The final legal or ethical consideration that cocaine has on a person or family is because of the use of drugs. Husak (2002) asserts that being in possession of the drug is just cause for an arrest. There can also be other legal and ethical ramifications to drug use because of the risky behaviors that cocaine addicts participate in.
Diagnosis and Treatment
A person that is addicted to cocaine is not likely to seek treatment for their addiction on their own unless something drastic happens in their life or forced to by legal actions (Passetti & White, 2007). There are several types of therapies available for cocaine addiction. They are: (1) Cognitive-behavioral therapy (CBT), (2) Contingency Management, and (3) Community Support Meeting. The National Institute of Drug Abuse (2010) states “behavioral therapies are often the only available and effective treatments for many drug problems” (p. 6).
Lee and Rawson (2008) characterize CBT as talk therapy that stands on the theory of conditioning and learning that is used to teach, give confidence, and support to people on how to decrease or stop their dangerous drug use. Beck, Wright, Newman, & Liese, (2001) describe CBT as a psycho-therapy that utilizes the understanding of why the user is using the drug to reduce the behavior by changing the user’s thought process on why they are using the drug. Therefore, CBT helps cocaine addicts to abstain from cocaine. It is a learning technique that plays an important part in the progress of cocaine addiction. CBT also helps the cocaine addict identify, stay away from, and deal with the situation that cause them to use cocaine in the beginning (NIDA, 2010). CBT is considered a good therapy process to prevent relapse. It is important for an addict to be able to take what is learned in therapy into the real world to challenge the behaviors.
According to the National Institute Drug Abuse (2010) contingency management treatment is useful in helping cocaine addicts abstain from cocaine and help them stay in a treatment program through a voucher that rewards them who give up cocaine after they have taken a test to see if they are drug-free. When cocaine addicts struggle with relapse, they should be placed in a support recovery group. Passetti and White (2007) assert that “following addiction treatment, most people struggle with recovery and relapse, and high relapse rates have been reported during the first 90 days after discharge” (p. 97). They went on to say that youth recovery from drug abuse needs to be in a support recovery meeting such as a 12-step program. They also stated that the “handful of existing studies designed to explore the helpfulness of young people’s involvement in 12-step groups shows promise in this approach to help with relapse” (p. 102).
Treatment Intervention (Trends Critique)
Cognitive Behavioral Therapy
Description
Cognitive-Behavioral Therapy (CBT) is therapy that makes a user/abuser aware of their addictive behavior and how this addictive behavior is affecting them and their environment (VandenBos, 2007). It also teaches the user/abuser how to change their thoughts of using a substance into positive and constructive behaviors in society. For example, if a person’s addiction is to cocaine than CBT would challenge the thought of using cocaine as a coping skill and change the coping skill into a behavior such as painting. National Institute of Drug Abuse (2010) states that
“CBT helps clients recognize, avoid, and cope that is, they recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with drug abuse” (p. 6).
Strengths
One strength of cognitive-behavioral therapy (CBT) is the client will be able to identify negative thoughts (Dingle, Gleadhill, & Baker, 2008). When applying CBT to cocaine addiction, it can teach the client new coping skills to their problems instead of relying on their destructive behavior. Dingle, Gleadhill, and Baker (2008) states
“the hallmark of CBT approach are a functional analysis of the addictive behavior (identifying the consequences) and skills training, in which the individual learns to avoid situations that are high risk for substance use or to use better coping strategies when such situations cannot be avoided.” (p. 191)
Applying CBT allows an individual with cocaine addiction to concentrate on the positive behaviors they already display and how they can make their life better. Since they are spending more time looking at the positive behaviors and thoughts, the destructive thoughts that lead to destructive behaviors change and the individual can mold their thought processes into much a more positive way of thinking. Denning (2004) conveys that this approach is excellent for those specifically who are abusing drugs alone. Teaching the client about positive behaviors is important and strength of CBT.
Weaknesses
Much like any therapy, CBT has its weakness with certain diagnoses. The first weakness when it comes to cocaine addiction, the client must want to accept their addiction and want to change. With CBT therapy the individual must confront their behaviors and understand how damaging they are. Since this is the way CBT must be done, many addicts feel alienated from society or the environment they are used to thus causing them to not seek treatment (Robinson-Riegler, & Robinson-Riegler, 2007). The second weakness of CBT is that as Denning (2004) describes, it is not complex enough for those with cocaine addiction and mental health disorders.
Other Issues
Human rights are very important when dealing with individuals, no matter what the setting. Human rights during therapy are even more important because a counselor practicing in cognitive behavioral therapy (CBT) are delving into the triggers of cocaine addicts and those addicts are still humans and deserve to be treated with respect. A client going through therapy using CBT will explain their behaviors to their counselor that the individual would not normally discuss with any other person. So just like any other type of counseling, the counselor must portray the most confidence in confidentiality with the client (Robinson-Riegler, & Robinson-Riegler, 2007).
Cognitive Behavioral Therapy is a good therapy for some cultures and possibly not for other cultures. It is designed to deal with the way a person think. CBT counselor must be culturally aware of the individual thought pattern, beliefs, and the person’s values. Webb, Scudder, Kaminer, & Kadden (2007) states
“the clinician needs to be sensitive to ethnic and cultural problems that may cause problems in the diagnosis and treatment (eg, difficulty in communicating in the individual’s first language, in eliciting symptoms or understanding their cultural significance, in negotiating an appropriate relationship or level of intimacy, in determining whether a behavior is normative or pathological)” (p.28).
The legal issue surrounding CBT is if the addict exposes something that could harm another person, the counselor is obligated to take reasonable steps to protect, and warn that other person or the federal authorities. It is also the duty of the CBT counselor to report recent events of any dangerous or sexual abuse (Webb, Scudder, Kaminer, & Kadden, 2007).
The ethical issue surrounding CBT is that the counselor must maintain a judgment free setting in which the individual can openly discuss the destructive behaviors he/she is participating in without being judged by the counselor. It is imperative the counselor keeps all sessions and information pertaining to the client confidential (Robinson-Riegler, & Robinson-Riegler, 2007).
Cognitive Behavioral Therapy (CBT) appears to be the recommended form of treatment for those with a drug addiction like cocaine addiction. CBT is a form of therapy that makes the client aware of why they participate in certain destructive behaviors, as well as teaching them how to change their behavior to something positive. This approach is an appropriate treatment for cocaine addiction because it has been used through out society (NIDA, 2001).
Contingency Reinforcement Description
Contingency reinforcement is a treatment approach that replaces the cocaine addiction with other positive reinforcement. Contingency reinforcement has been proven to be effective in promoting cocaine addicts who stop using cocaine by replacing highs of the drugs by natural highs such as reinforcers for the client. It provides other types of reinforcers for abstaining from drugs such as a job, a house, and money if they can prove that they are drug free from a urine sample (LeSage, 2008).
Strength
A strength of contingency management is that it has the capability to form behaviors that are connected, which includes abstaining from drugs. In other words, it will give the client avenues in which to focus on to change those behaviors.
Weaknesses
One weakness of contingency management is the skills required for this treatment is not familiar to experienced counselors. Another weakness of contingency management is that the results from completing the treatment fail to show that many of the cocaine addicts do not react to this treatment often because they do not give an example of the changed behavior, and that they receive no reward (Carroll, & Rounsaville, 2007).
Other Issues
Human rights are an important part of any counseling treatment. The human rights of contingency management is that the client has the right to know the procedures in which they will have to follow in order to change that targeted behavior for incentives, how long the treatment last, and what are the consequences of the client’s success or failures in making the behavior change (Higgins, & Petry, 1999).
Contingency management treatment is appropriate for the diverse clients no matter what ethnic group they are from. Barry, Sullivan, and Petry (2009) states
“contingency management is effective regardless of the ethnic background of clients participating because it is mainly focusing on the behavioral treatment that provide tangible reinforcement for objective verifiable abstinence from cocaine or other targeted behaviors whether than the ethnicity and their beliefs” (p. 168).
The legal issue involved in contingency management treatment is that if the therapeutic process between the drug addict not done with respect and trust in making sure they understand the contingency contract between them, and they do not receive the incentives or does not abstain from drug use that was outlined in the treatment plan, the therapist could face ethical issues from the client or the family because the counselor did not comply to the contingency management treatment plan.
The contingency management treatment can be a productive process for clients with cocaine addiction. It can help them abstain from cocaine through incentives such as money, housing, and a job if they can prove that they can abstain from cocaine when tested through a urine sample and live a productive life free of drugs. This is not the best treatment approach due to the fact that it does not prevent relapse and recovery by abstaining from cocaine on their own freewill. It is done through incentives that may not work. Addiction is a behavior that is difficult to overcome and this process only goes into the reasons for the behaviors and not ways to fully prevent them.
Other Intervention
There is an alternative option to therapy for those suffering with cocaine addiction. Support Community Meeting, which is also known as support recovery group have been found to be very effective for cocaine addiction (Passetti, & White, 2007). This option is for addicts who struggle with relapse. Passetti and White (2007) assert that “following addiction treatment, most people struggle with recovery and relapse, and high relapse rates have been reported during the first 90 days after discharge” (p. 97). They continued to say youth recovery from drug abuse need to be in a support recovery meeting such as a 12-step program. They also stated a “handful of existing studies designed to explore the helpfulness of young people’s involvement in 12-step groups’ shows promise in this approach to help with relapse” (p.102). The most important thing for an addict is not to feel alienated during therapy. The 12-step groups benefits the cocaine addict because the addict does not feel like they are alone when going through treatment (Passetti, & White, 2007).
Comparison of Cognitive Behavioral Therapy & Contingency Reinforcement
The implementation of CBT is desirable in those cases where the counselor intends to focus on helping the cocaine addict to refrain from the use of cocaine. It is a technique that is a key component in the progress of cocaine addiction recovery. The process through which a counselor guides their client during CBT begins with assistance in recognizing those thoughts that lead to negative behaviors which in turn lead to or contributed to the use of cocaine. Once these behaviors have been identified the counselor works with the client to cease from, and address the negative behavior that caused the addict to abuse cocaine in the first place, as well as face the underlying issues of their behavior.
Contingency reinforcement is another alternate in the treatment of cocaine addiction which is designed to reward a client for successful progress towards total addiction recovery. In a treatment plan consisting of contingency reinforcement, a key component of overcoming cocaine addiction is offering rewards when the client has met the treatment goals. These goals are met when the client has succeeded in abstaining from the undesired behavior, which, in this case, is cocaine use. The client, along with their counselor set the treatment goals at the beginning of the treatment plan to assist the client in abstaining from cocaine use and thus be able to receive the incentives which are also set at the beginning of treatment.
These two treatment styles are complete opposite therapy methods: CBT looks at modifying the thought process of a client and how they view situations; where as contingency reinforcement uses a reward system to promote continued success in treatment. CBT focuses on underlying causes and looks at the cognitive thought processes behind the behaviors. Contingency reinforcement is a behavioral therapy that seeks to promote certain behaviors while diminishing others through the use of natural results. CBT focuses on the way a person thinks and attempts to modify their behavior by having them take a situation which would normality lead to cocaine use and making them look at it from a perspective different from that initially lead them to use cocaine. In contrast, contingency reinforcement attempts behavior modification by rewarding behavior to try to make other certain behaviors, such as the use of cocaine, extinct and labeling the cocaine use as bad and the lack of cocaine use as good. In short, CBT is a cognitive therapy and contingency reinforcement is a behavioral therapy.
Intervention Design
Description and Case Study
Cocaine is a natural drug, originally from leaves of the coca-cola plant. Cocaine is typically inhaled, ingested, or smoked in the favorably refined form known as crack. The most problematic aspect of treatment and recovery from cocaine includes the guilt and severe shame felt by most cocaine addicts. It is factual that all addicted individuals feel shame because drug-using behavior is often in disagreement with a person's self-worth and morals. Cocaine addiction is causing addicts to spend excess amounts of dollars having affairs, lying, and stealing, which are hard things for the addicts to face. The guilt behind cocaine addiction becomes the main reason for addicts to use more cocaine. In a sense, reaching a level of highness is a brief vacation from the intense guilt and shame associated with cocaine addiction.
Effectively treating cocaine addiction is the combination of the three previously discussed treatments. Cognitive-Behavioral Therapy, Contingency Management, and Support Community Meeting. As a counselor, it is important to treat the person and not the disease. This means that the counselor must allow three the interventions to work cohesively and effectively together.
Each intervention must be explained to the client in a clear and concise way so the interventions are easily understood. As this is done, the combination of the interventions in one session must be avoided so that there is no confusion for the client.
The following case study is an example of this intervention design. A woman, who is 49 years old, has come to seek help for her addiction to smoking cocaine, which has caused her to miss days, and cannot perform her duties at work and home. She has the support of a friend and her boss, who referred her to counseling. This intervention assists with both the emotional and behavioral aspects of cocaine addiction.
A solid assessment of the addiction is the key to treatment with a client suffering from cocaine addiction. Many cocaine addicts have addictions to other things which are also diagnosable, such as other drugs leading to a diagnosis of Polysubstance abuse. When dealing with other addictions, treatment should be coupled with subsequent treatment. For the purpose of this is case study, there is not another addiction for treatment with the client.
There are many things that the client must face when going through treatment. The information the best helps with successful treatment and recovery include such things like their environment, culture, past and family medical history, or support systems in place. When this information has been collected, the intervention and therapy can begin. Step one in a successful treatment is that the client understands and recognizes that they have an addiction. She must then understand that they are there because they want to be there to get the help they need. Most people in treatment for cocaine addiction are in treatment because of family members that have pushed them into treatment or a judge’s orders to go through treatment. This is not helpful because these clients do not want to change and do not see that they have a problem. If this is the case, the family must be willing to get involved in therapy to help the client understand that they have a problem.
Once the client understands that they have a problem the counselor can then seek out why they started their destructive behavior of use. This can come from any number of reasons including negative stress in their environment. When the counselor is doing this, they are using cognitive-behavioral therapy. Since this part of treatment can be very intense the counselor must explain what the client can expect from this process in therapy. The counselor does not want the client to feel uncomfortable at any time when talking about past traumatic experiences that may have cause the client to start using or what happened while the client was using.
CBT focuses on helping cocaine addicts to refrain from cocaine. It is a technique that is a key component in the progress of cocaine addiction. It also assists the addict to recognize, cease from, and face the negative behavior that caused the addict to abuse cocaine in the first place. To continue our case study; CBT will help the client face the fact that her brother was having sex with her for many years that it was not her fault, she does not have to use cocaine to cope with this situation. This process of the treatment that was presented to the client is an important one because it will lead to her abstaining from cocaine. After several sessions of discussing the trauma that caused the negative behaviors with her, she begins to open up to the counselor about her problem. The counselor learns that she began smoking when she was 12-years old to forget about the fact that her brother began having sex with her at the age of six. During one of the sessions, she describes to the counselor how her brother would come into her room and had sex with her every night and tell her this is right because this is what brothers and sisters do to show their love for each other and no one else must know because they would not understand their relationship. She did not know that this was wrong until she was older, but she did not think that it was affecting her until she begin failing in school because she was trying to forget that it happen so she dropped out in the tenth grade, and begin doing drugs every day with her friends, being defiant with her mother. She continued to do drugs and began having sex with men and stealing from her mother to support her habit. She became depressed during session every time she would think about what her brother did to her. The counselor must be very sensitive to the nature of this disclosure, but work with her to move past it. The counselor must help her realize that it was not her fault. This step of the intervention will continue until the client has dealt with the negative behaviors through coping skills so she will be able to forget about the negative behaviors connected with cocaine abuse, and learn healthy behaviors until the counselor has gained her trust and willingness to move on to abstaining from cocaine.
The model this counselor is proposing would next consist of the contingency management therapy. A key component of cocaine addiction is offering rewards when client has met treatment goals by abstaining from the undesired behavior, which is cocaine use. In order for the client to abstain from cocaine, she will have to complete a set of treatment goals that is set by her and the counselor that will help her abstain from cocaine so she will be able to receive the incentives. Abstaining from cocaine will enable the client to regain control of her life and be able to function on a daily basis through the rewards such as housing, a job, and money from staying free of cocaine. For example, if the client can think about her brother, and the rape is not causing her to want to use cocaine, she will have a place of her own to live and not have to live in a shelter or abuse her body for survival, and live a productive life.
The final portion of therapy is follow up. This will be face to face in the beginning and then progressively move into telephone check-ups. The client must also attend her support community meeting which would consist of a 12-step program to prevent relapse. Since this is the last step of intervention the client must be able to not use cocaine and be able to discuss their addiction with their support community. In the 12-step program the client must complete logical steps that, with the help of her support community, help her stay strong in her non-usage of cocaine. The important part of this last step in therapy is for the client to realize that they can have a normal life that does not involve the use of cocaine, or any other substance.
Like any intervention this one does have its weaknesses. First, it would be difficult to help the client abstain from cocaine because it offers incentives. Next, the incentive would be very difficult to continue because of the cost. Lastly, the client may not abstain from cocaine because she is being rewarded to stay free not on her own free will.
Conclusion
Fundukian and Wilson (2008) define cocaine as a “whitish crystalline powder that produces feelings of euphoria when ingested, it is most commonly inhaled or snorted, and it may also be dissolved in water and injected” (p. 268). Cocaine is addictive and keeps one coming back for more because of the craving, which makes them do anything to purchase this drug because it gives them that high. It does not matter what it is, it could be lying, stealing, cheating, or prostitution. A person that is addicted to cocaine is not likely to seek treatment their own unless something extreme happens in their life or required to by legal actions. There are several types of therapies available for cocaine addiction. For example, a counseling intervention model for cocaine addiction using a combination of CBT, contingency management, and support recovery meeting can be effective. For instance, support recovery meeting, which is a 12-step program for cocaine addicts who struggle with relapse. In a few counties, there are drug rehabs and drug recovery programs like support community meeting, that is making an impact such as Serenity House, which is an inpatient facility that focuses on drug treatment programs once the client is ready.
This student feels that the intervention as a whole is an effective model because it looks at several aspects of the addiction, negative experiences such as anxiety, personality, as well as neglecting responsibilities, the neurotransmitter of the brain, it causes heart damage, and the intense energy creates emotional and physical depression (Inaba, & Cohen, 2007), which could have caused trauma leading to the addictive behaviors. The behaviors themselves that were linked to the negative have now become positive so the follow-up therapy along with support group will enable the client to live a productive life without drugs.
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