Assignment Code: MCFTE-003 / TMA-8(3) / ASST-8(3) / 2022- 23

Course Code: MCFTE-003

Assignment Name: Substance Abuse Counselling and Family Therapy

Year: 2022 - 2023

Verification Status: Verified by Professor

Note: - (i) Answer all the questions in both sections.

(ii) Answers to questions of Section “A” should not exceed 300 words each.

Section A - Descriptive Questions (10X3=30 marks)

Q 1. Analyse substance abuse as a ‘family problem’, with reference to any two frameworks.

Ans) People may think of drug use and abuse as a family problem instead of a problem with the person. Some models or frameworks have been put forward to show how this idea works. These things are:

1. Ecological Framework

People are viewed as components of various systems, such as families and communities, within the ecological framework that is used to discuss drug abuse. The individual's family, friends, treatment providers, non-family support sources, the workplace, and the legal system could all be considered parts of the individual's ecosystem if they have a problem with drugs. The concept that substance abuse occurs within the context of an ecological framework is analogous to the way in which family therapy attempts to understand how people behave by observing how they engage with various aspects of their lives. Therefore, this demonstrates how essential it is to view substance abuse as a process that can be affected by the way a family operates, as well as a process that can change the way a family operates.

2. The Family Systems Model

This conceptual framework is predicated on the notion that the manner in which members of a family discuss the topic of drug use provides insight into the composition of the family unit. If the family can figure out how to deal with the drug use, it will be able to maintain its equilibrium, also known as homeostasis. For instance, a man who has a problem with substance abuse may not be able to communicate how he is feeling unless he is under the influence of alcohol. Some members of the family might start to accept this mode of communication because it might help them talk to another member of the family, which would make it simpler for the family members to communicate with one another. Using the systems approach, a therapist or counsellor may attempt to alter the ways in which family members interact with one another in ways that are counterproductive in order to bring about a change in the individual's pattern of drug use.

Q 2. Explain how injecting drug use is related to HIV risks and vulnerabilities.

Ans) Injecting drug users are more at risk of HIV as compared to the general population because of factors such as exposure to high-risk situations as a result of their drug taking behaviour as well as are highly vulnerable to HIV infection due to discriminatory laws against them/their practices, decreased access to health services and increased stigma and marginalization by society.

Injecting Drug Use: HIV Risks

People who inject drugs (IDU) may be more likely to get HIV because of how they inject or behave sexually. Drugs can be taken in many ways, such as by drinking, smoking, snorting, or rubbing, but when it comes to HIV, injecting drugs is the most dangerous way to get the virus. Sharing a needle that has been contaminated with HIV-infected blood is one of the best ways to get HIV. When two people share a used needle, the risk is five times higher than when two straight people do the same thing. This is one reason why so many IDUs in India have HIV. It has also been found that HIV spreads very quickly through a network of IDUs and then to their sex partners because of how well it is spread.

Injecting drugs can increase the risk of HIV transmission in several ways:

1. Sharing of needles and other injection equipment: When people who inject drugs share needles or other injection equipment (such as cotton, water, or cookers), they increase their risk of exposure to blood-borne viruses like HIV.

2. Damaged veins: Injecting drugs can cause damage to veins, making it easier for infections like HIV to enter the bloodstream.

3. Risky behavior: People who inject drugs may engage in other risky behaviours, such as unprotected sex, that increase their risk of exposure to HIV.

4. Lack of access to harm reduction services: People who inject drugs may not have access to harm reduction services, such as needle and syringe programs or opioid substitution therapy, that can help reduce their risk of HIV and other blood-borne viruses.

3. Suppose a young couple, belonging to middle SES, comes to you with the problem that the husband is an alcoholic. Discuss the strategies and techniques you would use, in the context of behavioural marital therapy.

Ans) Behavioural marital therapy can be an effective approach to help a husband who is struggling with alcoholism.

Behavioural therapy for alcoholics may include:

An alcoholic husband's substance abuse, relationship dynamics, couple relationship, family system, and other social systems must be addressed to intervene at multiple levels. This comprehensive approach addresses addiction's effects on all aspects of the individual's life through individual, couples, and family therapy.

A thorough assessment is needed to identify the main reasons an alcoholic husband uses. Assessing individual and couple skills and deficits should motivate change. This helps the therapist create a husband-couple treatment plan. Assess the husband's substance abuse history, effects on life and relationships, goals, and motivation to change. The therapist can treat addiction by assessing the husband.

An alcoholic husband's therapy aims to identify psychological issues and reinforcers for continued use and abstinence. Alcohol may affect his health, relationships, and finances. The therapist would help the husband understand his expectations about alcohol use and its consequences and develop more realistic and positive sobriety attitudes. The husband's treatment plan will be based on this assessment.

Treating an alcoholic husband requires teaching coping skills. Self-management, stimulus control, substance refusal, alcohol use, and impulse monitoring can be taught. These skills can help the husband manage cravings, alcohol use, and self-control. The therapist may help him identify and avoid drinking triggers, plan for situations where he may be tempted to drink and track his alcohol use over time. These coping skills can help the husband overcome addiction.

Alcoholic husbands can learn problem-solving and communication skills from therapists using substance-related topics. The therapist may help the husband develop alcohol-free strategies for social gatherings and holidays. The therapist may help the husband discuss his addiction and treatment with family and friends. The husband learns problem-solving and communication skills to stay sober and recover.

Helping an alcoholic husband recognise high-risk situations prevents relapse. Examine social situations and people who may influence his drinking. The therapist may help the husband identify friends or social activities linked to his alcohol use and develop a healthy, substance-free plan to handle them. Recognizing and managing high-risk situations can help the husband recover.

Section B - Short Answer Type Questions

1. Write short notes (in about 150 words each) on the following: (5x4=20 marks)

i) Substance abuse in women

Ans) Substance abuse in women refers to the harmful use of drugs or alcohol by women. Women who abuse substances face unique challenges, including greater risk for addiction, physical and mental health problems, and social consequences. Substance abuse can also exacerbate pre-existing conditions such as anxiety, depression, and trauma. It is important for women to receive specialized care that addresses their specific needs, including access to gender-specific treatment programs. Effective treatments include behavioural therapy, medication-assisted treatment, and support from family and peers.

A more recent study of 1865 women who use drugs from all over the country came to the same conclusion: 75% of them use heroin regularly and about 50% of them use alcohol and sleeping pills regularly. At the national level, the NHFS III (2005-2006) is the only source of data on tobacco use, and it shows that around 10.8% of Indian women use tobacco, mostly in chewable form (8.4 percent). Indian women don't all smoke cigarettes or bidis (1.4 percent).

ii) Treatment resistance

Ans) Treatment resistance is when someone with a substance use disorder doesn't respond to treatment and keeps using drugs even though there are efforts to help them. This can happen for a number of reasons, such as bad treatment, lack of motivation, having more than one mental health problem, or factors in the environment. Some ways to deal with treatment resistance are to do a more thorough assessment of the person's needs, combine behavioural therapies, and treat people who have more than one disorder. In some cases, a person may need to be sent to a higher level of care, such as inpatient treatment.

Resistance to treatment is something that people often have to get past. This can happen in the early stages of drug abuse when people deny or downplay their drug use and its effects. Patients who are getting treatment and also have other mental illnesses, like personality disorders, and those with the least amount of social and occupational dysfunction are the most resistant to treatment.

iii) Principles of RPT

Ans) Relapse prevention treatment (RPT) is a form of behavioural therapy that helps individuals with substance use disorders manage triggers and avoid returning to substance use.

The principles of RPT include:

1. Addictive behaviours are learned habits that people keep doing because they get immediate rewards that either make them feel better or make them feel less bad.

2. The rewards keep people using drugs even though they know there will be bad things that happen later, which may be very bad and last a long time.

3. Behaviours that are learned can be stopped by breaking the link between using alcohol or drugs and getting more pleasure or less pain.

4. The client can be helped to develop a set of new, more useful behaviours.

These principles are designed to help individuals develop the skills and resources they need to maintain sobriety over time.

iv) Concept of psychosocial rehabilitation

Ans The term "psychosocial rehabilitation" refers to a collection of interventions and strategies that are aimed at restoring or improving the psychological and social functioning of individuals who are suffering from mental illness or substance use disorders. This strategy is predicated on the idea that, given adequate support and resources, an individual is capable of making a full recovery and leading a life that is meaningful to them.

The goals of psychosocial rehabilitation include:

1. Improving psychological and emotional well-being

2. Building social skills and relationships

3. Developing independent living skills

4. Enhancing vocational and educational opportunities

5. Reducing hospitalization and promoting community integration

Interventions in psychosocial rehabilitation may include cognitive-behavioural therapy, skills training, peer support, employment and education services, and community integration activities. The goal is to help individuals achieve a sense of purpose, meaning, and fulfilment, and to lead self-directed, productive lives in the community.