Conclusion

9

Intervention and Evaluation

Intervention and Evaluation

This section outlines an intervention strategy and evaluation plan for a 35-year-old client with co-occurring generalized anxiety disorder and alcohol dependency, receiving dual-diagnosis treatment at Center to Rise Wellness Spa Studio in Arlington, Texas. Grounded in the Mental Health and Substance Misuse specialization, the intervention integrates evidence-based practices tailored to the client’s needs, with measurable outcomes to assess progress. A single-subject research design evaluates effectiveness, critiques the intervention’s strengths and limitations, and explores policy, practice, and research implications. Ethical considerations and social justice principles ensure client-centered, equitable care, aligning with the NASW Code of Ethics.

Goals and Objectives

The client and social worker established three SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goals to address anxiety and alcohol dependency, which impair occupational and social functioning. The first goal is to reduce anxiety symptoms to a Generalized Anxiety Disorder-7 (GAD-7) score below 10, indicating mild anxiety, within six months, improving work and social engagement, as measured by self-reports. The second goal is to decrease alcohol dependency to an Alcohol Use Disorders Identification Test (AUDIT) score below 8, reflecting low-risk drinking or abstinence, within six months, enhancing stability, tracked by reduced alcohol-related incidents. The third goal is to increase social engagement by participating in two weekly social activities, such as support groups, within six months, documented through session discussions. These goals are achievable due to the client’s motivation and align with integrated treatment for co-occurring disorders (Spencer et al., 2021).

Intervention

The intervention integrates Cognitive Behavioral Therapy (CBT) and motivational interviewing (MI) over 24 weekly sessions, addressing the client’s co-occurring disorders. In the initial phase (weeks 1–4), the social worker builds rapport and identifies triggers for anxiety and alcohol use through CBT thought records and MI open-ended questions. The middle phase (weeks 5–16) focuses on teaching adaptive coping strategies like mindfulness to manage anxiety without alcohol. Research supports CBT’s efficacy in dual-diagnosis populations (Beck et al., 2023). The final phase (weeks 17–24) develops relapse prevention strategies and prepares for termination by connecting the client to community resources like Alcoholics Anonymous.

The social worker negotiated treatment by co-creating session plans, mediated by facilitating discussions with the client’s sibling to strengthen family support, and advocated by linking the client to ACA-covered resources to overcome financial barriers. Termination involves reviewing progress and providing referrals. This evidence-based approach enhances motivation for change (Lee & Sherman, 2024).

Theoretical Background

The intervention is grounded in cognitive theory, self-determination theory, and systems theory. Cognitive theory, underpinning CBT, suggests maladaptive thoughts drive anxiety and substance use, modifiable through structured interventions (Beck et al., 2023). Self-determination theory, the basis for MI, fosters intrinsic motivation by aligning interventions with the client’s values, such as employment stability (Lee & Sherman, 2024). Systems theory, rooted in Bronfenbrenner’s ecological framework, contextualizes challenges within micro (family history), meso (limited resources in Arlington), and macro (societal stigma) systems, guiding holistic interventions (Bronfenbrenner, 1979). This multi-theoretical approach ensures comprehensive care.

Intervention Practice Techniques

The social worker implemented three evidence-based practice techniques, each rooted in the intervention’s theoretical framework, to support the client’s recovery.

Cognitive restructuring is a tool that helps the client to notice and restructure the maladaptive thoughts, e.g., "I cannot live without alcohol," and transform them into adaptive ones, e.g., "I can employ mindfulness to cope with anxiety." This CBT intervention decreases anxiety-related alcohol consumption and encourages emotional control, and studies prove its success in the population with dual diagnosis (Beck et al., 2023).

Behavioral activation will motivate the client to participate in organized social activities like going to community events or support groups to fight social isolation. The given CBT-based approach promotes positive behavioral change, which corresponds to the objective of enhanced social engagement, which is supported by co-occurring disorders studies (Spencer et al., 2021).

Motivational enhancement applies MI to discuss the values of the client, like the desire to keep the job to support the determination to stay clean. Language adapted to the culture deals with stigma, making help-seeking normal and increasing engagement, and evidence has shown its effectiveness in the treatment of dual diagnosis (Lee & Sherman, 2024).

Such methods enable the client to come up with lasting coping skills and minimize their dependence on maladaptive behaviors.

Evaluation Methodology

The pre-post evaluation single-subject research design (SSRD) was selected to assess how effective the intervention is, as it is suitable for tracking individual progress in direct practice (Spencer et al., 2021).

The assessment monitors the severity of anxiety with the GAD-7 score, alcohol dependency with the AUDIT score, and social functioning by the number of social interactions that the client reports, which is in line with the SMART goals.

Data collection will entail completion of the GAD-7 and AUDIT at baseline (week 1), monthly (weeks 4, 8, 12, 16, and 20), and termination (week 24) during structured interviews. The social functioning is measured through client self-report in the session notes that record weekly social activities.

The GAD-7 and AUDIT are dual-diagnosis-validated instruments, which guarantee the measures of the severity of symptoms (Ashraf et al., 2024; Oesterle et al., 2024). The appendix contains blank copies.

Since it is an SSRD, there is no need to have any other sampling since the evaluation is limited to the client, and thus data is collected in an individualized manner.

The approach followed guarantees accurate outcome monitoring, which is in compliance with evidence-based practice in measuring dual-diagnosis interventions.

Evaluation Results

The evaluation expects a GAD-7 score reduction from 18 to below 10 and an AUDIT score from 12 to below 8 by week 24. The client is anticipated to report two weekly social activities, reflecting improved functioning. These outcomes indicate progress in managing anxiety and alcohol use. Success is driven by the client’s motivation and the intervention’s design. Challenges, like financial instability, may impede progress but are mitigated through advocacy for ACA-covered services (Ford et al., 2021).

Intervention Critique

The intervention’s strengths include its evidence-based integration of CBT and MI, tailored to the client’s needs, and cultural adaptation, enhancing engagement by reducing stigma (Lee & Sherman, 2024). It empowers the client through autonomy and skill-building. Limitations include external stressors, like Arlington’s limited healthcare infrastructure, which may hinder progress (Ford et al., 2021). The intervention avoids discrimination by prioritizing cultural sensitivity, but overemphasizing rapid symptom reduction could undermine long-term empowerment. Earlier peer support group involvement could enhance social reintegration.

Ethical Challenges

An ethical conflict arises between respecting the client’s autonomy (NASW Standard 1.02) and potential mandatory reporting if alcohol use escalates dangerously, such as driving under the influence (NASW, 2021). Resolution involves transparent safety discussions and co-developing a relapse prevention plan, aligning with ethical standards.

Policy, Practice, and Research Implications

Policy implications include increasing ACA funding for telehealth in rural areas to enhance access (Ford et al., 2021). Agencies should prioritize culturally adapted interventions and community partnerships to improve resource availability (Lee & Sherman, 2024). Research is needed on CBT and MI’s long-term efficacy in low-income, rural dual-diagnosis populations (Oesterle et al., 2024). These reforms support equitable care.

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, 1359348. Retrieved from 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. Retrieved from 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, 26334895211033659. Retrieved from 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. Retrieved from https://doi.org/10.1177/15346501231222554

NASW. (2021). Code of ethics of the National Association of Social Workers. Retrieved from 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. Retrieved from https://doi.org/10.1016/j.mcpdig.2024.03.004

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. Retrieved from https://doi.org/10.1542/peds.2020-023523F