Clinical Experience with a History of Substance Abuse

Clinical Experience with a History of Substance Abuse

People with substance use disorders are unable to regulate the use of drugs. Common drugs and substances of abuse include alcohol, opioids, inhalants, cannabis, and hallucinogens such as phencyclidine (Americanaddictioncenters.org, n.d.). Substance abuse should be managed adequately because it is associated with physical and psychosocial problems. This paper describes my clinical experience with a client with alcohol withdrawal syndrome. Our assignment writing help is at affordable prices to students of all academic levels and academic disciplines.

Client’s History and Diagnosis

I interacted with a 62-year-old African-American male. He presented with excessive sweating and nausea, hand tremors, visual hallucinations, anxiety, and vomiting. Social history revealed that the patient had quit drinking alcohol four weeks ago. According to him, the sudden death of his wife and son triggered his drinking habit. He engaged in binge drinking and became an alcoholic, which made him check himself into a drug abuse and rehabilitation centre. His presenting complaints developed after cutting down on drinking. As such, the patient is likely to be experiencing alcohol withdrawal syndrome (AWS). Day and Daly (2022) report that AWS occurs in individuals who quit drinking abruptly or those who minimize alcohol intake. Poorly managed AWS can progress to delirium tremens characterized by hypertension, diaphoresis, global confusion, and nightmares (Pribék et al., 2023).

Treatment Recommendations

Both pharmacological and non-pharmacological approaches should be used to manage a patient with AWS. Pharmacological approaches embrace benzodiazepines, neuroleptics, beta antagonists, and alpha-adrenergic agonists (Day & Daly, 2022). Notably, benzodiazepines such as diazepam are the treatment of choice (Day & Daly, 2022). They manage seizures, delirium, agitation, tremors, and hallucinations associated with AWS. Neuroleptics manage agitation, whereas beta-blockers and alpha-adrenergic agonists manage hypertension and tachycardia (Airagnes et al., 2019). Nutritional support should include thiamine and folic acid to mitigate the risk of Wernicke’s encephalopathy (Airagnes et al., 2019).

On the other hand, non-pharmacological approaches entail group therapy and counselling. Group therapies address various aspects. Firstly, they address psychoeducational, which educates clients about drug and substance abuse (NIH.gov, n.d.). Secondly, they address skill development, during which clients learn to avoid addictions. Thirdly, cognitive behavioural groups enable clients to develop desirable behaviours that avert the risk of addiction (NIH.gov, n.d.). Fourthly, support groups promote constructive transformation by allowing members to share their experiences.

Medications

As earlier stated, the recommended medications include benzodiazepines, neuroleptics, beta antagonists, and alpha-adrenergic agonists. Benzodiazepines manage seizures, delirium, agitation, tremors, and hallucinations associated with AWS (Day & Daly, 2022). Common side effects related to benzodiazepine use include somnolence, ataxia, dizziness, drowsiness, and respiratory depression (Day & Daly, 2022). Next, neuroleptics manage agitation, whereas beta-blockers and alpha-adrenergic agonists manage hypertension and tachycardia (Airagnes et al., 2019). Neuroleptics are associated with extrapyramidal symptoms such as akathisia and tardive dyskinesia (Airagnes et al., 2019). Further, beta-blockers are associated with dizziness, headache, bradycardia, and tiredness, whereas alpha-adrenergic such as clonidine is associated with somnolence, drowsiness, dizziness, and hypotension (Airagnes et al., 2019).

Co-Morbidities and Impact of Substance Abuse on Mental and Physical Health

Comorbid medical conditions can impact the client’s mental health. Notably, the presence of psychiatric disorders such as major depressive disorder, panic, and anxiety disorder will affect the client significantly. Anxiety and panic disorders are likely to worsen anxiety associated with AWS. Furthermore, major depressive disorder is likely to impede the client’s ability to cope with anxiety associated with AWS.

Moreover, chronic and acute alcohol abuse will impact the client’s physical health. Firstly, chronic alcohol consumption will increase the risk of liver cirrhosis. Secondly, short-term effects include impaired vision and coordination (Bacidore et al., 2020). These short-term effects increase the risk of falls, accidents, and severe injuries. Thirdly, alcohol consumption increases the risk of erectile dysfunction (Bacidore et al., 2020). Also, Bacidore et al. (2020) report that chronic alcohol consumption increases the risk of cardiovascular conditions such as hypertension and heart failure.

Therapeutic Communication

I embraced therapeutic communication during my interaction with the patient. Accordingly, I upheld active listening, empathy, paraphrasing, and summarizing (Xue & Heffernan, 2021). To begin with, active listening enabled me to use nonverbal cues such as nodding and maintaining meaningful eye contact. Also, it enabled me to avoid interrupting the client. As a result, the client shared detailed information that facilitated the diagnosis. Secondly, empathy enabled me to avoid discriminatory practices and to share the client’s experience and feelings. Lastly, paraphrasing and summarizing enabled the client to acknowledge his understanding. Conclusively, these therapeutic communication techniques were effective. They enabled me to establish a rapport with the client and facilitated information sharing to make a diagnosis.

Maladaptive Behavior Related to Addiction

            Chatzittofis and Kim (2023) report that maladaptive behaviours impede an individual’s ability to cope with undesirable situations or events. Most people adopt these behaviours to escape from realities and find comfort. However, maladaptive behaviours do not solve underlying problems and are likely to worsen the situation by predisposing the individual to other risks. In the context of addiction, when faced with problems, people are likely to start using alcohol and substance abuse to cope with the problems or impacts of those problems. Continuous alcohol and substance abuse lead to physical and psychological addiction. For instance, in this context, the client started using alcohol to cope with the grief and anger of losing his wife and son.

Nursing Diagnosis and Interventions

The diagnosis is sensory-perceptual deficits, as evidenced by visual hallucinations and anxiety. The first nursing intervention is to ensure that the environment is calm and free from noise or shadows. This intervention aims at minimizing the likelihood of hallucinations and delusions (Vera, 2022). The second intervention is to monitor the patient’s laboratory findings, such as electrolyte levels and liver function tests. This is relevant because sensory perceptual disturbances are likely to be caused by alterations in organ function (Vera, 2022). These findings will form the basis for initiating other interventions. The third intervention is to ensure safe medication administration as prescribed. Relevant medications such as benzodiazepines will reduce sensory-perceptual deficits associated with AWS.

Conclusion

Alcohol withdrawal syndrome should be detected and managed adequately to reduce the risk of progressing to delirium tremens. Pharmacological and non-pharmacological approaches should be leveraged to manage AWS. Patients should be closely monitored to identify and manage side effects associated with pharmacological management. Also, the availability of pertinent coping mechanisms will avert maladaptive behaviours such as addiction.

References

Airagnes, G., Ducoutumany, G., Laffy-beaufils, B., & Faou, A. Le. (2019). Alcohol withdrawal syndrome management : Is there anything new ? La prise en charge du syndrome de sevrage de l ’ alcool : quelles nouveautés ? La Revue de m?®decine Interne, 40(6), 373–379. https://doi.org/10.1016/j.revmed.2019.02.001

Americanaddictioncenters.org. (n.d.). What is a Substance Use Disorder (SUD)? https://americanaddictioncenters.org/rehab-guide/substance-use-disorder

Bacidore, V., Kameg, B., & Mitchell, A. M. (2020). Strategies for Alcohol Screening, Brief Intervention, and Referral to Treatment Sustainability in the Emergency Department. Advanced Emergency Nursing Journal, 42(3), 225–230. https://doi.org/10.1097/TME.0000000000000311

Chatzittofis, A., & Kim, H. S. (2023). Editorial: Behavioral addictions: Emerging science. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1127444

Day, E., & Daly, C. (2022). Clinical management of the alcohol withdrawal syndrome. Addiction, 117(3), 804–814. https://doi.org/10.1111/add.15647

NIH.gov. (n.d.). Substance Abuse Treatment: Group Therapy. https://www.ncbi.nlm.nih.gov/books/NBK64223/

Pribék, I. K., Kádár, B. K., Péter, L., Daróczy, J., Bajsz, A., Kovács, C. S., Demeter, I., Janka, Z., Urbán, R., Demetrovics, Z., Lázár, B. A., Kovács, I., Kálmán, J., & Andó, B. (2023). Seasonality and Delirium Tremens in Hospitalized Patients with Alcohol Dependence Syndrome. European Addiction Research, 1–9. https://doi.org/10.1159/000527973

Vera, M. (2022). 5 Alcohol Withdrawal Nursing Care Plans. https://nurseslabs.com/5-alcohol-withdrawal-nursing-care-plans/

Xue, W., & Heffernan, C. (2021). Therapeutic communication within the nurse–patient relationship: A concept analysis. International Journal of Nursing Practice, 27(6), 1–8. https://doi.org/10.1111/ijn.12938

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Submit a paper describing a client from your clinical experience with a history of substance abuse. Include at least three APA citations from sources that support or address your opinions or ideas:

Clinical Experience with a History of Substance Abuse

 Describe the client’s history, diagnoses and reasons for being in that clinical setting.
 Discuss treatment recommendations, including outpatient group psychotherapy and addiction counselling.
 List the medications the client is prescribed and their purposes and side effects.
 Discuss the effects of co-morbid medical conditions on your client’s mental health and the effects of substance abuse on the client’s physical health.
 Describe the therapeutic communication used during this clinical experience (both verbal and non-verbal communication) and evaluate the effectiveness of the therapeutic communication tools used.
 Discuss the maladaptive behaviour related to addiction
 Develop a nursing diagnosis with three nursing interventions that may be helpful for the client, their expected effects, and why they are important.
 This case study is expected to be 3-4 pages long (not including the title page), double-spaced, Times New Roman font. Your paper should include an introduction and conclusion and proper APA citations from any source material you use, including your text.

On February 7th, I met with a 62-year-old African-American client at the VA who was experiencing alcohol withdrawal. He’s been clean for four weeks now. He checked himself into rehab after he developed an alcohol problem following the deaths of his wife (who passed away peacefully in her sleep) and son (who was shot and killed in Minneapolis on his way home from church). He began drinking heavily under the false assumption that doing so would alleviate the pressure he was under. I went to his group therapy sessions with him and saw that he was trying to cut down on drinking.