TPC Journal V8, Issue 3- FULL ISSUE

234 The Professional Counselor | Volume 8, Issue 3 An additional individual-level concern that must be addressed is Jason’s chronic pain frommultiple herniated disks. During the first week of substance abuse treatment, Jason’s plan should include a complete physical examination with an emphasis on assessing pain level and spinal functioning, as well as HIV and hepatitis screening. Throughout his substance abuse treatment, Jason should receive psychoeducation via group work, lectures, reading materials, and videos or other media in order to enhance his understanding of the cyclic nature of pain disorders and opioid addiction. Jason also should make an appointment and establish a relationship with a medical specialist who is knowledgeable in both pain management and addictive disorders. Jason and this medical professional can develop an action plan to address his chronic back pain while minimizing his risk of opiate relapse. Acute fiscal concerns and the accompanying stress associated with lack of financial resources were identified as primary risk factors for relapse. Individual-level interventions should include connecting Jason with vocational rehabilitation counselors who will assist him in identifying personal and employment strengths, acknowledging limitations in the current job market, and assisting him in finding employment. Finally, in order to enhance the likelihood of success in his recovery, Jason should address issues of shame resulting from his drug use and loss of family, employment, health, and identity. While in treatment, he should receive extensive psychoeducation as to the meaning and significance of shame in the recovery process. Jason should be encouraged to discuss, in individual and group counseling, the complex nature of his drug use and related intra- and interpersonal consequences. Microsystem: Face-to-face interactions between individual and environment . Primary face- to- face interactions impacted by Jason’s addiction to opiates include communications with his ex-wife, sons, and mother. Although Jason’s marriage was negatively impacted by the family’s moving to Ohio, his use of prescription opioids following the move hurt his ability to communicate, restricted his interactions with his wife and children through gradual withdrawal from family events, and transferred parenting responsibilities to his wife. These changes in functioning within his nuclear family caused further alienation from others, including but not limited to his mother, friends, neighbors, fellow church members, and extended family. As a result of his opiate use, he no longer attended parent–teacher conferences at school and only sporadically appeared at his children’s baseball and football games. Having grown up in a small town, Jason was well known and well liked by many in his community. While working at the local concrete company in his home town, he had developed a tight-knit group of close friends, many of whom he knew from childhood. Upon his return to West Virginia following his loss of employment and injury while in Ohio, Jason no longer reached out to this group of friends. Instead, his primary focus became finding, paying for, and using opioids in order to avoid painful withdrawal symptoms. His social circle was nearly replaced by his drug dealer and occasional fellow heroin users with whom he would shoot up and share needles. It should be noted that all of the individual-level treatment concerns involve microsystem-level interactions between Jason and his environment. Jason’s counselor should be aware that achieving these goals will depend upon Jason’s pursuit or avoidance of interactions with various individuals, groups, and settings (i.e., the microsystem). This ecological awareness will increase the counselor’s understanding of the magnitude of Jason’s task, allowing for both deeper empathy and better planning. By highlighting the microsystem interactions required to pursue treatment goals, the counselor can help Jason become aware of the many variables in the environment he may not be able to control, thus emphasizing the importance of remaining steadfast regarding those elements of his treatment and life in which he does have power and choice.