Application: Considering Alternative Treatment Options For A

Application: Considering Alternative Treatment Options for Anxiety Disorders

Considering the complexities of pharmacological interventions in the treatment of anxiety disorders, mental health professionals need to critically evaluate the appropriateness, efficacy, and potential risks associated with prescribed medications. Particularly, when a medication such as diazepam, a benzodiazepine, is introduced, it raises significant concerns about dependency, side effects, and its interaction with the client's history of sobriety. Ethical considerations must guide decisions around advocating for alternative therapies, especially if medication poses a risk of relapse or adverse effects. This paper discusses the implications of prescribing benzodiazepines, the ethical issues related to client autonomy and safety, the importance of information sharing, and a comprehensive treatment strategy tailored to the client's needs.

Concerns Regarding the Client’s Treatment with Diazepam

The primary concern with the prescription of diazepam for a client with a history of substance abuse and sobriety concerns is the drug’s potential to induce dependence, tolerance, and withdrawal symptoms. Benzodiazepines enhance the effect of gamma-aminobutyric acid (GABA), a neuroinhibitory transmitters, producing anxiolytic effects; however, their mechanism also predisposes users to physical dependence (Lichtblau, 2011). Given the client’s history of sobriety, the risk that diazepam could trigger a relapse is significant, as it closely mimics the effects of alcohol, a substance the client has successfully abstained from for five years. Ethical issues also involve respecting the client’s autonomy and right to informed consent, requiring transparent communication about medication risks, benefits, and alternatives (American Psychological Association, 2017).

Factors to Consider in Developing a Treatment Strategy

When developing a treatment plan, several key factors must be considered. First, the client’s history of substance use and current sobriety status necessitate a cautious approach to pharmacotherapy. This includes evaluating alternative medications with lower dependency risks, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), which are often first-line treatments for generalized anxiety disorder (GAD) (Preston, O’Neal, & Talaga, 2017). Second, the client’s preferences, treatment history, and response to previous interventions should influence the strategy. Third, integrating psychotherapy—particularly cognitive-behavioral therapy (CBT)—can optimize outcomes, reduce reliance on medication, and address underlying cognitive patterns (Caputo & Bernardi, 2010). Finally, monitoring for side effects and effectiveness is essential to ensure safety and adherence.

Proposed Treatment Strategy and Justification

A comprehensive and ethically sound treatment strategy involves initiating a combination of evidence-based psychotherapy and cautious pharmacological management. Given the client's history, I would prioritize non-pharmacological interventions such as CBT, with a focus on developing coping skills, cognitive restructuring, and relapse prevention techniques. CBT has demonstrated robust efficacy in reducing anxiety symptoms and promoting long-term resilience (American Psychiatric Association, 2013).

In conjunction, I would recommend considering SSRIs, such as sertraline or escitalopram, as first-line agents for GAD. These medications have a favorable safety profile, lower dependence potential, and proven efficacy (Preston et al., 2017). If medication is pursued, close monitoring for side effects, interactions, and signs of relapse is essential, especially given the client’s sobriety. Moreover, psychoeducational sessions to inform the client about medication effects, potential risks, and the importance of medication adherence would be integral.

Ethically, advocating for this approach aligns with principles of beneficence and nonmaleficence, prioritizing the client’s well-being while minimizing harm. Establishing a collaborative treatment plan respecting client autonomy fosters trust and ensures a more engaged recovery process.

Advocacy and Information Sharing

To implement this treatment plan, a release of information (ROI) would be necessary to communicate with the prescribing psychiatrist and other healthcare providers involved in the client’s care. Such communication ensures coordinated treatment efforts, facilitates medication management, and provides comprehensive safety oversight. The ROI would enable the therapist to share insights into the client’s mental health history, treatment preferences, and progress, while respecting confidentiality and legal standards. Clear documentation and informed consent are critical to uphold ethical standards and safeguard the client’s rights.

Conclusion

In summary, prescribing diazepam to a client with a history of sobriety presents significant ethical and clinical challenges. Mental health professionals must advocate for safer, evidence-based alternatives, emphasizing psychotherapeutic interventions complemented by appropriate pharmacotherapy when necessary. An individualized treatment plan, grounded in ethical principles and clinical best practices, can optimize outcomes, reduce risks, and support sustained recovery from anxiety disorders. Effective interdisciplinary communication through informed consent and shared decision-making is pivotal in ensuring safe and ethical care delivery.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• American Psychiatric Association. (2017). Ethical principles of psychologists and code of conduct. Retrieved from https://www.apa.org/ethics/code
• Caputo, F., & Bernardi, M. (2010). Medications acting on the GABA system in the treatment of alcoholic patients. Current Pharmaceutical Design, 16(19), 2118–2125.
• Lichtblau, L. (2011). Psychopharmacology demystified. Clifton Park, NY: Delmar, Cengage Learning.
• Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists (8th ed.). Oakland, CA: New Harbinger.
• Laureate Education (Producer). (2012b). Anxiety disorder case study: Mary: Generalized anxiety disorder [Video file]. Baltimore, MD: Author.