Substance abuse can be explained as the use of harmful psychoactive substances. It also includes the use of alcohol and other prohibited drugs. The use of psychoactive drugs may lead to dependence syndrome which is a series of physiological, behavioral and cognitive patterns that come about as a result of recurrent substance use. This condition may include consequences such as continued use of the drug despite negative effects, a craving for the drug, problems in controlling the use of the drug, and may result in increased tolerance of the substance.
Substance Abuse Case
During this week a 23-year-old male was seen for substance abuse of cigarettes, alcohol, marijuana, and cocaine. He reported having been introduced to these drugs at the age of 18 by his peer friend when he joined campus. It all started with a puff of cigarette and before he knew it he had already graduated to doing cocaine. According to him he indulged in drugs in order to fit in his friends’ social circle. He later stated that after a while he could only feel alive when he was high on drugs. In his second year, he used the money meant for school fees to obtain drugs and when his parents knew they declined to pay for his tuition. He was forced to go back home to live with his parents. This did not deter him from indulging in drugs. It was not until his third year on campus that he realized he had a problem and that he required help. At this point his performance in school had deteriorated to a point that he was about to be discontinued. He decided to get sober and checked himself into a healthcare facility for detoxification. He had not been diagnosed with any disease before, he was not on any medication and had no prior hospitalization.
Substance use disorder can be defined as a health condition in which the consumption of one or more substances leads to clinically substantial damage or suffering (DSM 5). Substance use disorder can be portrayed through important features that may include a series of behavioral, physiological and cognitive indicators. The people involved usually tend to continue using the substance in spite of the substance-related complications (DSM 5). Substance use disorder can be characterized by many things with a shift in brain circuit being the main characteristic which may go on even after detoxification. The brain change in behavioral effects can be indicated by the person relapsing and even having a deep need for drugs when they come into contact with anything that may influence them to take the drug. Social impairment, pharmacological indicators, impaired control, and risky use are the four primary classifications of criteria that must be met while diagnosing a substance abuse disorder (DSM 5).
Humanistic-existential therapy is based on the idea that people share a degree of self-awareness, choice, and self-actualization (Watson & Schneider, 2016). The theory goes further to explain that when people are given the right conditions they usually chose to follow the right path and discover meaning in their lives. According to Watson & Schneider (2016), the subjective mind of a person in most cases chooses the option of positive growth when provided with the best conditions. Humanistic-existential therapy uses two approaches, the humanistic approach and the existentialist approach (Watson & Schneider, 2016). The humanistic approach was formed on the basis that people are fundamentally good and are perfectly capable of maintaining good relationships and making the best choices that may befit them and others. The existentialist approach involves guiding people and providing them with ways through which they can discover their logical meaning in life while facing distress (Watson & Schneider, 2016). So, humanistic-existential therapy would be of great value to this client since he is open-minded and ready to give therapy a chance.
Legal and Ethical issues
Throughout history, people with substance abuse disorder have been characterized as criminals instead of recognizing them as people suffering from a chronic disease. There is a red tape when it comes to screening people for substance abuse disorder. This raises the concern and the exercise is followed by various legal implications. There are Federal laws that have been enacted to safeguard information about people’s substance abuse. According to Bhalla et al. (2018) regulation by the confidentiality of alcohol and drug abuse patient records provides the confidentiality of the patient records through the statutory authority (Bhalla et al. 2018). These laws allow people with the problem of substance abuse to come and get treated without the fear of being discriminated against it in future. These state laws differ from one state to the other and the level of protection changes depending on the state.
One of the laws that protect the substance abuse patients is the involuntary commitment to a healthcare facility. After the patient is involuntarily committed he or she is then admitted to a substance abuse program. For this to happen a qualified doctor has to assess the patient and determine that he/she is at the risk of injuring himself/herself or others and is in need of treatment (Walton & Hall, 2017). Each state has a law that governs the involuntary process. According to Walton & Hall (2017), 37 states and the District of Columbia by 2017 had already established laws that govern the involuntary commitment of addicts or people misusing drugs (Walton & Hall, 2017). There were over 64,000 cases of drug overdose deaths according to the national institute on drug abuse reports in 2016. To reduce this number and prevent more drug abuse-related deaths, substance abusers are often ordered by the court into treatment for the sake of public safety. When this happens, a family member or neighbor will go to the court and apply for a petition to have the person admitted to the emergency room for a substance abuse assessment. The police are issued with a civil commitment order by the judge to find the person and involuntarily take them to the hospital (Bhalla et al. 2018).
Doctors take a medical oath of nonmaleficence to do no harm to the patients they treat. These physicians respect the patient’s autonomy, or their ability to consent to or deny treatment (Cavaiola & Dolan, 2016). Many patients that go into the emergency room for substance abuse treatment may be mentally capable of deciding to refuse treatment. State laws give doctors guidance on how to proceed when intervening for patients not able to make the best decisions for themselves, and at the same time, protecting the best interest of the citizens.
I receive my clinical supervision from my preceptor in every session that I have with the clients in the field. Most of the time I would accompany my preceptor to the field. We would start by him giving me the breakdown of how the day’s sessions would go. He would advise me on the things to look out for and at times he would allow me to learn out on my own and report to him my findings. Most of the times we would sit together with the client during the sessions and at other times he would allow me to first attend the client and later go through my findings before he sees them. After the session he would correct me where I went wrong and explain to me I detail the areas that I did not understand completely. Through this I was able to learn a lot in terms of clinical experience and assessment of patients.
Substance use can be regarded as a national concern. The government together with people must come together in order to solve this problem. The government must set rules and policies that govern substance use. The public must also recognize that this is a health problem and those affected require help rather than isolation. Healthcare professionals must also continue to do more research in order to find out the factors behind this problem. Substance use disorder is a problem that can be solved when the affected people accept their situation and asks for help.
- Bhalla, I. P., Cohen, N., Haupt, C. E., Stith, K., & Zhong, R. (2018). The Role of Civil Commitment in the Opioid Crisis. The Journal of Law, Medicine & Ethics, 46(2), 343-350.
- Cavaiola, A. A., & Dolan, D. (2016). Considerations in the civil commitment of individuals with substance use disorders. Substance abuse, 37(1), 181-187.
- McCabe, S. E., West, B. T., Jutkiewicz, E. M., & Boyd, C. J. (2017). Multiple DSM‐5 substance use disorders: A national study of US adults. Human Psychopharmacology: Clinical and Experimental, 32(5), e2625.
- Walton, M. T., & Hall, M. T. (2017). Involuntary civil commitment for substance use disorder: Legal precedents and ethical considerations for social workers. Social work in public health, 32(6), 382-393.
- Watson, J. C., & Schneider, K. (2016). Humanistic–existential theories.