Counseling Case Report: Smoking Cigarette

This paper is a counseling case report of 15 sessions on a client who has been diagnosed with smoking cigarette from Kelem Worq Preparatory School. CO6 was an 18 -year-old grade 12th social stream student in Keleme Worq Preparatory School. CO6 was the second of the four children in his family. Assessment tools included a detailed interview and behavioral records. CO6 has been smoking cigarette since grade eight. At the time of counseling CO6 smoked five per day. CO6 drunk 4-6 glasses of beer occasionally, has done this for several years. Other than these drugs no other drug use reported. Many factors identified during the assessment were considered critical in accounting for the cause and persistence of CO6’s cigarette smoking [1,2]. Cognitive behavioral counseling was the theoretical framework that informed the case formulation. The counselor used self-reports of the client as outcome measures. SQ3R study method, the five Ds and cognitive behavioral therapy technique were applied to solve the client’s major problems of academic, smoking and alcohol drinking problems, respectively. Progress was evident by improved class attendance, more sustained focus on her academic studies, and continued improvement in sleep. The client has minimized his cigarette smoking and stopped his alcohol drinking.


Introduction
This paper is a counseling case report on a client who has been diagnosed with smoking cigarette from Kelem Worq Preparatory School. The assessment part has included the necessary identifying information with appropriate changes to shield the client's real identity [3]. As part of the treatment plan the presenting problems will be identified and matched to the criteria set forth in the

Nicotine or Tobacco Use Disorders
Tobacco Use Disorder according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), diagnosis assigned to individuals who are dependent on the drug nicotine due to use of tobacco products. Tobacco contains the psychoactive drug nicotine, which is a central nervous system stimulant. The immediate effects of nicotine administration are tachycardia, hypertension, increased respiration, hyperglycemia, enhanced memory storage, improved concentration, and appetite suppression. Nicotine can be taken through several routes, including inhalation (smoking cigarettes, cigars, or pipes), chewing tobacco and snuff [4][5][6][7][8]. Nicotine produces dependence and withdrawal symptoms upon cessation of use, the onset of which occurs about one hour after the last dose. Withdrawal symptoms include irritability, annoyance, anxiety, and cravings for nicotine. Substance abuse disorders have high comorbidity with tobacco use disorder. People in early recovery from other drugs or alcohol tend to smoke heavily or chew tobacco.
Features of tobacco products that enhance their addictive potential include the rewarding properties of nicotine, the behavioral reinforcement of the hand-to -to mouth habit, lack of social support to cease smoking, the ease of access of tobacco products, and the cultural acceptance of tobacco products.
Another factor which enhances nicotine's addictive qualities is bioengineering by tobacco companies, which add ammonia to nicotine to facilitate absorption and bioavailability ( Figure 1)

Abstract
This paper is a counseling case report of 15 sessions on a client who has been diagnosed with smoking cigarette from Kelem Worq Preparatory School. CO6 was an 18 -year-old grade 12th social stream student in Keleme Worq Preparatory School. CO6 was the second of the four children in his family. Assessment tools included a detailed interview and behavioral records. CO6 has been smoking cigarette since grade eight. At the time of counseling CO6 smoked five per day. CO6 drunk 4-6 glasses of beer occasionally, has done this for several years. Other than these drugs no other drug use reported. Many factors identified during the assessment were considered critical in accounting for the cause and persistence of CO6's cigarette smoking [1,2]. Cognitive behavioral counseling was the theoretical framework that informed the case formulation. The counselor used self-reports of the client as outcome measures. SQ3R study method, the five Ds and cognitive behavioral therapy technique were applied to solve the client's major problems of academic, smoking and alcohol drinking problems, respectively. Progress was evident by improved class attendance, more sustained focus on her academic studies, and continued improvement in sleep. The client has minimized his cigarette smoking and stopped his alcohol drinking.

Case Description
CO6, code name of the client, was an 18-year-old grade 12 th social stream student in Keleme Worq Preparatory School. He was the second child among the four children. His father was 55 years old and lives outside Addis Ababa due to his workplace, but he visits his family in every weekend day. C06 had smooth communication with his father. His mother was housewife and learned up to grade 12. C06's mother was a smart for him, and she communicates friendly. His oldest sister in the family was 22 years old, and she was indulgent, reluctant to take great care of others. The rest younger sister and brother are 14 and 8 years old, respectively, and both of them have good communications with him. C06 described his parents' parenting style as democratic. C06's birth and childhood time were normal. He grew up in a close and loving family and recalls a happy childhood, and uneventful adolescence. As he reported that his parents were supportive and sensitive to his needs and encouraged his to be independent and responsible.
CO6 describes himself as a "good boy" who excelled socially and involved in many extracurricular activities. But he described himself as not good boy in academic performance as he was socially.
He had a healthy self-esteem growing up and never engaged in risky behaviors or got into trouble other than smoking cigarette and drinking alcohol. CO6's peer relationships during childhood and adolescence were good and he remains close with several high school friends and he was remembered by his jocks. CO6 had also developed good peer relationships with neighborhood children and enjoyed with them sometimes. CO6 dated during elementary school and had a few casual relationships while he was high school students. Still he has not serious romantic relationship with anyone.
CO6 struggled to get out of bed in the morning, sometimes missing his morning classes. He stays up until 8:00 or 10:00 pm for eating and watching TV but he did not have much involvement during super time. And he had good self-esteem towards himself and had not suicidal ideation and never attempted suicide. Until this professional contact CO6 had not seen by any other professionals for a serious physical or mental problem.

Clinical Assessment
I would like to inform you that I have had 15 sessions in person with this client. The clinical assessment included a clinical interview and behavioral observation. CO6 has been smoking cigarette since grade eight. At the time of counseling the client smoked five per day. He started smoking again after awaking the first cigarette smoked was within the first 30 minutes. CO6 drunk 4-6 glasses of beer occasionally, has done this for several years. He didn't see alcohol drinking as a problem. CO6 always smokes while drinking alcohol and CO6 used coffee sometimes. Other than these drugs no other drug use reported. When CO6 became depressed he wants to smoke. In addition to his depression, head ace, watching his friends while they smoked or handed cigarette, drinking alcohols and sometimes his low performance in academic were the most triggering factors for his desire to smoke.
CO6 had no past successes with behavior change: Quit smoking twice when he was grade nine for 2 months but relapsed. He, at the time of counseling, wanted to quit smoking to prevent the medical and social consequences of smoking. Even if CO6 was ready to quit at this time, CO6 was worried about his ability to succeed in his quitting. His limited time for self-care, peer pressures, his low selfconfidences to quitting, absences of social supports from his schools and families and his alcohol consumptions were his potential barriers to quitting. However, his strong motivation, strong health reasons, one previous quit attempt with some duration (2 months), his high self-esteem towards himself and, friends who want to quit with him were the assets of the client.

Diagnostic Formulation
Based on the assessment findings in the initial interviews, the following diagnosis was formulated. The emphasis placed on developing a case formulation leads to treatment goal-setting and planning. CO6 was an eighteen-year-old boy who came from a medium class family. His chief complaint when he met the counselor was that he smoked cigarette accompanied by symptoms such as withdrawal and tolerance symptoms. CO6 said that he can't concentrate in attending classes every day, which was why CO6 said he left school to smoke cigarette after break time.
As the clinical interview revealed that the client had not exposed his smoking for his parents. CO6's most serious problem was his cigarette smoking. From a behavioral perspective, these impulse CO6'S strengths include his sociable behaviors with school and neighboring friends. CO6 has a strong desire to quit smoking as CO6 believed that health and social consequences of cigarette smoking was inevitable. The counselor selected cognitive behavioral therapy for this client to solve his problems of cigarette smoking and its associated symptoms. It has been shown that cognitive-behavioral therapy, combined with a smoking cessation medication (such as the nicotine patch, nicotine gum, for example), is quite effective for smokers who are motivated to quit. Cognitive-behavioral counseling is an evidenced-based psychological treatment that focuses on identifying and changing maladaptive thoughts, emotions, and behaviors that trigger, worsen, and/or maintain a range of problems (such as depression, anxiety, addiction, etc.). Because changing your smoking-related behaviors-and restructuring your thoughts related to smoking urges-is essential to quitting, cognitivebehavioral counseling can effectively be applied to smoking cessation. An intensive cognitive-behavioral therapy program is typically composed of three phases: preparation, quitting, and maintenance (or relapse prevention).

Treatment Plan and Course of Treatment
Based on the case formulation, CO6 and the counselor collaborated in the development of the following prioritized list of problems and treatment goals. The order and relative importance placed on these goals was largely determined by the client, although there was input from the counselor in directing treatment efforts to goals that would have the most impact on CO6's cigarette smoking and its associated symptoms, and had the greatest likelihood of success. The treatment plan followed the problem format, a format that presents the target problems with its major goal and objectives and intervention methods in structured form.
Problem-1: low academic performance a) As evidenced by: low results grade to grade. b) As evidenced by: poor class attendance.

c)
As evidenced by: lack of study skills. d) As evidenced by: absent from schools. e) As evidenced by: late in the morning to go to school.

Goal-1: to improve academic performance
Objectives and Interventions.

Objective-1: teaching study skills
Interventions: The SQ3R study method was employed to target co6's poor study skills and to improve his academic performance.

Objective -2: Increase class attendances
Interventions: To improve class attendance, a behavioral contingency was developed to ensure CO6's woke up by 7:00 am so he could attend all his scheduled classes for that day. In addition, CO6 would shower, eat a light breakfast, and walk to school. If he completed this schedule 3/5 days, CO6 would reward himself by going pool houses for the weekend or to the movies with classmate.

Objective -3: work on sleep difficulty
Intervention: Poor class attendance and an inability to study were major contributors to poor academic performance. It was decided to target CO6's sleep difficulties that were a major cause of missing classes and daily fatigue that made it difficult to study.
Maladaptive sleep-related behaviors were identified, and corrective    n) View quitting as a day-at-a-time process rather than an immediate lifelong commitment.

Problem 3: alcohol drinking
Goal 3: To stop drinking alcohol: The psychologist also offered cognitive behavioral therapy techniques for his alcohol abuse and some behavioral tips.

Progresses
The counselor used self-reports as outcome measures. The therapist reviewed co6's sleep log and daily activity record to evaluate the success of these interventions at modifying sleep behavior and class attendance. Progress was evident by improved class attendance and a more consistent bedtime routine. CO6 reported better class attendance; more sustained focus on her academic studies, and continued improvement in sleep. The client has minimized his cigarette smoking and stopped his alcohol drinking. The treatment is still under supervision.

Strengths and Weakness
Use of the core conditions of (empathy, genuine and unconditional positive regard) as relationship building throughout the whole counseling processes helped me to express my values,

Consent for Publication
This part is not applicable because the manuscript contains no individual person's data in any form (including individual details, images, or videos.