Essay on Self-Medication Model and Substance Abuse/Dependence/Psychiatric Disorders

From the depicted Andrew's case study, the selected model to explain how he developed substance abuse or dependence or psychiatric disorders is the self-medication model. According to the model, chemical dependency takes place as a coping deficits mechanism in psychological functioning or structure or as a symptom of a specific primary metal disorder (Brower, Blow, & Beresford, 1989). Andrew is, therefore, viewed as a person who uses chemicals to fill the gap left by deficiencies in psychological functioning or structure or to do away with the painful symptoms of another mental disorder like depression from his family. Thus, the primary aim of treatment through the self-medication model is to enhance and improve the mental functioning where the victim is expected to change from being mentally ill to becoming psychologically healthy (Brower et al., 1989).

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The change strategies include pharmacotherapy and psychotherapy of the underlying mental disorder. Moreover, the model is neither blaming nor punitive as it focuses on treating and diagnosing the coexisting psychiatric challenges which might be present. The significance of solving the problem is thus, highlighted by the outcome treatment studies which showcase various prognoses for drug addicts as well as the psychopathology who involve themselves with treatment programs of the chemical dependencies (Brower et al., 1989). However, the primary disadvantage of the self-medication model is derived from its psychopathology emphasis as etiology. For instance, in most chemical dependencies, psychopathology is always the result but not the cause while in some cases, it is still hard to determine the effect and the cause when the depicted chemical dependency coexists with the rest of the psychopathology (Brower et al., 1989).

For some victims like Andrew, psychopathology might still be the chemical dependency cause, but it is always not a guarantee that treating the cause in the victims will often grant the required and sufficient treatment for the chemical dependency. The action is because the chemical dependency's perpetuating factors might develop and increase adding up to the psychopathology, which initiated the chemical dependency (McLellan et al. 1983). Therefore, in most scenarios like the case of Andrew, optimal treatment needs attention and concentration to the perpetuating and initiating factors of substance abuse. Unfortunately, according to the model's implication, the treatment of launching psychiatric challenges often give the required treatment for chemical dependency. For instance, substance abusers and therapists can easily be manipulated to believe that once the underlying cause is outlined and treated, there is a guarantee that the chemical challenges will disappear. However, the action is not the case as for the substance abuser, to postulate a treatable etiology grant the hope that using chemicals will at one point be possible if treatment of the underlying cause is successful (Brower et al., 1989).

On the other hand, for a therapist, focusing on the victim's treatment on the underlying psychological factors easily facilitates cooperation with the denial of the substance abuser of chemical dependency. Therefore, the challenge of coinciding with denial can always be highlighted through the examination of various denial configurations that are mostly encountered in substance abusers. The configurations (complete denial, no denial, partial denial type 1, and partial denial type 2 settings) will then depend on whether the denial is directed towards the associated challenges, the chemical dependency, neither of the two or both.

The victims who are always in complete denial can neither recognize their chemical dependency nor other challenges they face when drinking alcohol or using drugs. They will always have behavioral disorders whose signs and symptoms are disturbing and ego-syntonic to the people neighboring them but not themselves (Brower et al., 1989). Also, unless forced by external pressures, they will always tend not to seek treatment. For example, as depicted in the case study, Andrew is forced to go for treatment by his girlfriend, but he rejects the offer and says that he does not need treatment. Therefore, through projection use, the victims will always see other people be having the problem instead of themselves. Additionally, substance abusers who do not have behavioral disorders might adopt the same configuration in some instances, especially when they feel threatened (McLellan et al. 1983).

However, as the chemical dependency progresses, substance abusers or victims who present in no denial represent the other extreme. The victims often become suicidal as they are always painfully aware of their drug and alcohol dependency, of the numerous relapses of their shame and depression, conflicts with the law and their family, regarding unemployment or their current jobs, as well as the medical sequelae regarding their chemical dependency (Brower et al., 1989). Therefore, despite the clinical imperative to overtake or break through the denials, professionals often do not recommend the configuration as most victims of substance abusers are always at high risk for committing suicide especially when they feel the entire impact of their interpersonal conflicts and losses. Nonetheless, it is always the type 1 partial denial configuration which poses the largest problem to the self-medication model. In this type of configuration, substance abusers always deny for their chemical dependency but not for other challenges they face which makes them seek treatment for other problems like interpersonal conflicts, stress on their jobs, or depression (McLellan et al. 1983).

If in the course of the treatment or evaluation of the substance abusers, the therapist knows their harmful chemical use but agrees on the self-medication model, then collusion might take place following the denial of the substance abuser. Therefore, through a covert covenant, both the therapist and the substance abuser will do away with the chemical dependency as the most significant treatment focus. And, in effect, the victim will always be supported for concentrating on the chemical use and other problems, which can always be interpreted as a coping mechanism (Brower et al., 1989). However, if the configuration is allowed, the therapist and the substance abuser will always have a treatment illusion while the abuse of drugs and alcohol continues.

The recommended type of configuration would be the type 2 partial denial where the drug victim is always encouraged to concentrate on their chemical dependency while minimizing or denying the importance of other challenges they face. Instead of eliminating or breaking through the denial, the therapist often works to redirect almost all the denials away from the chemical dependency but towards other challenges that the substance abuser face. Thus, through the action, the substance abuser becomes represented with the rationale that other challenges might improve when the chemical dependency is first treated and that an abstinence time is needed to assess other problems (Brower et al., 1989).

DSM5 Diagnosis

A primary alteration from DSM-IV to DSM-5 is always the combination of substance dependence disorder and substance use disorder into a single substance use disorder. Therefore, the DSM5 diagnosis of substance use requires an endorsement of one or more symptoms out of four and no substance dependence history for the substances' category. Moreover, the criteria for substance dependence requires the endorsement of three or more symptoms out of seven within twelve months (Grant et al., 2015). The diagnostic hierarchy rules for DSM5 also specify that an individual who has met the criteria for substance dependence and substance abuse for a particular substance is diagnosed to have an only substance dependence. The diagnosis aims to reflect the rise in dependence severity over the abuse diagnosis.

The DSM5 has excluded and eliminated the distinct dependence and abuse disorders for reasons such as little treatment guidance is always provided by the distinction, diagnostic orphans (people who have endorsed two symptoms of dependence and no symptom of abuse and therefore, do not meet any criteria for the diagnosis) are created by the distinction. Also, the anticipated relationship between dependence and abuse (where abuse is a less severe dependence prodrome) is not followed by the hierarchical structure, and the separation led to the diagnosis of the abuse to suffer from pressing problems of reliability (Agrawal, Heath, & Lynskey, 2011). Therefore, the DSM5 combines the criteria of dependence and abuse under a new rubric known as substance use disorder, that needs two out of eleven criteria in twelve months for a diagnosis. The DSM5 has also eliminated the standard of abuse, which is related to recurrent substance-related legal challenges such as added craving criterion, arrest for disorderly conducts that are substance-related.

Under the DSM5 criteria, the definition of craving is a strong lust, urge, or desire to use a harmful substance. And, according to the DSM5 diagnosis, the craving phenomenon always makes it hard for an addict to think of anything else which leads the individual to the inset of use ((Agrawal et al., 2011). However, through the DSM5, craving as a substance use disorder indicator does not add to the data provided by other criteria of dependence. Thus, other approaches of addiction such as withdrawal, tolerance, and continued use of drugs despite various health problems, overlap with a craving so that the identified craving addition is for the few individuals who have not met the disordered threshold through other criteria of dependence. However, the craving inclusion through the abuse criteria always adds to various diagnostic data, which makes craving for harmful substances to be a target for biological treatments (Grant et al., 2015).

Treatment Plan

Acknowledgment of Substance Abuse

Different substance use disorders have varying treatment plans depending on the level of addiction, abuse, and dependence of the drugs or alcohol. For Andrew, the first step towards recovery through the self-medication model is acknowledging that substance abuse for him is a challenge in his life, which is disrupting the quality of his life. The action can, thus, result from impairment in social, work, recreational, school, or other significant areas of function. Moreover, once a substance abuser recognizes the negative impacts of substance abuse on their life, a vast range of treatment options is always available. One who has an addictive disorder often needs access to treatment (Marlatt, & Donovan, 2005). However, for most individuals, treatment might last throughout their lifetime, and the only action they will require is abstinence from the substance on a life-long basis, which might be hard in most cases. Therefore, treatment plans for various addictive disorders will always be altered to meet the requirements of the victim or patient (Liese, 2009).

Detoxification

Detoxification involves clearing a harmful substance from one's body and limiting the reactions of withdrawal. For instance, an NSS-2 device can be used to reduce opiate withdrawal. The device works in a way that it is placed behind the ear to give off various electrical pulses to trigger specific nerves which may provide relief from other symptoms of withdrawal (Marlatt, & Donovan, 2005).

Counseling and Behavioral Therapies

Therapy might take place on a family, group, or one-on-one basis depending on the requirements of the patient or victim. The therapies are always intensive during the treatment onset with various sessions reducing gradually over some period as symptoms improve. Di...