The alcohol is the most frequently used substance
have positive correlates with the psychosis. The literature doesn’t provide substantial
data for determining the link between alcohol and psychosis (Department of
Health, 2002). A few studies suggested the people who are regular users of
alcohol
reported the three major reason for alcohol use i.e. negative affective state, boredom and depression(Barrowclough et al., 2005). Some of the users reported they use alcohol to increase pleasure. While the empirical data from the people with psychotic systems suggested, they use alcohol to reduce negative affect state, and the symptoms of hallucination or delusion (Miller & Rollnick, 2002). The root cause of the alcohol abuse found to negative affective state, boredom, depression, hallucination and delusion. The management plan has been designed considering these point and the condition of the client (Assessment of the Alcohol-induced psychosis section 1).
reported the three major reason for alcohol use i.e. negative affective state, boredom and depression(Barrowclough et al., 2005). Some of the users reported they use alcohol to increase pleasure. While the empirical data from the people with psychotic systems suggested, they use alcohol to reduce negative affect state, and the symptoms of hallucination or delusion (Miller & Rollnick, 2002). The root cause of the alcohol abuse found to negative affective state, boredom, depression, hallucination and delusion. The management plan has been designed considering these point and the condition of the client (Assessment of the Alcohol-induced psychosis section 1).
Intervention plan for Alcohol-Induced Psychosis
Intervention plan was made according to the assessment and observation results.
•
Rapport building was done to establish for the assessment and management
behavioural problem appropriately.
•
The client was often complaint that he had a physical weakness. He was
not energetic enough to play or pray actively; his body only gets energetic
after having drugs. The client was psycho educated about the harms of drugs.
How it destroyed the human body and was being told different activity for
getting energy. Craving management technique will be taught to the client for
controlling the need of the drugs.
•
The client has conflict about women, according to the client they only
love money, and love does not have any value before them. To remove a bad image
of the women from the client mind, positive imagery will be used.
•
The client had been staying in PIMH for last four years. Three to four
times he was being discharged by the psychologist, but as he confronts the
stressors again in the environment, he got disappointed and started using drugs
and get a relapse. Copying statement will be used to develop the strength to
face the stressors.
•
The client was in the state of denial for the harm of drugs; insight will
be developing to aware him for the harm of drug. 6 step of assertive training
was used for that purpose.
•
The client had delusions of persecutory, as the delusion and hallucination
were found to be at an early stage. Therefore, CBT and other technique for
psychotic symptoms were used to develop the insight about his failure depends
on him rather than other peoples.
Implementation of
Therapeutic Strategies
Rapport Building. The Rapport was built to establish the comfort
level of the client so that he could actively and confidently take part in
session activity which will help assess the client behavioural problem and
strengths as well.
Building
rapport is important in an interpersonal relationship, to communicate in a more
relax and effectively (Millitenberger, 1997).
The
Rapport was built gradually as the client starts telling his actual problem. In
the first session, he was not accepting that he ever used drugs; rather he was
cursing those people who used drugs. But in the second and third session, the
client confesses that he used drugs for gaining energy.
Psychoeducation. The client has been psycho educated about his
misconception towards life and self.
Psychoeducation
is a process of teaching clients with mental illness and their family members
about the nature of the illness, including its etiology, progression,
consequences, prognosis, treatment and alternatives (Donley, 1911).
The client
was unaware of the harm of drugs, according to him it was the best source of
peace and energy, and he was psycho educated about the harms of drugs that how
it destroys and addict a person.
Craving Management Technique: The client was asked to identify the causes or
triggers that have set up the cravings. Have you recently experienced
environmental cues or emotional/psychological cues? Resist the cravings and
spend your mental energy thinking about how you can avoid these same triggers
in the immediate future or how you deal with them without using. Practice
distraction until the craving has gone. Do something to engage your thinking,
your attention, your body, so that you give the craving a chance to pass.
Examine-
evidence. To modify client thought about females, examine-evidence technique
was used so that he could overcome his conflict towards women and start a new
life with her wife.
The
examine evidence is a procedure of collaborative exercise used to test the
validity of automatic negative thoughts (Beck, 1979).
As the
client had negative feelings for the women, so to remove his false beliefs, he
was asked to provide evidence on how women are wicked. The client replied that
they loved money; love doesn’t matter to them. Then he was asked about did you
experienced that thing, the client replied yes, there was a woman, who used to
love the client when he used to give him money. But as he lost his business,
that women left her. It was also reported by the client that her wife also left
her for the sake of money. The client was asked about the evidence for those
people who are successful in managing both wife and girlfriend at the same
time. The client replied that many males are successful in running more than
three relations. Then he was asked about the moral, social and spiritual value
about such relation. Do any of them support such relations; the client remained
silent about that. Then he became agreed that women are not wicked, unfair
relation can’t be faithful.
Coping Imagery: This technique helps the client to visualise
himself coping with an anticipated difficult situation.
Copying
imagery is a technique of CBT to help the client to visualise himself coping
with an anticipated difficult situation (Leahy, 1996).
As the
client got relapse after discharge due to the same stressors, the client was
asked to imagine and face those situations which were or will be stressful for
him, such as her sister in law, criticism of brother, and stress on the job.
The client was asked to react alternatively in a better way. These copying
practices intended to make the worst situation less painful for the client. The
client imagined the situation as reported that he will face his brother by
saying that he is responsible for all his actions, don’t pressurise me for
anything, and he also reported that he would avoid meeting her sister in law.
The
technique found to be helpful as it was observed by the therapist that the
client was confident enough to admit the worst aspect of his behaviour and now
he was ready to face them fearlessly.
12 Steps Programme. 12 step programme was used to break the denial for
drugs harm and develop the insight about the fatal disease associated with the
drug.
The 12
steps were the spiritually-based intervention that required individuals to
recognise God's power as an important avenue for healing (Recovery org, 1992).
First of
all the client was told the introduction about the harms caused by drugs, then
gradually all steps were being covered.
In the
first step, the client was asked a different question about the physical,
psychological, Social and spiritual reaction of drugs. The client accepted that
he was helpless before drugs, and wanted to find the way to get rid of it, but
side by side he was admitting that it’s a necessity of life, for getting power
and for functioning it should be taken.
In the
second step, the client was informed that drug addiction is a fatal disease,
only cured with the help of God. The client was not ready to accept it a
disease; rather he thinks everybody should take drugs in old age to get
strength. The client also accepted that every kind of disease could be cured by
God. He was excessively showing his interest in religion; he was using
displacement to overcome his anxiety.
In the
third step, the client was taught to spend his lives according to the will of
God, without expecting unrealistic miracles. Spiritual help from God help to
forget all the worries of the past, and anxiousness about the future and helps
to live today with full peace of mind. Whenever a person decides to leave
drugs, a will power inside that person start working against your decision, and
the person feels more attraction toward drugs, but with a spiritual patient,
and strongly believe on God will make him firm at his decisions.
In the
fourth step, the client was asked to take one more step, examine all of his
action fearlessly and write down it. The client was asked how he examined
himself, daily, weekly or monthly basis. He was advised not to think it’s a
negative part of treatment, it will not open all of his secrets or worst
aspects of his personality, and rather it will give the confidence to accept
all his weaknesses. The client hesitantly started confessing his mistakes, that
he got aggressive on caring behaviours of a family in drugs effect and
disappointed them by his behaviour.
Terminating therapy
All the
management plan of the client was done successfully, and the client corporate
in all therapeutic interventions. The client was informed about the termination
process, as the client was aware of the purpose of the session activity, so it
was told to the client that now the time has over for sessions. He was advised
to maintain his learned behaviour in the future.
Outcomes
The
outcome of management was assessed through pre and post-test assessment. The
client was responding positively on assertive training steps, at least he
accepted that he did not think in that direction ever before.
His
conflict about female was reduced through positive imagery as he wasn’t someone
in her life, but due to a previous experience he was maintaining a gap from
them, but that thing causing distress. Through a few kind ladies of her life, he
was visualising a peaceful new life. The
outcome was positive as he decides to start a new life with his family.
His
delusion of persecutory was tried to remove through psychoeducation; the client
was asked to accept all his failure to her own mistake. Nobody is perfect in
this world. The client admitted that.
The client
was psycho educated about the harm of drugs and advised to control his cravings
physically and emotionally. The client was at least tried to control his urges
of drugs.
Figure 1
The
significant result between pre and post assessment was noticed by the
therapist. The client conflict for female was decreased and he showed positive
results in an assertiveness training program. Psycho-education also brought
fruitful result as the client starting differentiating between the peace of his
life before drug addiction and dissatisfaction from the current situation
because of drug abuse.
The session could not prolong as the client was
being discharged from the hospital. The proposed invtervention plan has been
made to treat the patient with Alcohol Induced intervention.
Proposed
Intervention
Brief Intervention. Brief interventions prolong for a maximum of two
sessions — the brief interventions aimed at increasing the possibilities of
change by reducing the harmful behaviour associated with alcohol. The brief
intervention primarily focuses on empathy with the client, reducing adherence
for not quitting alcohol. The brief intervention can be delivered in clinical
or non-clinical settings. The brief intervention was based on the motivational
interviewing principles and found to be effective for the management of alcohol
abusers.
Self-help Based
Intervention. Self-help
based intervention the psychologist provides the material to the patients for
monitoring and reviewing the consequences of treatment. The self-help based
interventions may be delivered through the phone. The intervention is based on
CBT and motivational theories regarding drinking behaviour. The intervention
duration prolongs on four sessions and two follow up session. The psychologist
utilised the range of books, CD Roms and websites.
Self-help Group. In self-help groups, the people of alcohol meet
regularly and support and solve the problems of each other. The group can be
formed in a non-clinical setting such as peer-led or community-based settings.
Behavioural Therapies. Cue exposure, contingency
management, and behavioural self-control training are very effective therapies
to reduce the alcoholic behaviours of the patient.
Cognitive Behavior
Therapies. The cognitive model of
substance abuse drove the standard CBT, copying, social skill training, and
family intervention. The emphasis of such therapies to emphasis on the
irrational thoughts, managing negative mood and intervening after a lapse to
reduce the risk of full-blown relapse.
Motivational Techniques. Motivation enhancement therapy
and motivational interviewing are two useful techniques to increase intrinsic
motivation by resolving and exploring ambivalence.
Social Services and Environment Based Therapy. Social
network therapy, community-based reinforcement approach, and social system
management plan promote the absentees for alcohol intake by indulging the
client into activities.
Literature is enriched with the number of
alternative therapies, intervention and management plans for alcohol-induced
psychosis. the
Limitations
There were many limitations in a setting which were
faced to achieving long and short term goals.
• The client himself was compliant, but his peer in the hospital was so aggressive towards drug management, they make fun of the client when he follows the steps of assertive training.
• The client had to work under an attendant; he got free for a concise period that was the basic issue which was creating difficulty in obtaining positive results.
• The client was fed-up from interviews; he did not allow opening diary to note the point; he often suggested not to write about his personal life.
Recommendation
• More groups should be conducted about the awareness of psychologist work and their aim, and they should be aware of the term help, not the interview.
• Psychologists should not take excessive work from clients; they should be free for a session to enhance their weakness.
• The clients should be ensured about the confidentiality of the recorded data.