1. Client’s Biographical InformationName : Razul Bin Abdullah

IC number : 750609-06-5211

Age : 35 years old

Sex : Male

Ethnic : Malay

Religion : Islam

Date of birth : 04 Disember 1978

Hometown address : No. 38, Kampung Jawa, Lorong Hj Kamili, Rantau

Panjang 42100, Klang, Selangor Darul Ehsan

Current place of stay : Pusat Pemulihan Akhlak (Penjara) Muar, Johor.

Education level : Standard 6 (managed to complete UPSR)

Placement in family : Fifth from 10 siblings

Marital status : Married (with no children)

Current occupation : Currently unemployed (still under detention)

Hobby : indoor games and playing music

Addiction problem : Opioid (Heroin)

Period of addiction : 16 years (1997)

2. Presenting ProblemsTwo counseling sessions with the subject (hereafter named MSO) had

been successfully carried out on 07th and 14th of April 2012. Both of the counseling

sessions took place at the Deputy Superintendent of Prison’s management office

of Penjara Penor, Kuantan, Pahang. My client was detained at Penjara Penor, KM

!8, Jalan Kuantan Pekan on 12th December 2011. He was detained for the drug

offence under section 20(1)(b) Akta Penagih Dadah (Rawatan dan Pemulihan

1983)(Pindaan 1998) which carries the penalty of 9 months imprisonment. This

the 8th time he entered into the prison. This counseling session was

held in two sessions in which the first session is more towards building a rapport

with the client. The sescond session on the other hand focussed more on

exploring the client. MSO got married the girl of his choice when he was 33 years

old, they met when both of them were working at Kuantan Plaza (supermarket).

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3. Background InformationMSO started to get exposed to tobbaco / cigrattes as early as 16 years old when

he was in secondary school due to peer pressures. He started seriously involved

in drug abuse when he was 25 years old and at that time he was working on shifts

as promoter at Kuantan Plaza. He was introduced to heroin by his old time

colleagues and started from that he became dependent on it. According to him he

used to consume as much as 1 packets a day (one packet weights about 2 grams)

which worth RM100.00 per packet. He considered unlucky because he had

relatively little or no knowledge about HIV / AIDS or how it is spread therefore he

chose “intravenus” (IVDU) method as a route of drug administration. He knew that

he been infected with HIV during screening session done by the prison authority.

He stated that the main reasons for experimenting drug was due deep curiosity

and which was later developed into abuse and finally dependent. Another reasons

were to fill in the gap during his free time and felt boring waiting for the work shift.

After years involved in the serious drug addiction he finally get caught for the first

time in 2001. After released from prison he returned to his wife to start all over.

Fortunately his wife is very supportive until now. Once he’s back to his place he

still could not stop taking drug because many of his old friends / colleagues at his

place were also drug users (very tempestuous situation). Furthermore, he knew

how to get drugs supplies because he was familiar with his own hometown.

4. Assessment Instruments / ProceduresUniversity of Rhode Island Change Assessment Scale (URICA)The URICA assesses motivation for change by providing scores on four stages of

change: precontemplation, contemplation, action and maintenance. The

URICA consists of 32 questions and there are FIVE possible responses (5 point -

Likert scale) to each of the items in the questionnaire :

1 = Strongly Disagree  2 = Disagree 3 = Undecided    

4 = Agree 5 = Strongly Agree

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i. Relevant to the Presenting ProblemThe instrument was chosen in because it has the ability to access the

client’s stages of chance and motivation to change. From this instrument

we would be able to know whether the client is at precontemplation /

contemplation stage or already taking actions to change and most of all

starts doing something to maintain the action / changes he / she been

made on their present problem which is drug addiction.

ii. Technical AdequacyPsychometrics :

1. Have reliability studies been done? - Yes

2. What measure(s) of reliability was used?

Test-retest

Internal consistency

3. Have validity studies been done? - Yes

4. What measures of validity have been derived?

Criterion (predictive, concurrent, “post dictive”)

Construct (predictive)

iii. Suitability for Use With the Individual ClientMethod of administration is simple. Only paper and pencil are needed. The

time for administration is roughly about 15 minutes and time for scoring is

around 5 minutes. The items in the instrument is in dual language (English

and Bahasa) and it was being translated using the simple and easy to

understand Bahasa. The inventory was administered by me and the client

was free ask anything that he unfamiliar with.

5. Assessment OutcomesFrom the client’s URICA scoring / outcome are interpreted as follows:

Precontemplation Stage (PC) = 14 (Low score)Contemplation Stage (C) = 30 (Highest score)Action (A) = 23 (Low score)Maintenance (M) = 29 (Low score)

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HIGHEST score which is 30 (Contemplation Stage) - The client directly

acknowledge that he is having problems related to his addiction, tending to

express a desire for change and to perceive that harm will continue if he do not

change.

6. Practitioner’s Conceptualisation of the Presenting Problem

Based on the overall assessment and counseling sessions conducted it can be

concluded that the client is still thinking or rather at ambivalence stage whether to

change or not and have not put in much effort to do something to improve his

problem in drug addiction. Furthermore there are “enable” factor present which is

his wife still supporting him therefore he’s lack of resposibility either to himself or

family. His wife in this case should also undergo counseling to make her realize

that she’s not helping her husband to change if she still doing what she is doing

now.

The client also blamed his surrounding / enviroment (interpersonal issues) for not

accepting him as normal people but in this case I would say he should focus on

himself first rather than others beccause he’s the one who first created all the

problems or mess.

7. Intervention Plan or Recommendations

Goals of the intervention

Increase motivation of the client to stay in the rehabilitation program by

increasing the focus on self - esteem, self - focus and empathy issues.

Assist the client to understand to danger of abusing drug and assist him to

perceive that harm will continue if he does not change.

Assist the client on how to handle cope with HIV / AIDS disease.

Assist the client on how to handle problems / decision making skills.

Assist the client on matters pertaining to his CSO or other support systems.

Strategies of the intervention

Moivational Enhancement Therapy (MET)

Assertiveness training

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Homework (responsibility training)

Coping strategies / skills

Explore treatment options

Reach out for support

Learn healthy ways to cope with stress

Keep triggers and cravings in check

Learn health issues relating to HIV / AIDS

Relapse prevention and relapse education

Duration of the intervention

More than 1 year

Expected outcome from the intervention

Will assist the client the reasons he wants to change

Will assist the client to think about his past attempts at quitting, if any

Will assist the client to set specific, measurable goals, such as a quit date or

limits on his drug use and be assertive on his decision to quit

Lean on close friends and family

Build a sober social network

Consider moving in to a sober living home

Relieving stress without drugs

Look after his health

Coping with drug cravings

8. Intervention Procedures

Drug Interventions

Usually the first step in drug rehabilitation is to schedule a family drug intervention.

Let it be known that, in the collective world history of drug abuse, there has never

been an "easy" intervention. The very nature of it is difficult, and the sensitivity of

such a subject is sometimes the reason why families delay an intervention or,

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worse still, avoid it altogether. In the long run, though, the drug

intervention process is absolutely necessary for rehabilitation.

Scheduling or drug intervention for a young adult can seem like an impossible

task. You need to round up family and peers, inform them of your loved one's

addiction, and get their unwavering support during the addict's lengthy and difficult

recovery. Then there's the intervention itself.

The first step in the intervention process is to schedule a pre-intervention. The

actual intervention must go off as fluidly as possible (and that's a relative term).

Some participants will actually be speaking to the abuser, and others will probably

be there just for presence and emotional support. Everyone must meet ahead of

time so that they know who is going to say what. The more planning and

understanding between those attending the interventions, the better.

The whole point of a drug intervention is to get the abuser to admit that he or she

has a problem, and needs professional help. The intervention is, therefore, just the

beginning step, but an essential one nonetheless. Another part of the pre-planning

is what to do next, assuming the intervention is a success.

Family Intervention

During family interventions, other friends and peers are usually invited as well. The

point is to get your loved one to admit that he or she has a substance abuse

problem, and to willingly ask for help. It is this willingness to right what has been

wronged that stands at the root of the drug intervention; rehabilitation must be self-

motivated as well as externally reinforced.

A main goal of the family intervention is to get the drug abuser to want

professional help. The abuser might try to take the easy way out by saying, "I can

stop - I won't do this anymore - thanks for telling me - I understand." In almost all

cases, however, drug abuse is simply too difficult to self-correct; interventions are

a necessary first step.

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9. Overview and Further Recommendations

Overview

Even though the client is showing a good sign of recovery but nevertheless he

must be reminded that RELAPSE can happen at any point of time in his life.

Therefore he must be able to withstand and be prepared to face all the possibilities

of being relapsed by making use all the knowledge and skills that he had learned.

Recommendations

More focus should also be given to after care services such as job

placement, housing, financial help etc in order to help the client once he

completed the rehabilitation programmes.

Other support systems such as Narcotic Anonymous, 12-step facilitation

programmes and other support programmes should be continued after

completed the rehabilitation programmes.

Role of significant others in treatment It is of vital importance that family

members, friends, and others involved with the client be involved in the

treatment process, since they have also been affected by the client's use of

alcohol and other drugs. I recommended for providing involvement for those

individuals is family group counseling.

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REFERENCES

http://www.helpguide.org/mental/drug_abuse_addiction_rehab_treatment.htm

http://www.kap.samhsa.gov/products/manuals/taps/11k.htm

http://www.dualdiagnosis.org/resource/articles/drug-abuse-counseling/

recovery-counseling

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APPENDIX:

PSYCHOMETRIC TOOL / INVENTORY

CLIENT’S UNIVERSITY OF RHODE ISLAND CHANGE ASSESSMENT SCALE (URICA)

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