Conclusion

11

Engagement, Assessment, and HSBE Theory

Engagement, Assessment, and HSBE Theory

This section provides a detailed examination of the engagement, assessment, and application of Human Behavior in a Social Environment (HBSE) theory for a 35-year-old client receiving dual-diagnosis treatment for generalized anxiety disorder and alcohol dependency at Center to Rise Wellness Spa Studio in Arlington, Texas. The analysis aligns with the Mental Health and Substance Misuse specialization, emphasizing evidence-based practices, diversity considerations, social and economic justice, client strengths, and ethical challenges.

Engagement: Practice Skills

The situation of a client with comorbid generalized anxiety disorder and alcohol dependency will require a delicate manner of handling to build trust and cooperation. The three evidence-based engagement skills that the social worker applied were based on the requirements of the client and in line with the specialization of mental health and substance misuse.

Motivational Interviewing

The motivational interviewing approach assisted the social worker to promote the desire by the client to overcome his or her alcohol dependency, which was crucial because the client used alcohol as an unhealthy coping strategy to deal with anxiety. This client-centered approach included open-ended questions, affirmations, reflective listening, and summarizing in dealing with the ambivalence of the client to change. An example would be that during initial sessions, the social worker would ask, What do you think you will achieve by reducing the intake of alcohol?, to expose the inner motivation, which in this case is the improvement in occupational stability and social relations. Such an approach established a collaborative communication, through which the client was able to reveal her goals. Spencer et al. (2021) confirms the positive impacts of motivational interviewing in this population with dual diagnoses since it has the ability to enhance client participation in the treatment and reduce substance use by matching the interventions with the values of the client (Lee & Sherman, 2024).

Active Listening

To ensure that the social worker has a clear view of the experiences of the client, as she has chronic anxiety, active listening was also employed by the social worker, with the application of verbal affirmations, paraphrasing, and reflective responses. In illustration, the social worker responded, “your worry must be out of control to the extent that it is extremely difficult to accomplish most things, including work,” when the client responded that she felt overwhelmed. It created trust, and this was manifested in the fact that the client was more willing to discuss emotional problems in the follow-up sessions. Active listening is the basis of the therapeutic rapport, particularly with the clients with mental health problems, because it demonstrates empathy and helps to establish a nonjudgmental environment that promotes disclosure (Spencer et al., 2021). The approach has been chosen to address the emotional suffering of the client and to encourage him to take part in the treatment.

Culturally Adapted Engagement

Cultural sensitivity was obtained when the social worker determined the cultural affiliation of the client and the stigma surrounding mental health and substance use in that community and tailored the approach to engagement. This involved the use of language and metaphors that were close to the experience of the client, and this included conveying the idea of recovery as a process of reclaiming strength that matched the cultural value of resilience. The social worker also addressed the issue of stigma by normalizing the help-seeking process, saying, “Many other individuals who have gone through the same thing consider therapy as one of the means of healing.” This plan decreased the involvement obstacles because the client felt relieved due to the knowledge. The literature in favor of cultural adaptation of interventions proves the enhanced treatment engagement in populations of diversity, particularly in the groups facing stigma-related obstacles (Lee & Sherman, 2024).

The choice of these engagement skills was made because they are aimed at empowering the client, meeting the individual needs of the client, and being consistent with the evidence-based practices on co-occurring disorders. The integration of motivational interviewing, active listening, and culture-sensitive engagement allowed the social worker to build the solid therapeutic relationship, which preconditioned successful assessment and intervention.

Assessment: Tools

The assessment process involved the use of two evidence-based instruments that have been validated to gather, summarize, and analyze data on the mental health and substance use issues of the client to have a complete picture of their requirements.

Generalized Anxiety Disorder-7 (GAD-7).

The severity of anxiety symptoms of the client was evaluated with the help of the GAD-7, a seven-item self-report scale. The tool was administered at the first session and required the client to provide ratings on the frequency of such symptoms as feeling nervous, anxious, or on edge within the past two weeks. It is appropriate to use it to measure generalized anxiety disorder in dual-diagnosis populations because it has high reliability and validity in different populations (Ashraf et al., 2024). The structured nature of the GAD-7 enabled the social worker to assess the severity of the symptoms in a quantitative manner, which can form the basis of treatment and the monitoring of the progress.

Alcohol Use Disorders Identification Test (AUDIT).

The client was assessed using a ten-item screening measure, the AUDIT, which determines the alcohol intake, dependence, and harm. Questions like how many times have you had a drink with alcohol, have you or someone been hurt due to your drinking, and so on gave a clue to the alcohol consumption habits of the client. The AUDIT can be applied to the dual-diagnosis population and is supported in digital interventions, which is why the dependency was assessed correctly (Oesterle et al., 2024). The standardized scoring of the tool allowed the monitoring of the changes over time, which informed the intervention strategy.

Such tools were selected because of their psychometric rigor, ease of administration, and relevance to dual-diagnosis populations. They were evidence-based, which guaranteed their accuracy in collecting data so that the social worker could come up with a customized treatment plan that would deal with the co-occurring disorders of the client.

Assessment: Overview of Client Assessment

The evaluation provided essential information regarding the state of the client, where the interaction between mental health and substance abuse issues was noted. GAD-7 produced the score of 18 that reflects the severe anxiety with the persistent and uncontrollable worrying that had a strong negative effect on daily functioning, including work and social aspects. These symptoms were restlessness, inability to concentrate, and sleep disturbances, which the client described as overwhelming and interfering with his/her ability to have consistent work performance. The AUDIT score was 12, indicating moderate alcohol dependency, and the patient applied alcohol as a coping tool to deal with anxiety and contributed to social isolation and lack of stability at work (Beck et al., 2023). As an illustration, the client mentioned that she used to drink to feel relaxed before going out and eventually avoided relationships.

The age of the client (35), the single state of marriage, and the cultural background were the relevant diversity factors that influenced the experiences of the client. The socioeconomic factors of the client constrained the available resources to the client, including the use of a private therapist, and cultural stigma towards mental health and substance use in their community of Arlington curbed help-seeking behavior. The client was ashamed that he had decided to get treatment, as he said, “People in my community believe that only weak individuals seek therapy.” These reasons, along with their gender (not specified but pertinent to social norms), highlighted the necessity of culturally aware interventions to overcome obstacles and encourage participation (Lee & Sherman, 2024).

Assessment: Social and Economic Justice

The case of the client illustrates that the access to care is affected by high levels of social and economic injustice. They have a low socioeconomic status that limits their access to integrated mental health and substance use treatment, which is a system-wide barrier common in the rural and underserved parts of Arlington. Lack of providers and insufficient healthcare infrastructure restrict the regular participation in treatment, which is against the right of a client to equitable healthcare provided by the NASW Code of Ethics (NASW, 2021). To illustrate, the client could not locate local services that were affordable, and she depended on the Center to Rise Wellness Spa Studio, which was one of the accessible providers in the neighborhood. The stigma in society regarding mental health and substance use also puts the client on the periphery and does not encourage seeking help, increasing disparities. These problems are in line with the studies that show that there are systematic disparities in the provision of mental health care to low-income groups (Ford et al., 2021). To overcome these obstacles, it is necessary to promote better resource distribution along with culturally competent care in order to provide equal access to treatment.

Assessment: Strengths and Areas for Growth

The evaluation revealed the main strengths and areas of development on the basis of which the intervention was based. The main strength of the client is his/her motivation to change, as he/she regularly attends therapy sessions and reports his/her desire to begin to lead his/her life. Provision of family support, though limited, as in encouragement by a sibling, is an added element of recovery. The improvement areas are the creation of adaptive coping mechanisms to cope with anxiety without the use of alcohol, including mindfulness or cognitive strategies, and socialization to decrease isolation. An example would be that the client showed interest in meeting with friends again but did not have skills on how to do it. The results are consistent with other studies that focus on the significance of focusing on the strengths of the clients in treating dual diagnoses and addressing the deficits using skill-building interventions (Spencer et al., 2021).

HBSE Theory

The systems theory, which is based on the ecological model, was chosen to place the client with co-occurring disorders in context. According to this theory, individual behavior is influenced by the interaction at several levels of the systems: micro (family, peers), meso (community resources), and macro (societal policies and stigma) (Bronfenbrenner, 1979). In the case of this client, both their anxiety and alcohol dependency are caused by a complicated combination of environmental factors. At the micro level, having a family history of substance use makes alcohol a normal coping mechanism, as the client remembers how their parent used to resort to alcohol in stressful situations. On the meso level, there is poor access to mental health services in Arlington, thus worsening the untreated symptoms because the client could not access affordable care until she was linked to Center to Rise. On the macro level, there is a stigma against mental health and substance use, which leads to the discouragement of seeking help, and the client develops the idea that going to therapy is a weakness (Pino-Lozada et al., 2021). The systems theory is applicable in such cases as it contextualizes the problems of the client in their context to provide interventions that consider individual, family, and systemic levels to discontinue the maladaptive behaviors and facilitate recovery.

Ethical Challenges

An ethical conflict arises between respecting the client’s autonomy (NASW Standard 1.02) and the need to intervene if their alcohol use escalates, potentially requiring mandatory reporting to ensure safety (NASW, 2021). For example, if the client’s drinking leads to behaviors endangering themselves or others, such as driving under the influence, the social worker faces a dilemma: honoring the client’s right to self-determination versus prioritizing their well-being through protective measures, such as reporting to authorities. This tension challenges the NASW Code of Ethics’ emphasis on autonomy and requires careful navigation. To resolve this, the social worker can engage the client in transparent discussions about safety concerns, co-developing a safety plan that aligns with their values, such as agreeing to contact a support person during high-risk situations. This approach balances ethical obligations while maintaining a client-centered focus.

Conclusively, the engagement, assessment, and application of systems theory provided a comprehensive framework for addressing the client’s co-occurring generalized anxiety disorder and alcohol dependency. By utilizing evidence-based engagement skills and validated assessment tools, the social worker established a strong therapeutic alliance and gained critical insights into the client’s needs. Systems theory highlighted the interplay of environmental factors, guiding holistic interventions tailored to the client’s context. Ethical considerations, balanced with client-centered care, underscored the importance of aligning interventions with the NASW Code of Ethics to promote recovery and equity.

References

Ashraf, N., Arabi, T. Z., Dabaliz, A., Abou Shaar, B., Baqal, O. J., Taha, R. M., ... & Ouban, A. (2024). Assessing the prevalence of generalized anxiety disorder in a multicultural medical education setting in Saudi Arabia during the COVID-19 pandemic. Frontiers in Psychiatry, 15, Article 1359348. https://doi.org/10.3389/fpsyt.2024.1359348

Beck, J. G., Bowen, M. E., Majeed, R., Free, B. A. L., Brown, T. A., Brown, B., & Farchione, T. (2023). Alcohol use and mental health symptoms in nurses during the early months of COVID-19. Journal of Dual Diagnosis, 19(4), 240–247. https://doi.org/10.1080/15504263.2023.2260346

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.

Ford, J. H., Kaur, A., Rao, D., Gilson, A., Bolt, D. M., Garneau, H. C., ... & McGovern, M. P. (2021). Improving medication access within integrated treatment for individuals with co-occurring disorders in substance use treatment agencies. Implementation Research and Practice, 2, 1–11. https://doi.org/10.1177/26334895211033659

Lee, C. S., & Sherman, D. K. (2024). Integration of motivational interviewing and self-affirmation theory into a culturally adapted motivational interview: A case study. Clinical Case Studies, 23(3), 212–229. https://doi.org/10.1177/15346501231222554

National Association of Social Workers. (2021). Code of ethics of the National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics

Oesterle, T. S., Hall-Flavin, D. K., Bormann, N. L., Loukianova, L. L., Fipps, D. C., Breitinger, S. A., ... & Karpyak, V. M. (2024). Therapeutic content of mobile phone applications for substance use disorders: An umbrella review. Mayo Clinic Proceedings: Digital Health, 2(2), 192–206. https://doi.org/10.1016/j.mcpdig.2024.03.004

Pino-Lozada, E. D., Garcés-Granda, I. A., & Vallejo-Acurio, B. A. (2021). Family resilience in time of crisis.  Revista Científica y Arbitrada de Ciencias Sociales y Trabajo Social: Tejedora. ISSN: 2697-3626,  4(7), 104-115. https://publicacionescd.uleam.edu.ec/index.php/tejedora/article/view/218

Spencer, A. E., Valentine, S. E., Sikov, J., Yule, A. M., Hsu, H., Hallett, E., ... & Fortuna, L. (2021). Principles of care for young adults with co-occurring psychiatric and substance use disorders. Pediatrics, 147(Suppl. 2), 229–239. https://doi.org/10.1542/peds.2020-023523F