic. Over the next five years, Pete has been in and out of the rehab. He has relapsed four times, but continues to seek a clean life. He has not used in the last eight months, and as his year mark creeps up, he feels that he will fail again. Lately his depression has worsened, and he has gotten into the habit of self-harming (burning or pinching himself) when he becomes triggered.
In this case, Pete has been struggling with his mental illness and substance abuse for a long time. Using techniques to curb his severe depression, and self-harm like Cognitive-Behavioral Therapy (CBT) will do wonders on his self-esteem, and identity. Tackling his substance abuse with weekly group meetings, and other positive, and supportive outlets will help him keep on the track to sobriety. Having trained staff, like a psychiatrist, or nurse practitioner can also help Pete, but this avenue will have to be monitored closely, if not avoided due to his past (McKee, Harris, & Cormier, 2013).
References
McKee, S., Harris, G., & Cormier, C. (2013). Implementing Residential Integrated Treatment for Co-occurring Disorders. Journal of Dual Diagnosis, 9(3), 249–259. https://doi-org.ezp.waldenulibrary.org/10.1080/15504263.2013.807073
Moore, K., Young, M. S., Barrett, B., & Ochshorn, E. (2009). A 12-Month Follow-Up Evaluation of Integrated Treatment for Homeless Individuals With Co-Occurring Disorders. Journal of Social Service Research, 35(4), 322–335. https://doi-org.ezp.waldenulibrary.org/10.1080/01488370903110829
Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.
2. Classmate (C. Ree)
Main Discussion Post
Co-occurring disorders are the presence of both a mental health and concurrent substance use illness. Examples of co-occurring disorders include a person who is both an alcoholic and dealing with depression, or an individual who is addicted to illicit drugs and also struggles with post-traumatic stress disorder. The handling of mental illness and substance use is known as integrated treatment. Integrated treatment provides simultaneous treatment for the mental illness and the substance use disorder (Van Wormer & Davis, 2018). Van Wormer and Davis continue to discuss the strengths and weaknesses of integrated treatment. Stating that integrated treatments include more stable remission rates (10-20%), better housing, decreased shame, and learning and insight. Whereas the weaknesses include small studies, heterogeneous samples, short follow up periods and unclear description of treatment components. Successful implementation requires vigorous on-site leadership, managing of staff turnover, and technical, financial, and political support from the greater administrative environment (Torrey, Tepper, & Greenwold, 2011).
Hypothetical Client Example
Derek, an African American male, aged 40 deal with mental illness (depression) and a substance (alcohol). Derek is married and works at the local Piggly Wiggly as the Assistant Manager. His wife reports that he spends more time at the bar after work then he does at home. Derek also has two sons age 12 and 15. He sons say that their dad has missed several of their games or when he comes he is drunk and embarrassing. Derek has received several DUI’s and has missed some of his appointments with his mental health counselor. Derek declares that his drinking is under control and that he drinks to ease his sad moods. An integrative treatment approach would work for Derek since he displays signs of a mental illness coupled with a substance use issue. The evidence for mental health and addiction service integration is strong (Woods & Drake, 2011) so getting Derek into such a program will help him tremendously. It would be important to get him services that will allow him to focus on his behavior, his substance use, and to help him connect with community resources. In process this would include a multidisciplinary team engaging him in the community using outreach, support, motivational interviewing, and other techniques. Bond, Drake, Mueser, and Latimer (2001) discuss a holistic approach known as Assertive Community Treatment (ACT) that is geared towards providing services like helping with medications and finances or any need the client may present. This treatment seems to fulfill the needs that Derek need to help him with his depressive symptoms and alcohol use.
References
Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness. Disease management and health outcomes, 9(3), 141-159.
Torrey, W. C., Tepper, M., & Greenwold, J. (2011). Implementing integrated services for adults with co-occurring substance use disorders and psychiatric illnesses: A research review. Journal of Dual Diagnosis, 7(3), 150–161.
Retrieved from the Walden Library databases.
Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.
Woods, M. R., & Drake, R. E. (2011). Treatment of a young man with psychosis and polysubstance abuse. Journal of Dual Diagnosis, 7(3), 175–185.
Retrieved from the Walden Library databases.
3. Classmate (L. Sim)
It is important to understand the presentation of an individual with co-occurring addiction and mental health issues. Different concerns will arise, requiring specific treatment. Van Wormer and Davis (2018) shared that treatment of individuals with coexisting disorders needs a supportive, long-term commitment and a combination of substance abuse and mental health treatment approaches. There must be an understanding of how to treat all aspects of an individual. Utilizing an integrated approach will be beneficial, even with presented weaknesses.
Strengths and Weaknesses
There are both strengths and weaknesses with an integrated treatment approach. Utilizing an integrated approach suggests treatment of an individual entirely. It allows for the individual to be looked at as an individual, as different treatment needs are addressed. Further, Van Wormer and Davis (2018) shared that simultaneous treatment is provided for mental health and substance abuse, also meaning an individual only must travel to one location. This may be a huge benefit for someone, certainly if they are struggling with their mental health and addiction. Another strength of this approach is how it looks at individuals through a strengths-based perspective (Van Wormer & Davis, 2018). Treating individuals with a strength perspective will provide support and encourage personal motivation to be successful in treatment.
Services should include specifically trained employees, including 24-hour availability (Van Wormer & Davis, 2018), which is a weakness of integrated treatment. The specialist needed may not be available, requiring other staff members. There is a potential need for many staff members to be employed. Additionally, Torrey, Tepper, and, Greenwold (2011) stated that integrated treatment is long term and the process can be long to successful treatment. This extensive time frame for treatment can present as a weakness, where individuals may struggle to remain engaged and committed.
Client
Jack is a 35-year-old man, who is presenting with symptoms suggesting a mental health disorder and substance abuse disorder. He reports hearing voices, the inability to speak clearly and in an organized manner, and behaviors which have caused him to be unable to maintain a job. Jack is diagnosed with schizophrenia. In addition to this diagnosis, Jack has been utilizing drugs. Van Wormer and Davis (2018) shared that 50% of those diagnosed with schizophrenia have comorbid substance abuse. Jack presents with significant symptoms related to his mental health diagnosis. Due to his presentation, working with Jack from the quadrant model, he fits into category II (Van Wormer & Davis, 2018) as his schizophrenia is more severe.
Assessment and treatment need to be appropriate for Jack. Lubman, King, and Castle (2010) shared that there needs to be comprehensive assessment with access to a large range of interventions. Assessment can assist with understanding the severity of the disorders Jack presents with. This can allow clinicians to understand where Jack is and help him receive treatment in the best environment. As stated, he fits in category II, where he would receive treatment in a mental health system. Lubman et al. (2018) shared that psychopharmacological intervention is appropriate for treating schizophrenic symptoms with comorbid substance use. This is important for Jack, as medication can work to limit his experienced schizophrenic symptoms. Further, psychosocial interventions are appropriate, which is a must in conjunction with medication (Lubman et al., 2018). It is important to note the need for different interventions and the concept of the impact on both disorders. Lubman et al. (2018) shared that one intervention alone was not successfully, but including cognitive behavioral therapy (CBT), motivational interviewing (MI), and family work prove to be successful. Again, this speaks to the need for an integral approach. Utilizing CBT and MI with Jack can assist him with understanding presenting symptoms, potential warning signs for psychosis and relapse, and help him to understand how his disorders impact his life. His understanding of the negative impact can support his want to change, impacting his dedication and commitment.
Conclusion
Individuals presenting with co-occurring disorders need to receive integral treatment, as they need to be addressed in their entirety. Understanding the needs of individuals with co-occurring disorders is important. Integral treatment approaches encourage the best treatment, as both disorders and their specific impacts are addressed.
References
Lubman, D. I., King, J. A., & Castle, D. J. (2010). Treating comorbid substance use disorders in schizophrenia. International Review of Psychiatry, 22(2), 191. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edb&AN=50872258&site=eds-live&scope=site
Torrey, W. C., Tepper, M., & Greenwold, J. (2011). Implementing integrated services for adults with co-occurring substance use disorders and psychiatric illnesses: A research review. Journal of Dual Diagnosis, 7(3), 150–161.
Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.
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Required Resources
Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.
Chapter 4, “Substance Misuse with a Co-occurring Mental Disorder or Disability” (pp. 151-190)
Drapalski, A., Bennett, M., & Bellack, A. (2011). Gender differences in substance abuse, consequences, motivation to change, and treatment seeking in people with serious mental illness. Substance Use & Misuse, 46(6), 808–818. Retrieved from the Walden Library databases.
Kennedy, K., & Gregoire, T. K. (2009). Theories of motivation in addiction treatment: Testing the relationship of the transtheoretical model of change and self-determination theory. Journal of Social Work Practice in the Addictions, 9(2), 163–183. Retrieved from the Walden Library databases.
Kerfoot, K., Petrakis, I. L., & Rosenheck, R. A. (2011). Dual diagnosis in an aging population: Prevalence of psychiatric disorders, comorbid substance abuse, and mental health service utilization in the Department of Veterans Affairs. Journal of Dual Diagnosis, 7(1/2), 4–13. Retrieved from the Walden Library databases.
Lachman, A. (2012). Dual diagnosis in adolescence—An escalating risk. Journal of Child & Adolescent Mental Health, 24(1), pv–vii. Retrieved from the Walden Library databases.
Torrey, W. C., Tepper, M., & Greenwold, J. (2011). Implementing integrated services for adults with co-occurring substance use disorders and psychiatric illnesses: A research review. Journal of Dual Diagnosis, 7(3), 150–161. Retrieved from the Walden Library databases.
Woods, M. R., & Drake, R. E. (2011). Treatment of a young man with psychosis and polysubstance abuse. Journal of Dual Diagnosis, 7(3), 175–185. Retrieved from the Walden Library databases.
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