Trauma-Informed Treatment Plan for Native American Substance Abuse Recovery

Identifying Information

• Age: 30
• Race/ ethnic identification: Native American
• Socio-Economic Status: Co-Manager (retail)
• Marital Status: Single
• Family Constellation: Youngest of two children, has an older brother.
• Gender: Male
• Education/Occupation: BS in Biology (Northern Arizona University – graduated top 10%)
• Religion: Non-Religious

Nature of the Presenting Problems

• History: Alcoholism and the occasional substance abuse
• Duration: Has been addicted for 5 years.
• Frequency: Daily drinking and drug use
• Exceptions to the problem: Family history of alcoholism
• Consequences: He is on the verge of losing his co-manager position because of his problems with alcoholism and substance abuse.
• Antecedents: He recently moved to Flagstaff, Arizona, and desires to return home. However, he worries that this substance abuse problem may worsen in a familiar environment.
• Other Problems that contribute to the presenting problem: His best friend was killed during the war in Afghanistan

Client Functioning

• Physical/Medical: Besides his alcoholism and drug use, he is in good physical shape.
• Emotional/Behavioral: Intense depression, difficulties with interpersonal relationships,
• Roles and Adjustment to Roles: Just was promoted to manager, and has a very toxic store manager he works for.
• Social/Interpersonal: Have a difficult time making healthy relationships.
• Cognitive/Intellectual: Graduated in the top 10% from Northern Arizona University.

Client’s Strengths and Resources

Despite this client facing extraordinary circumstances occasioned by alcoholism, drug abuse, depression, and a toxic work environment, he has several strengths that could aid in his recovery. His most important strength lies in his intellectual ability and achievements, as he graduated in the top 10% of his class at Northern Arizona University with a bachelor’s degree in Biology. Such an achievement is not easily achieved and requires years of dedication, hard work, discipline, critical thinking, and a long-term commitment to academic excellence. With his achievements in academics, he has demonstrated that when motivated, he can apply himself and succeed. This capability will be a great asset to him throughout therapy and substance abuse treatment sessions.

Generally, rehabilitating and helping an individual with problems such as the ones this client is experiencing revolves around a rewiring of deeply ingrained thinking and behavior. This is similar to rebooting their mindset and behavior so they can unlearn the harmful behavior (Karloh et al., 2023). Since this client has already honed dedication and commitment to a singular goal through his academic success, he will not experience problems during treatment. He will fully invest himself in the treatment to change himself psychologically and change his behavior for the better. The rigorous academic field in which he excelled has shown that he is mentally tough and has the willpower to take action to improve his life.

Other than his academic excellence, the client is also successful professionally, having attained the position of co-manager despite his alcoholism and drug abuse. While his struggles may have hampered his productivity, achieving this position required that he possess the requisite skills, knowledge, motivation, and responsibility to successfully fulfill the responsibilities that accompany a manager’s role. His efforts to be professionally successful should not be discounted, as they can be built upon when creating an effective coping mechanism for his work stress and the toxic work environment. With treatment and sustained sobriety, he could achieve more success and unlock his full potential.

At a personal level, the client is aware of his family’s history of alcoholism. His commitment and desire to address this problem demonstrate remarkable self-awareness that could be enhanced to improve his treatment. In many cases, individuals with similar problems are often blinded by their destructive behavior and try to rationalize and justify it (Klussman et al., 2022). The client is aware that his current path is destructive and not sustainable. This is especially crucial because it means he will be an active participant in his recovery, no matter the difficulties he encounters along the way.

The final strength is that the client is not particularly alone in this journey. Specifically, he has potential support from his older brother, who could be his greatest ally and a motivator to remain sober. While the deep connection between them may be strained due to years of alcoholism, the familiar bond is still there, as temporary and superficial differences cannot sever it. With proper support from his brother and his commitment to recovery, he can rebuild and reinforce the motivation to remain sober. For this client, the road ahead will be extremely difficult, but these strengths can be leveraged to eliminate some of the challenges that he will encounter.

Interpretive Summary

An analysis of the data collected reveals that the client’s drug abuse and alcoholism are linked with trauma, unresolved grief, and a lack of a positive coping mechanism. His downward spiral represents circumstances in his life that have overwhelmed his ability to effectively cope with emotions in a way that is not destructive. Several key themes emerge from the data that could explain his alcoholism and drug abuse. One of these is the unresolved trauma of losing his best friend during the war in Afghanistan. This experience seems to have triggered extreme emotional pain, sadness, anger, and psychological upheaval. Losing a friend in such circumstances constitutes a major traumatic event with the potential to negatively impact their psychological and mental well-being for a long time.

Additionally, the client seems to have few disclosed outlets for processing such strong emotions and loss. So, to numb the pain of losing a friend, he engaged in destructive behavior such as alcohol and drug abuse. This coping mechanism relieves him of distressing emotions and intrusive thoughts temporarily and helps him not think of the loss for some time (Eng et al., 2019). However, this coping mechanism is maladaptive as it compounds the original trauma by making it more difficult for him to confront, process, and work through the emotions in a way that is healthy and will not adversely affect him or his professional life.

The client also disclosed that he is dealing with an extremely toxic and abusive manager in his workplace. The negative experience at his work compounds the problems that he is already dealing with by adding more stress, even though he is ill-equipped to handle the additional upheaval in his life. The anxiety, emotional fatigue, and demoralization that he experiences at his work from being frequently denigrated and abused could trigger substance abuse cravings to distract and self-medicate in an attempt to cope with this stress (Al-Khair, 2023). Additionally, he lacks a positive support system that he could lean on during such situations, as he is unable to sustain any meaningful social connections and relationships. The self-imposed isolation lets the alcoholic voice in him take over and rationalize this destructive behavior. If he had close friends and relatives, they could show more concern for him, which would motivate him to remain sober.

As a Native American, he could also approach grief from a uniquely cultural way as opposed to the mainstream therapeutic perspective. In many Native communities, the belief that the inner experience could be influenced by death, spirituality, and familial bonds is common (Grim & Grim, 2019). For example, rituals are performed to keep a connection with the dead, with protocols such as burning tobacco being usually done to maintain proper rationality with the deceased. His drug abuse and alcoholism could cause a disconnect with his traditional roots, creating an imbalance that may require a Native to restore.

The persistent problem with alcoholism is caused by the underlying depressive state and the client’s struggle with self-worth. The client initially pursued a career in biology, where he performed better than 90% of his classmates. However, he now works in retail as a store co-manager. This is a significant derailment of his career aspirations and ambitions. His above-average intellect and the skills he gained while at the university would have offered him more than he currently has in terms of professional growth. He most likely never envisioned himself working in such a field, and his qualifications are a clear example of an unmet life expectation. Being overly qualified for his current role, yet taking insults and disrespect from an inconsiderate co-manager could further foster feelings of inadequacy, underachievement, and demoralization. These disappointing life circumstances often trigger depression and cognitive patterns of self-criticism. With the client already holding himself in low regard, he turns to alcohol for a reprieve from his sadness.

Additionally, the client’s failure to process the death of his friend could have further damaged his mental health, creating perfect conditions for addictive behavior. Therefore, he is stuck in a self-perpetuating cycle where he uses alcohol and substance abuse to find reprieve from negative emotions, only to create more problems for himself by deepening his depressive symptoms, eroding his motivation, and increasing the impulse to engage in addictive behavior. Underlying all this is the inability of the client to work through transition and loss and accept that life is a struggle for everyone. Additive behaviors represent an immature defense mechanism against deeply rooted issues, which cannot be resolved with reprieve in the form of alcohol and substance abuse. What he is lacking is a credible and positive coping mechanism to help him navigate uncomfortable emotions while building his resilience.

Finally, his intent to move back home seems to elicit intense anxiety as he worries that he could exacerbate his substance abuse problem by relocating. Without a better coping mechanism, the client is unsure of how moving would affect him, as he fears that social connections, routines, and memories at home will trigger his drinking memory. Being thrust into uncomfortable territory could prompt him to take comfort in alcohol and drugs, further hindering his journey to sobriety.

Treatment Goals and Objectives

Achieve Long-Term Sobriety

The fundamental starting point with this client is the maintenance of his sobriety, free from drugs and alcohol, in the long term. Without first dealing with his alcohol and substance addiction, which is currently threatening to derail his career, any other therapeutic effort would come to naught. This goal is accompanied by four objectives that will ensure that the client frees himself from the shackles of addiction.

Completing an Intensive Substance Abuse Treatment Program Tailored to His Native American Identity

Treating addiction is a massive undertaking that requires the combination of several interventions to break addictive patterns and teach a client new coping mechanisms and behavior. This client can opt for an inpatient program to temporarily remove himself from the toxic environment perpetuating his addiction. Additionally, he can choose an outpatient program, which is more flexible if he is unable to take time off from work. No matter his choice, he will require regular therapy, counseling, support groups, physical and emotional care, and a regimented schedule that will facilitate him to more closely lean into his recovery work.

Participating in Regular Individual Therapy with a Trauma-Informed Approach

Given his trauma and grief surrounding the death of his friend in Afghanistan, the client is in dire need of a mental health professional well-versed in dealing with patients who have experienced traumatic events. The gold standard in such cases is the utilization of trauma-focused cognitive behavioral therapy (Knight, 2019). This approach is evidence-based, and its efficacy has been proven in numerous cases. Dealing with his trauma will resolve an underlying issue that triggers his addictive behavior.

Engaging in a Culturally-Informed Family Therapy

The client needs family therapy, especially with his brother, who will play a crucial role in his recovery. As a Native American, this will not be the normal family therapy, as it needs to be culturally attuned to deal with issues such as relationships, spirituality, and intergenerational bonds. This type of therapy will re-anchor the client into a healthy family connection, which will provide further motivation for him to remain sober.

Connecting with a Community of Native Peer Supports

Native peer recovery networks are pivotal in this client’s sobriety journey. This is because the local tribal support can provide him with a crucial cultural context for building and affirming a sober community. It would also help him reconnect with peers he can mingle with freely, further eliminating his self-imposed isolation. It might also allow him to make quality friends whom he can rely upon in times of difficulty.

Cultivate Emotional Wellness and Positive Life Restructuring

Achieving goal number one will not be enough to guarantee long-term recovery and life satisfaction. To be fully rehabilitated, the client must heal psychologically and regain the motivation to improve his personal and professional life.

Participating in Cognitive Behavioral Therapy (CBT) and Mindfulness Interventions

CBT has a long history of being utilized by therapists to deal with issues such as low self-esteem, depression, the improvement of interpersonal functioning, and preventing patients from relapsing. Incorporating mindfulness interventions such as meditation and acceptance and commitment therapy bolsters impact, increasing the success rate.

Undergoing Vocational Counseling and Career Rehabilitation Programming

The client pursued Biology and excelled, only to become a co-manager at a retail store. This created a feeling of underemployment and a derailed career, which hurt his self-esteem. Thus, vocational counseling will boost his motivation, purpose, and quality of life. Additionally, it could help the client explore career redirection that fits his knowledge, skills, interests, and ambitions.

Exploring Positive Community Reintegration and Social Reconnection

For sustained recovery, the client must be in an environment that matches his goals and values. This will require restricting the client’s leisure activities and developing new hobbies other than drinking. He will also require a new set of friends who will reconnect him to the native collectivist values, teachings, and practices.

Rationale and Research Support

The goals and their accompanying objectives as regards this client are grounded in empirical evidence. They are also culturally informed and offer a holistic approach to treating the underlying issues that trigger the client’s alcoholism and substance abuse. The first goal aims to treat the client’s addictive behavior, offer him skills to deal with trauma, and reconnect him to his native roots (Hahmann et al., 2022). The second goal and its objective will ensure the client’s long-term sobriety by engaging in individual and family therapies using modalities such as CBT, mindfulness, and culturally attuned interventions (Gee et al., 2023). These will improve the client’s coping mechanisms and self-worth and ensure that he has strategies to endure when he is distressed. In addition, the interventions will restructure his social connections so that he remains grounded in his cultural tradition to maintain sobriety in the long term.

The client’s cultural and spiritual contexts are considered to improve the interventions recommended for this client. This step was taken as research shows that understanding the cultural background, practices, and values of Native Americans is key to their recovery during therapy (Verbunt et al., 2021). Therefore, incorporating some elements of the Native communities will not only be culturally sensitive, but it will also be a key factor in ensuring long-term rehabilitation of the client. Without this holistic perspective, the client’s recovery is unlikely to be long-term.

Evaluation

Assessing whether the goals and objectives of the treatment plan are being achieved is instrumental in ensuring that the clients make a full recovery at the end of the interventions. Some of the measures that will be used to evaluate the effectiveness and success of the measures undertaken will include toxicology screening of the patient to ensure there are no alcohol or drugs in his system. Additionally, the clinically-rated scales (e.g., PHQ-9, PCL-5) will periodically be deployed to assess the client’s depression, trauma, and anxiety symptoms. For family therapy, attendance tracking and session participation evaluations will be used. Finally, to measure progress in overall recovery, tools such as diagnostic criteria, evaluations of lifestyle restructuring, and client self-reports will be used.

Self-Reflection

In assessing this case, I can point out several of my strengths that will be crucial to the client’s treatment and recovery. My initial interaction with the client established a warm, non-judgmental rapport that enabled him to share his struggles and frustrations. Additionally, my empathetic demeanor helped build trust, which will be extremely crucial in the treatment phase. I also exhibited clinical insights and flexibility in assessing the client. Rather than focusing on his two main problems of drug abuse and alcoholism, I have identified factors such as depression, self-esteem, trauma, history, identity issues, and other life stressors that could be triggering his addictive behavior.

However, I had to remain vigilant and aware of potential biases and ethical pitfalls that could have undermined my assessment capabilities. One of them was my unfamiliarity with the indigenous cultural traditions, which necessitated deferral to an expert on Native American culture. Additionally, sensitivity to trauma required me to tread carefully, not to exploit the client’s vulnerability or rescue him from the hard internal work that is necessary to deal with such situations.

References

Al-Khair, F. A. (2023). Substance Abuse, depression, and social Anxiety: case study and application of Cognitive Psychotherapy. Case Reports in Psychiatry, 2023, 1–5.

Eng, J. A., Drabwell, L., Stevenson, F., King, M., Osborn, D., & Pitman, A. (2019). Use of alcohol and unprescribed drugs after suicide bereavement: Qualitative study. International Journal of Environmental Research and Public Health/International Journal of Environmental Research and Public Health, 16(21).

Gee, G., Hulbert, C., Kennedy, H., Dwyer, J. J. M., Egan, J., Holmes, L. J., Mobourne, A., & Paradies, Y. (2023). Development of an Aboriginal resilience and recovery questionnaire – a collaboration between practitioners and help-seeking clients of a Victorian Aboriginal community-controlled health service. BMC Medical Research Methodology, 23(1).

Grim, B. J., & Grim, M. E. (2019). Belief, Behavior, and Belonging: How faith is indispensable in preventing and recovering from substance abuse. Journal of Religion and Health, 58(5), 1713–1750.

Hahmann, T., Perri, A., Masoud, H., & Bombay, A. (2022). Parent and/or grandparent attendance at residential school and dimensions of cultural identity and engagement: Associations with mental health and substance use among First Nations adults living off reserve. Society and Mental Health/Society and Mental Health., 13(1), 1–22.

Karloh, M., Matias, T. S., De Oliveira, J. M., Lima, F. P. D. A., Pinheiro, D. H. A., Barbosa, G. B., Furlanetto, K. C., & Carvalho, C. R. F. (2023). Breaking barriers to rehabilitation: The role of behavior change theories in overcoming the challenge of exercise-related behavior change. Brazilian Journal of Physical Therapy, 27(6).

Klussman, K., Curtin, N., Langer, J., & Nichols, A. (2022). The importance of awareness, acceptance, and alignment with the self: A framework for understanding self-connection. Europe’s Journal of Psychology, 18(1), 120–131.

Knight, C. (2019). Trauma-informed practice and care: Implications for field instruction. Clinical Social Work Journal, 47(1), 79–89.

Verbunt, E., Luke, J., Paradies, Y., Bamblett, M., Salamone, C., Jones, A. M., & Kelaher, M. (2021). Cultural determinants of health for Aboriginal and Torres Strait Islander people – a narrative overview of reviews. International Journal for Equity in Health, 20(1).