Substance Abuse Program Visit

1. Descriptive information and Target Population

The substance abuse rehabilitation agency that I interview is Northbound Seattle rehab center which is based in Washington. Precisely, the facility is located right in Lower Queen Anne, which is one of the Seattle`s nicest neighborhoods. Its location is close to the Space Needle and right on the Puget Sound, and this makes it easy to attract clients from the dozens of the nearby islands due to the high accessibility of ferry (Northbound Seattle Rehab Center, 2018). This facility is a behavioral healthcare provider that is specialized in substance abuse treatment among adults and young adults who are suffering from addiction and co-occurring mental health disorders. In addition, the Northbound Seattle Rehab Center has licensed clinicians and works closely with professional referral sources, family members and clients in order to determine the level of care that should be administered to the client. In addition, the clients who enroll in the facility`s Sober Living and Outpatient Rehab Programs tend to enjoy safety and privacy while being able to experience everything that Seattle has to offer including hiking, fishing and kayaking. The environment within this setting is also enhanced not only by the rehab programs that it offers, but also by the Seattle`s outdoorsy culture and favorable experiences ranging from the beautiful museums, artisanal coffee shops and great food. The facilities within this facility also create a conducive environment for the recovery of the clients. Precisely, the rehab center is comprised of one main building which is comfortable and modern, with numerous rooms for all of its clinical services.

There are numerous Intensive Outpatient and Outpatient services that are offered in the Northbound Seattle Rehab Center targeting those who are afflicted with substance use disorders as well as co-occurring mental health issues. For example, some of the services that are offered in the intensive outpatient section are not limited to individual and group therapy and psycho-education, individual case management, psychiatric care, ongoing drug testing, experiential and recreational activities and day, evening, and combination schedules. In the outpatient section, the services that are offered are not limited to psychiatric care, drug testing, experiential and recreational activities, individual and group therapy and psycho-education, 12 step immersion and 13 step engagement.

Description of the screening, assessment, intervention, and discharge

Clients who happen to seek services from this facility first undergo pre-screening prior to admission, and it is through this process that the facility clinicians happens to assess the severity of the addiction or the mental problem, and plan for the necessary level of care that the client needs. The next aspect entails assessing the client using the biopsychosocial assessment model for diagnosis and history. Biopsychosocial model of assessment is an assessment approach that advocates for the importance of a systematic view of an individual and an integration of psychological, biological and socio-cultural factors on human development and functioning. The clinicians in this rehabilitation facility tends to conduct biopsychosocial interview with the client and his or her family members at the beginning of the therapy in order to assess the psychological, biological and social factors which might be contributing to a problem or problems with a client. The assessment is considered holistic especially due to the fact that it focuses on examining the client on all different levels. For the biological factors, the therapists and counselors seeks to establish medical issues, genetic issues, physical characteristics and developmental milestones that could be contributing to the client`s problem or problems. Some of the aspects that are examined in this category entails the family history of homicidal or suicidal ideations, medical problems that are negatively impacting the client`s life, and personal and family history of alcohol or drug use. For the psychological perspective, the therapists and counsellors seeks to assess the client`s thought processes, mental status, feelings, behaviors, history of trauma or abuse, emotions among others. For the sociological perspective, the therapists assesses the cultural and social factors that might be affecting the client.

The therapists and counsellors within this facility then proceeds to establish intervention plans based on the biopsychosocial assessment where specific, and measurable goals are formulated with therapeutic interventions in order to assist the client in reaching their goals. Then, clients are discharged when the therapists and counsellors perceives that they (clients) are ready and have successfully completed the program. During the discharge process, aftercare is established in order to assist the clients to effectively transition from the facility to the life outside the facility, and this helps in preventing the clients from relapsing.

2. Theoretical Approaches

There are numerous prominent theories that underlie the services provided at the Northbound Seattle Rehabilitation Center.  Some of these therapies are not limited to motivational interviewing, dialectical behavioral therapy, cognitive behavioral therapy, eye movement desensitization and reprocessing, mindfulness based therapy, experiential therapy, psychodrama and expressive arts.

Motivational Interviewing Therapy

Motivational interviewing is a counselling method that aims at helping clients to resolve ambivalent insecurities and feelings so as to gain internal motivation that they require in order to change their behavior. This therapy is an empathetic, practical and short term process that takes into consideration how challenging it is to make life changes. This therapy is effective in addressing addiction as well as the management of physical and mental health conditions. Therapists and counselors within the Northbound Seattle Rehabilitation Center use this therapy in order to motivate clients to change their behaviors to the better and learn to make healthier choices. Actually, this is the first therapy that therapists within this facility embrace and implement during the admission process, and continue to implement it even after the client has been discharged from the facility. Moreover, this therapy uses a non-confrontational and collaborative effort between the clients and therapists in order to not only spark motivation but also initiate change. Instead of a therapists acting in a combative or antagonistic way, he or she tries to engage with the client to explore his or her feelings, including ambivalence about changing.

Cognitive Behavioral Therapy

Cognitive behavioral therapy is a form of psychotherapy that focuses not only on treating the problem but also boosting happiness among clients especially by modifying dysfunctional behaviors, emotions, and thoughts. Therapists and counselors within Northbound Seattle Rehabilitation Center use CBT as a solution to the mental health needs of the clients by encouraging them to challenge distorted cognitions as well as change destructive patterns of behavior. The CBT settles on the idea that perceptions and thoughts influence behavior. Moreover this therapy identifies destructive thoughts, assess whether they are an accurate depiction of reality, and in case they are not, clinicians employ measures of challenging and overcoming these harmful thoughts. For example, if the client is suffering from depression, the clinicians use the CBT to stimulate accurate depiction of reality, and encourage him or her to change his thinking patterns.

Dialectical Behavior Therapy

The dialectical behavior therapy is a therapy that specifically focuses on providing therapeutic skills in four main areas which are not limited to mindfulness, distress, emotional regulation and interpersonal effectiveness. Mindfulness focuses on enhancing the client`s ability to accept and be present in the current moment. Distress tolerance focuses on empowering the client to bear with the negative emotions rather than trying to escape from it. Emotion regulation covers measures of managing and changing intense emotions that might be contributing to problems in a client`s life. Lastly, interpersonal effectiveness is composed of techniques that allow the client to communicate with others in a manner that is assertive, strengthen relationships, and more importantly, maintain self-respect.

Expressive Arts Therapy

Art therapy entails the use of creative techniques such as collage, painting, drawing, sculpting, or coloring in order to help clients express themselves artistically as well as examine the emotional and psychological undertones of their arts. Credentialed therapists and counselors within the Northbound Seattle Rehab Center use this therapy as one way of decoding non-verbal messages, metaphors, and symbols that are often found in these art forms. The therapists in this rehab facility do contemplate that the use of the art can help the to understand the behavior and feelings of their clients, after which they can manage to not only help them to resolve their deeper issues, but also to move on with their normal lives.

Experiential Therapy

The experiential therapy is a therapeutic strategy that uses expressive activities and tools such as role acting or playing, animal care, music, arts and crafts, guided imagery, or various forms of recreation in order to re-experience and re-enact emotional solutions from past and recent relationships. The major aim of therapists and counselors in this rehabilitation facility to use this therapy is to encourage the client to focus on activities and through the experience, start to identify emotions that are associated with disappointment, success, self-esteem and responsibility. Under the guidance of a credentialed experiential therapist, the client can start to explore and release negative feelings of hurt, anger, or shame as he or she tries to relate with past experiences that may have been blocker or still linger.

Biopsychosocial Therapy

As aforementioned earlier, this therapy aims at identifying the biological, psychological and social aspects that might be contributing to the occurrence of the mental or addiction behavior among clients. The therapists and counselors within this facility use this therapy as soon as the client arrives within the rehab facility as a preliminary way of identifying the underlying factors that might be contributing to the occurrence of an adverse behavior of the client at hand. For example, a client who might be having a history of abuse or rejection may develop low self-esteem and start abusing alcohol in order to do away with regretful past memories which might be disturbing him or her.

Mindfulness Based Therapy

Mindfulness based cognitive therapy is a modified form of cognitive therapy that incorporates mindfulness practices such as breathing and meditation exercises. The therapists and counselors in this rehabilitation center use this therapy to teach clients concerning how to break away from negative thought patterns which contribute to downward spiral into depressed state in order for them to manage to fight off depression before it takes hold. Moreover, this therapy helps clients to forget their past experiences and start focusing on their current and future states, and this enables them to focus on motivational methods that the therapists are encouraging them to embrace and implement.

Psychodrama Therapy

This therapy is used to also mean group psychotherapy or group therapy. The therapy entails the use of deep action methods to correct and explore issues that might have been identified in the group. For example, if it’s for the case of clients who have been struggling with alcohol addiction, the therapists and counselors within this rehabilitation facility may put them in the one group and use this therapy to help them to fight their addiction behaviors. Through this therapy, the therapists and counselors within this facility provides the clients with a platform of sharing their addiction process with others as well as how he or she have managed to overcome the challenge after coming to the facility. The most important aspect of this therapy is that it helps most clients from relapsing even after being discharged from the facility.

3. Critical Analysis of Treatment

In Northbound Seattle Rehabilitation Center, the treatment method is based on admissions that are on a rolling basis. There are no emergency cases where some clients are treated before others. Precisely, there are no treatment on demand in terms of the clients who happen to be admitted to the facility. The only time where treatment on demand is administered is when some clients some clients who have already been admitted happens to worsen in their situation or become incontrollable to the extent of disrupting the wellbeing of others within the facility. Even when the client who have been initially treated and discharged happens to relapse, he or she undergoes the same procedure ranging from admission to the treatment options that are given. The only consideration that is given to a client who happens to relapse is that special treatment options that would help him or her to overcome relapse is administered, and this is done during the normal operations of the facility rather than being treated as an emergency case. One of the main advantage with this facility is that there are not waiting lists in terms of admissions and treatment methods being offered, and this is due to the fact that the management of the facility does not want to discourage clients from coming to the facility with the fear of encountering a long waiting list. It is worth noting that in public health facilities, most clients fear to seeking for quality health care services due to the fear of having to wait for a number of hours before they are served. The management of this rehabilitation facility ensures that it has adequate therapists, clinicians and counselors to not only facilitate the admission of clients but also serve them without discrimination.

Urine Analysis

Urine analysis is one of the preliminary step that the clinicians embrace soon after a client is admitted and as he or she progresses with the treatment process. The major aim of conducting urinalysis is to monitor drug alcohol, levels within the system of a patient. Based on the concentration of alcohol within the system, the clinicians manage to establish the plan of care that is best suited to an addicted client. In addition, urinalysis helps the clinicians to establish whether the client has been adhering to the therapeutic treatment processes that he or she has been receiving within the facility. Urinalysis is often done to the outpatient clients since they are likely to relapse after being treated within the facility. To a large extent, the consequences of urinalysis are based on the clinical appropriateness of the situation. For example, if the urine analysis reveals that the client is highly addicted to alcohol, the clinicians manage to plan the appropriate plan of care that they should administer to him or her, as well as whether to admit him or be treating him or her as an outpatient client.

Curriculum

The treatment curriculum within Northbound Seattle Rehabilitation center is broad and consists of numerous lessons. Some of the lessons that are stressed are not limited to shame resiliency, emotional sobriety, relapse prevention, family systems, and dialectical behavioral therapy. Emotional sobriety entails the aspect of empowering clients to do away with negative emotions that might be negative influencing them to develop the problem. The credentialed therapists within this facility focus on stabilizing the mental health of the clients. Shame resilience entails the aspect of empowering clients to overcome shame that may result after the latter realizes the negative behaviors that he or she had done when he or she was not in his sober state. Therapists within this rehabilitation facility empower clients on how to face shame once they are discharged from the facility. It is worth noting that shame is a serious universal emotion which can have negative consequences if left unchecked, and this is why therapists in this facility focus on not leaving anything into chances. Family systems entails the aspect of empowering clients on how to associate with the family members. The lesson is integrative in a way, especially due to the fact that it may involve family members especially when it comes to advising them on how to support the client once he or she is discharged from the facility. Relapse prevention is one of the major lessons that is highly stressed within this facility. The clinicians do comprehend that chances of clients to relapse are very high especially if supporting environment is not put in place. Precisely, therapists do not only educate the clients on how to overcome relapse, but also involve the family members on how to support the clients to avoid relapses.

Cultural Competencies/Cultural Diversity

The management of this rehabilitation center contemplates that cultural diversity is one of the effective tools of ensuring that the set goals and objective are achieved within the set deadlines and budget. For this reason, the facility ensures that its workforce have adequate cultural competency skills and knowledge in order to assist the clients effectively. One way of ensuring that the employees have adequate cultural competency skills and knowledge is ensuring that all the employees participate in an annual training on cultural diversity. When clients are admitted within the facility, they are asked about their religious and cultural preferences in order to ensure that their treatment process and life within the facility is culturally appropriate.

Northbound Seattle Rehabilitation Center do not address patients who are suffering from both mentally ill conditions and chemically addicted. The facility admit clients with stable anxiety or depression diagnosis. In addition, the program also treats the family system. Precisely, the program is composed of a family night that lasts 3 hours every 1^st and 3^rd Wednesday of the month in addition to weekly family contact. The management of this rehabilitation facility contemplates that the clients cannot fully recover without relapsing if their immediate environments are not advised on how to support them.

Additionally, the executive director and the lead therapists do meet regularly in order to ensure that the clients are properly cared for and are receiving treatment interventions, structure, and methodology that each one of them needs. The management of this rehabilitation facility also evaluates its method of success especially by analyzing the number of clients that it treats and discharge and those who manage to fully recover to their normal lives. In every year, the facility records the number of patients it has treated and discharged and those who have been brought back after relapsing. Clients are also followed and asked to rate the treatment methods and the experience that they acquired within the facility.

4. Implications of social work practice

There are numerous aspects that I need to improve concerning the quality of work with my client. First, I need to improve on the treatment therapies that I should consider when addressing the problem that my clients might be having. Initially, I thought cognitive behavioral therapy is the core therapy that a psychologists can adopt and implement in order to help clients who are suffering from substance abuse addiction or mental illnesses. However, after visiting the Northbound Seattle Rehabilitation Center, I have contemplated that it is necessary to embrace and implement a collective approach of therapies in order to not only manage to precisely identify the issue that the client is having, but also to plan the effective measures of intervention. I have learnt the importance of using motivational interviews, biopsychosocial therapy, and arts therapy among others. In addition, I need to improve on working with diverse workforce, as this is an effective way of ensuring that the treatment options that the administered to the client are culturally appropriate. Initially, I never knew that culture and religion of a client matters when it comes to addressing his or her mental or addiction problem.

Moreover, I also need to improve on extending the level of care to those who are immediate to the client. Precisely, I need to go beyond treating the client, by also having programs that are meant for the family systems. I need to understand that the family members are the ones who will spend most of the time with the clients and, therefore, there is need to educate them on how to support the latter on to life that promotes his or her health. In addition, I need to improve on the curriculum base or the lessons that I should provide to my clients. Initially, I thought that counselling the clients on how to overcome addiction or mental health problem that he or she might be having, as well as relapsing prevention is enough. It is only after visiting this rehabilitation facility that I have learnt the importance of having additional lessons including shame resiliency and family systems.

References

Northbound Seattle Rehab Center, (2018). Drug and Alcohol Treatment Seattle Washington. Retrieved from, https://www.northboundtreatment.com/drug-rehab-seattle/