old African-American male, the client represents a seriously underserved population cohort when it comes to providing effective substance abuse prevention and intervention support. According to Williams & Chang (2000), research on adolescent substance abuse treatment is sparse. Available evidence is even scantier when addressing the needs of non-white youth. Yet to be effective, interventions need to be tailored to the specific population.
Empirical evidence supporting a comprehensive and effective substance abuse intervention for the adolescent cohort began with an evaluation of the case. The client has experienced trauma, which should be taken into consideration while developing a treatment plan and during the course of treatment. At the age of twelve, the client’s mother’s sister in law and her two children — the client’s cousins — were murdered. The client was deeply affected by the event, as was his family. It took a decade before the perpetrator of the crime was brought to justice, leading to many years of unresolved psychological pain for the entire family. The client admits that his unresolved bitterness adversely affected his behavior and likely led to his behavioral problems starting in adolescence soon after the crisis.
In addition to the personal experience with trauma, socio-cultural and socio-economic factors should be taken into consideration when developing a treatment plan and intervention. Unemployment, underemployment, poverty, and discrimination disproportionately affect the African-American communities in the United States and are linked, possibly causally, to the display of behavioral problems including substance use and abuse (Costen, 2009). Moreover, incarceration and the criminal justice system in general are used disproportionately for the young African-American male cohort, versus the use of substance use treatment and professional psychological interventions. Yet psychological interventions prove far more effective in reducing rates of relapse in substance abuse; research has shown that those who entered substance abuse programs on a doctor or other medical providers’ recommendation tended to stay the longest in treatment and have the best outcomes (Cooper, MacMaster, & Rasch, 2009). Clients like these should be seeing psychologists instead of parole or corrections officers. Therefore, one of the core treatment goals will be to eliminate the time the client spends in the criminal justice system and maximize time spent in the care of qualified practitioners.
Strengths and protective factors in the African-American community can provide social support systems in lieu of, or in addition to, psychological counseling. The African-American community usually exhibits strong interdependence, including the use of extended family unit living that can provide ongoing social support. The client in this case should be encouraged to rely on the pre-existing social and family networks as part of the recovery process. At the same time, it is strongly recommended that the client have access to an initial in-patient treatment program. In-patient treatment programs provide the necessary separation from triggers and stressors and can therefore help the client to envision and practice a life without relying on substances to cope. It is then strongly recommended that the client have a structured exit strategy involving transitioning from the in-patient to outpatient status. This would involve ongoing therapy and heavy involvement in his community, ideally through his family’s church.
It is strongly recommended that the client commit to a three-week in-patient treatment program followed by a minimum of one year in outpatient activities that include, but are not limited to, church-based activities and interventions. Research has shown that the more time a substance abuser spends in treatment the more successful s/he usually is at remaining in recovery (Cooper, MacMaster, & Rasch, 2009). For the client’s treatment to be successful, he will need consistency in his case managers and continuity of care. For the client to “buy into” the treatment plan, he will need the support of his family, mentors, and ideally, peer group too. The client reports a healthy relationship with his family, including his parents and sister. He also attends church regularly.
Another way for the client to commit fully to his treatment program is through the creation of routine and structured leisure time. The client currently works in a steady job, which will provide some protective factors such as routine and time insulated from the triggers or temptations to use. He reports taking pleasure in his work as a mechanic and therefore, improving his skill levels and attaining career advancement will help improve the client’s confidence and self-esteem, leading to a greater likelihood he can envision a life without depending on drugs for his identity or ability to cope. The client should be encouraged to explore art, music, theater, and other expressive hobbies that can engage his body, mind, and emotions without the use of drugs. The client can be actively engaged in creating a leisure time plan for himself, by alerting his counselors to his hobbies and interests.
In fact, his leisure time might present some risk factors that the treatment plan is designed to ameliorate. The client has reported that he played football and baseball throughout high school and was on the wrestling team one year. At the time he started using, he chose not to pursue his athletic endeavors. Getting clean might inspire him to reinvest time and energy into athletics. Sports will provide structure in his leisure time, through a mentally and physically healthy activity. Unfortunately, the client has reported that he has a neck injury and experiences chronic pain. It may be necessary to help the client find non-medical ways to manage his pain.
Alternative or complementary medicine may help the client cope with physical and psychological pain. Recommended interventions include acupuncture and relaxation exercises. Yoga, meditation, and other practices may help the client become more aware of his body and mind in ways that help him to manage uncomfortable emotions, feelings, and sensations. Combined with cognitive-behavioral therapy, these interventions can help the client to unearth the dysfunctional thought patterns and belief systems leading to his substance use. The client’s church may have meditation or yoga courses regularly, and the client is encouraged to participate in these programs or any others that he prefers.
To evaluate the efficacy of the practice plan, regular assessments should be used that encourage trust and inspire confidence. Therefore, it is not recommended that the client be required to take drug tests. Instead, the client should be able to admit if and when he does use drugs and talk about the factors that triggered use. The client should be encouraged to keep a journal, writing down his feelings before and after using, if he did use.
More quantitative assessments will involve factors such as absenteeism or performance records from his place of employment, and his level of engagement in structured leisure activities. Interviews and reports from his parents, sister, and other social supports including pastors will also be helpful in providing ongoing program evaluation. Although the reliance on qualitative assessments might be considered unconventional, it is believed that the client needs to develop self-efficacy and trust in the treatment model rather than being coerced into treatment through measures like drug testing. The goal is for the client to move away from the label as “deviant” or “criminal” and towards labels that are constructive for his self-esteem and social development. The most important goals of treatment is improving how the client feels about himself and his future prospects, and helping the client to envision a future in which drug use and behavioral problems are not a part.
Summary and Reflection
Evidence-based practice is the cornerstone of effective care. The first step in the process of gathering empirical evidence was via the use of online databases including Psych Info, PubMed, NCBI, JSTOR, National Institute of Mental Health, National Criminal Justice Reference Service, and Google Scholar. It was disconcerting to have found such little data related to young black males with substance use issues. The research — or lack thereof — shows that clients like this one are chronically underserved by mental health care.
The criminal justice system is not an effective alternative to preventative care or intervention in mental health. In fact, the decriminalization of cannabis is a strongly recommended method of diverting clients like these into mental health instead of the criminal justice system. The client has experienced trauma that was unresolved. Examining the body of evidence for the population cohort shows that most persons in the client’s condition are led through the criminal justice system rather than being offered access to mental health care services. The client therefore highlights some of the structural disparities in health care, and draws attention to some of the ways institutionalized racism has led to pernicious problems with social justice.
Research into the client’s age and ethnic cohort has been remarkably inconclusive due to the prevalence of young African-American males in prison for non-violent drug offenses. Even the most robust studies like Williams & Chang’s (2000) report reveal inadequate follow-up reporting in the vast majority of studies on adolescents with substance abuse problems. These weaknesses in the body of literature make it difficult to definitively say whether in-patient versus out-patient treatment would be preferable. Generally, though, in-patient treatment provides a temporary means by which the client can get “clean,” contemplate ways of living without reliance on drugs, and develop new coping mechanisms in a systematic way removed from the triggers and temptations of being in his typical daily life environment. When the client then pursues outpatient treatment, he may do so with greater confidence in his abilities to remain clean.
References
Cooper, R. L., MacMaster, S., & Rasch, R. (2009). Racial differences in retention in residential substance abuse treatment: The impact on African-American men. Retrieved from University of North Carolina, Greensboro: http://libres.uncg.edu/ir/uncg/f/R_Rasch_Racial_2009.pdf
Costen, J. A. (2009). Drug use and the Black American male. Retrieved from Kennesaw Sate University: http://ksuweb.kennesaw.edu/~jcosten/papers/paper_drug-use-and-the-black-american-male.pdf
Williams, R. & Chang, S. (2000). Addiction Centre Adolescent Research Group. A Comprehensive and Comparative Review of Adolescent Substance Abuse Treatment Outcome. Clinical Psychology: Science and Practice, 7(2): 138-166.
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