Addictive Behaviour and Psychology: Case Analysis - Essay Example

?Table of Contents Introduction…………………………………………………………………………….2 1 Type 2 Diabetes………………………………………………………………2 2 Target group………………………………………………………………….3 1.3 Key Issues……………………………………………………………………3 1.3.1 Compliance and patient communication with physician…………………..3 1.3.2 Driving and diabetes……………………………………………………….3 1.3.3 Hereditary complications…………………………………………………..4 2 Applied Psychological Theory…………………………………………………………4 2.1 Health Belief Model (Hubley and Copland 2008)…………………………. 4 2.3 Stages of Change Model (Prochaska and DiClemente, 1992)……………….4 3 Aims of the Intervention………………………………………………………………5 4 The Intervention……………………………………………………………………….5 4.1 Exercise………………………………………………………………………5 4.2 Diet…………………………………………………………………………..6 4.3 Structured Education…………………………………………………………6 4.4 Mental Health Counselling……………………………………………………6 4.4 Final Outline of Intervention………………………………………………….7 5 Evaluations and Conclusions……………………………………………………………7 6 References………………………………………………………………………………8 Appendix A Case Study B 25………………………………………………………….9 Addictive Behaviour and Psychology: Case Analysis 1 Introduction This is a report that will analyse the various issues that are affecting Adam from Case Study C. The study will identify his needs and the psychological theories that apply to his issues. Evidence will be given to describe different types of intervention based on the behaviours that Adam presents. 1.1 Type 2 Diabetes Diabetes is described as a chronic disease that happens to an individual when their pancreas cannot process sugars and starches properly in order to turn them into energy. This means that the hormone that produces this assistance, insulin, is not working properly in the body (Servier UK, 2010). There have been 2.6 million people diagnosed with diabetes in the UK since 2009 and it is predicted that at least four million people will have diabetes in the UK by 2025 (Diabetes UK, 2010). Of those people, 90% of the adults with diabetes have Type 2 and Adam in the case study is one of these people. In Type 2 diabetes, the body is producing insulin but not enough to function normally. According to Whitmore (2010) 90% of adults with diabetes are overweight. Diabetes is generally seen in adults after the age of 40 and can continue to be diagnosed as the individual ages. If someone in the family already has diabetes, others in the immediate family can also have it. In Type 2 diabetes, weight is a contributing factor and in fact, there is a very strong link to obesity (Diabetes, 2010). Usually, the individual is not exercising and has poor eating habits as in Adam’s case. Adam is only 35 and he received his diagnosis nine months ago but he has not done anything to help himself. He has been told that he can control it if he loses weight and changes his diet and if he does these things, he will not have to use insulin tablets or take injections. The primary treatment for most people with Type 2 Diabetes is diet and exercise because of its link to obesity. The challenge is that the longer an individual has it, the more pronounced it becomes and the individual may eventually need insulin (Servier UK, 2007). When diabetes is not controlled it can lead to cardiovascular disease, kidney disease, eye disease, and many other types of disease as diabetes is allowed to progress. If diabetes continues with no assistance, it can also lead to amputation of lower limbs (Diabetes UK, 2010). Most people with Type 2 diabetes will need to have regular check-ups with their doctor for have blood and urine tests so that the levels of glucose in the body can be monitored. Today, patients can also check their glucose levels themselves through a device that they can purchase. In order to keep track of his diabetes, Adam will need to have these regular check-ups as he has been doing to this point. Often, these check-ups are used to understand the types of interventions that are necessary. There is a more advanced test called the HbA1c that tests the haemoglobin in the blood. This test is performed about every three to four months so that the doctor can see how the individual is doing with their own insulin monitoring. If an individual has high levels of glucose in the blood (seen if there is glycated haemoglobin in the blood) it means that they have not been monitoring their diabetes appropriately for the last few months (“HbA1c” 2011). 1.2 Target group Adam is a 35 year old male and according to Diabetes UK (2010) males in Adam’s age range (35-44) are 2.4% as likely as women to have diabetes (women are shown at 1.2%). Adam is younger than most people are when they are diagnosed with diabetes, because usually, they are not diagnosed until they are in their 40s. The case study does not mention Adam’s race, but statistics show that minority and ethnic groups, particularly South Asians, African and African-Caribbean are more prone to diabetes (Diabetes UK, 2010). Adam lives in the borough of Croydon in London. Croydon has done several health profiles for people who live in this borough. According to McIntyre (2010) 14% or one in over 23 patients were diagnosed with diabetes in 2010. Croydon men have higher rates of diabetes than women, and the obesity is twice as high for those with diabetes in Croydon than in the general population. It is also estimated that 13.6% of Croydon residents in the age group between 22 and 77 in 2008 may have died from the disease (McIntyre, 2010). Adam fits into this category and could be at risk for death from complications of diabetes if he does not do what the doctor ordered. 1.3 Key Issues This document has already discussed risks in Adam’s target group, but there are other key issues that are very important to discuss that relate to his lifestyle, his family, and his physician that need to be taken into consideration before an intervention can be discussed and presented. 1.3.1 Compliance and patient communication with physician People with chronic diseases like diabetes have a difficult time complying with the things they must do to stay healthy. Generally speaking patients have a difficult time self-medicating and taking responsibility for their health needs (Vermeire, et al., 2003). In a study by Vermeire et al. (2003) it was found that there were several reasons for noncompliance which included low quality of doctor/patient communication, whether the patients really understood information about their disease and how they were supposed to treat it at home and body awareness were all factors that stopped many patients from complying to their treatment at home. Sometimes doctors can give incomplete or mixed information for patients and they are reluctant to ask for more information. Banyard (1996) stated that at least 75% of those patients with Type 2 diabetes were not eating properly and another 75% did not eat when they were supposed to which put both types of patients at risk for having more complications with their diabetes. Adam is seeing his GP regularly but there seems to be a communication gap in his treatment because he is not complying with his doctor’s orders. As an example, he is still eating convenience foods rather than cooking healthy meals and he is not exercising well. Adam may not understand at a deeper level what he is supposed to do to stay happy or he my not understand the information that he has received from his GP. 1.3.2 Driving and Diabetes The case study states that Adam is driving a car most of the time. He drives to work but he is a mechanic and he probably drives many times during the day to make sure that the cars he works on are working properly. Adam could lose his job in the future because it is dependant on driving and he could have his driver’s license taken from him or restricted if he develops complications that would stop him from driving (Diabetes UK, 2010) (e.g. blurred vision, neuropathy in legs or other complications that can happen). If Adam were to have a hypoglycaemic attack while he is driving to work or driving other places, he could hurt himself or others. The case study does not state whether he is aware of this and it could be a way to motivate him to take better care of himself. 1.3.3. Hereditary complications The case study does not say whether anyone else in Adam’s family had diabetes as he was growing up. He does have a two year old son which could mean that he is passing diabetes on to his son. If the entire family is eating the same way and they are not exercising, they could also be at risk for developing diabetes as they grow older. 2 Applied Psychological Theories 2.1 Health Belief Model (Hubley and Copeland, 2008) The Health Belief Model (1966) first introduced by Becker was created to explain why people did not use health services. The model looks at how people perceive healthcare through three sets of beliefs: 1) perceived susceptibility, 2) perceived seriousness, and 3) perceived benefits and disadvantages. The health belief model suggests that people have a set of beliefs that they come to healthcare with and that their beliefs will either push them to take care of their health or stop them from doing what they are supposed to do. In Adam’s case, it can be seen that he has developed some belief that may be telling him that his condition is not as bad as they think. If we look at the first aspect of this model, it can be seen that Adam does not see himself as susceptible to the disease. He may feel that because he already has the disease that it cannot become worse since he does not have to use medication at this stage. Also, he may not perceive his condition as serious because he does not have to use medication. The case study does not state his financial resources, but because a he lives in Craydon and many people in that area are living in poverty (McIntyre, 2010), it could be that Adam does not have the money to purchase healthier foods. If he believes that healthier food is more expensive, and he has not checked the grocery stores in his area to see how much it would cost to adopt a healthier lifestyle, he may feel that this is an unreasonable expense. Adam does not seem to see a benefit to changing his lifestyle. If he spends time exercising, he may not have time with his family, which seems to be very important to him. He may not be aware of what a healthier lifestyle could do for him and for his family and he may not see the larger picture of how his family could benefit from being healthier. Adam may not move towards action until he is met with complications from the diabetes. If he develops complications, this may worry him more. The case study does not state anything about his education and it is not known if he can read well. He may need a different kind of information, but this will be discussed in the intervention section. 2.2 Stages of Change Model (Prochaska and DiClemente, 1992) This model states that people go through five stages before they make a change in their life. The five stages include: 1) Pre-contemplation where the individual is unaware of their behaviour and not interested in making a change, 2) Contemplation where the individual has some information and is thinking about change, 3) The individual is ready to change and wants to try it out, 4) Maintenance where the individual incorporates the change into their lifestyle and 5) Relapse where a person tries out the change, and then returns to their old lifestyle. It would seem that in each stage, the individual could go to relapse until they understand what the change will do for them. In applying this model to Adam, it would seem that he is in stage two. He is contemplating the change and has some information about it, and he may be thinking about the change. However, he may not be ready to make the change if there are other factors involved. The model could affect his entire family and this may be frightening to him. Right now, he is doing what he wants to do and he understands what is expected of him. The family is doing exactly what they have always done. If he begins to change, they will also need to change in some way and this may cause some challenges for him. If he talks to his family more and finds out that his wife is supportive of his change, he may be able to make the change easier. The case study does not state whether Adam has a support group of any kind or whether he has finds that he socialises with. This would be something to understand in order to help him in his future endeavours. 3 Aims of the Intervention The main goal for Adam would be to help him get his diabetes under control so that he does not have more complications. If Adam can begin now to take care of himself, he may not need any medication. Another objective would to help Adam change his lifestyle habits and in particular help him to find a way to exercise that is fun for him and to eat better food. Adam may need a team of people to help him which would include his physician, a nutritionist and a mental health practitioner who has a background in working with people who have diabetes (Diabetes UK, 2010). He would also need information on self-education about diabetes. 4 The intervention 4.1 Exercise Adam is obese and this is a factor in his diabetes. If he can lose some of his weight, he may no longer be at risk for diabetes. Egton Medical Information Systems (2011) states that most adults should aim for 30 minutes a day that does not have to be done all at one time, and they suggest that this happen five days per week. Adam may not know that there are several exercises he can do that do not require money. As an example, he could go for walks or purchase an inexpensive bicycle to use instead of walking to work. Croydon also has a Physical Activity Programme that would allow him to take classes that would help him ease into exercise. If he does not like walking alone, he could join Walking for Health which has several different guided walks. Adam should look for different exercises that he can enjoy, whether they are singular exercises or classes. He may find that swimming or dancing would be something he should do. 4.2 Diet Diet is important for Adam because his doctor has suggested that he eat more nutritional food. He would benefit from work with a nutritionist and with someone who could take him to the store and show him the types of food that he needs to eat. If he could have the nutritionist or someone from a home health organization come to his home and take him to the store, they could point out alternatives for the food that he likes, that have more nutritional value. Generally, a diet that is low-fat and high in fibre is a good choice as long as there is a low simple sugar/high complex sugar intake in order to regulate blood glucose (The British Medical Association, 2001). Adam does not have to make large changes to his diet right away because small changes will also help. Adam could drink more water which would fill him up and he could try sugarless drinks. He could also do tea if he does not do this already. There are many fine herbal teas that are flavourful but they do not include sugar. Dietary advice will be an on going aspect of Adam’s intervention and continued work with a nutritionist. This would be important for him to continue keeping good nutrition so that he could have the support throughout his weight loss process. There may be cooking classes that he and his wife could take together so that they both could cook if he does not already do this. 4.3 Structured Education Adam may not have enough education about his diabetes to understand why it is important for him to follow his doctor’s suggestions. In a study by Sigurdardottir et al (2007) they found that education based interventions were important to help people with type 2 diabetes. When people were educated thoroughly about diabetes and attended regular check-ups, it was found that their HbA1c levels decreased. Diabetes UK (2008) states that structured education programs that meet NICE criteria should be used for people with both type 1 and type 2 diabetes so that the individual has on going assistance with their diabetes. They also state that structured education along with a monitoring device are very important to success for the diabetes patient. 4.4 Mental Health Counselling Adam may benefit from mental health counselling that includes individual as well as group counselling. He may benefit from Cognitive Behaviour Therapy because it works with individuals who need behavioural intervention. Nash (n.d.) states that CBT is helpful because it allows people to challenge their thoughts and choose different thoughts if they are to become successful. There may be psychological or emotional reasons why Adam is overweight and attending counselling could be a way for him to express these feelings. Adam may also find assistance through a type 2 diabetes support group. His doctor or health team can probably refer him to a couple and he could try them out and see whether they help. His wife could possibly go with him if they can find a sitter so that she can show her support to him and gain more information about the disease. A support group would give Adam on going group support and he would know that he was not alone. 4.4 Final Outline of Intervention There will be several parts in the final outline for Adam. A good idea for a start would be for Adam to enrol in a structured education program that would begin his understanding of diabetes. At the same time, he would need to see a nutritionist to gain assistance with what he was eating now, and how he could change his eating habits. With these two changes, it would be a good idea for him to start some type of exercise that was not too strenuous at first but it would need to be something he enjoyed dong. He could receive this type of information during his course, but he should also discuss with his medical team about options for exercise. Adam would be encouraged to attend mental health counselling as part of the total aspects of his diabetes regimen. A therapist skilled in Cognitive Behavioural Therapy (CBT) could help Adam because he seems to be struggling with this diagnosis. Nash (n.d.) states that CBT is helpful because it allows people to challenge their thoughts and choose different thoughts if they are to become successful. Adam would have a safe place to explore his thoughts and to understand the other thoughts that he could develop. The intervention for Adam would be based on the stages of change model because he is in the contemplation stage. The intervention would focus on not only helping him to make changes, but to guide him to the resources that can help him through these changes. It would be hoped that as Adam gained the resources that he needs to manage his diabetes that he would have more motivation to do so. With the help of CBT and the other interventions, it is hoped that he would have a plan if he should get to the relapse stage and need to begin again. 5 Evaluations and Conclusions Adam is a 36 year old young man who has been diagnosed with type 2 diabetes. He is overweight which has contributed to his diagnosis and he has an unhealthy lifestyle. He lives with his wife and two year old son. The case study does not say whether anyone else in his family (siblings, parents, grandparents) had diabetes but his son is at risk for getting it as he gets older because genetics can play a part. Although he has had regular check-ups with his GP, he has not followed the recommendations that he should change his diet and begin exercise. Adam states that he is walking to his office, but his GP is not sure that he is telling the truth. Adam may believe that his condition is not a concern because he is not taking medication yet. Because of where he is in the process, it will be important for him to have the resources and the support that he needs to get him through the different aspects of his diabetes. Diet and exercise are very important to controlling and managing diabetes so it is important to make sure that Adam is supported in these measures. The objective for him is to get him motivated to start working with his diabetes now, so that it does not grow into more complications. Adam will need to continue to make his appointments with his GP so that he can be monitored monthly to see whether the intervention is working. He should also make regular appointments with an ophthalmologist and a podiatrist to make sure that there are no other factors that are advancing his diabetes. If Adam moves out of Croydon at some point, the intervention may need to be tailored to his new circumstances. Based on the information that has been given, if Adam continues to make changes in his life, he should be successful in monitoring his type 2 diabetes. 6. References Banyard, P. (1996). Applying Psychology to Health. London: Hodder & Stoughton. British Medical Association (2001). “New Guide to Medicine and Drugs” Dorling Kindersley, London. Diabetes UK. (2010). “Diabetes in the UK 2010: Key Statistics on Diabetes” [Online] accessed 27 May 2011, available from http://www.diabetes.org.uk/ Documents/Reports/ Diabetes_in_the_UK_2010.pdf Diabetes UK (2008). “The National Service Framework (NSF) for Diabetes: Five Years On … are We Halfway There? [Online] Accessed 27 May 2011, available from http://www.diabetes.org.uk/Documents/Reports/Five_years_on_-_are_we_half_way_there2008.pdf Egton Medical Information Systems. (2011). “Physical Activity for Health” . [Online]. Accessed 27 May 2011, available from http://www.patient.co.uk/health/Physical-Activity-For-Health.htm “HbA1c” (27 May 2011). Health Guide: The New York Times. Accessed 27 May 2011, available from http://health.nytimes.com/health/guides/test/hba1c/overview.html Hubley, J. and Copeman, J. (2008). “Health Believe Model and Stages of Change Model”. Practical Health Promotion (Extract). Polity Press. [Online] Accessed 27 May 2011, available from http://www.polity.co.uk/healthpromotion/download/Health_behaviour.pdf McIntyre, D. (2010). “Croydon Joint Strategic Needs Assessment 2010/11: Diabetes”. [Online]. Accessed 27 May 2011, available from http://www.croydonobservatory.org/docs/strategies/1049047/JSNA_2010-11_diabetes.pdf Nash, J. (n.d.). “Diabetes and Cognitive Behavioural Therapy”. Diabetes.co.uk. [Online] Accessed 27 May 2011, available from http://www.diabetes.co.uk/emotions/cognitive-behavioural-therapy.html Servier UK. (2007). “Diabetes, Type 2 Diabetes”. [Online] accessed 27 May 2011, available from http://www.servier.co.uk/disease-information/diabetes/diabetes.asp Sigurdardottir et al. (2007) “Outcomes of Educational Interventions in Type 2 Diabetes: WEKA data-mining analysis” Patient Education and Counselling, 67, 21-31. UCLA Centre for Human Nutrition. (n.d.). Prochaska and DiClemente’s Stages of Change Model. [Online] Accessed 27 May 2011, available from http://www.cellinteractive.com/ucla/physcian_ed/stages_change.html Vermeire,E, Van Royen, P, Coenen,S, Wens J, and Denekens, J (2003). The Adherence of Type 2 Diabetes Patients To Their Therapeutic Regimens: A Qualitative Study from the Patient’s Perspective. Practical Diabetes International, 20.6, [Online] Accessed 27 May 2011, available from http://onlinelibrary.wiley.com/doi/10.1002/pdi.505/pdf Whitmore, C. (2010). “Type 2 Diabetes and Obesity in Adults” British Journal of Nursing, 19 (14) 880 – 886. Appendix A Case Study B Adam is a 35 year-old mechanic who lives with his wife and two year-old son in Croydon and was diagnosed with Type 2 diabetes nine months ago. He is overweight and has a poor diet which is probably what has led to him to becoming ill. He attends GP appointments regularly to monitor his condition and his GP recommended that Adam change his diet (which is mainly made up of convenience foods) and to exercise more in order to lose weight. If he does this he may be able to manage his diabetes without needing to take insulin. However, since this recommendation, Adam has not lost any weight and his GP suspects that Adam is not exercising, although he claims to have changed his eating habits and is walking to work every day instead of taking the car. Read More