1. Brooke Harrison
PY 605 Case Conceptualization
The therapeutic approach that will be implemented for this particular case will be Twelve
Step Facilitation Therapy. For this therapy, the counselor will be a facilitator as the patient goes
through the traditional twelve steps and traditions. Twelve Step is based on the philosophy that
addiction is a progressive illness that affects the body, mind, and spirit and the only remedy is
abstinence. Twelve Step believes the individual has lost complete control over the substance,
has become powerless, and, therefore, can only heal through complete abstinence. Another goal
of this therapy is for the patient to engage in active participation with the fellowship of
Alcoholics Anonymous or various other 12-step groups. Two themes often emerge when using
this treatment modality: spirituality and a belief in a higher power, whatever that may be, as well
as, pragmatism and using whatever works for that individual to stay abstinent. These themes
become part of the two major objectives which are acceptance and surrender. The patient must
accept their powerlessness over alcohol and surrender to the higher power’s control. The
sessions in this therapy are often very structured. The structure typically includes 12 sessions
with, possibly, 2 conjoint sessions, facilitating involvement in 12-step meetings, keeping a
personal journal, and reading the ‘Big Book’. The sessions are broken down into topics of
acceptance, surrender, and getting active, as well as, several supplemental sessions.
There are certain aspects of the treatment modality that will be utilized and emphasized
more for the case of Jamie. The first topic of acceptance will be important for Jamie. There may
be a decent amount of time spent here, helping Jamie understand her powerlessness over the
substances. Here we will explore how much Jamie is denying this powerlessness and, possibly,
denying the negative consequences the substance has had on her life. With the current

2. information it is undetermined what Jamie’s spirituality is. This will be important to address
when using the 12-step model. Jamie does not need to be Christian necessarily, because 12-step
is inclusive of all religions and spirituality; however, it would be helpful if Jamie could connect
with some feeling of a higher power. One of the most helpful pieces of this treatment, for Jamie,
will probably be getting active in 12-step meetings. Jamie does not appear to have many social
supports in her life, besides her boyfriend. Plus the social supports she does have seem to be
enabling her addiction. It will be helpful in her recovery to connect with a group of peers with a
common addiction and build strong, healthy social supports. A few of the supplemental sessions
may be helpful for Jamie to move forward in these major objectives. Creating a genogram may
help with continued acceptance and ‘People, places, and things’ as well as ‘HALT’ may help
with surrender. Much of this will be addressed and more sessions may be needed as more is
learned.
According to the 12-step model Jamie’s substance use can be conceptualized as a
progressive illness or disease. She is powerless to the substance and this will explain her history
of usage. Jamie’s family history is unknown currently, but there is a great possibility that
substance use has ran through her family. Between genes, powerlessness, and enabling from
others her substance use has been able to grow. It appears that Jamie’s drug use intensified
during her marriage, which shows some enabling happening in the relationship. Jamie did then
go through a time of abstinence from substances, but, once again, was powerless to them and
slipped. This slip demonstrates not only powerlessness, but also using substances out of
emotions. The 12-step model includes the concept of HALT (Hungry, angry, lonely, and tired).
Addicts are particularly vulnerable to these emotions and have trouble regulating them, which
often leads to using. The slip was prompted by the difficult custody battle which led to negative

3. emotions for Jamie. Another concept of the 12-step model that explains some of Jamie’s
behaviors is having moral defects. A part of this modality is recognizing the wrongs and errors
the patient had done as a result of the drinking. Jamie has not been able to hold a steady job or
prove to the judge that she is fit to have custody of her children. These negative doings and
consequences can be a result of character defects due to drug abuse. It is important to balance
these defects with positive characteristics. Identifying these positives and negatives may help
solve some of the ambivalence she feels towards keeping custody of her children.
There will be two main behavioral goals that Jamie will strive to achieve while working
this program: Abstinence from cocaine and alcohol usage and active involvement in 12-step
fellowship. Of course, there are other concerns, such as gaining custody of her children, but
these concerns should be addressed through these two main goals. Abstinence will occur
through a few different treatment objectives that the 12-step process aids in. First objective will
be for Jamie to accept her powerlessness over alcohol and recognize that her life has become
unmanageable. This acceptance may come through attending meetings, actively using the
journal, and recognizing her slips. The second objective will be to surrender. For this objective
Jamie will take some time understanding her concept of a higher power and what she will use to
motive her to become sober. A third objective to becoming abstinent will be to cut ties with
people who are enabling her addiction. This may be challenging because she works with some
of them, but finding separation and the power of saying ‘no’ is critical.
The second goal of becoming active in a 12-step fellowship will also aid Jamie in
becoming abstinent. The first objective will be to participate and complete her 90 meetings in 90
days. It is important that Jamie find a meeting that best suits her and feels most comfortable in.
Since Jamie is experiencing addiction with both alcohol and cocaine she may want to try both

4. Alcoholics Anonymous and Narcotics Anonymous to see where she feels more connected. The
second objective will be using the telephone. Here, Jamie will get the phone numbers of people
she connects with in meetings and reach out to them in between meetings. A third objective will
be to get a sponsor. A sponsor is someone Jamie can reach out too for practical advice. These
two goals will hopefully address many issues Jamie is experiencing such as low social support,
responsibility for her children, and low mood. If these problems persist, other measures will
need to be discussed.
Jamie has the ease of being able to complete this treatment nearly anywhere. There are
12-step meetings all over the country and she should be able to find meetings close to her
residence. Therapy will be given in an outpatient setting for approximately 12 sessions. This
timeline may be altered as things come up, such as, desire for conjoint sessions. After
therapeutic treatment has ended, Jamie can still have continued care. An advantage to using the
12-step is a community is built around the patient that they can continue for as long as they
please. Although the therapy sessions may end after a few months, Jamie can continue attending
12-step meetings. This can be a way to prevent against relapse and keep Jamie active in
recovery still. Other relapse prevention strategies will be cultivated before the end of therapeutic
treatment as well.
Jamie has a few different comorbid issues that should be considered in her treatment
plan. Jamie is using more than one substance as well as experiencing symptoms that may be
indicative of depression. According to the 12-step model, Jamie would have to practice
abstinence with all substances. For the purposes of this treatment we would focus on abstinence
from alcohol and cocaine. Her nicotine dependence is something that can be addressed later but
is not causing the same negative consequences as the alcohol and cocaine. The 12-step model

5. also recognizes that mild depression can be very common with addiction. This depression can be
brought on through withdrawal, realization of negative consequences, or acceptance. If the
depression does not cease after being in treatment for some time and practicing abstinence,
further evaluation will be needed. This may include treatment specific to treating depression or
anti-depressant medication. It is also important to address Jamie’s unwillingness to take the
medication for Hepatitis C. If this medication will better Jamie’s health then it may be important
to try to persuade her to taking it. It doesn’t appear that Jamie will need maintenance medication
for her drug use. It can also be difficult to be on maintenance drugs while going for the 12-step
model, because they are often looked down on in the community. Trying to get Jamie sober
without medication would be the most ideal route.
One thing Jamie may struggle with throughout treatment is committing to complete
abstinence. Jamie has mentioned wanting to return to light cocaine use and does appear to notice
the addiction to alcohol. This may be a roadblock in treatment. It will be important to stress to
Jamie why becoming completely abstinent is part of the treatment goals. This may be remedied
with tackling one substance and then another. Because of the IV usage of cocaine beginning
again, it is probably most critical to become abstinent from this first. Jamie may also have
difficulty with the surrender portion of the treatment plan. Like stated earlier, her spirituality is
unknown, but if she does not have a faith it may be challenging to complete this portion. The
surrender topic may need to be twisted to encompass whatever Jamie’s spiritual view is. Jamie
has a motivating factor of gaining custody of her kids again, as well as, maintaining her current
relationship, which appears healthy. It appears that she will do well with connecting in the
community. It will look good to the judge if Jamie is getting out there and becoming active in

6. things. Overall, as long as motivation can be increased, Jamie can be very successful in her
recovery.