HARAMAYA UIVERSITY

COLLEGE OF EDUCATIONAL AND BEHAVIORAL SCIENCES

DEPARTEMENT OF PSYCHOLOGY

A Case Report on SUD

Course tittle; practicum in counselling psychology

BAMLAK GETACHEW

Advisor; Mr. Abate Assefa

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 ACKNOWLEDGMENT
First, I want to thank our kind, gracious, almighty GOD for granting me the strength, the zeal,
and the wisdom. His love and providences kept me safe and inspired.

My special thanks also go to my advisor Mr. Abate Assefa, for your guidance and support during
my writing.

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 TABLE CONTENT

Contents
ACKNOWLEDGMENT..............................................................................................................................i
CHAPTER ONE..........................................................................................................................................1
1 INTRODUCTION....................................................................................................................................1
1.1 Overview...........................................................................................................................................1
1.2 BACKGROUND OF THE CLIENT.................................................................................................2
1.3 Objective of the case report...............................................................................................................2
1.4 APPROACH AND THE ORGANZATION OF THE CASE REPORT..............................................3
1.4.1 Approach.....................................................................................................................................3
1.4.2 Organization of the case report...................................................................................................3
CHAPTER TWO.........................................................................................................................................4
2. DIAGNOSIS OF THE PROBLEM.........................................................................................................4
2.1 Development of rapport.....................................................................................................................4
2.1.2 Structuring the relationship.........................................................................................................4
2.1.1.1 Limiting the relationship..........................................................................................................4
2.1.1.2 Structuring the relationship..................................................................................................5
2.2 Problem diagnosis (Assessment).......................................................................................................6
2.3 Session summaries.............................................................................................................................7
2.4 Goal of counselling............................................................................................................................7
CHAPTER THREE.....................................................................................................................................8
3. REVIEW OF RELATED LITERATURE................................................................................................8
3.1 Review of related literature on SUD..................................................................................................8
3.2 Symptoms of SUD.............................................................................................................................8
CHAPTER FOUR.......................................................................................................................................9
4 TREATMENT PLAN AND PRACTICE..................................................................................................9
4.5 Evaluation........................................................................................................................................11
CHAPTER FIVE.......................................................................................................................................12
5 THE RESULTS......................................................................................................................................12
5.1 Results.............................................................................................................................................12
5.2 Recommendation.............................................................................................................................12

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CHAPTER ONE

1 INTRODUCTION
1.1 Overview
Counseling is an art and science. It's a short term, interpersonal, theory based, helping
profession. Its aim is to resolve developmental and situational difficulties. Counseling helps to
bring change in life: change in thought; change in emotion; and change in behavior. Both the
American Counseling Association (ACA) and Division 17 (Counseling Psychology) of the
American Psychology Association (APA) have common points, some of which follow.

Counseling is a profession. practitioners should complete a prescribed course of study usually

leading to a master's degree or a doctorate degree. Counselors are members of organizations that
set professional and ethical standards and promote state licensing and certification by national
association (ittmer & Loesch, 1986).

Counseling deal with personal, social, vocational, empowerment, and educational concerns.
Counselors work only in area in which they have expertise. these areas include intra- and
interpersonal concerns related to school or college adjustment, psychological health, aging,
marriage/family issues, employment, and rehabilitation.

Counseling is conducted with persons who are considered to function within the "normal range".
Clients have adjustment, development, or situational concerns; and their problems require short-
term intervention. They are not considered "sick" but "stuck". Sometimes they just need
information, but usually they are looking for a way to clarify and use the information they
already possess.

Counseling is a process in which clients learn how to make decisions and formulate new way of
behaving, feeling, and thinking. Counselors focus on the goals their clients wish to achieve.
clients explore their present levels of functioning and the changes that must be made to achieve
personal objectives. Thus, counseling involves both choice and change, involving through
distinct stages.

Counseling encompasses various subspecialities. Subspecialities include school or college

counseling, marriage and family counseling, psychological health counseling, gerontological
counseling, rehabilitation counseling, addiction counseling, and career counseling.

Thus, counseling can be more precisely defined as relatively short-term, interpersonal, theory-
based processes of helping persons who are basically psychologically healthy resolve
developmental and situational problems. Counseling activities are guided by ethical and legal
standards and go through distinct stages from initiation to termination. Personal, social,
vocational, and educational matters are all area of concern; and the profession encompasses a

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number of subspecialities. A practitioner must complete a required course of study on either the
master's or doctoral level. Important goals of counseling are as:

 Facilitating behavioral change

 Enhancing one's coping skill

 Promoting decision making

 Improving relationship

 Facilitating one's potentials

Counseling takes place in the context of a helping relationship in which the counselor and the
client work together to resolve a problem, change behavior or foster personal growth and
awareness. Although clients may have a number of helping relationships with friends and family,
the counseling relationship is different in a number way. Counseling is about taking control and
making the changes your clients want.

1.2 BACKGROUND OF THE CLIENT

Abel was born in 1994 E.C in Ethiopia around Addis Ababa nearby bole sub city. He is the only
son for his parents and they treat him very special. His family get divorced when he was 13; after
their separation he have been through difficult time. He starts living with his father and his mom
move to other countries and get married to other man. His father didn't control him as he
supposed to. So, the way he was valise was so lame. He has been through serious mental illness;
like stress, depression, antisocial, anxiety and become substance addicted to loss this illness. He
starts using cannabis for some long time. His father didn't know about such thing. Then when he
turns 17 and half, his father gets sick and doctor's try hard to treat him for long period of time,
but they couldn't help him last long because he was having cancer in his blood. So, they told him
to get injection at his home and can be treated there. His son was the only one to help him. After
getting through this thing. Abel start using pills as addiction drug to lose his illness. This one bad
day as usual Abel was about to give his father his medication. He was high and illusional. So, he
forgot about the dose, he should inject his father. He over dosed him and his father died. Because
of his father death his father's family blamed him. Then he leaves the house and start living alone
by the support of his mother. And then Abel felt guilt and start to messed up his life and start
using other highly intensive drug like cocaine.

1.3 Objective of the case report

 To fulfil the course practicum in psychology.

 To apply the theory and the technique of the counselling in practice

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1.4 APPROACH AND THE ORGANZATION OF THE CASE REPORT
1.4.1 Approach
In this paper the approach the counselor has followed is the narrative approach of discipline to
writing the client's information in narrative approach of writing skill there is detail full
information from his personal history up to the day treatment starts. In this paper the clients all
information described.

1.4.2 Organization of the case report

The counselor organizes this paper in five chapter, each chapter has their own way to express
about counseling process between the client and the counselor respectively. The first chapter was
talk about the counseling definition, general background of the client and his family, start point
of the client problem and the objective of case report. The second chapter as well discusses about
the diagnosis classification of the client problem, the rapport between the counselor and the
client and communication system between them.

Chapter three is literature review about the problem, which depends on the topic. So, there are
some, characteristic of substance use disorder and cause of substance use disorder. Chapter four
talks about the treatment plan and practice, in this chapter you can get what kind of therapy the
counselors used to treat the client problem, and how the counselor was practices the therapies
and how the treatment was effect for client. And next chapter is chapter five, it talks about the
result, describe the outcome of the counseling relationship. And it includes the conclusion and
recommendation. And there is Appendices at last.

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CHAPTER TWO

2. DIAGNOSIS OF THE PROBLEM

2.1 Development of rapport
Keep up emotionally warm and associated counseling relationship was the main task of
counselor. This is completed by developing mutual trust, liking and respect between the
counselor and the client the counselor also took this as his main objective building a very
interesting and inductive environment in order to make the client free and relaxed for the
counseling rapport.

In practice the counselor’s interest in created good relationship demonstrated by meeting the
client on time on the place we meet with a warm hand shake and greeting him by naming, it was
mainly the objective of the first session that was to lay a conductive environment or ground for
the smooth and successful activities of all interest for the other sessions building a good
empathetic about the counseling relationship was done by the counselor and the client.

2.1.2 Structuring the relationship

In counseling rapport it is one of the ethical responsibilities of the counselor to enabling the
client participate in defining and setting of goals that they wish to accomplish. Thus the client
was totally informed and consent to and participate in setting of goals.

2.1.1.1 Limiting the relationship

In the counseling relationship the counselor together with the client tried to made time
limitation, action limitation and role limitation of the counseling rapport.

 Time limitation

Having the specific time of consultation helps each the client and the counselor to have a clear
thought about how much time the total relationship will take and arranging the program when
and how require the counselor and client meet. As an end result we arranged to have or meet two
times per week for one hour for every session that means the counselor can have two sessions
per week.

 Action limit

In the action limit the counselor described to the client for the different actions that would be

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implemented through the counseling relationship such as the client to be

 Answered all the required questions

 Participate on every activity in all session

 Presence of interviews every time in each meeting session

 Role limitation

In the role limitation the counsellor tried to make clear for the client that what expected from her
to solve the problem. Thus, among the main roles of the counsellor were,

 Arguing with some selected friend of the client in order to make the communication
better and to make the client to have interactive ability.

 Providing some significant plans which are helpful in encouraging & as long as a good
interpersonal relation to help the client.

 Enabling the client to conscious her irrational thought negative attitude and to change
them and some roles of the client.

 The techniques used by the counsellor can be applied to the client.

 The client to be cooperative in all actions in counselling practice.

2.1.1.2 Structuring the relationship

The communication way between the counselor and the client was open and we discussed in
each issue. The counselor and the client communication styles had been look like the following: -
 active communication
 discussion
 observation
 unstructured interview
 warm communication
These communication methods help the counselor to classify simply without bored the client
problem and similarly the client express freely his problem. So, the counselor was used this

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communication method from starting the rapport building to the end or to the termination
session.

2.2 Problem diagnosis (Assessment)

As it’s the first practice in counselling to treat the client problem by classifying the actual
problem by using different techniques. Diagnosis is the process of understanding, describing,
determining and recognizing the problem and gives the name of the problem. (Million, 1977).

The counselor was Depending on the information collected from the client’s presenting
problem by using the formation assessment technique. The counselor was tries to diagnosis the
client problem depends on the symptoms of the client. The client has a feeling of loneliness,
helplessness, and worthlessness. He spending a lot of time getting and use of the substance,
feeling of exhalation, excess confidence and irritability. According to DSM-V classification my
client’s problem's. As the clients was involving in substance abuse he faced many challenge and
problem. His emotional health and behavioral health become problematic.

Emotional health

 loneliness

 helplessness

 worthlessness

Behavioral health

 Aggressiveness

 Irritability

 Substance addicted

2.3 Session summaries

The first session was aimed at establishing a rapport with the client to done this the counsellor
used the smooth conversation and observation to create a good rapport. After establishing the

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rapport with the client, the second, third and fourth session the counsellor assessed the client
personal history and educational background by using unstructured interview. The fifth session
was to identify the symptoms of the problem by letting the client to tell his chief compliant. In
the sixth session the counsellor diagnosis the client problem by using the DSM-V classification
after getting sufficient information about the client problem with DSM-V and diagnosed the
problem of the client as a SUB. And the seventh session was aimed to conduct the treatment
orientation for client. Depending up on the problem of the client, the following intervention
techniques were applied which are appropriate for alleviating the client problem.

 Cognitive Behavioral Therapy (CBT)

The techniques were applied from eighth to tenth session. Specifically, stress inoculation,
prolonged exposure, cognitive processing therapy and multiple channel exposure therapy were
applied. In the eleventh session the counsellor checked if there is a change or not in client. The
twelfth and the last session was aimed at follow up and terminating the relationship with the
client.

2.4 Goal of counselling

Short term-goal

 Help to understand and be better able to deal with the presented illness.

 To reduce the amount of substance he takes.

Long term-goal

 Stop blaming him self for his father’s death

 Stop his substance abuse step by step

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CHAPTER THREE

3. REVIEW OF RELATED LITERATURE

3.1 Review of related literature on SUD
Substance abuse is Persistent or sporadic drug use inconsistent with or unrelated to acceptable
medical practice. A maladaptive pattern of substance use leading to clinically significant
impairment or distress, as manifested by one (or more) of the following: failure to full fill major
role obligations at home, school or work; substance use in situations in which it is physically
hazardous; recurrent substance-related legal problems; continued substance use despite having
persistent or recurrent social or interpersonal problems exacerbated by the effects of the
substances.

Some studies have indicated that substance misuse is associated with psychological distress,
suicide attempts functional impairment, physical ill-health and risk-taking behavior.

Substance abuse is becoming a serious ongoing public health problem; it affects almost every
community and family in some way. Globally, there were about 190 million substance abusers.
Out of these substance abusers, around 40 million serious illnesses or injuries were identified
each year. The trend is increasing as period goes.

3.2 Symptoms of SUD

 Feeling of exhilaration and excess confidence.

 Increased alertness.

 Increased energy and restlessness.

 Behavior changes or aggression.

 Rapid or rambling speech.

 Dilated pupils

 Confusion, delusions and hallucinations.

 irritability, anxiety or paranoia.

Their experience might include;

Social isolation; such as isolation thought and feeling of SUD; staying away from his family,

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friends and resisting conversations to anyone.

Changes in thought and feeling; such as he blamed his self, he feels loneliness, helplessness
and worthlessness.

There are many complications to substance use problem. They can cause physical problem such
as;

 liver disease

 lang disease

 heart disease

 vitamin deficiencies and brain damage

Some substance can cause birth defects and other can damage the immune system. increasing the
risk of infection

CHAPTER FOUR

4 TREATMENT PLAN AND PRACTICE

As the client feels loneliness, helplessness and worthlessness. Treatment at this stage focuses on
self-compassion and understanding. The clients blaming himself for his father’s death. Treatment
focuses on challenging the blame, challenging become sociable, help to learning to look at is
environment and family positively and challenging the wrongly thought, help clients deal with
his emotional distress and problems in living.

Cognitive behavioral therapy

The CBT approach to treating SUD can be divided into its cognitive and behavioural
components. In the cognitive component of treatment, therapist and patient learn to identify the
distorted negative thinking that causes SUD. Then they question the veracity of these feeling and
come up with alternative balanced emotions. They also learn about the patient's core beliefs
underlying the daily automatic negative thinking.

In the behavioural component of treatment, the therapist helps the patient assess how the
different daily activities have an impact on the patient's feeling and how some of them can

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improve symptoms of anxiety. Therapists usually help patients develop an action plan, based on
the behavioural activation approach. In this approach the therapist and patient create a list of
activities and then they order them from less to more difficult to achieve. As the patient goes
from easier to harder activity.

CBT can work to enhance abstinence; long duration of psychotherapy is associated with better
outcome. Relaxation techniques are used to deal with the symptoms of distress. It helps in
feeling relaxed and in a better state of mind. Relaxation technique was used with the client in
order to make the client relaxed and feel better and to deal with his stress symptoms. Progressive
muscle relaxation was used because he reported muscles stuffiness and pain. This technique is
used for learning to control the state of tension in one’s muscles.

ABC model: in ABC model, client is told that how his negative and irrational beliefs (IBs) or
behaviors are causing disturbance in his life. The rational was explained to help client to
understand his believes or behaviors, and to replace the dysfunctional believes or behaviors with
functional ones. ABC model was explained in which the client was told that there can be any
stressful even, that can become the antecedent of poor consequence, and the thing that actually
leads to a poor consequence is a fault belief or behavior. The was drawn for the client and he was
asked to identify any of his events that underlie his faulty belief. The outcome of this technique
was positive and he easily understood the concept and the connections between A, B, C, and able
to relate the model with his real-life experiences.

Generally, longer stays in outpatient maintenance and residential rehabilitation programs are
related to better follow-up outcomes. Benefits increase with time in the program and retention is
a fairly reliable proxy measure of success for most types of treatment. Given that most people
who are studied in drug abuse treatment program have chronic and diverse problems, it is to be
expected that the longer they remain in treatment, the greater the likelihood that significant
lifestyle improvements will be achieved and consolidated.

Objective of the treatment models

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General objective

 To help the client reduce his SUD.

 The counselor helps the client to challenge his such problems.

Specific objective

 To help the client reduction of substance he was taken.

 The counsellor helps the client to coping his problem for the future life.

Follow-up and Termination

After therapeutic process was applied, the clients show so many changes (positive) and also thde
counselor notice and observe such changes including reduce his drug use, he become sociable,
when he became sociable, he got a friend who make him feel worthy, stops blaming his self.
Therefore, the counselor tells the clients he is in good position comparing from his past. And
both the counselor and the clients believed that the counseling process can be terminated as the
client’s situation situation is improving, but the counsellor assured her client whenever he wants
any help or if the client’s problem relapse, they can contact again.

4.5 Evaluation
The aim of this practicum is the counsellor getting the counseling knowledge, skill practically
than learning in class by theory and it also enables the student to see the practical aspect of the
counseling course. The counsellor tried to apply the techniques. A technique employed in the
counselling process was including active listening, empathic understanding, unstructured
interview. The counsellor uses her potential to treat the client and the client was in a better
progress.

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CHAPTER FIVE

5 THE RESULTS
5.1 Results
The counsellor used the cognitive behavioural therapy. Those techniques are reduced in some
extent the client problem but not really solved. The client reduces some his irrational thought and
he stop blaming his self. So that the client problem has shown a good progress and the client
improved from his problem and he come to understand how to help himself.

5.2 Recommendation
I. Proper follow-ups should be taken, and new techniques should be applied with the
rehearsal of the old ones.

II. On daily basis, sessions should be conducted with the client and his problems and current
issues should be inquired.

III. Family therapy should be providing to the client’s family.

Appendix

Name <> Mr. Abel

Age <> 20

Religion <> Christian

Birth order <> only the first only

Education background <> tenth grade

Place of born <> Addis Ababa

Economic status <> medium

Occupational status <> student

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