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mental retardation

Introduction

In 2006, the 130-year-old American Association on Mental Retardation changed its name to the American Association on Intellectual and Developmental Disabilities because it recognized that within the culture of its membership opinion toward the term mental retardation had turned negative. In its press release, an official noted, “This new name is an idea whose time has come. Individuals with disabilities and family members do not like the term mental retardation and their advocacy is encouraging political and social change at national, state, and local levels. Our members demanded that we keep up with [the] times and they voted for this name change” (American Association on Intellectual and Developmental Disabilities, 2006).

Like the disabilities field, the field of addictions also relies on terms and labels to diagnose, treat, and intervene. One precaution in working in the field is to understand the controversy surrounding labeling, the effect of labeling on clients, and the influence of cultural context on labels. A consideration affecting assessment and treatment is the underlying model used to inform processes.

This week, you examine the implications of labeling in addictions assessment, and you explore the relationship between addiction models and assessment processes.

Objectives

Students will:

  • Analyze implications of labeling in the addictions assessment process
  • Analyze influences of cultural context on labeling in the addictions assessment process
  • Analyze the relationship between models of addiction and assessment processes
  • Evaluate controversies associated with models of addiction

Required Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Readings

  • Gordis, E. (2009). Contributions of behavioral science to alcohol research: Understanding who is at risk and why. In G. A. Marlatt, & K. Witkiewitz (Eds.), Addictive behaviors: New readings on etiology, prevention, and treatment (pp. 19–32). Washington, DC: American Psychological Association.
    Addictive Behaviors: New Readings on Etiology, Prevention, and Treatment, 1st Edition by Marlatt, G. &Witkiewitz, K.  Copyright 2008 by American Psychological Association. Reprinted by permission of American Psychological Association via the Copyright Clearance Center.

    For your Assignment, focus on thevarious hypotheses that describe why some individuals develop addictions and how certain age groupings are affected by alcohol.
  • Miller, G. (2010). Learning the language of addiction counseling. New York, NY: Wiley.
    Learning the Language of Addiction Counseling [Third Edition] by Gerri Miller.  Copyright 2012 by John Wiley and Sons – Books. Reprinted by permission of John Wiley and Sons – Books via the Copyright Clearance Center
    • Chapter 1, “Introduction”

      For your Assignment, focus on the various models of addiction and how they might relate to assessment.
  • Allamani, A. (2008). Views and models about addiction: Differences between treatments for alcohol-dependent people and for illicit drug consumers in Italy. Substance Use & Misuse, 43(12/13), 1704–1728.
    Retrieved from the Walden Library databases.

    Focus on the cultural context surrounding substance abuse and dependence and gambling.
  • Kroska, A., &Harkness, S. K. (2008). Exploring the role of diagnosis in the modified labeling theory of mental illness. Social Psychology Quarterly, 71(2), 193–208.
    Retrieved from the Walden Library databases.  

    Focus on the concept of consequences of labeling to the individual. Though this article is focused on mental illness, the concepts apply to the field of addictions.
  • Richard, A. J., Trevino, R. A., Baker, M., & Valdez, J. (2010). Negative reflected appraisal, negative self-perception, and drug use intentions in a sample of suburban high school students. Journal of Child & Adolescent Substance Abuse, 19(3), 193–209.
    Retrieved from the Walden Library databases.

    Focus on how labeling might affect adolescents.
  • Van derAa, N., Overbeek, G., Engels, R. C. M. E., Scholte, R. H. J., Meerkerk, G-J.,& den Eijnden, R. J. J. M. (2009). Daily and compulsive internet use and well-being in adolescence: A diathesis-stress model based on Big Five personality traits. Journal of Youth & Adolescence, 38(6), 765-776.
    Retrieved from the Walden Library databases.

    For your Assignment, focus on how the diathesis-stress model is applied in assessing Internet addiction in adolescents. Pay particular attention to how this model was incorporated into the assessment of Dutch adolescents in order to study their behavior.
  • Young, R. S., & Joe, J. R. (2009).Some thoughts about the epidemiology of alcohol and drug use among American Indian/Alaska Native populations. Journal of Ethnicity in Substance Abuse, 8(3), 223–241.
    Retrieved from the Walden Library databases.

    Focus on the cultural context of alcoholism in the Indian/Alaska Native populations. How might such labels as alcoholic and drinker differ in these populations as opposed to a different population in the United States?
  • Addiction Treatment Magazine. (2011). New definition of addiction causing controversy among doctors. Retrieved from http://www.addictiontreatmentmagazine.com/addiction/new-definition-addiction-controversy/

    Focus on
    how the new definition of addiction differs from definitions of years past. Why would this new definition be controversial? How would it affect treatment and practices?

Optional Resources

Implications of Labeling

Assessment starts out with the best of intentions. Addictions professionals apply labels associated with common presenting characteristics in order to provide an understanding of the type of help each person may require. This is the rationale behind the American Psychiatric Association’s classic Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952 to consolidate census and psychiatric hospital information. This resource crosses many fields, from medicine to psychiatry to psychology.

Despite the success of this text and the respect it has garnered in the field, a decades-long controversy has surrounded the use of labels in addictions. As the primary provider of labels, the DSM is at one end of the spectrum. At the other end are those who criticize labels as being too limiting for various reasons, including cultural considerations. (For the purposes of this course, culture goes beyond race and ethnicity to include other defining aspects, such as social group, neighborhood, sexual orientation, occupation, and others.) An individual’s behavior might be perceived as deviant by one culture but not by another. It is also important to remember that the DSM has undergone many revisions, the most recent in the DSM-5; it is important to stay abreast of the changes as they occur.

In this week’s Discussion, you will analyze the implications of labeling and cultural considerations in the addictions assessment process.

To prepare

Review the Learning Resources, including the following articles:

  • “Some Thoughts About the Epidemiology of Alcohol and Drug Use Among American Indian/Alaska Native Populations”
  • “Views and Models About Addiction: Differences Between Treatments for Alcohol-Dependent People and for Illicit Drug Consumers in Italy”

Post by Day 4 your response to the following:

What role, if any, should labeling play in the addictions assessment process? In your response, include implications and cultural considerations.

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Psychology: Implications of Labeling

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Labeling

The Role of Labeling in the Addiction Process

            Labeling is a term that defines the influence on individual self-identity and behaviour by the terms used to describe their disorders (Allamani, 2008). The adoption of labels has a long history dating back to 1960s and more modifications have been adopted. The adoption and use of labels has a number of roles in the disorder assessment. However, the use of labels must take into consideration the cultural contexts under which they are being used.

            Labeling helps psychologists in classification of disorders, which are important in the design of the appropriate treatments for a particular disorder diagnosed in the assessment process. The use of labels helps to put disorders in categories depending on the assessment outcomes. Different disorder categories have different treatment and their classification based on labels helps in identifying the appropriate treatment strategies.

            According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Hamlin, n.d.), using labels helps in statistical catering of the disorders 9for purpose of census records). When assessments are carried out and disorders are categorized based on labels, it helps in identifying the number of disorders that fall under a certain category thus providing the severity of that particular disorder within a population and in the country as a whole.

Implications and Cultural Considerations of Labeling

            The use of labeling has a number of implications, which include the likelihood of it carrying a stigma (Hamlin, n.d.). Labeling a disorder may lead to stigmatization, which could lead to damage of the self-image of the client, resulting in stereotyping by the individuals who know the client. In addition, there are likelihood of use of diagnoses as labels, thus excluding certain individuals from services, depriving them in purchasing certain programs and insurance coverage. Therefore, the use of labeling must consider the cultural contexts under which it is used. Some labels under certain cultural contexts may mean a different disorder. For example being labeled an alcoholic may not elicit a stigma in certain culture, while being labeled a drunkard may elicit hug………………………………………………….

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Writers Solution

Psychiatric Mental Health Nurse Practitioner

 2 REFERENCES

A comprehensive psychiatric assessment is a necessary element for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to provide the necessary treatment for a client with mental illness while establishing a  criteria-based diagnosis (Sadock, Sadock & Ruiz, 2014).  A comprehensive psychiatric assessment depends on the skills and training of the PHMNP to interact well with their client and gather the information that will guide them to an accurate diagnosis and course of treatment.

 Classification of mental health diagnosis in a clinical setting for diagnosis, treatment, and evaluation for the child or adolescent depends on the availability of reliable and valid instruments such as standardized diagnostic interviews (SDIs).  These SDIs include the Diagnostic Interview Schedule for Children, 4th ed. That takes 90-120 minutes to administer,  and the Mini International Neuropsychiatric Interview for Children and Adolescents and takes about thirty-five minutes to administer, enabling the PMHNP to document the presence and severity of symptoms and diagnose a specific psychiatric disorder (Duncan et al., 2018).

These assessments will include background information regarding family, whom the client lives with if the parents are separated, and their relationship with family members—information of past mental health issues, inpatient or outpatient treatment, and current medication.  The PMHNP will also need to know about any medical conditions the client may have, and there is a need for medication.  The client will also give information about his or her social life, friends, school activities, how well they are doing in school, and favorite subject. All of this information helps to discuss goals and develop a treatment plan.

This discussion is based on the video by YMH Boston, 2013 where I am observing an initial interview between and the provider and a male adolescent give additional suggestions of improvement and concerns that may or may not have been addressed during the initial interview and any additional questions that may need to be asked.

Observation of what the Practitioner Did Well and Areas of Improvement

The practitioner addressed confidentiality issues and when confidentiality will be broken, and Shawn was receptive and understood. The practitioner was able to establish a rapport with Shawn and obtain some basic information. The practitioner was able to talk about school sports, favorite subjects, and identify two people who can relate.

When talking about Shawn’s relationship with his mother, the practitioner’s comment makes Shawn uncomfortable and defensive when Shawn does not understand why his mom sent him for therapy. Shawn also becomes defensive when the practitioner probes why Shawn’s mom wants him to come to this appointment.  The practitioner could have asked more questions regarding the school and the reasons for Shawn not liking school, and how Shawn’s dad fit into the picture.

Compelling Concerns and Additional Questions

The concerns would be at the root of the anger and how Shawn’s father fits into the picture. Does he take an active role in Shawn’s life, and I would ask Shawn about his dad, especially when Shawn states that he can confide in his coach and sees him as a father figure. I would want to know more about the difficulties he has at school, and his mom is aware of these difficulties.  How do these issues need to be addressed? How are his grades? Does he need a tutor or peer support for subjects such as English to keep his grades up so that he can continue to play basketball?

I would also want to know what makes him angry, are there any identifiable triggers? Does he threaten his mom physically or verbally? Does he need group therapy whose focus is on anger management?  Once again, are his school issues overflowing into his relationship with his mom, causing these angry outbursts?

Conclusion

One possible diagnosis for Shawn based on the interview would be Disruptive Mood Dysregulation Disorder 296.99 (F34.81). Shawn states that he loses his temper nearly every day and that his angry mood and yelling cause problems at home and could be a possible cause at school. He clearly stated that he gets upset when his mom asks him questions, mostly about school that triggers him, and he starts yelling. He stated that his mom set up the appointment because she believes he needs help managing his anger.

I would want to know about anxiety or depression, but there was not enough information or screening questions to come to any other diagnoses.

Anger is a secondary emotion that the root cause can be due to various internal and external factors. These factors can be biological, psychological, and social, a particular personality trait, anxiety and depression, and the ability to problem-solve, leading to verbal and physical aggression. By helping Shawn to acknowledge his anger and learns more about his anger and ways to manage the triggers that cause his anger, he will see a decrease in aggressive behavior and an increase in communication skills (Farisandy & Hartini, 2020)

References

American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Duncan, L., Comeau, J., Wang, L., Vitoroulis, I., Boyle, M. H., & Bennett, K. (2018). Research         review: Test-retest reliability of standardized diagnostic interviews to assess child and                      adolescent psychiatric disorders: A systematic review and meta-analysis. Journal of             Child Psychology and Psychiatry60(1), 16–29. https://doi.org/10.1111/jcpp.12876

Farisandy,E., & Hartini, N. (2020). The effect of anger manatment training toward aggressive

            Behavior in adolescents. Jurnal Psikologi, 19(1),95-107.             https://doi.org/10.14710/jp.19.1.95-107

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

YMH Boston. (2013, May 22). Vignette 4 – Introductions to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE

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Writers Solution

Medications Used to Treat Mental Illness

You are a nurse at an outpatient clinic and are presented with a 68-year-old female client.  She is experiencing the following symptoms: decreased appetite, disturbed sleep pattern, fatigue, difficulty concentrating, disordered thought process, anhedonia, guilt, and low self-esteem. The doctor diagnoses the client with major depressive disorder.  Answer the following questions:

  • What medication do you think is likely to be prescribed for this client and why? 
  • What are some important teachings you would give this client when administering the first dose? 
  • When following up with the client 2 months later.  What are some changes you may expect to see with the client? If the client is not displaying the expected outcomes, what are some possible alternatives for the client? 
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Writers Solution

mental disorder or illness, terminally-ill patients, incarcerated individuals, undocumented immigrants, or convicted felons)

Observation project 

The paper should be between 3 and 8 pages in length (excluding title page and reference page). It should include a minimum of 3 to 10 valid outside sources. Students will choose a setting or group and conduct an observation, focusing on noting deviant behavior in that setting or group. Suggested settings include busy street corners, malls, coffee shops or restaurants, airports, churches, public parks, courtrooms, etc. They will write a paper relating their observations and analyzing the deviant behavior using what they have learned in the course. Sociology majors will format their paper using the ASA style. Other majors may use the style they are most familiar with (APA, MLA, etc.).

Guidelines about how to conduct observations are presented at the end of this syllabus.

PLEASE NOTE: This project is classified as a “class activity” by the Saint Leo University Institutional Review Board. To respect this classification, the following parameters must be applied:

• Students will not interact directly with the people they observe, beyond answering basic questions or carrying casual conversations. They will not conduct lengthy interviews.

• The results will only be shared in the context of the class, excluding any presentation or report to an audience outside of the classroom for which it is completed.

• The goal of the activity is NOT to contribute to generalizable knowledge. Students may collect and analyze data using scientific methods, but the protocol is too limited to permit any valid contribution to the general body of scientific knowledge.

• The activity does not involve any risk to participants beyond those of daily life.

• If the observation takes place on private property, in a setting that is not open to the public: The student must provide proof of authorization to conduct their observation there. The participants do not belong to a sensitive population (such as individuals under 18 years of age, individuals diagnosed with a mental disorder or illness, terminally-ill patients, incarcerated individuals, undocumented immigrants, or convicted felons). Observations in public settings (including stores, restaurants, malls, coffee shops, airports) may involve any kind of participants.