Assgn – WK9 (G)

Group Therapy for Addiction

Consider the following scenario:

The psychiatric mental health nurse practitioner is working for a community health clinic that offers state mandated “intensive outpatient rehabilitation” services for individuals who face incarceration for driving while under the influence. Mr. Smith, a 24-year-old male patient, shows up for his initial intake appointment and says, “Look, this sounds like it’s going to be an AA meeting. Can’t I just go there? I only had a couple of drinks. I don’t know why the judge was such a jerk.”

Clients with addictive disorders may present for therapy for various reasons. Some, like Mr. Smith, attend because it is court mandated. Some attend because family or friends have pushed them to do so, while others may attend because life has become unmanageable. Regardless of clients’ reasons for presenting for therapy, to reach these clients and effectively treat them, you must be able to break down barriers, establish relationships, and help them see the benefits of this therapeutic approach.

PLEASE REMEMBER TO REVIEW THE ATTACHED 7 VIDEO TRANSCRIPTS BEFORE DOING THE ASSIGNMENT, and to include a title page, introduction, summary, and references

The Assignment

In a 2- to 3-page paper, address the following:

· Identify the psychotherapeutic approach that the group facilitator is using and

explain why she might be using this approach.

· Determine whether or not you would use the same psychotherapeutic approach

if you were the counselor facilitating this group and justify your decision.

· Identify an alternative approach to group therapy for addiction and explain why

it is an appropriate option.

· Support your position with evidence-based literature.

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565–596)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

Chapter 13, “Problem Group Members” (pp. 391–427)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Gamble, J., & O’ Lawrence, H. (2016). An overview of the efficacy of the 12-step group therapy for substance abuse treatment. Journal of Health & Human Services Administration, 39(1), 142–160. Retrieved from

http://jhhsa.spaef.org/

Kim, J. W., Choi, Y. S., Shin, K. C., Kim, O. H., Lee, D. Y., Jung, M. H., … Choi, I. (2012). The effectiveness of continuing group psychotherapy for outpatients with alcohol dependence: 77-month outcomes. Alcoholism: Clinical & Experimental Research, 36(4), 686–692. doi:10.1111/j.1530-0277.2011. 01643.x

Required Media

Allyn & Bacon (Producer). (2000). Motivational interviewing [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: You will access this media from the ATTACHED TRANSCRIPT. The approximate length of this media piece is 102 minutes.

Laureate Education (Producer). (2013d). Levy family: Sessions 1-7 [Video file]. Baltimore, MD; Author.

Levy Family Episode 1

Levy Family Episode 1
Program Transcript

[MUSIC PLAYING]

FEMALE SPEAKER: You’re not dressed? You’re going to be late for work.

MALE SPEAKER: I’m not going to work. I’m sick.

FEMALE SPEAKER: Of course you’re sick. You’re hungover. I don’t want the

boys to see you like this. Go back to bed.

MALE SPEAKER: See me like what? I told you, I’m sick.

FEMALE SPEAKER: Well, what do you call it when someone is sick almost

every morning, because they drink every night while they sit in the dark watching

TV?

MALE SPEAKER: You calling me a drunk?

FEMALE SPEAKER: What do you call it?

MALE SPEAKER: I call it, leave me the hell alone.

FEMALE SPEAKER: Baby, you need to stop this. It’s tearing us up. The drinking,

the anger– you’re depressed.

MALE SPEAKER: You said, for better or worse.

FEMALE SPEAKER: My vows don’t cover this. You were never like this before.

You’ve changed. I want us back, the way we used to be.

MALE SPEAKER: That way is dead. It died when I went to Iraq.

Levy Family Episode 1
Additional Content Attribution

MUSIC:
Music by Clean Cuts

Original Art and Photography Provided By:
Brian Kline and Nico Danks

Levy Family Episode 2

Levy Family Episode 2
Program Transcript

FEMALE SPEAKER: I want to thank you for getting me this Levy case. I think it’s
so interesting. Just can’t wait to meet with the client.

MALE SPEAKER: What do you find interesting about it?

FEMALE SPEAKER: Well, he’s just 31. Usually the vets I work with are older. If
they have PTSD, it’s from traumas a long time ago. But Jake, this is all pretty
new to him. He just left Iraq a year ago.

You know, I was thinking he’d be perfect for one of those newer treatment
options, art therapy, meditation, yoga, something like that.

MALE SPEAKER: Why?

FEMALE SPEAKER: Well, I’ve been dying to try one of them. I’ve read a lot of
good things. Why? What are you thinking?

MALE SPEAKER: I’m thinking you should really think about it some more. Think
about your priorities. It’s a good idea to be open-minded about treatment options,
but the needs of the client have to come first, not just some treatment that you or
I might be interested in.

FEMALE SPEAKER: I mean, I wasn’t saying it like that. I always think of my
clients first.

MALE SPEAKER: OK. But you mentioned meditation, yoga, art therapy. Have
you seen any research or data that measures how effective they are in
treatment?

FEMALE SPEAKER: No.

MALE SPEAKER: Neither have I. There may be good research out there, and
maybe one or two of the treatments that you mentioned might be really good
ideas. I just want to point out that you should meet your client first, meet Jake
before you make any decisions about how to address his issues. Make sense?

FEMALE SPEAKER: Yeah.

Levy Family Episode 2

Levy Family Episode 2
Additional Content Attribution

MUSIC:
Music by Clean Cuts

Original Art and Photography Provided By:
Brian Kline and Nico Danks

Levy Family Episode 3

Levy Family Episode 3
Program Transcript

JAKE LEVY: We’d be out on recon in our Humvees, and it would get so hot. We
used to put our water bottles in wet socks and hang them right outside the
window just so the water would cool off of a bit, and maybe then you could drink
it.

Man, it was cramped in there. You’d be drenched, nowhere to breathe. It’s like
riding around in an oven. And you’d have your helmet on you, 100 pounds of
gear and ammo. I swear, sometimes I feel like it’s still on me, like it’s all still
strapped on me.

FEMALE SPEAKER: How many tours did you do in Iraq?

JAKE LEVY: Three. After that last recon, I just– There were 26 of us. Five
marines in the Humvee I was in. I remember I was wearing my night vision
goggles. We passed through a village and everything was green, like I was in a
dream or under water.

And then there was a flash, bright light just blinded me. There was this explosion.
I can’t– I can’t–

FEMALE SPEAKER: It’s OK, Jake. Take it easy. I understand this is difficult.
There’s something I;d like to try with you. It’s called exposure therapy, and it’s a
treatment that’s used a lot with war veterans, especially those struggling with
anxiety and PTSD.

JAKE LEVY: Exposure therapy?

FEMALE SPEAKER: Yes. It’s to help someone like yourself to confront your
feelings and anxieties about a traumatic situation that you’ve experienced. It’s a–
It’s meant to help you get more control of your thoughts, to make sense of what’s
happened, and to not be so afraid of your memories.

JAKE LEVY: Put that in a bottle and I’ll buy 10 cases of it.

FEMALE SPEAKER: Well, one part of it is learning to control your breathing. And
when you practice that, you can learn to manage your anxiety, to get more
control of it, not let it control you, to protect yourself. Do you want to try it?

JAKE LEVY: Right now?

FEMALE SPEAKER: Sure.

JAKE LEVY: Why not?

Levy Family Episode 3

FEMALE SPEAKER: OK. Well, I know this sounds crazy, but a lot of people don’t
breathe properly. And it really comes from bad habits. When they inhale and
exhale, all the effort is here in their chest and shoulders. And the problem with
that is you get a really short, shallow breath. And that really increases the stress
and anxiety in your body.

Instead, a more natural breath should always involve your diaphragm, right here
in your abdomen. When you breath in, your belly should expand. And when you
breath out, your belly should fall. OK?

JAKE LEVY: OK.

FEMALE SPEAKER: So, let’s practice. Close your eyes. Now, I want you put one
hand on your abdomen and the other across your chest. Good. Good. Now, I just
want you to take a few breaths, just like normal. What are you feeling?

JAKE LEVY: I feel my chest moving up and down. But my belly, nothing.

FEMALE SPEAKER: OK. So that’s what I was just talking about. That’s OK. Let’s
try this. I want you take a breath. And this time, I only want you to allow your
abdomen to expend when you breathe in and to fall when you breathe out.

OK, let’s try it. Breathe in. Breathe out. Breathe in. Breathe out.

You feeling better? More relaxed?

JAKE LEVY: Yes.

FEMALE SPEAKER: And the more you practice it the easier it will become. So
when you find that stress and anxiety coming on, just do your breathing. You can
keep yourself from getting swept by all those bad thoughts. OK?

JAKE LEVY: Yes. Thank you.

FEMALE SPEAKER: So, do you want to try to go back to what you were telling
me about before?

JAKE LEVY: I can try. It was night. We were out on recon. It was my third tour in
Iraq.

Levy Family Episode 3

Levy Family Episode 3
Additional Content Attribution

MUSIC:
Music by Clean Cuts

Original Art and Photography Provided By:
Brian Kline and Nico Danks

Levy Family Episode 4

Levy Family Episode 4
Program Transcript

FEMALE SPEAKER: So do you want to try to go back to what you’re telling me
before?

LEVY: I can try. It was night. We were out on patrol. I remember it was so hot
packed in our vehicle. Suddenly there was an explosion. We got tossed into a
ditch. And somehow I made it out, and I could see it was the Humvee behind us.
It’s whole front end was gone. It had hit a roadside bomb. Our vehicle had just
driven past it, just mistriggering it. But not them. They didn’t make it.

FEMALE SPEAKER: Remember how we practiced. Slow your breathing down.
Inhale and exhale from your abdomen.

LEVY: Thank you.

FEMALE SPEAKER: And just take your time. Whenever you are ready.

LEVY: So the bomb went off. I managed to get out. I had my night vision goggles
on. And I could see the Humvee, the one that got hit. It’s whole front end was
gone. And there’s this crater in the road. And inside it I could see– I could see
Kurt’s– our platoon Sergeant, he was lying there everything below his waist was
gone, blown off. And he was screaming. Screaming like nothing you’d ever
heard.

And then he was looking at me. And he was screaming for me to kill him. To stop
his suffering. He was yelling, please. Please. And someone tried putting
tourniquets on him. But the ground just kept getting darker with his blood. And I
was staring into his face.

I had my rifle trained on him. I was going to do it. You know. He was begging me
to. I could feel my finger on the trigger. And I kept looking into his face. And then
I didn’t have to do nothing. Because the screaming had stopped. He’d bled out.
Died right there.

And all I could think was I’d let him down. His last request, and I couldn’t do it. I
couldn’t put a bullet in him so he could die fast not slow.

FEMALE SPEAKER: I can see and hear how painful it is for you to relive this
story. Thank you for sharing it. Do you think this incident is behind some of the
symptoms you’ve been telling me about?

LEVY: When I go to sleep at night, I close my eyes, and I see Kurt’s there staring
at me. So I don’t sleep too good. That’s why I started drinking. It’s the only way I

Levy Family Episode 4

can forget about that night. So I drink too much. At least that’s what my wife yells
at me.

We’re not doing too well these days. I’m not exactly the life of the party. I left Iraq
10 months ago. But Iraq never left me. I’m afraid it’s never going to leave me
alone.

Levy Family Episode 4
Additional Content Attribution

MUSIC:
Music by Clean Cuts

Original Art and Photography Provided By:
Brian Kline and Nico Danks

Levy Family Episode 5

Levy Family Episode 5
Program Transcript

FEMALE SPEAKER: It was such an intense story. I just kept seeing things the
way he did, you know. The weird green of his night-vision goggles, his sergeant
screaming for Jake to kill him. I just keep seeing it all in my head.

[MUSIC PLAYING]

MALE SPEAKER: Why, do you think?

FEMALE SPEAKER: Why what?

MALE SPEAKER: Why do you think you keep thinking about this story, this
particular case?

FEMALE SPEAKER: I don’t know, maybe because it’s so vivid. You know, I went
home last night, turned on the TV to try to get my mind off it. And a commercial
for the Marines came on, and there was all over again– the explosion, the
screams, the man dying. Such a nightmare to live with, and he’s got a baby on
they way.

MALE SPEAKER: Could that be it, the baby?

FEMALE SPEAKER: Maybe. That’s interesting you say that. I mean, the other
vets I work with are older, and they have grown kids. But Jake is different.

I just keep picturing him with a newborn. And I guess it scares me. I wonder if
he’ll be able to deal with it.

Levy Family Episode 5
Additional Content Attribution

MUSIC:
Music by Clean Cuts

Original Art and Photography Provided By:
Brian Kline and Nico Danks

Levy Family Episode 6

Levy Family Episode 6
Program Transcript

FEMALE SPEAKER: I know three of you did tours of duty in Iraq, and the others
in Afghanistan. So I just wanted to follow up on that, talk about how you’re
adjusting.

[MUSIC PLAYING]

MALE SPEAKER 1: You say adjust to, but there’s no adjustment. You’re just
thrown back into your life like you’re supposed to pick up where you left off, but
that’s a joke. Two years ago, I was dug in, pinned down by 50 Cal sniper fire, just
praying the chopper would get me out alive. Now, the hardest part of my day is
standing in the grocery store trying to decide if I want yellow or brown mustard

with my hot dogs.

JAKE: Nah, two six packs or a case.

FEMALE SPEAKER: You find that you drink more than you used to?

JAKE: Why not ask him if he finds he’s eating more hot dogs than he used to?

BILL: You know why?

JAKE: Why is that? Oh great, Buddha.

BILL: Because I’ve been where you are. You talk about booze like it’s some joke,

but nobody’s laughing. You can’t get adjusted to anything when you’re trying to

get loaded.

JAKE: I guess you won’t be joining me for a drink at the bar later. I was going to

buy.

FEMALE SPEAKER: No, that’s a good point, Bill. Sometimes we do things to

avoid dealing with unpleasant feelings, like adjusting to life back at home.

JAKE: What do you know about it? Give me a break. Back off, or I’ll make you.

BILL: I drink too much too. But I’ve had enough of you mouthing off.

JAKE: My wife’s had enough of me too. She’s the reason I’m here. We never
used to fight. I never used to drink so much, but now I can’t stop myself from

doing either.

FEMALE SPEAKER: So why do you drink too much?

Levy Family Episode 6

BILL: It’s the only way I can shut it out, images of what I saw over there, horrible
things that no one should ever have to see. I wake up some nights and I hear
mortar rounds coming in. And I reach for my helmet and my weapon, but they’re
not there. So I freak out.

And then I see pretty curtains. TV’S on. And then I remember I’m at home. I
realize I’m not going to get blown up after all.

FEMALE SPEAKER: Thanks for sharing, Jake. You make a good point. It can
seem a lot easier to self medicate rather than face the fears, the bad memories
that we have. So what do you think? What are some other things, maybe, you do
to avoid the challenge to being a civilian again?

Levy Family Episode 6
Additional Content Attribution

MUSIC:
Music by Clean Cuts

Original Art and Photography Provided By:
Brian Kline and Nico Danks

Levy Family Episode 7

Levy Family Episode 7
Program Transcript

FEMALE SPEAKER: How did you find out?

MALE SPEAKER: There’s a guy who served in our platoon. He didn’t call. Wrote
an email. He said it would bother him too much if he talked about it.

Sorry to be the one who tells you that Eric committed suicide last night. The last
time I saw him, he said he was adjusting to civilian life pretty well. His girlfriend
told me it wasn’t true. She said he told everyone he was doing fine.

But the nightmares kept after him even when he wasn’t sleeping. It just tore him
up. I guess he decided he’d had enough. He ended it with a service revolver.
Marine to the end.

FEMALE SPEAKER: I’m sorry, Jake.

MALE SPEAKER: Thank you. You know, I spend almost every night in front of
the TV, drinking until I can’t remember anything else. But I read that email last
night, and I didn’t drink a drop. I just kept thinking about Eric. You know we went
through Parris Island together?

FEMALE SPEAKER: I didn’t know that.

MALE SPEAKER: Yeah. I didn’t turn on the TV, either. I went straight to the
computer. And before I knew it, I was reading about veterans and suicide. They
say about 22 veterans commit suicide every day, 22. That’s like one every hour.
Makes it sound like we’re time bombs. Makes you wonder which one of us is
going to go off next.

FEMALE SPEAKER: You sound glad that you didn’t drink last night.

MALE SPEAKER: Yeah. I’ve been trying to quit for my wife. But that email– you
know what else I read online? I checked all over with the VA, but it doesn’t look
like they do anything to help prevent suicide. I mean, they offer help if you ask for
it, but no prevention.

Who’s going to ask for help, right? They train you to be stronger than everyone
else, to endure. Asking for help is just not something most men do.

FEMALE SPEAKER: Do you need help, Jake?

MALE SPEAKER: I need a lot, but not like that. I’m not ready to check out yet. I
got a baby on the way.

Levy Family Episode 7

I found out something else. I was reading about this veteran who committed
suicide in another state. And they started this program in his memory that brings
other vets together to help each other.

FEMALE SPEAKER: Peer counseling?

MALE SPEAKER: Yeah, that’s it. And I spent the whole rest of the night thinking,
why don’t we have something like that? We should be reaching out to all vets, not
just those who are already getting mental health services. I’d even volunteer to
get something like that going.

FEMALE SPEAKER: Well, that’s a great idea. But we’d need to find the money
for a program like that. I mean, our budget is maxed out. We’d have to lobby the
state legislature for the funding.

MALE SPEAKER: Well, I’ll do it. I’ll write the letter. I want to try.

FEMALE SPEAKER: Well, OK.

MALE SPEAKER: I can’t let Eric go without doing something for him. For me, too.

Levy Family Episode 7
Additional Content Attribution

MUSIC:
Music by Clean Cuts

Original Art and Photography Provided By:
Brian Kline and Nico Danks

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