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Assignment: Assessing Clients with Addictive Disorders

Assignment: Assessing Clients with Addictive Disorders

Assignment: Assessing Clients with Addictive Disorders

Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. For this Assignment, as you examine the Levy Family video in this week’s Learning Resources, consider how you might assess and treat clients presenting with addiction. Assignment: Assessing Clients with Addictive Disorders

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The Assignment

In a 2- to 3-page paper, address the following:

  • After watching Episode 1, describe:
    • What is Mr. Levy’s perception of the problem?
    • What is Mrs. Levy’s perception of the problem?
    • What can be some of the implications of the problem on the family as a whole?
  • After watching Episode 2, describe:
    • What did you think of Mr. Levy’s social worker’s ideas?
    • What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?
  • After watching Episode 3, discuss the following:
    • What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?
    • What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?
    • Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.
    • Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?
  • In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.
    • Discuss how you would have responded to this revelation.
    • Describe how this information would inform your therapeutic approach. What would you say/do next?
  • In Episode 5, Mr. Levy’s therapist is having issues with his story.
    • Imagine that you were providing supervision to this therapist, how would you respond to her concerns?
  • Support your approach with evidence-based literature.

Note: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. 

Rubric:

 

Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.–

Excellent 27 (27%) – 30 (30%)Good 24 (24%) – 26 (26%)Fair 21 (21%) – 23 (23%)Poor 0 (0%) – 20 (20%)

Quality of Work Submitted:
The purpose of the paper is clear.–

Excellent 5 (5%) – 5 (5%)Good 4 (4%) – 4 (4%)Fair 3.5 (3.5%) – 3.5 (3.5%)Poor 0 (0%) – 3 (3%)

Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:

Understand and interpret the assignment’s key concepts.–

Excellent 9 (9%) – 10 (10%)Good 8 (8%) – 8 (8%)Fair 7 (7%) – 7 (7%)Poor 0 (0%) – 6 (6%)

Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.–

Excellent 18 (18%) – 20 (20%)Good 16 (16%) – 17 (17%)Fair 14 (14%) – 15 (15%)Poor 0 (0%) – 13 (13%)

Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.–

Excellent 18 (18%) – 20 (20%)Good 16 (16%) – 17 (17%)Fair 14 (14%) – 15 (15%)Poor 0 (0%) – 13 (13%)

Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–

Excellent 5 (5%) – 5 (5%)Good 4 (4%) – 4 (4%)Fair 3.5 (3.5%) – 3.5 (3.5%)Poor 0 (0%) – 3 (3%)

Written Expression and Formatting

English writing standards: Correct grammar, mechanics, and proper punctuation–

Excellent 5 (5%) – 5 (5%)Good 4 (4%) – 4 (4%)Fair 3.5 (3.5%) – 3.5 (3.5%)Poor 0 (0%) – 3 (3%)

Written Expression and Formatting

The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–

Excellent 5 (5%) – 5 (5%)Good 4 (4%) – 4 (4%)Fair 3.5 (3.5%) – 3.5 (3.5%)Poor 0 (0%) – 3 (3%)

Resources:

 

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

  • Chapter 7, “Motivational Interviewing” (pp. 299–312)
  • Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565–596)
  • attachment

    Episode1.pdf

    Levy Family: Episode 1

    Levy Family: Episode 1 Program Transcript

    [MUSIC PLAYING]

    FEMALE SPEAKER: You’re not dressed? You’re going to be late for work.

    MALE SPEAKER: I’m not going to work. I’m sick.

    FEMALE SPEAKER: Of course you’re sick. You’re hungover. I don’t want the boys to see you like this. Go back to bed.

    MALE SPEAKER: See me like what? I told you, I’m sick.

    FEMALE SPEAKER: Well, what do you call it when someone is sick almost every morning, because they drink every night while they sit in the dark watching TV?

    MALE SPEAKER: You calling me a drunk?

    FEMALE SPEAKER: What do you call it?

    MALE SPEAKER: I call it, leave me the hell alone.

    FEMALE SPEAKER: Baby, you need to stop this. It’s tearing us up. The drinking, the anger– you’re depressed.

    MALE SPEAKER: You said, for better or worse.

    FEMALE SPEAKER: My vows don’t cover this. You were never like this before. You’ve changed. I want us back, the way we used to be.

    MALE SPEAKER: That way is dead. It died when I went to Iraq.

    Levy Family: Episode 1 Additional Content Attribution

    MUSIC: Music by Clean Cuts

    Original Art and Photography Provided By: Brian Kline and Nico Danks

    © 2016 Laureate Education, Inc. 1

  • attachment

    Episode2.pdf

    Levy Family: Episode 2

    Levy Family: Episode 2 Program Transcript

    FEMALE SPEAKER: I want to thank you for getting me this Levy case. I think it’s so interesting. Just can’t wait to meet with the client.

    MALE SPEAKER: What do you find interesting about it?

    FEMALE SPEAKER: Well, he’s just 31. Usually the vets I work with are older. If they have PTSD, it’s from traumas a long time ago. But Jake, this is all pretty new to him. He just left Iraq a year ago.

    You know, I was thinking he’d be perfect for one of those newer treatment options, art therapy, meditation, yoga, something like that. Assignment: Assessing Clients with Addictive Disorders

    MALE SPEAKER: Why?

    FEMALE SPEAKER: Well, I’ve been dying to try one of them. I’ve read a lot of good things. Why? What are you thinking?

    MALE SPEAKER: I’m thinking you should really think about it some more. Think about your priorities. It’s a good idea to be open-minded about treatment options, but the needs of the client have to come first, not just some treatment that you or I might be interested in.

    FEMALE SPEAKER: I mean, I wasn’t saying it like that. I always think of my clients first.

    MALE SPEAKER: OK. But you mentioned meditation, yoga, art therapy. Have you seen any research or data that measures how effective they are in treatment?

    FEMALE SPEAKER: No.

    MALE SPEAKER: Neither have I. There may be good research out there, and maybe one or two of the treatments that you mentioned might be really good ideas. I just want to point out that you should meet your client first, meet Jake before you make any decisions about how to address his issues. Make sense?

    FEMALE SPEAKER: Yeah.

    Levy Family: Episode 2 Additional Content Attribution

    © 2016 Laureate Education, Inc. 1

     

    Levy Family: Episode 2

    MUSIC: Music by Clean Cuts

    Original Art and Photography Provided By: Brian Kline and Nico Danks

    © 2016 Laureate Education, Inc. 2

  • attachment

    episode3.pdf

    Levy Family: Episode 3

    Levy Family: Episode 3 Program Transcript

    JAKE LEVY: We’d be out on recon in our Humvees, and it would get so hot. We used to put our water bottles in wet socks and hang them right outside the window just so the water would cool off of a bit, and maybe then you could drink it.

    Man, it was cramped in there. You’d be drenched, nowhere to breathe. It’s like riding around in an oven. And you’d have your helmet on you, 100 pounds of gear and ammo. I swear, sometimes I feel like it’s still on me, like it’s all still strapped on me.

    FEMALE SPEAKER: How many tours did you do in Iraq?

    JAKE LEVY: Three. After that last recon, I just– There were 26 of us. Five marines in the Humvee I was in. I remember I was wearing my night vision goggles. We passed through a village and everything was green, like I was in a dream or under water.

    And then there was a flash, bright light just blinded me. There was this explosion. I can’t– I can’t–

    FEMALE SPEAKER: It’s OK, Jake. Take it easy. I understand this is difficult. There’s something I;d like to try with you. It’s called exposure therapy, and it’s a treatment that’s used a lot with war veterans, especially those struggling with anxiety and PTSD.

    JAKE LEVY: Exposure therapy?

    FEMALE SPEAKER: Yes. It’s to help someone like yourself to confront your feelings and anxieties about a traumatic situation that you’ve experienced. It’s a– It’s meant to help you get more control of your thoughts, to make sense of what’s happened, and to not be so afraid of your memories.

    JAKE LEVY: Put that in a bottle and I’ll buy 10 cases of it.

    FEMALE SPEAKER: Well, one part of it is learning to control your breathing. And when you practice that, you can learn to manage your anxiety, to get more control of it, not let it control you, to protect yourself. Do you want to try it?

    JAKE LEVY: Right now?

    FEMALE SPEAKER: Sure.

    JAKE LEVY: Why not?

    © 2016 Laureate Education, Inc. 1

     

    Levy Family: Episode 3

    FEMALE SPEAKER: OK. Well, I know this sounds crazy, but a lot of people don’t breathe properly. And it really comes from bad habits. When they inhale and exhale, all the effort is here in their chest and shoulders. And the problem with that is you get a really short, shallow breath. And that really increases the stress and anxiety in your body. Assignment: Assessing Clients with Addictive Disorders

    Instead, a more natural breath should always involve your diaphragm, right here in your abdomen. When you breath in, your belly should expand. And when you breath out, your belly should fall. OK?

    JAKE LEVY: OK.

    FEMALE SPEAKER: So, let’s practice. Close your eyes. Now, I want you put one hand on your abdomen and the other across your chest. Good. Good. Now, I just want you to take a few breaths, just like normal. What are you feeling?

    JAKE LEVY: I feel my chest moving up and down. But my belly, nothing.

    FEMALE SPEAKER: OK. So that’s what I was just talking about. That’s OK. Let’s try this. I want you take a breath. And this time, I only want you to allow your abdomen to expend when you breathe in and to fall when you breathe out.

    OK, let’s try it. Breathe in. Breathe out. Breathe in. Breathe out.

    You feeling better? More relaxed?

    JAKE LEVY: Yes.

    FEMALE SPEAKER: And the more you practice it the easier it will become. So when you find that stress and anxiety coming on, just do your breathing. You can keep yourself from getting swept by all those bad thoughts. OK?

    JAKE LEVY: Yes. Thank you.

    FEMALE SPEAKER: So, do you want to try to go back to what you were telling me about before?

    JAKE LEVY: I can try. It was night. We were out on recon. It was my third tour in Iraq.

    © 2016 Laureate Education, Inc. 2

     

    Levy Family: Episode 3

    Levy Family: Episode 3 Additional Content Attribution

    MUSIC: Music by Clean Cuts

    Original Art and Photography Provided By: Brian Kline and Nico Danks

    © 2016 Laureate Education, Inc. 3

  • attachment

    episode4.pdf

    Levy Family: Episode 4

    Levy Family: Episode 4 Program Transcript

    FEMALE SPEAKER: So do you want to try to go back to what you’re telling me before?

    LEVY: I can try. It was night. We were out on patrol. I remember it was so hot packed in our vehicle. Suddenly there was an explosion. We got tossed into a ditch. And somehow I made it out, and I could see it was the Humvee behind us. It’s whole front end was gone. It had hit a roadside bomb. Our vehicle had just driven past it, just mistriggering it. But not them. They didn’t make it.

    FEMALE SPEAKER: Remember how we practiced. Slow your breathing down. Inhale and exhale from your abdomen.

    LEVY: Thank you.

    FEMALE SPEAKER: And just take your time. Whenever you are ready.

    LEVY: So the bomb went off. I managed to get out. I had my night vision goggles on. And I could see the Humvee, the one that got hit. It’s whole front end was gone. And there’s this crater in the road. And inside it I could see– I could see Kurt’s– our platoon Sergeant, he was lying there everything below his waist was gone, blown off. And he was screaming. Screaming like nothing you’d ever heard.

    And then he was looking at me. And he was screaming for me to kill him. To stop his suffering. He was yelling, please. Please. And someone tried putting tourniquets on him. But the ground just kept getting darker with his blood. And I was staring into his face.

    I had my rifle trained on him. I was going to do it. You know. He was begging me to. I could feel my finger on the trigger. And I kept looking into his face. And then I didn’t have to do nothing. Because the screaming had stopped. He’d bled out. Died right there.

    And all I could think was I’d let him down. His last request, and I couldn’t do it. I couldn’t put a bullet in him so he could die fast not slow.

    FEMALE SPEAKER: I can see and hear how painful it is for you to relive this story. Thank you for sharing it. Do you think this incident is behind some of the symptoms you’ve been telling me about?

    LEVY: When I go to sleep at night, I close my eyes, and I see Kurt’s there staring at me. So I don’t sleep too good. That’s why I started drinking. It’s the only way I

    © 2016 Laureate Education, Inc. 1

     

    Levy Family: Episode 4

    can forget about that night. So I drink too much. At least that’s what my wife yells at me.

    We’re not doing too well these days. I’m not exactly the life of the party. I left Iraq 10 months ago. But Iraq never left me. I’m afraid it’s never going to leave me alone.

    Levy Family: Episode 4 Additional Content Attribution

    MUSIC: Music by Clean Cuts

    Original Art and Photography Provided By: Brian Kline and Nico Danks

    © 2016 Laureate Education, Inc. 2

  • attachment

    episode5.pdf

    Levy Family: Episode 5

    Levy Family: Episode 5 Program Transcript

    FEMALE SPEAKER: It was such an intense story. I just kept seeing things the way he did, you know. The weird green of his night-vision goggles, his sergeant screaming for Jake to kill him. I just keep seeing it all in my head.

    [MUSIC PLAYING]

    MALE SPEAKER: Why, do you think?

    FEMALE SPEAKER: Why what?

    MALE SPEAKER: Why do you think you keep thinking about this story, this particular case?

    FEMALE SPEAKER: I don’t know, maybe because it’s so vivid. You know, I went home last night, turned on the TV to try to get my mind off it. And a commercial for the Marines came on, and there was all over again– the explosion, the screams, the man dying. Such a nightmare to live with, and he’s got a baby on they way.

    MALE SPEAKER: Could that be it, the baby?

    FEMALE SPEAKER: Maybe. That’s interesting you say that. I mean, the other vets I work with are older, and they have grown kids. But Jake is different.

    I just keep picturing him with a newborn. And I guess it scares me. I wonder if he’ll be able to deal with it.

    Levy Family: Episode 5 Additional Content Attribution

    MUSIC: Music by Clean Cuts

    Original Art and Photography Provided By: Brian Kline and Nico Danks

    © 2016 Laureate Education, Inc. 1

  • attachment

    SAMPLEGAGNIER_WEEK_6_ASSIGNMENT_1_NURS_6640.docx

    ASSESSING CLIENTS WITH ADDICTIVE DISORDERS 2

    ASSESSING CLIENTS WITH ADDICTIVE DISORDERS 4

     

    Assessing Clients with Addictive Disorders

    Psychotherapy with Individuals

    NURS 6640

    ASSESSING CLIENTS WITH ADDICTIVE DISORDERS 1

     

    Addictive Disorders

    Substance use and addictive disorders are at an all-time high in the United States and unfortunately highly common in military veterans. The psychiatric mental health nurse practitioner must be prepared to properly assess and treat individuals that struggle with the disorder. The purpose of this paper is to assess clients presenting with addictive disorders, analyze therapeutic approaches for treating clients with addictive disorders and evaluate outcomes for clients with addictive disorders using evidenced based research.

    Episode 1

    To begin, it is apparent that Mr. Levy has a problem with alcohol. He is drinking alcohol nightly by himself and it is affecting his job, relationship with his wife and children and his mood. Mrs. Levy is aware of the issue and pleads with him to get help so he can be the person he was before the alcohol abuse began. Mr. Levy is attributing his drinking every night because of things that he experienced in Iraq while in the military. It seems as if Mr. Levy is using drinking to cope with his possible PTSD. Alcohol abuse a significant problem among our nation’s military veterans. If someone has both PTSD and SUD, it is likely that he or she also has other health problems (such as physical pain), relationship problems (with family and/or friends), or problems in functioning (like keeping a job or staying in school). Assignment: Assessing Clients with Addictive Disorders

    Episode 2

    To continue, I agree with the social workers supervisor in this situation. The first thing any mental health provider should do before coming up with treatment options is to get to know the client first so you have a better understanding about that individual as a whole. Also the first line of treatment for PTSD in war veterans is Cognitive Behavioral Therapy (CBT). CBT is considered to have the strongest evidence for reducing the symptoms of PTSD in veterans and has been shown to be more effective than any other nondrug treatment (Reisman, 2016). If the social worker tries a new form of therapy with little evidence that it is effective, and it fails this could have a major impact on the client causing him not to adhere to treatment. Assignment: Assessing Clients with Addictive Disorders

    Episode 3

    Moving forward, I believe that the way the therapist responded to what Mr. Levy had to say regarding his experiences in Iraq were very good. She did not speak much she only asked how many times he served in Iraq. When someone is opening up about a traumatic experience the therapist should provide supportive and active listening. In my opinion this was a great session the therapist provided supportive listening, taught the client a new relaxation technique with deep breathing exercise and gained his interest in participating in exposure therapy to treat his PTSD. Diaphragmatic breathing involves contraction of the diaphragm, expansion of the belly, and deep inhalation and exhalation, which ultimately decreases the respiration frequency and maximizes the amount of blood gases (Ma, et al., 2017). Deep breathing can trigger body relaxation responses easing a person experiencing anxiety. Assignment: Assessing Clients with Addictive Disorders

    Exposure therapy is a good option for this client for the treatment of his PTSD. Exposure therapy is an evidenced-based psychotherapy and a form of CBT. According to Reisman (2016), the most studied types of CBT are cognitive processing therapy (CPT) and prolonged exposure (PE) therapy and are recommended as first-line treatments in PTSD practice guidelines not only in the United States but around the world. Exposure therapy has shown to be effective in 60% of veterans with PTSD. The treatment will take approximately 12 weeks of weekly therapy and will include revisiting of the trauma and aids the client in how to overcome fear- and stress-inducing situations moving forward (Reisman, 2016). I agree with the therapist’s choice on this form of therapy

    Episode 4

    The client expressed a major trauma that he faced while in Iraq regarding watching his sergeant die. After the client told the story and reported that he cannot sleep at night due to flashbacks of his sergeants face I would inform him that in conjunction to this therapy that there are pharmacological options that can assist with his PTSD symptoms. The client has been very open to treatment options and has the desire to get better. Educating the client on different medications that assist with PTSD symptoms can give him hope and a stronger desire to continue treatment.

    Episode 5

    To conclude, the first line treatment for PTSD psychotherapies, but this involves the client sharing their past trauma to a mental health professional. Traumatized patients are encouraged to confront their associations, often by purposefully reliving the traumatic event to experience their full emotional and physical reactions. Secondary trauma also known as compassion fatigue and vicarious traumatization is defined as indirect exposure to trauma through a narrative of a traumatic event (Gil, & Weinberg, 2015). The vivid recounting of trauma by the survivor and the clinician’s subsequent cognitive or emotional representation of that event may result in symptoms mimic PTSD. Mental health professionals that work with individuals that suffered from traumatic experiences need to make sure they have enough time for self-care by maintaining a reasonable balance between work and their personal life., Assignment: Assessing Clients with Addictive Disorders

     

     

    References

    Gil, S., & Weinberg, M. (2015). Secondary Trauma among Social Workers Treating Trauma Clients: The Role of Coping Strategies and Internal Resources [article]. International Social Work, (Issue 4), 551. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edshol&AN=edshol.hein.journals.intsocwk58.54&site=eds-live&scope=site

    Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., … Li, Y.-F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology, 8, 874. http://doi.org/10.3389/fpsyg.2017.00874

    Reisman, M. (2016). PTSD Treatment for Veterans: What’s Working, What’s New, and What’s Next. Pharmacy and Therapeutics, 41(10), 623–634.

    Sodeke-Gregson, E. A., Holttum, S., & Billings, J. (2013). Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients. European Journal of Psychotraumatology, 4, 10.3402/ejpt.v4i0.21869. http://doi.org/10.3402/ejpt.v4i0.21869

    Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance Abuse and Rehabilitation, 8, 69–77. http://doi.org/10.2147/SAR.S116720

    Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse : a how-to guide for evidence-based practice. New York, NY : Springer Publishing Company, LLC, [2014].