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Abnormal Psychology - Substance Abuse

See the attached file.

Imagine you are the head of a local, non-profit, substance abuse treatment facility and you have just received a grant that will allow you to expand the different types of treatment offered at your facility. You have the option of either hiring a psychoanalytic therapist, a cognitive behavioral therapist, or you can use the money to acquire more medication that can be used to treat your clients (i.e. methadone, suboxone, etc.).

Also, you can instead choose to donate the money to local agencies that provide aid in the form of food, clothing and shelter to the underprivileged members of the population in the area.

1) Based on the information presented, select how you will spend the grant money given to your agency. Use the scholarly research articles presented to defend your selection and explain why you feel your decision will be the most effective way to reduce the rate of substance abuse in the area.

2) After reviewing the chapter on "Research in Abnormal Psychology," describe a research design that you would use to provide evidence that your decision has been effective (i.e. describe a correlational study, an experiment, or an alternative method of investigation that will allow you to demonstrate how your decision has lowered the rate of substance abuse in the area).

Read: Coping Strategy Use Following Computerized Cognitive-Behavioral Therapy for Substance Use Disorders by Dawn E. Sugarman, Charla Nich and Kathleen M. Carroll.

These are the resources available:

http://www.drugabuse.gov/faqs
http://highered.mcgraw-hill.com/sites/dl/free/0073401498/506358/Goode7_Sample_ch03.pdf
http://www.bing.com/videos/search?q=60+minutes+episodes+addiction+2012&mid=F76FCC794C4B6F8403C3F76FCC794C4B6F8403C3&view=detail&FORM=VIRE3
http://www.nytimes.com/2012/07/29/opinion/sunday/neuroscience-and-moral-responsibility.html?_r=1
http://www.learner.org/vod/vod_window.html?pid=782.

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I think this here below should get you going. I included many theories and well known articles that deal with cognitive behavioural therapy (CBT) and its importance, so I went with the CBT option, and cited the sources to prove it.

Here is a great place to start:
http://www.drugabuse.gov/sites/default/files/podat_0.pdf

My first impression is to worry about cognitive behavioral therapy (CBT). This is because such an approach is long term and goes to the root of how and why addictions come into existence. This is not to degenerate medications (i.e. hiring a psychiatrist), but medications only work when in conjunction with CBT. CBT, on the other hand, can work without medication in some cases.

Let me throw out a few ideas from this source:

1. Drug abuse, especially over the long term, alters the chemical structure of the brain. This suggests two things: first, medication is often a necessity, but since the brain is far more malleable than earlier thought, CBT also becomes essential.

2. It seems also that the intensity and longevity of the addiction will dictate whether or not medications need to be administered. As far as the question is concerned, there is nothing wrong with hiring a CBT person, and, if necessary, referring patients to an MD that can provide the proper medications. This is not to mention that hiring a CBT counselor is far cheaper than hiring an MD.

3. From page 9: "Psychoactive medications, such as antidepressants, antianxiety agents, mood stabilizers, and antipsychotic medications, may be critical for treatment success when patients have co-occurring mental disorders, such as depression, anxiety disorders (including post-traumatic stress disorder), bipolar disorder, or schizophrenia." While this is true again, this does not force you to hire an MD. This can be "farmed out" to the local behavioral health facility.

4. Here is a key quote from page 11: "According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning. For example, methadone treatment has been shown to increase participation in behavioral therapy and decrease both drug use and criminal behavior." This quote is essential for your answer. It's not just a matter of getting into treatment or even having the will to stop: it's about the long term commitment to remission. This, of course, is the domain of CBT.

5. CBT counselors also build trust. Addicts need to build a relationship with a professional CBT person who can build these bridges. This is what keeps people in treatment.

Now, let's look at the NYT source:
http://www.nytimes.com/2012/07/29/opinion/sunday/neuroscience-and-moral-responsibility.html?_r=1

I think there is one point from this piece that you should focus on: worrying too much about brain chemistry passes over the most important point- that responsibility is paramount for treatment. If we were to stress the concept that brain damage, problematic childhoods or peer groups are "responsible" for addiction, then we are eliminating responsibility. It might be easier to relapse if we are convinced that our addiction is about "chemistry" that cannot be changed.

Again, this argues for using the money to hire a counselor (or two) rather than a MD. I'm pretty sure that (at least) 2-3 counselors (maybe more) are paid about the same as one MD.

Looking at the article by Sugarman, Nich and Carroll, I found the following:

This article is great because it backs up my (our) view of the matter: CBT is the most important and crucial element of any treatment program.

Good quote from the first page:

"Studies with alcohol dependent individuals provide evidence of an inverse relationship between coping strategy use and alcohol use. For example, Moser and Annis (1996) reported that maintaining abstinence during a stressful situation was predicted by total number of coping strategies used. Another study found that alcohol dependent participants who relapsed following inpatient treatment were less ...

Solution Summary

This solution discusses cognitive behavioral therapy as a treatment for substance abuse disorders. It also provides several articles to support the viewpoint of the author, and the research design for testing CBT.

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