Вы находитесь на странице: 1из 15

Question 1

1.1 What problems or issues in this case need further assessment and/or immediate attention ? ( 10 marks )

Introduction Client in this case is Maria. She is 28 years old and have two kids. She has difficulty in sleeping. She tells that she really doesnt have any other problems except with her poor sleep and she needs the sleeping pills or cant get to sleep at all. She mention that without the pills she feels shaky anxious and sick. Maria knew that sometimes the sleeping pills dont work well but she has to take more of them to get a good sleep. She has been taking the pills for about 2 years. She also admitted that taking pills ! to " or sometimes more pills a night. #s a conse$uences of taking this pills more she felt groggy and shaky in the morning and get angry and annoyed when her children create noisy situation.

#fter analysing this case can make assessment that Maria is very much dependent on sleeping pills and alcohol to overcome her depression. %er sleeping problem had made her difficult with focusing at her &ob as a computer engineer and she is often too tired to engage or do things with her children. 'he fact that Maria couldnt sleep at night increased her stress level made her dependent on sleeping pills. 'his can be concluded that Maria has became addicted to sleeping pills. #ctually Maria has (nsomnia )isorder. She may be didnt realise that disease. So to overcome her difficulty to sleep she has been dependent on sleeping pills. #s a counsellor has responsibility to make understand Maria about her disease first before organising any counselling session or treatment plan.

Sundra Rajan Ellumalai Matrix Number: 3120110

Page 1

What Is Insomnia (nsomnia is a condition in which you have trouble falling or staying asleep. Some people with insomnia may fall asleep easily but wake up too soon. *ther people may have the opposite problem or they have trouble with both falling asleep and staying asleep. 'he end result is poor+$uality sleep that doesn,t leave you feeling refreshed when you wake up. 'his symptom suits to Marias case.

(nsomnia is a distressing condition that can take a lot of en&oyment out of life. -eople will turn to various medications as a way to deal with the problem. .hile most individuals will only use these pills as a means to cope with their sleeping difficulties there is the risk of addiction. 'hose who only use this night sedation short term and under doctors instructions will have a low risk for addiction. (t is more often those people who grow to rely on sleeping tablets over a long time period who are most at risk.

.hen it comes to defining sleeping pill addiction the meaning is more specific. (t refers to a situation where an individual has become both physically and psychologically dependent upon this medication. (f they were to stop using these sleeping pills they would not only have to battle a mental compulsion but also go through physical withdrawal symptoms. -eople can abuse a substance for a period of their life without becoming physically addicted to it. *nce the addiction has taken hold though it will be a lot harder to deal with.

-eople do not normally start out with the intention of becoming addicted. Many start off taking sleeping pills that have been prescribed by their doctor for medicinal purposes. 'hey later become dependent on this medication and might take it even when it is not re$uired. 'here are also those who use this medication as a means to enhance the effect of alcohol or
Sundra Rajan Ellumalai Matrix Number: 3120110 Page 2

other drugs. -eople can grow to like the way that this type of drug sedates them and calms down the mind. 'aking sleeping pills can create similar feelings to being drunk on alcohol. (t can be tempting for individuals to abuse these substances as a way to escape their problems.

'here is a wide range of different medications that are classified as sleeping pills. 'hese drugs differ in their ingredients and how they work to promote sleep. /arbiturates are a type of drug that causes sedation by depressing the central nervous system. (n larger doses it can be used as a general anesthetic to put people to sleep. /en0odia0epine s are commonly prescribed for sleeping problems. 'his is a psychoactive depressant that works by enhancing the effect of a neurotransmitter called 1#/#. 'his chemical has a sedative and calming effect which can help people sleep.

*nce Maria has been made clear about her problem and the disease suggest to have a individual counseling session.

the counselor can


What are the possible diagnosis for

aria ? !ustif" "our ans#er (10 marks )

'he health care practitioner will seek to identify any medical or psychological illness that may be contributing to Maria,s insomnia. # thorough medical history and examination including screening for psychiatric disorders and drug and alcohol use is paramount in evaluation of a patient with sleep problems. (n this case scenario Maria and her husband used
Sundra Rajan Ellumalai Matrix Number: 3120110 Page 3

to have alcohol drinks every night in order to relieve stress.

-hysical examination may

particularly focus on heart and lung examination and measurement of si0e of the neck and visuali0ing oral and nasal air passages 2to see whether sleep apnea needs to be assessed in more detail3.

# patient with insomnia may be asked about chronic snoring and recent weight gain. 'his may direct an investigation into the possibility of obstructive sleep apnea. (n such an instance the doctor may re$uest an overnight sleep test 2polysomnogram3. Sleep studies are fre$uently done in speciali0ed 4sleep labs4 by doctors trained in sleep medicine fre$uently working with pulmonary 2lung3 specialists. 'his test is not part of the routine initial workup for insomnia however.

$% &I'&() $iagnostic *riteria for Insomnia $isorder the predominant complaint is difficulty initiating or maintaining sleep or non+ restorative sleep for at least 5 month that is associated with daytime fatigue or impaired daytime functioning. 'he sleep disturbance 2or daytime se$uel3causes clinically significant distress or impairment in social occupational to be or other important areas of functioning 'he insomnia is &udged to be related to another #xis ( or #xis (( disorder 2e.g6 Ma&or )epressive )isorder 1enerali0ed #nxiety )isorder ad&ustment disorder with anxiety3but is sufficiently severe to warrant independent clinical attention 'he disturbance is not better accounted for by another sleep disorder2e.g6 narcolepsy breathing+ related sleep disorder3 'he disturbance is not due to the direct physiological effects of substance 2e.g6 drug of abuse a medication3or a general medical condition.

Sundra Rajan Ellumalai Matrix Number: 3120110

Page 4

$% &I'&() $iagnostic *riteria for +lcohol +buse and $ependence #ccording to the )SM+(7 criteria for alcohol dependence at least three out of seven of the following criteria must be manifest during a 52 month period6

'olerance .ithdrawal symptoms or clinically defined #lcohol .ithdrawal Syndrome 8se in larger amounts or for longer periods than intended -ersistent desire or unsuccessful efforts to cut down on alcohol use 'ime is spent obtaining alcohol or recovering from effects Social occupational and recreational pursuits are given up or reduced because of alcohol use

8se is continued despite knowledge of alcohol+related harm 2physical or psychological3

1., $e-ise a treatment plan for aria. Include components that address deto.ification/ immediate treatment/ maintenance/ relapse pre-ention and an" other issues "ou think #ill need attention. !ustif" "our ans#er ( ,0 marks )

(reatment of %leeping 0ill +ddiction 'he danger of sleeping pill addiction means that the only safe treatment is to come off them completely. (f the addiction is mild it may be possible to recover by tapering off the medication. 'his involves gradually reducing the dose over time so that there are no sudden withdrawal symptoms. 'here are specific regimens available for the safe tapering off from sleeping pills. %owever in some instances the doctor might decide to allow the individual to reduce the dosage as they feel comfortable.
Sundra Rajan Ellumalai Matrix Number: 3120110 Page 5

# heavy or long+term addiction to sleeping pills may re$uire some type of rehab program. (n recent years there has been an increase in the number of people seeking residential treatment for this type of addiction. 'his can be a good way to deal with the problem because the individual will receive a lot of support and gain skills for living life without the drug.

(reatment 1or +lcoholism 'reatments for alcohol dependence can be separated into two groups those directed towards severely alcohol+dependent people and those focused for those at risk of becoming dependent on alcohol. 'reatment for alcohol dependence often involves utili0ing relapse prevention support groups psychotherapy and setting short+term goals. 'he 'welve+Step -rogram is also a popular process used by those wishing to recover from alcohol dependence.

%elf +cceptance #cceptance can be defined as the act of taking or receiving something offered. (n human psychology the word is used to describe a persons assent to the reality of a situation. 'he individual is able to accept the reality of what is happening and they do not feel the need to protest it or change it.

Self acceptance can be defined as an affirmation or acceptance of self in spite of weaknesses or deficiencies. (t is closely linked with self esteem but there are important differences between the two. (f the individual has high self esteem they will see themselves as valuable and worthwhile. Self acceptance is unconditional and it means that the individual is able to

Sundra Rajan Ellumalai Matrix Number: 3120110

Page 6

embrace their bad points as well as their bad points. 'he individual who has developed self acceptance has nothing to hide. 'hey &ust accept who they are 9 warts and all.

%leeping 0ill $eto.ification 'he detoxification process from sleeping pills is similar the ben0odia0epine class of drugs. Many people unwittingly have become dependent on sleep aid medications prescribed by seemingly well intentioned doctors. Sleeping pill dependency can be a harrowing experience and coming off them a difficult ordeal if not managed by experienced medical professionals. 'he -otter,s Clinic provides detoxification from sleeping pills or sleep aids on an outpatient basis. )iscontinuing sleep aids use without medical supervision can produce symptoms such as6 Severe insomnia .ithdrawal symptoms # general miserable feeling

.ithdrawal from sleep aids besides being uncomfortable can be downright dangerous if not properly managed. Many people unwittingly have become dependent on ben0odia0epine prescription medications prescribed by seemingly well intentioned doctors. .hatever your case may be sleep aid dependency can be a harrowing experience and coming off them a lengthy and painful ordeal if not managed by experienced medical professionals.

(he 2 $rug *lass 'his class of drugs are called sedative hypnotics. 'he drugs listed below belong to a class of drugs called : drugs. 'hese drugs have a similar chemical makeup to the ben0odia0epine class of drugs. 'he -otter,s Clinic offers a safe detoxification program from sleep aids such as #mbien; #mbien C<; and =unesta; on an *ut+-atient basis.
Sundra Rajan Ellumalai Matrix Number: 3120110 Page 7

<ef. http6>>thepottersclinic.com>Sleeping?-ill?)etox.html

Immediate (reatment ( would suggest that if Maria wants to stop using them she should taper slowly. So take them for @ day stop for 5 night. )o this for a couple of weeks. She won,t sleep well 2or possibly at all3 on the pill+free night but she can recoup the next night. 'hen she should do 2 nights with pills 5 night with half a pill and one night pill+free. #gain. do this cycle for a couple of weeks. #nd &ust continue decreasing by half a pill every couple of weeks. (t will take a while but eventually Maria will be able to get down to @ nights off 5 night on the pills. She may even be able to stop them altogether but that depends on the person. Some people never manage to stop them completely. 1enerally any sleeping pill can cause this rebound effect. #ny sleeping pill should only be used for 5 night out of @. (n addition using a sleeping pill every night means they lose effectiveness. So you wind up having to up the dose or go to a stronger pill. (f you stick to a @ off 5 on schedule that won,t happen. So your pills will continue to work. 'he same method should be apply to reduce #lcohol drinking habit.

aintenance +nd )elapse 0re-ention 'hose individuals who are not aware of their dual diagnosis will struggle to find happiness in recovery. 'hey may decide that life away from alcohol or drugs is &ust dissatisfying and decide to relapse.

Aust because an individual manages to stop abusing alcohol or drugs it does not necessarily mean that their problems are all behind them. 'he reality is that stopping the substance abuse is &ust the first step in a long process that leads to a full recovery from addiction. 'hose who
Sundra Rajan Ellumalai Matrix Number: 3120110 Page 8

remain abstinent from alcohol or drugs without achieving sobriety will struggle to find any real en&oyment in life. Such people would be better described as on the wagon rather than free of addiction. 'he risk of relapse will always be high for these individuals. (n many ways their life in recovery may mirror their life as an alcoholic

(n common speech it is usual to think of sober as meaning any individual who is not intoxicated but the word can have a much fuller meaning. (n recovery the word sobriety usually refers to something a lot more than &ust not drinking alcohol or abusing drugs. 'hose who advocate the 52 step approach view sobriety as a life where the individual is not only free of addiction but also moving towards complete physical emotional mental and spiritual health. #bstinence is something that can be forced onto an individual by others but sobriety re$uires a lifelong commitment that re$uires personal effort. 1etting sober in this instance is not a once+off event but instead a continuing process.

'he reason why people become dry drunks is that they get stuck in recovery. 'he early years free from addiction involve many hurdles that need to be dealt with. 'his is because addicts have poor coping skills for dealing with life. Bew strategies have to be developed in recovery and these are ac$uired by confronting obstacles and overcoming them. (t is lack of an ability to cope with life that attracted such people to alcohol abuse in the first place. Aust removing alcohol is not going to be enough to allow the individual to find happiness and comfort in life.

#s the individual meets each new challenge they develop and grow. Sometimes though a challenge comes along which the person in recovery refuses to face. 'hey get stuck and will not be able to progress any further until the challenge is dealt with. Many of those who fail to
Sundra Rajan Ellumalai Matrix Number: 3120110 Page

progress will end up relapsing but a minority somehow remain abstinent for years despite being stuck in recovery.

<ecovery from alcohol addiction should always mean moving towards a life that is fulfilling and en&oyable. -eople can lose their way but there is almost always a way back on track. Most individuals will have to deal with at least a brief period where they get stuck in recovery but there is almost always a way to move forward from this. 'he important thing is to recogni0e the problem and take steps to remedy the situation. %elp can be found from support groups counselors sponsors or addiction therapists.

Sobriety is a &ourney and all the individual needs for success is to keep on moving forward. 'his means facing all the challenges that appear along the way and seeking out the right type of help and support. #s the months and years in sobriety accumulate dealing with life becomes a lot easier. (t is important to reali0e though that the end of the path is never $uite reached no matter how long people remain sober. 'his should not be a cause of concern as most of the fun of life is to be found in the &ourney itself and not at the destination.

Sundra Rajan Ellumalai Matrix Number: 3120110

Page 10

Q34%(I56 2

As a counsellor, how do you handle a case of dual diagnosis in substance abuse client while client is under the care of physician ? Please justify and support your answer with the example and scenario. ( 20 mar s !

# case example of dual diagnosis in alcoholism and psychiatric problem is listed down here to explain an counsellor responsibility.

Mala is a C! year old (ndian woman with a 2! year history of alcohol dependency. She is divorced and is living in a local hostel. She has two grown+up boys in Singapore that she has lost contact with. She has had several prison sentences in the pastD offences range from mugging to shoplifting and drug dealing. She is recently been caught snach theft. 2kes ragut3. She has a court case pending for this.

She has been known to the local mental health service for several years. She states she has Ereally bad depressionF and hears her fathers voice at night 2her father died when she was
Sundra Rajan Ellumalai Matrix Number: 3120110 Page 11

eight3 She is terrified of the fathers voice as his father was a drinker and used to physically abuse her and her brothers as well as her mother. %er diagnosis is alcohol dependenceD psychosis and depression. She has been offered anti+depressants and antipsychotics which are prescribed by her doctor but none is really sure if she takes them.

Medical tests have shown that her liver is being badly affected by her drinking and she has been told by her doctor that if she carries on drinking she will be dead in a year. )espite this she is craving alcohol badly and finding this hard to cope with. She becomes verbally aggressive at times due to this. # doctor by the name name Choi Gong was representing as a physician for Madam Mala. She has been offered anti+depressants and antipsychotics which are prescribed by her

physician. #t the same time Mala was refer to me who were acting as counsellor. /efore performing my counsellor duty ( have a responsibility to explain to her about the problem that she face. #ccording to my assessment thru this case scenario ( had identified Mala has dual diagnosis ie #lcoholism dan psychiatric. ( began to explain what is )ual )iagnosis and psychiatric.

$ual $iagnosis 'o say that somebody has a dual diagnosis means that they are not only dealing with a substance abuse problem but also a mental health problem. (t may have been this other condition that drove the individual to substance abuse in the first place. 'here will also be those people who develop a dual diagnosis as a result of their abuse.

("pes of $ual $iagnosis # dual diagnosis may refer to addiction combined with a metal health problem such as6
Sundra Rajan Ellumalai Matrix Number: 3120110 Page 12

#nxiety disorder )epression #ntisocial personality disorder /ipolar disorder *bsessive compulsive disorder -hobias

'he addiction may involve alcohol prescription drugs or illegal drugs.

*ause of a $ual $iagnosis Some people will already have a mental health problem before they turn to substance abuse. (n many instances the individual will not know that their symptoms are caused by a mental health condition. 'hey &ust know that they do not feel right and that when they use alcohol or drugs it makes them feel a bit better. (n the beginning the individual may be able to successfully self medicate their symptoms but substance abuse is only a temporary solution at best. Bot only does alcohol and drug abuse become less effective as a form of self medication but it starts to exacerbate the problem. (t leads to a dual diagnosis where the individual has far more problems than when they began self medicating.

'here are also people who will develop a dual diagnosis as a result of their substance abuse. #lcohol and drugs can be highly toxic to the body. 'hese substances can wreak havoc on every organ in the body 9 including the brain. #lcohol is a type of depressant and so it is hardly surprising that this type of abuse leads to the symptoms of depression. Substance abuse can lead to paranoia anxiety hallucinations extreme mood fluctuations suicidal thoughts and emotional problems. 'hose who engage in this type of behavior over a long
Sundra Rajan Ellumalai Matrix Number: 3120110 Page 13

period of time are putting their mental health at risk. (n many instances those mental health problems that have been caused by substance abuse will improve once the individual stops using alcohol and drugs.

)eco-er" and $ual $iagnosis (n recent years there is an increase in the number of resources available for people who are dealing with a dual diagnosis. 'his means that many more of these people are managing to escape their addiction and build a good life in recovery. (n many instances these individuals will need to have both of their conditions treated at the same time. 'his will mean that their mental health condition will not prevent them from building a life in early recovery. 'here is also far more awareness of dual diagnosis these days and those who are struggling to find happiness in sobriety are not &ust given the &udgment that they are doing something wrong 9 although this does still happen.

0s"chiatric $isorder # mental disorder or psychiatric disorder is a psychological pattern or anomaly potentially reflected in behavior that is generally associated with distress or disability and which is not considered part of normal development in a person,s culture. Mental disorders are generally defined by a combination of how a person feels acts thinks or perceives. 'his may be associated with particular regions or functions of the brain or rest of the nervous system often in a social context. 'he recognition and understanding of mental health conditions have changed over time and across cultures and there are still variations in definition assessment and classification although standard guideline criteria are widely used. (n many cases there

Sundra Rajan Ellumalai Matrix Number: 3120110

Page 14

appears to be a continuum between mental health and mental illness making diagnosis complex.

#fter make her understand about her situation ( began to start my first counseling session with her. 'he purpose of this counseling session is to handle her alcohol addiction. ( had to suggest the 52 step approach which was introduced #lcoholic #nonymous 1roup.

Sundra Rajan Ellumalai Matrix Number: 3120110

Page 15