AOD Youth Work: Harm Minimization Approach Vs Alcoholics Anonymous

Two Different Models of Alcohol Addiction Treatment

Liz is a 44-year old ex-nurse who has recently re-entered the workforce after a 12-year break. She’s now a part-time case worker at her local Community Youth Centre and she specialises in working with young people who have alcohol and other drug (AOD) issues.

Today Evan, Liz’s supervisor, has asked her to meet with Helena who is a new case worker and a recent graduate. Evan has asked Liz to brief Helena on a new client who has come to the service for support. The new client is Cory, a 22-year-old male. According to his file notes, Cory has tried a number of different interventions to reduce harm from his alcohol use over the years and he has recently successfully completed a detox and rehab program.

Even though Cory is only 22, he has already had periods in his life where he has been alcohol dependent. These periods have coincided with events in which he has experienced significant losses and trauma. Cory lost his mother to cancer when he was 7 years old. Two years later his big brother, Tom, was killed in a car accident. Following these events Cory was diagnosed with depression. He was also ‘self-medicating’ with alcohol to cope with the feelings of loss and the loneliness he was experiencing.

Cory was referred to a grief counsellor to address these issues and he feels they were major factors in his depression and his inability to control his drinking. He is now looking forward to getting his life back on-track. Currently, he has a very supportive partner in and he enjoys spending time with a few close friends. He also has a job and has stated that he doesn’t want to stop drinking completely. His file notes say that he is coming to the Community Youth Centre because he would like support to help him moderate his drinking.

During the briefing session, Helena argues passionately with Liz. She states that Cory should be abstaining from alcohol altogether and attend AA (Alcoholics Anonymous) meetings. Liz explains to Helena that according to his file, Cory has had long periods in his life where he has controlled his drinking very successfully. This Harm Minimisation approach aligns with their organisation’s policies and it is considered a more realistic approach than abstinence. Given Cory’s age and experiences so far, his file notes state that he should be supported in learning how to control his drinking rather than trying to never drink alcohol again. 

Identify the two different ‘models’ being discussed by Liz and Helena and provide a brief explanation of each. 

Identify Cory’s rights in this scenario. Refer to your understanding of ‘client’s rights’ from the learning material and your work practice to inform your answer. (Use bullet points)

1. c) Provide an explanation outlining what Liz could say to Helena to convey

• the practice values and philosophy of the AOD Youth Work sector.

• the key purpose and benefits of using a person-centred (client-centred) approach

• Recognising that we are all influenced by the values and beliefs we grew up with, how might your own experiences or values impact on your work with young clients who are experiencing AOD related issues

  Remember, being aware of our own biases in AOD related Youth Work and developing self-awareness improves our ability to work with vulnerable young clients effectively and without judgement.

  Reflect on the questions below and answer them as honestly as you can.

• b) How can you can ensure that your practice reflects the core values of the AOD Youth Work sector.

Briefly describe 5 specific strategies that Liz would discuss with Helena and might use when working with Cory that show consideration of his rights, his values and his treatment choices.  Your responses need to reflect a person-centred (client-centred) approach and take into account Liz and Helena’s roles as case workers within the AOD Youth Work context e.g. the relevance of the Harm Minimisation approach, stages of change etc.

Alcoholics Anonymous (AA) is more comprehensively assessed as an approach rather than a model to help the alcohol addicts in keeping abstinence from alcohol use (Kaskutas, 2009). The program is usually run and monitored by an organization of the same name. In this approach, the members can take part in meetings without having to pay any money and those people are treated with a spiritual stance which suggests the belief in a highly powerful entity (Vourakis, 2013). The program consists of twelve stages through which the addicts might develop a strategy to keep abstinence from alcohol abuse and quit drinking forever. Research works suggest that AA might prove to be an efficient approach if the properly trained professionals administer and monitor the program (Krentzman et al., 2011).

Harm Minimization approach or strategy is designed for ensuring that the potential harms due to alcohol abuse is minimized and appropriately assessed (Crofts and Deany, 1999). However, this strategy does not emphasize much on abstinence, rather it suggests that approaches should be carefully developed in order to minimize the harms by controlling and reducing the extent of alcohol abuse (Moore and Rhodes, 2004). In this approach, the professionals attempt to help the addicts by reducing the supply of alcohol, reducing the demand for alcohol, and finally, reducing the potential harms (Bessant, 2008). The strategy is suitable for especially those who have demonstrated an will or actual evidence to control their alcohol drinking or drug abusing habits.

The AOD Youth Work Sector is driven by various practice values and philosophical underpinnings that should be critically and essentially considered in order to provide the best available treatment in a particular scenario. Firstly, the service providers need to thoroughly assess the personal, professional, environmental, and social factors associated with the individual so that they can design or adopt an approach which suits best for the person and in that scenario (Savic et al., 2017). Secondly, the service providers need to provide utmost value to the respectability, dignity, personal choices and preferences of the clients in order to deliver an ethically competent and professionally efficient treatment (NSW Department of Education and Training, 2009).  Finally, along with maintaining the confidentiality of the data related to the client, the service providers need to appropriately utilize their knowledge and experience (instead of personal choices or biased preferences) in order to develop strategies that is applicable to the person and his/her state (Savic et al., 2017). Thus, the service providers will be able to deliver treatment which is peculiar to the condition of each and every different individual. 

t is suggested that a professional associated with the AOD youth work sector needs to overlook the perceptions, beliefs and thoughts which might prove to be a hindrance to the entire professional sphere. In this regard, it should also be taken into consideration that personal values and experiences would help a professional to assess a particular scenario better than others. If a professional develops high ethical values or if he/she gains immense experience while working in this sector, the professional individual might make good use of his/her values and experiences while addressing the issues faced by a help-seeking person.  On the other hand, negatively identified values and experiences would lead to negative consequences. Therefore, I, as an AOD Youth Work Sector assistant, need to focus on the ethically guided aspect where the importance is given to the client instead of the service provider's personal preference. 

Client's Rights in AOD Youth Work

In order to ensure that my practices reflect the core values of AOD Youth Work Sector, I need to focus on a number a number of aspects. Firstly, the confidentiality of the data related to the client needs to be maintained at any cost. Secondly, the strategies should be adopted and implemented in accordance with the personal values and preferences adopted by the clients as much as possible. Moreover, it should be made sure that the client is treated and assisted from an angle which does not incorporate personal inclinations by the service provider. The safety and dignity of the client should be utmost important aspect aspects for the professionals associated with this sphere. 

Motivational interview sessions allude to a bunch of intercessions that emphasis on expanding the individual's preparation to transform conduct. It can likewise be alluded to as motivational upgrade and motivational guiding. It is a client-focused, mandate strategy for improving natural inspiration to change by investigating and settling vacillation (Miller and Rollnick, 2002). The approach does not concentrate on instructing new adapting aptitudes, reshaping insights, or unearthing the past. It is very centred around the individual's available advantages and concerns. The system includes helping a man to investigate his/her association with substances to increase better understanding into where their utilization fits as far as future objectives and life esteem (Mills et al., 2009). It accomplishes this by expanding a man's comprehension of the advantages and disadvantages of their liquor and other medications utilize, while enabling them to consider the potential effects, frequently as far as a glorified future situation (O'Leary-Tevyaw and Monti, 2004). In this context, Liz and Helena needs to specifically focus on the personal preferences and psychological state of Cory in order to motivate him to reduce the  extent of alcohol intake.

Cognitive behaviour therapy (CBT) is the mix of a couple of helpful frameworks associated with addiction prevention therapy: behaviour-based treatment and psychological treatment. The behaviour-based treatment rose up out of the emphasis on the courses through which conduct is found out and fortified (Bruun and Mitchell 2012). Contemporary behaviour-based brain research considers issues to be maladaptive examples of conduct that have been learned and fortified after some time. On the other hand, the cognitive treatment perceives that issues develop because of mutilations in musings and convictions. These mutilated musings and convictions are frequently unchallenged and the errand of the advisor is to start to test and question the unhelpful convictions and suspicions that lead individuals to brokenness (Rachman, 1997). Although there are some basic contradictions amongst these two aspects, their combined treatment yield fruitful results as they design the treatment by depending on why and how the individual has developed an addiction for drug substances or alcohol  (Hofmann et al., 2012). In this regard, Liz and Helena should focus on exploring the behavioural traits of Cory in order to properly assess his psychological conditions and conductive stances so that more appropriate treatment can be delivered.

Strengths-based case management alludes to the strategy which focuses on developing approaches in accordance with the psychological strengths of the client which might assist in yielding better outcomes. The system concentrates on administration and coordination, confirmed by an accentuation on undertakings, rules, expenses, and results (Gronda, 2009). In a domain of expanding administration multifaceted nature, the part of case administration winds up noticeably one of administration route and mutual cooperation amongst the service providers and help seekers (Prendergast et al., 2011). The approach suggests that a treatment procedure might prove to be greatly helpful if the service providers take into account the psychological strengths of the client because of the fact that it is psychological fortification that works the most in solving a particular issue (Jenner, Devaney and Lee, 2009). Those strengths should be thoroughly exploited so that they can assist in the therapeutic procedure. Thus, Liz and Helena needs to consider the fact that Cory has already demonstrated strong will and intention to reduce the extent of alcohol intake, and therefore, this should be considered as one of his strengths which can be psychologically exploited to yield better results. 

Personal Values and AOD Youth Work

The dialectical behaviour therapy or the rationalistic conduct treatment is quite similar to the CBT, be that as it may, the main contrast is that DBT uses care as a method for expanding resistance of upsetting passionate states (Lienhan, 1993). The strategy sees risky practices as a maladaptive endeavour to manage feelings. The treatment includes learning techniques to screen and react to different enthusiastic states. DBT likewise views restorative organization together as of focal significance furthermore, early sessions concentrate on building this before some other exercises are considered. The attention to the helpful organization together is noteworthy on the grounds that a great many people with marginal identity issue have originated from traded off family foundations that can be depicted as nullifying conditions (Geddes, Dziurawiec and Lee, 2013). In this context, Liz and Helena should consider that as Cory has gone through extreme emotional turmoil which has negatively contributed to his addiction to alcohol, they should initially assess his emotional states and develop techniques to manage the emotions in a positive manner so that he is inspired to reduce the extent of alcohol intake.

The Australian media, in general, has a strongly negative point of view toward meth utilization. This is normal in light of the fact that the media wants the general populace to be aware of the hazardous consequences of such substance abuse. However, it should be kept in mind that the media needs to promote the welfare and interest of the citizens. Thus, instead of simply criticizing the meth users and asking for reducing the number of such users, the media needs to advocate for the policies to arrest and detain the meth suppliers. Furthermore, they should also emphasize on developing strategies that are peculiar to and suitable for different scenarios The Australian media shows glimpses of such advocacy. Be that as it may, the overall stance of the media is quite helpful in increasing awareness among the general population and influencing the respective authorities to adopt and implement appropriate techniques for addressing and mitigating the issue.

The articles suggest that the government is implementing different kinds of policies in order to address the issue. For example, the administration is focussing on the supply reduction strategy in order to make sure that meth is not available in most of the scenarios so that the youngsters cannot get addicted to this substance (The Conversation, 2015). Furthermore, it has also been identified that the administration is strengthening the law enforcement offices as well as youth work sectors to assist the individuals in reducing the potential harm (Fitzgerald, 2015). Finally, it has also been suggested that the spread of education and knowledge regarding the use of meth is being emphasized by the administration in order to reduce the demand for the substance as much as possible (Conifer and Greene, 2015).

The approach of harm reduction comprises of arrangements, policy development, projects, and practices that point principally to decrease the unfavourable wellbeing, socially and financially identified outcomes of the utilization of lawful and illicit psychoactive substances as well as excessive alcohol without essentially lessening the utilization of these substances (McCambridge et al., 2014). This particular strategy benefits individuals who utilize drug substances and alcohol, the relatives and families, and the entire social group which they belong to (Fermín, 2014). The specific strategy to deal with drug and alcohol abuse depends on a solid sense of duty regarding general wellbeing and human rights. The approach alludes to ways to deal with psychoactive medication utilization that intends to decrease the damages related to sedate and alcohol abuse for individuals who are not able to or unwilling to maintain abstinence (Witkiewitz and Alan Marlatt, 2006). The counteractive action of damage is considered as the most elevated need as opposed to accomplishing uncertain restraint from unlawful drug and alcohol utilization paying little mind to the unintended negatively identified results (Jourdan, 2009).

Strategies for AOD Youth Work Professionals

References

Bessant, J. (2008). From ‘harm minimization’ to ‘zero tolerance’ drugs policy in Australia: how the Howard government changed its mind. Policy Studies, 29(2), pp.197-214.

Bruun, A. and Mitchell, P. (2012). A resource for strengthening therapeutic practice frameworks in youth AOD services. Melbourne: Youth Substance Abuse Service (YSAS).

Conifer, D. and Greene, A. (2015). PM sets up task force to tackle ice 'menace'. [online] ABC News. Available at: https://www.abc.net.au/news/2015-04-08/tony-abbott-announces-war-on-drug-ice/6376492 [Accessed 10 Sep. 2017].

Crofts, N. and Deany, P. (1999). A global voice for harm reduction: the establishment of regional harm reduction networks. Drug and Alcohol Review, 18(2), pp.221-229.

Epstein, R. and Street, R. (2011). The Values and Value of Patient-Centered Care. The Annals of Family Medicine, 9(2), pp.100-103.

Fermín, F. (2014). Application of Harm Reduction Interventions to Recreational Drug Use. Journal of Socialomics, 03(1), p.e123.

Fitzgerald, J. (2015). Don’t panic: the ‘ice pandemic’ is a myth. [online] The Sydney Morning Herald. Available at: https://www.smh.com.au/comment/dont-panic-the-ice-pandemic-is-a-myth-20150515-gh2plm.html [Accessed 10 Sep. 2017].

Geddes, K., Dziurawiec, S. and Lee, C. (2013). Dialectical Behaviour Therapy for the Treatment of Emotion Dysregulation and Trauma Symptoms in Self-Injurious and Suicidal Adolescent Females: A Pilot Programme within a Community-Based Child and Adolescent Mental Health Service. Psychiatry Journal, 2013(1), pp.1-10.

Gravely, S., Giovino, G., Craig, L., Commar, A., D'Espaignet, E., Schotte, K. and Fong, G. (2017). Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study. The Lancet Public Health, 2(4), pp.e166-e174.

Gronda, H. (2009). What makes case management work for people experiencing homelessness? Evidence for Practice. AHURI Final Report No. 127. Melbourne: Australian Housing and Urban Research Institute.

Hofmann, S., Asnaani, A., Vonk, I., Sawyer, A. and Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), pp.427-440.

Jenner, L., Devaney, M. and Lee, N. (2009). Case management in alcohol and other drug treatment settings. Victoria: Turning Point Alcohol and Drug Centre.

Jourdan, M. (2009). Casting light on harm reduction: Introducing two instruments for analysing contradictions between harm reduction and ‘non-harm reduction’. International Journal of Drug Policy, 20(6), pp.514-520.

Kaskutas, L. (2009). Alcoholics Anonymous Effectiveness: Faith Meets Science. Journal of Addictive Diseases, 28(2), pp.145-157.

Keck, M. and Correa-Cabrera, G. (2015). U.S. Drug Policy and Supply Side Strategies: Assessing Effectiveness and Results. Norteamérica, 10(2), pp.47-67.

Krentzman, A., Robinson, E., Moore, B., Kelly, J., Laudet, A., White, W., Zemore, S., Kurtz, E. and Strobbe, S. (2011). How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-Disciplinary Perspectives. Alcoholism Treatment Quarterly, 29(1), pp.75-84.

Landen, M. (2003). Methodological Issues in the Surveillance of Poisoning, Illicit Drug Overdose, and Heroin Overdose Deaths in New Mexico. American Journal of Epidemiology, 157(3), pp.273-278.

Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press

McCambridge, J., Kypri, K., Drummond, C. and Strang, J. (2014). Alcohol Harm Reduction: Corporate Capture of a Key Concept. PLoS Medicine, 11(12), p.e1001767.

Miller, W. and Rollnick, S. (2002). Motivational interviewing preparing people to change addictive behaviour. New York: The Guildford Press.

Mills, K., Deady, M., Proudfoot, H., Sannibale, C., Teesson, M., Mattick, R. and Burns, L. (2009). Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Sydney: National Drug and Alcohol Research Centre.

Moore, D. and Rhodes, T. (2004). Social theory in drug research, drug policy and harm reduction. International Journal of Drug Policy, 15(5-6), pp.323-325.

Moore, L., Britten, N., Lydahl, D., Naldemirci, Ö., Elam, M. and Wolf, A. (2016). Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scandinavian Journal of Caring Sciences, 7(2), pp.1-11.

NSW Department of Education and Training (2009). Demonstrate commitment to the central philosophies of the alcohol and other drugs sector - Demonstrate commitment to the central philosophies of the alcohol and other drugs sector. [online] Lrr.cli.det.nsw.edu.au. Available at: https://lrr.cli.det.nsw.edu.au/web/11236/lo/8529/8529_00.htm [Accessed 11 Sep. 2017].

O’Leary-Tevyaw, T. and Monti, P. (2004). Motivational enhancement and other brief interventions for adolescent substance abuse: Foundations, applications and evaluations: Review. Addiction, 99 (2), pp.63-75.

Palmer, R., Murphy, M., Piselli, A. and Ball, S. (2009). Substance User Treatment Dropout from Client and Clinician Perspectives: A Pilot Study. Substance Use & Misuse, 44(7), pp.1021-1038.

Pentz, M., Bonnie, R. and Shopland, D. (1996). Integrating Supply and Demand Reduction Strategies for Drug Abuse Prevention. American Behavioral Scientist, 39(7), pp.897-910.

Prendergast, M., Frisman, L., Sacks, J., Staton-Tindall, M., Greenwell, L., Lin, H. and Cartier, J. (2011). A multi-site, randomized study of strengths-based case management with substance-abusing parolees. Journal of Experimental Criminology, 7(3), pp.225-253.

Roche, A., O'Neill, M. and Wolinski, K. (2004). Alcohol and other drug specialist treatment services and their managers: findings from a national survey. Australian and New Zealand Journal of Public Health, 28(3), pp.252-258.

Savic, M., Best, D., Manning, V. and Lubman, D. (2017). Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review. Substance Abuse Treatment, Prevention, and Policy, 12(1), pp.19-25.

Stockwell, T. (2006). Alcohol supply, demand, and harm reduction: What is the strongest cocktail?. International Journal of Drug Policy, 17(4), pp.269-277.

The Conversation (2015). Are we in the midst of an ice epidemic? A snapshot of meth use in Australia. [online] The Conversation. Available at: https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697 [Accessed 10 Sep. 2017].

Vourakis, C. (2013). Spirituality and Alcoholics Anonymous. Journal of Addictions Nursing, 24(4), pp.205-206.

Witkiewitz, K. and Alan Marlatt, G. (2006). Overview of harm reduction treatments for alcohol problems. International Journal of Drug Policy, 17(4), pp.285-294.