Growing Up In A Case Of Diana Travine

Diana Travine is a 43 year old, African American woman with a long-term addiction to injecting heroin and prescription pain medication and tranquillizers. In the beginning, she was first introduced to heroin at the college age where she would do it only with her friends and was sure to use sterile needles. Unfortunately she continued to use, increasing in frequency, with no regard to the presence of others. At this point, she is no longer able to feel any significant high from the heroin. Diana now lives alone in a suburban townhouse. An accounting job with a gas and oil company is maintained and she is an active member of her church.
Five Issues Recently she was admitted to the hospital for what she presumed to be symptoms of pneumonia
and was tested positive for HIV. Through the use of injecting heroin and her sexual promiscuity over the last 3 years, it has undoubtedly increased her exposure to the virus. She has suffered with many illnesses over the last 18 months, likely due to becoming immunodeficient. The 20 pound weight loss she experienced during times of sickness was welcomed due to her poor self-image. Diana remains in denial about her diagnosis and current health status. She recently resorted to taking more than her prescribed dose of prescription medication in order to help her sleep. She admits she needs help for the prescription drug use but is adamant that the heroin use alone is not affecting her life in a negative way.
Major issue/Chosen Theory Her family background is a good indication of the most revealing cause of her addiction.
Growing up in a family with rigid moral and cultural values, it provoked feelings of shame and left her isolated in dealing with current issues. Her father is the minister of the church and had high expectations for all three of his children. Her older sister, Selma, is doing the most in the way of a prosperous family including three children and harvested a career as a university professor, soon to obtain a PhD. Pete, her younger brother, owns an electric company and has no children. In the profile, there is mention of his taste for alcohol. This indicates that their strict upbringing likely had a negative effect on him as well. All three children managed to live up to certain expectations professionally, though are lacking in certain aspects of their personal lives. For example, they are all considered “workhorses” and are not providing the effort into the creation of a strong support system for each other. This is likely the reason why Diana has not shared her drug use with any family members. Another consideration is that Diana could consider herself the least successful among her siblings and may resent them to some extent. Furthermore, she was prone to rebel during her college years given her new found freedom away from the confines set by a rigid and religious
father. The specific theory that applies the most to Diana and her addiction is the Cognitive Theory as described in the course. Most of us have the ability to assess a situation, react accordingly and even predict the outcome as Albert Bandura outlined. She is a prime example of an addict self-regulating in order to manage her chosen drug-induced lifestyle. Outcome expectancies are key to why she has continued to use heroin. She found it allowed her to be more relaxed around men, leading to her promiscuity. It is promising to hear Diana is willing to accept treatment for the prescription drugs though it is concerning that she has under-estimated the strength of her heroin addiction. This efficacy expectation created, leads to doubts of her success in treatment. I chose this model because she has acknowledged the consequence of feeling ashamed of what her lifestyle brought. I worry about her overall self-confidence and her expectations regarding using only heroin instead of both, pain medications and heroin. It is fairly obvious that she is in denial about her drug use and the implications it is having on her health. She has unknowingly isolated herself and is not being honest with those around her. The end goal for her treatment would be to change the way she thinks and feels about her drug use.

Treatment The most beneficial treatment for Diana given her fragile health status and two forms of opiate addiction is Cognitive Behavioural Therapy (CBT) paired with certain pharmacotherapies. The goal in using both treatments simultaneously has proven effective to minimize withdrawal symptoms in order for Diana to focus upon new ways of thinking and therefore behaving (Foote et al., 2014). Diana needs to be open and honest with her family in order to get the support and motivation she requires. Due to her denial displayed regarding a topic as serious as heroin use accompanied by her recent diagnosis of AIDS, she may benefit from a brief intervention. This involves a support system and a few key communications; a personalized assessment, non-judgemental feedback, distinct treatment options with attainable goals all outlined in an empathetic manner (Foote et al., 2014). She truly lacks the support of her family and most importantly, her father. The repercussions she suffered because of this are realized with her poor health and sexual promiscuity over the last three years. If treatment is accepted by Diana then CBT in a treatment program away from her current and toxic environment is warranted. There are several protocols in place revolving around training in communication, relapse prevention and cognitive strategies. With this technique, short and long-term goal setting and assigned homework is completed by the addict to obtain new skills and enhance problem solving in the real world (Foote et al., 2014). While not considered treatment, detoxification is a major initial step in order to follow up with proven treatments such as CBT. Detox or opiate agonist therapy includes the use of certain drugs that use the same opioid receptors in the brain as those used by the drug of choice. It is considered much safer in the way it reduces the withdrawal effects and behaviour characterized by addiction including; injecting and other risky behaviours (NIDA, 2014). There are a few specific drugs used in this type of therapy typically (depending on location) dispense daily doses from an outpatient facility. These opiates are Methadone, Buprenorphine and Naltrexone. Methadone has been in use since the 1960's, it “effectively suppresses opioid craving, blocks the euphoric effects of exogenous opioids (i.e. narcotic blockade) and stabilizes psychosocial functioning” (Tetrault & Fiellin, p. 220, 2012). In her diagnosis with the human immunodeficiency virus, it would be wise for Diana to be proactive in her treatments involving antiretroviral therapy along with preventative measures like avid hand washing and vaccinations. Methadone and the array of medications prescribed for individuals with HIV must be aware of the interactions as they are known to occur and may promote withdrawal symptoms or possible toxicity (Tetrault & Fiellin, 2012). This combination of treatments is ideal to help Diana get on the right path to have the heroin, prescription drugs and sexual behaviour curbed in order to forge a new and healthy way of life.