Thursday 13 December 2012
LEARNING NARRITIVE
Whether I knew it or not, I began creating this assignment
at the beginning of the program. Overall, my entire definition of addictions as
well as what encompasses the addictions field, has change dramatically since
the first week of classes. My personally theory has been developing throughout
this process by allowing myself to open up, remove myself from personal judgement, biases, and the stigma of addiction and focus on the individual; whom I believe, often gets lost in the mess.
One of my most prominent learning’s resulting from this
project so far is the many possibilities available for the role of the
intervener. I was aware of the numerous treatment options which where available
but I have never full understood the role of the intervener within each tier or
service. Furthermore; through this project as well as out other major projects
(healthy communities and mental wellness) I have come to a firm belief that a
helper must first help himself or herself before they should attempt to help
others. By this, I am referring to the dimensions of wellness and the
determinants of health – interveners need to be mentally and physically well to
provide the most effective help to clients. For me, this means the creating of
my wellness plan I had created for my mental wellness assignment and abiding by
my goals and interventions to improve the dimensions of wellness I think to be
lacking in.
I found myself to be challenged initially with identifying
with an existing theory or model where someone had attempted to group together
the cause and occurrence of substance use among individuals. I originally found
it hard to believe that everyone could fit one specific set of theoretical
guidelines of an addiction, how it came about, why it continued and how
treatment should be approached. However, this turned out not to be the case. I
was so busy trying to find a theory that fit that it took me a while to realize
that I don’t think there should be a theory of addiction. I believe the
classifying the reason for addiction as being the result of biological or
psychological processes of the moral strength or weakness of an individual is
as bad as using ones righting reflex. Telling individuals why they have become
dependence upon a substance or behaviour is not taking their story into account.
Currently, I have changed my outlook on the research findings available and now
look at them as being science based information, which provide us with many
possible options as to how individuals become enthralled into addiction.
Another area in which my thinking was challenged was in the
context of a starting point. Initially, a few days into the beginning stages of
working on this project I found myself very confused. I felt like I knew little
about what I should be writing about and even less I how to turn it into a
theory. Now, I can see that I was to caught up in looking at the field of
addiction as little pieces to a puzzle. We have the causes, substances, process
based addictions, mental health, dimensions of wellness, the determinants of
health, continuum or risk, prevention and health promotion – there are a lot of
factors at play within this field. I struggled with this for a while when I
decided to begin by writing out definitions for important terminology relating
to addiction. Here I began to make a few connections; how each part is inter-related
with some or all of the other aspects. It is only know as I write my learning narrative
that I can see how my prerogative concerning addictions has changed. I now see
the field of addictions in a holistic sense where each tiny piece influences
the other tiny pieces. I was mistaken to consider each piece of addiction as
something different however; I think it was necessary to fully appreciate the
whole picture.
My overall largest growth however, was seen in terms of
addiction treatment. I am beginning to come to a realization that there is no
actual treatment for an addiction. There is not formal rules or resources
developed to ‘cure’ the occurrence of addiction (whether it be substance
related or process based). In reality, treatment is more of how individuals
rebuild their overall wellness and wellbeing, which is based on personal
determinants such as the determinants of health and the dimensions of wellness.
I think it is as important to look at individuality and individual experience
within treatment as it is why assessed the route taken to get to harmful
involvement of substance use and process based addictions. I had always been
aware that there were different treatment options available within our
community but it was not until the process of creating my personal theory that
I began to consider why certain treatment options were chosen or successful.
I am not saying that every aspect of addiction should be
client specific as there are many consistent factors, which have proven to be
successful in the field. I think the use of standardized assessments and
screening tools are necessary to get the appropriate information to aid
treatment planning. Also, I think consistency matters in terms of vocabulary
and how individuals are classified (i.e. substance dependent, harmful
involvement. Rules and guidelines are important to adhere to however; I think
there is a necessary balance between group generalizations and individual
experiences, which must be considered within all aspects of addiction.
In conclusion, I think that the production of my personal
theory of addiction has made me consider and question many components of what I
had previously assumed addiction to be. Personally, I believe that the field of
addiction should be specifically designed for each individual involved whether
it be clients or interveners as everyone has their own, unique experiences
which have lead them to where they are today.
ADDITIONAL VOCABULARY
In addition to the vocabulary list at the beginning of this
blog, here are a few more definitions to terms which are used within the field
of addiction and some of which appear in this blog.
Intervener: an individual, group or organization who takes
on the helper role in the treatment of client of substance or process based
addictions and mental health (con-current disorder).
Tiered continuum of services: five tiers of differing types
of services available in Canada from broad and general which is seen in tier
one to specific an intensive which marks tier five.
Processed based addiction: an addiction or dependence on a
behavior which does not involve the use of a substance rather a behavior which
is preformed that has rewards which makes the participation in the behavior
addictive.
Mandated client: a client who has not made a personal
decision to seek assistance with substance use or abuse but rather has external
pressure from friends, family, employers, courts, social services, child and
protective services, the criminal justice system and so on.
MIND MAP
My mind map focuses on the different elements involved in the occurrence and the recovery of substance abuse. I think these are vitally important to how I view addictions as I belief that there is not only on theory for addiction but rather many different roots that lead to the same circumstance. I believe that how the individual believes they have gotten to the situation they are in, should be the only focus when asking why this has happened to them rather than classifying it as a disease, genetics, or any other specific mechanism. Essentially, I think that an individual experiences is the key to both the onset and they treatment of substance or process based addictions and that each individual needs to be assessed and treated accordingly. Similarly, I believe that the individual differences between individuals is the motivating factor in how they go about seeking treatment (i.e. where on the continuum of services), what approaches work best (i.e. group counselling, self help), and which areas of wellness need to be improved (i.e. emotional, social, occupational). Basically, everyone had their own story and they is the only one which should matter to the intervener.
Wednesday 12 December 2012
THE FUTURE
Will substance use and abuse ever change? In ways, I
believe. I think that humans will always use substance and I think the
motivating factors for their use will always be similar such as genetics,
coping, and positive reinforcements. However, I am sure we will see major
changes in they types of drugs use such as the use of tobacco had changed over
the past 20 years. Also, I am quite positive we will see changes in the best
practices used in treating or approaching substance use and abuse. This, again
can be seem when we look at the ‘scare tactic’ method which used to be used to
create enough fear in an individual to make them want to quit using.
Addiction is essentially the compulsion to consume a
substance or participate in a behavior for some form of reward may it be the
physical high, the alleviating of stress, to fit in with peers or whatever it
may be. This, unfortunately, I predict will forever be prevalent within
society. There are also a wide variety of terms or classifications of
addictions including substance use, substance dependence, misuse, harmful
involvement, abuse and so on; these may stay relevant or be subjected to change
depending upon how the general population continues to view addiction related
behavior. I have used this terminology
so far as it was is relevant within the field. The field of addictions is ever
changing so I can foresee changes to be made in the future.
It is my hopes that our greater community continues its
advancement in the overall view of addictions and what is means to have
substance related issues. There have been major strides taken over our history
in how we perceive addictions which have come far from the moral theory;
progressions have been made to include biology, psychology and sociology in the
theory development of addictions. I would like to see a more extensive
knowledge of substance abuse in the general population and to move towards harm
reduction and away from trying to hide or remove these individuals from
society. I believe it will be difficult to move away from the stereotypes we
have place on addictions that make certain assumptions about drug users (i.e. drug users are: dirty,
scary, criminals, crazy, violent etc.) but I hope it is possible.
The field of addictions has grown substantially over the
years and I can only hope it continues to progress and new research is being
conducted and current best practices are being implemented.
APPROACHING SUBSTANCE USE
As previously
mentioned, there are countless treatment options available within the five
tiers of services provided in Canada. Some methods work more effectively for
some individuals rather than others; there are differences similar to how the
substance issues began. Some treatment focuses on total abstinence while other
programs may favor reduction; each option is unique.
Most significantly,
I believe that treatment lies solely in the hand of the individual in terms of
developing the overall treatment plan. Primarily, I think there needs to be an
importance placed on individuals receiving adequate screening and assessment to
ensure they are receiving the best possible treatment program (i.e. screening
for mental health issues). With proper screening and assessment individuals
will be directed to the tier of care which will best suit their needs for
recovery. As well, I think it is extremely important that individuals
presenting with substance use or abuse problems be welcomed in a supportive and
non-judgmental environment. A part of this, I believe, includes being approach
with motivational interviewing techniques and the subtle push towards change
talk. It is important that clients are able to share and address what they need
to
Within an
individual seeking treatment for substance or behavior abuse problems it is
important to know where they lie within the stages of change. There are six
possible stages, which include: pre-contemplation, contemplation, preparation,
action, maintenance, and relapse. Where an individual fits within this
continuum relates to how far into the change process they are. If they are in
the pre-contemplation stage they may not even be thinking about changing their
behavior however, if they are in the contemplation stage they may be realizing
how their substance use is having negative impacts on their life. In the preparation
phase, individuals have decided to change and have made a plan to do so while
in the action phase they begin to make the changes outlined. The final two stages
involve constant monitoring on the behavioral changes as well as relapse which
is a possibility at anytime however, part of the process. Motivational
interviewing, techniques, as previously mentioned, are a way in taking an
individual in the pre-contemplation to the contemplation stage but using
strategies to aid a client in opening up and making personal realizations.
Personally, I
believe in harm reduction as being a leading form of increasing wellness among
substance users/abusers. Harm reduction methods strive to reduce the overall
harm or consequences associated with drug use as they have accepted that
substance use and abuse is an unavoidable part of life. The specific goals of
harm reduction models are disease prevention, to reduce deaths due to drug use,
to provide treatment for substance dependence, to empower communities and
reduce stigma as well as to reduce the societal, community and individual
impacts. I think this method of approaching substance use and abuse is most
effective way of confronting the issue as it takes a realistic approach.
Basically, the theory revolves around the idea that substance abuse can never
be solved or become extinct; it will always be around so why not make it safer?
Examples of these strategies include safe injection sites for intravenous drug
users. In these locations, drug users have access to clean needles, health
care, and addictions services if needed. This particular resource reduces
disease contracted from dirty needles, provides monitoring for potential
overdose, and takes drug users off the streets and out of the way of the
public. Overall, there is a reduced risk for intravenous drug users who use
safe injection sites.
Finally, I think it’s important, when approaching drug use,
to withdrawal personal opinion and judgment. There will be no progress made
when an intervener is telling a client that what they are doing is wrong or
inappropriate or detrimental to their health. It is necessary to ignore our
personal biases, writing reflex and the stigma attached to drug use (in both a
individual and societal manner) and focus on the individual who is seeking to change
their behavior.
THE INTERVENER
As we have learned
in class, only 10% of individuals with substance related problems visit
substance related organizations for help. Although substance related
organizations are beneficial they are not the only source of help available,
similarly, as how a 28 day treatment program is not the only option when
intervention in necessary. The intervener within substance abuse can have many
roles, which differ substantially.
As we know, in
Canada, we have a tier system of resources, which at one end, provides very
intensive, specific and individual interventions while the other maintain a
more broad, general and group-based interventions. The role of the intervener is very much decided
upon which tier is being targeted. Tier one is marked by health promotion and
prevention for the general population; here the role of the intervener can
include educating the population in mass such as can be seen with last years
new cervical cancer advertisements on television. The helper, in this stage, may be involved in
school system programs (i.e. D.A.R.E.), work with family support groups, or
self-care based prevention strategies.
In the second tier
of services we see primary care and public health. These may be programs that
are targeted at individuals at risk for substance abuse or addictive behaviors
such as anger management or mental illness support groups. Here, the intervener
may have the role of running seminars or workshops; they may see people consistently
for a short while or be interacting with different people all the time. They
may be responsible for presenting information, skills, running self-help
groups, facilitating discussions or a variety of other tasks. The first two
tiers mentioned are centered on the community as their prime user; these are
not limited to an individual rather serve the population however they can have
profound impacts on individuals.
The third tier of
services is where we see outreach, methadone maintenance treatment, home based
withdrawal management. In this capacity, the role of the intervener is to help
structure an individuals treatment plan while allowing them room to fulfill it
with minimal monitoring. The helper may see the client on a daily or weekly
basis for short periods of time and offer support or assistance for the
individual to complete their developed treatment plan. From here onwards, the
helper’s role is more focused on the individual rather than on the greater
community.
In the fourth tier
of addictions based services in Canada, the interveners role is centred on
outpatient counseling and day treatment options. Here, the intervener has a
close and consistent relationship with the clients however; the clients do not
live within the service. In many cases, the helper may be providing similar
care as seen in an inpatient treatment option, which may include full days and
a variety of different treatment methods (i.e. group therapy, individual
counseling, education sessions, other therapies ex: animal, music etc.)
The final tier of
services, the fifth tier, involves more intensive programing, which is usually
specialized and provides an impatient or residential personalized treatment
plan. Here, the helper is involved in a more one-on-one or focused treatment.
The intervener is more apt to be working closely and frequently with
individuals with substance use issues while the client lives within an
organization/institution. Here, is where a 28 day program may be found; where a
client is working towards treatment goals while being supervised 24/7.
No matter what role
the intervener may be taking there are some factors which ideally should remain
consistent regardless of what capacity the helper is involved; these include
building a relationship, this means the approach should be client centered,
however, there should be engagement on both parts. Furthermore, it is important
for the intervener to withhold judgment or their righting reflex; it is not the
helper’s job to tell the client what to do rather to support the clients’
realizations. Also, it is important for the intervener to be organized and
prepared; a lack or organization can give the impression of incompetence to the
client, which may bring out further feelings of ambivalence. Furthermore, in
any situation where individual or group discussion is being used it is
important to stay true to motivational interviewing techniques where the helper
focuses on open-ended questioning, reflections, affirmations and summaries
while evoking change talk with the client.
There are many
possibly roles for an intervener within the field of addictions. Help is
offered at a variety of differing levels within the continuum which makes
choosing a intervener role or choosing a method of help much more open.
Subscribe to:
Posts (Atom)