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Task Description:

Students will critique (not describe) a videoed substance-use interview (resource provided on the Moodle site in the folder entitled ‘Assessment 1’).
Students will view and then critique the interview in the video on the following elements using the literature (references):
• The interviewer’s initial contact with the person experiencing a substance-use disorder (the ‘interviewee’);
• The level of rapport and respect the interviewer shows to the interviewee;
• The interviewer’s assessment of the interviewee’s readiness to change;
• The interviewer’s identification of impact of substance use on the interviewee’s health;
• The interviewer’s identification of impact of substance use on the interviewee’s lifestyle;
• The interviewer’s identification of other stressors the interviewee may be experiencing;
• The interviewer’s level of overall engagement with the interviewee;
• The way in which the interviewer concluded (ended) the interview.

Effective Communication Approach for the Interviewer

Considering the statistical data available for Australian demographics, the percentage of drug and alcohol abuse among adolescents has enhanced to 13% in the last decade. Hence, there is a varied range of different programs and strategies in place for both preventing and improving the state of the youth under the grasp of substance abuse (Crits-Christoph et al., 2012). Dual Diagnosis Directive by the Victorian Government is one of the most remarkable innovative addition to the present improvement among the substance abuse victims in the Victoria. Assessment is one impactful element of the dual diagnosis procedure and any error or misinterpretation in the patient assessment interview can not only lead to misdiagnosis, but a behavioural error can agitate the patient and defeat the entire purpose of the interview (Cooper et al., 2012). This essay will attempt to explore and critically evaluate a patient assessment interview for a young substance abuse patient and be able to recognize and analyse the elements in detail and recognize any errors if present.

As mentioned by Le Berre et al. (2012), therapeutic engagement is a fundamental requirement of the relationship between the patient and the interviewer. If the communication approach, tone of voice, even the gesture of the interviewer offends the patient, it will restrict establishment of a mutually respectful between the patient and interview and can even agitate the patient which will restrict him or her from having the comfort or confidence to open up to the interviewer with their issues. As per the Australian guidelines for the interviewing, it is very important for the health care professional to undertake a warm and respectful attitude towards the patient. In this case, the interviewer has not undertaken a very warm approach and has not been engaged in easy conversation with the patient which is undoubtedly one of the key requirements of the effective communication needed for the psychosocial assessment of patients (Vancampfort et al., 2014).

It is crucial to maintain a warm and casual rapport with the substance abuse victim to ensure communication comfort for the interviewer and the patient. As mentioned in the guidelines for successful ASSIST interview by Sahealth.sa.gov.au (2018), it is crucial for the assessor to adequately introduce him or herself along with their professional role and the need for undertaken this assessment interview. Informed consent is a very important aspect while undertaking any care activity with a patient. As mentioned by Cooper et al (2012), non-judgmental open approach to communication and informed consent is considered to be respectful for the patient. In this case, the interviewer has started the communication with the patient with the fact his mother is concerned about him and has asked personal question without attempting to build a rapport with him with small talk. Along with that the interviewer also failed to initiate the interview with the mandatory confidentiality policy and informed consent either. Hence, it can be stated that the interviewer failed to establish rapport with the patient, however, the interviewer has successfully taken a respectful attitude towards the patient.

Impact of Substance Abuse on Patient's Health and Well-being

As mentioned by Connors, DiClemente, Velasquez and Donovan (2013), with respect to the substance abuse, readiness to change present in a patient has a huge impact on the behavioural modifications that the health care worker is able to implement. On a more elaborative note, recovery from an addiction habit would require implementation of varied range of changes in the lifestyle, hence readiness to change in the patient will determine the exact kind of referrals that can be provided to the patient (Lewis, Dana & Blevins, 2014). As the interview progressed, the interviewer had exhibited patience, perseverance and compassion interrogating the patient regarding the negative impact of smoking cannabis excessively. This subtle technique had been successful and the interviewer could assess that there had been considerable readiness for change in the patient. Gavin only appeared confused and agitated experiencing the early signs of psychosis.  Interviewer convinced Gavin to slowly limit and eventually stop smoking cannabis to be able to regain control of his life and prioritize his health needs.

One of the most key requirements of a substance abuse assessment interview is to explore and evaluate the impact of the prolonged substance used on the health and wellbeing factors of the patients. The referral of the substance abuse victim to different health professionals for psychotherapeutic treatment or intervention will depend on the exact need of the patient associated with the high degree of impact that the substance abuse has been successful in facilitating in the life of the patient affecting his health and wellbeing status. In this case as illustrated by Barnett, Sussman, Smith, Rohrbach and Spruijt-Metz (2012), while assessing the impact of the substance abuse on the victim the interview mistake a non-judgmental compassionate empathetic and yet inquisitors approach to help the patient to get comfortable and be able to explore the extent of the impact that the substance abuse have facilitated in his or her life. In the most cases the impact of substance abuse in centred around not just the physical and mental health outcomes, the impact extends towards the social, financial and spiritual well-being status of the addict as well. Hence, while assessing the impact of the substance abuse on the victim, it is crucial for the interviewer to assess all the mentioned aspects as well. Here he assessed the impact of the abuse on his sleep patterns and activities of daily living, which discovered that he has disturbed sleep patterns and personal hygiene due to his psychotic symptoms. The impact of substance in his behaviour was also accurately addressed or assessed in the interview which needs to be commended. Although, the approach taken by the interviewer could have been more compassionate and empathetic which could have avoided irritation or agitation in Gavin (Smith et al., 2012).

Impact of Substance Abuse on Patient's Lifestyle and External Stressors

As well as health and wellbeing status, the impact of substance abuse is very high on the lifestyle and living conditions of the patient as well. Addiction alters behavioural patterns, choices, judgment and decision making abilities of an abuse victim. As discussed by Bachman, Wadsworth, O'Malley, Johnston and Schulenberg, (2013), the impact of substance abuse is also high on the financial and educational life of the victim, often a substance abuse victim surpasses even the sense off appetite in severe cases of dependability on drugs. Here, the interviewer had started with assessing the impact of his addiction in his TAFE course, in which his progress was significantly threatened due to his psychotic symptoms such as delusions and hallucinations; which indicates the addiction affecting his education and in turn his career. Along with that, the financial impact of the substance abuse has also been discussed where the patient stated he spends $100 a week on cannabis which is affecting his financial stability. Hence, the addiction is affecting his financial stability as well which undoubtedly has a significant impact on his lifestyle deteriorating it every day.

External stressors can also have a deliberating impact on the lifestyle of a substance abuse victim and can even facilitate higher substance abuse as well. As illustrated by Konings et al. (2012), it is crucial for the interviewer that is assessing a particular substance abuse patient to identify the evidence of any stress or that can have a delimiting impact on the patient's lifestyle and substance abuse. In this case, ASSIST framework has a very elaborate questionnaire assessing each of the different substance abuse possibilities involving different drugs, alcohol and tobacco. This illustrative framework has been successfully explored by the interviewer which helped him discover his concerning drug habits involving tobacco, alcohol and cannabis. Furthermore, the interviewer had also been pressing with the intention to discover any stressor facilitating his addiction to cannabis. It was discovered that inability to focus and lack of motivation and self-worth acted as stressors, however there was need for more extensive efforts to explore the origin and exact impact of the stressors.

With respect to overall engagement, the interviewer had been attentive, focused and calm throughout the interview. He had a very perseverant and patient yet effective communication approach for the patient which helped calm him and give him a sense of comfort so that he can freely share his issues. Even when the patient got agitated the interviewer was very calm and apologetic in handling an agitated patient which is a key professional trait for a psychiatric counsellor. Hence, it can be considered that the overall engagement and competence of the interviewer was sufficiently, although his approach had been very professional and distant, and he could have incorporated more empathetic or compassionate approach (Grady, 2015).

Readiness to Change and Behavioral Modifications

Conclusion:

On a concluding note, substance abuse can be considered as one of the greatest threats or dangers associated with the health and welfare of the youth. The percentage of young adults or adolescents associated with some or the other form of substance abuse has enhanced drastically. This assessment had been an excellent opportunity for understanding the effectiveness of patient assessment interview for substance abuse and how the impact of interviewer assessment and how to conduct it successfully to analyse the effectiveness of the interview to adequately explore the exact issues.

References:

ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) :: SA Health. (2018). Retrieved from https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/professional+development/drug+and+alcohol+training+and+development/assist+alcohol+smoking+and+substance+involvement+screening+test

Bachman, J. G., Wadsworth, K. N., O'Malley, P. M., Johnston, L. D., & Schulenberg, J. E. (2013). Smoking, drinking, and drug use in young adulthood: The impacts of new freedoms and new responsibilities. Psychology Press. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=iS15AgAAQBAJ&oi=fnd&pg=PP1&ots=G_Oyz8HnCc&sig=N3W-08qxUU0t0o0gq8V64VG0hRY

Barnett, E., Sussman, S., Smith, C., Rohrbach, L. A., & Spruijt-Metz, D. (2012). Motivational interviewing for adolescent substance use: A review of the literature. Addictive behaviors, 37(12), 1325-1334. Doi: 10.1016/j.addbeh.2012.07.001

Bettmann, J. E., Russell, K. C., & Parry, K. J. (2013). How substance abuse recovery skills, readiness to change and symptom reduction impact change processes in wilderness therapy participants. Journal of Child and Family Studies, 22(8), 1039-1050. Retrieved from https://link.springer.com/article/10.1007/s10826-012-9665-2

Connors, G. J., DiClemente, C. C., Velasquez, M. M., & Donovan, D. M. (2013). Substance abuse treatment and the stages of change: Selecting and planning interventions. Guilford Press. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=spvR78osXbgC&oi=fnd&pg=PP1&dq=substance+abuse+interviewer&ots=BroCXCqvY4&sig=Q-FIPCR7UHsbUV6a8k0Vkknd6xE#v=onepage&q=substance%20abuse%20interviewer&f=false

Cooper, L. A., Roter, D. L., Carson, K. A., Beach, M. C., Sabin, J. A., Greenwald, A. G., & Inui, T. S. (2012). The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American journal of public health, 102(5), 979-987. Doi: 10.2105/AJPH.2011.300558

Crits-Christoph, P., Ring-Kurtz, S., Hamilton, J. L., Lambert, M. J., Gallop, R., McClure, B., ... & Rotrosen, J. (2012). A preliminary study of the effects of individual patient-level feedback in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment, 42(3), 301-309. Doi: 10.1016/j.jsat.2011.09.003

Grady, C. (2015). Enduring and emerging challenges of informed consent. New England Journal of Medicine, 372(9), 855-862. Doi: 10.1056/NEJMra1411250

Konings, M., Stefanis, N., Kuepper, R., De Graaf, R., Ten Have, M., Van Os, J., ... & Henquet, C. (2012). Replication in two independent population-based samples that childhood maltreatment and cannabis use synergistically impact on psychosis risk. Psychological medicine, 42(1), 149-159. Doi:   10.1017/S0033291711000973

Le Berre, A. P., Vabret, F., Cauvin, C., Pinon, K., Allain, P., Pitel, A. L., ... & Beaunieux, H. (2012). Cognitive barriers to readiness to change in alcohol?dependent patients. Alcoholism: Clinical and Experimental Research, 36(9), 1542-1549. Doi: 10.1111/j.1530-0277.2012.01760.x

Lewis, J. A., Dana, R. Q., & Blevins, G. A. (2014). Substance abuse counseling. Cengage Learning. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=tlo8AwAAQBAJ&oi=fnd&pg=PR7&dq=substance+abuse+interviewer&ots=8KdhJJy3TG&sig=MHsIStYyEvkTVRF_uMvaRN_ufAg#v=onepage&q=substance%20abuse%20interviewer&f=false

Smith, J. L., Carpenter, K. M., Amrhein, P. C., Brooks, A. C., Levin, D., Schreiber, E. A., ... & Nunes, E. V. (2012). Training substance abuse clinicians in motivational interviewing using live supervision via teleconferencing. Journal of Consulting and Clinical Psychology, 80(3), 450. Retrieved from https://psycnet.apa.org/buy/2012-09580-001

Vancampfort, D., Vansteenkiste, M., De Hert, M., De Herdt, A., Soundy, A., Stubbs, B., ... & Probst, M. (2014). Self-determination and stage of readiness to change physical activity behaviour in schizophrenia. Mental Health and Physical Activity, 7(3), 171-176. Doi: 10.1016/j.mhpa.2014.06.003

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