PS526 Unit 5 Community Reinforcement Case Study Example

Making a Sober Saturday Worth More: A PS526 Unit 5 Case Study Applying the Community Reinforcement Approach to a Roofer's Methamphetamine Use

[Student Name]

Purdue University Global

PS526: Advanced Addictions Counseling

Unit 5 Community Reinforcement Case Study

[Instructor Name]

[Date]

The client, his family, the treatment center and every detail of the case are composite and illustrative; the sources cited are real.

The Client

Dakota is 29 and has roofed houses across the northern Black Hills for nine years. He began using methamphetamine at 22 to work longer days in summer heat, and over the past three years his use spread to every weekend and many weeknights. He has lost two jobs, his girlfriend moved out last fall and he has no driver's license after a suspension. He entered our residential center in April after his mother found him unconscious from exhaustion in his truck. In our first session he said, "Take the meth away and there's nothing here for me. Work, sleep, work."

Diagnosis

Dakota meets the DSM-5-TR criteria for stimulant use disorder involving methamphetamine (American Psychiatric Association, 2022): use beyond what he intends, repeated failed attempts to stop, much time spent using and recovering, craving, lost jobs, conflict with his girlfriend and mother, giving up hunting and fishing, use while driving on mountain roads, tolerance and withdrawal marked by days of heavy sleep and low mood. That is ten criteria, a severe disorder.

Why the Community Reinforcement Approach

The community reinforcement approach starts from a behavioral idea: substance use continues partly because it is more rewarding than the alternatives available, so treatment should make a sober life more rewarding. Meyers et al. (2011) describe it as combining functional analysis of use and of sober behavior, sobriety sampling, in which the client commits to a trial period without the substance rather than to lifelong abstinence, job and recreation counseling, relationship skills and problem solving. The approach was developed first for alcohol and later applied to other substances and to families.

Dakota's complaint fits the model's starting point exactly. His sources of reward have shrunk to work and methamphetamine. If treatment removes the drug without adding anything, the model predicts relapse.

Supporting Evidence

Dakota's doctors have no approved pill for methamphetamine to offer him. Brown and DeFulio (2020) reviewed trials of contingency management, which rewards verified abstinence, and found consistent reductions in methamphetamine use while rewards were in place. Contingency management is often combined with the community reinforcement approach because both rest on the same principle: make not using pay.

The community reinforcement approach does not ask Dakota to give up his only reward; it asks him to build three or four new ones before he leaves.

Functional Analysis of Sober Behavior

The approach analyzes not only when a client uses but also when he enjoys being sober. We found three. Dakota likes fishing for trout in Spearfish Creek, which he has not done in two years. He likes working with his hands on something he can see finished. He liked being an uncle to his sister's two boys before his mother stopped letting him babysit. Each of these became a target.

Sobriety Sampling

Dakota does not believe he can stay away from methamphetamine forever, and asking him to promise that would end the conversation. Instead, we agreed on a ninety-day trial, starting at discharge, with a check at thirty and sixty days. He chose the length.

Job Counseling

Roofing is both his skill and part of the problem, since his first use came on a roofing crew. We looked at roofing companies in Spearfish known for drug testing and family ownership, and he applied to one whose owner is in recovery. We also practiced how he would explain the gap in his work history.

Recreation and Relationships

Dakota's plan includes fishing twice a week with a recovering resident he met at the center, who has a car, and rejoining his sister's family for Sunday dinners on a trial basis. With his permission, his sister and mother joined one session to agree on what trust would look like: Sunday dinners first, babysitting after sixty days of negative tests.

Contingency Management in Aftercare

His outpatient program offers prize-based contingency management for twelve weeks, with two urine tests a week. Dakota enrolled before discharge.

Problem Solving and Skills

Remaining sessions focus on refusing offers from his old crew, getting his license back through the state's reinstatement process and handling the long, empty winter months when roofing slows.

Barriers in Lawrence County

Life in Lawrence County puts three obstacles in the plan's way. The first is transportation. Without a license, Dakota depends on rides, and the fishing partner, his sister and the new job all require getting across town. We mapped a weekly schedule against the Spearfish bus route and the hours his mother can drive, and he will apply for license reinstatement as soon as he is eligible. The second is winter. Roofing slows from December to March, and so does fishing, which removes two of his three new sources of reward at once. We planned a winter version of the approach: indoor work at the roofing company's shop, ice fishing at a reservoir with his partner and a weekly game night at his sister's house. The third is his old crew. Two of them live in his mother's neighborhood. Dakota practiced, in role-plays, how he would turn down a ride, an invitation and a free sample, and he wrote the three sentences he will use on his phone. He read them aloud twice in the last session, and laughed at how plain they sounded, which was the point.

Goals

Within thirty days of discharge, Dakota will work at least three days a week, fish twice a week and have negative tests at least seven of eight times. Within ninety days, he will review sobriety sampling with his counselor, attend Sunday dinners regularly and start the license reinstatement process.

Limits

Meyers and colleagues' review draws largely on studies of alcohol, and the evidence for the full approach with methamphetamine is thinner than for contingency management alone. Lawrence County offers limited sober recreation in winter, which the plan will need to address.

Conclusion

Dakota's severe methamphetamine use disorder left him with almost no sources of reward. The community reinforcement approach, as Meyers and colleagues describe it, answers that directly by building a sober life worth having: a trial period of abstinence, a better job, fishing, family and the skills to protect them. Brown and DeFulio's review supports adding contingency management, which rewards the same choice in a more immediate way.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Brown, H. D., & DeFulio, A. (2020). Contingency management for the treatment of methamphetamine use disorder: A systematic review. Drug and Alcohol Dependence, 216, Article 108307. https://doi.org/10.1016/j.drugalcdep.2020.108307

Meyers, R. J., Roozen, H. G., & Smith, J. E. (2011). The community reinforcement approach: An update of the evidence. Alcohol Research & Health, 33(4), 380-388.