Harry is a 27 year old male who has presented to accident and emergency brought in by police following an incident at the local nightclub. According to the police Harry was at a night club with a group of friends last night and was involved in a fight and argument with a fellow patron at the nightclub. The ambulance officer treated a small laceration to his right forearm which did not requiring suturing. On initial assessment; Harry presented as irritable; argumentative; stating “let me go home; I am fine”; he was casually dressed in jeans and t-shirt; short dark hair; brown eyes and dark skin. He presents with breath smelling of alcohol; speech is slurred; gait is unsteady and as reported by the police Harry returned a PCA of 1.19 of alcohol and was positive for cannabis when tested at the nightclub.
Harry was accompanied to hospital by two friends who stated; “He hasn’t been himself for a while; he has been getting to work late; they have threatened to fire him; he has been spending all his money on grog; and he has been ringing his ex girlfriend all hours of the day and night while intoxicated”.
Harry stated he smokes 30 cones per day of cannabis; and drinks 2-3 Bundaberg rums; “ all my friends do the same there is nothing wrong with it”. He added that he has increased his use of drugs and alcohol; over the past 6 weeks. He states he has used cannabis and alcohol since he was 16. Three (3) weeks ago Harry broke up with his girlfriend after an argument; “she said I can’t cope with you being stoned and pissed all the time; either give up or I’m gone”. He states being stoned and smashed “helps me forget”. Harry states “my life is out of control; I can’t fix it; there’s no point”.
In taking Harry’s history; he stated “I am just like my father; he liked a drink”. On further questioning Harry reveals to you that when he was 15 he was sent to juvenile detention for six months charged with damaging property and assault. Harry described a poor relationship with his father who left him and his mother when he was 14. Harry stated” I was a bit scared of him; he used to hit my mother a lot”.
Using the above Case Study; please answer the following six (6) questions:
1. Using the DSM IV TR criteria for Substance Abuse; provide evidence from the case study that indicates that Harry may meet the criteria for a Substance Abuse disorder.
2. Investigate and outline the epidemiology of Cannabis use in Australia.
Your answer needs to cover the following areas: prevalence/incidence; possible causes; hospitalisation rates and burden of disease.
3. Discuss two (2) possible factors behind the development of Harry’s substance use disorder
( using current literature).
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Learning Guide – Spring 2013
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4. Harry is currently experiencing a number of substance and mental health related problems; using evidence from the case study list three 3 MAJOR problems or risks.
Your problem/risk identification should focus on nursing Harry in the next 1-5 days.
5. Outline and describe three 3 nursing interventions in the management of each of the three 3 problems or risks you have identified in questions 4.
Your interventions should be focused on nursing Harry over the next 1-5 days.
6. With reference to current literature (within the last 5 years); provide a rationale for each of the nine 9 nursing interventions.
Mental Health: Case Study
Use the DSM IV TR criteria for Substance Abuse to provide evidence to indicate that
Harry meets the criteria for a Substance Abuse disorder.
According to DSM IV TR criteria for substances abuse, the maladaptive substance abuse, which results into a clinically noteworthy distress or impairment, may be portrayed by the following factors occurring within the timeline of one year (NIDA, 2013).
- Consistent use of substances, which makes an individual in failing to perform his or her responsibilities. Harry meets these criteria as he is reportedly gets to work late and that his superiors have threatened to fire him because of this.
- Consisted drug abuse in circumstances where it becomes physically harmful. This fits well with Mr. Harry has he is taking drugs in dangerous places such as nightclubs. In this case, he had been roughed up in one nightclub after engaging himself with fights with the pub’s patron under the influence of alcohol and cannabis.
- Recurrent legal problems related to substance abuse. For Harry, he started landing on the wrong hands of the law while he was only 15. This was when he was jailed at the juvenile prison for six months for charges related to assault and damage to property. He has also been abusing drugs and alcohol since he was merely 16. The present case is also a legal issue since it is involving the police after an argument and fighting in the local pub.
- The last criteria are the consistent drug abuse irrespective of the regular interpersonal or social problems, which may be derived from the intake. Despite being deserted by his girlfriend over what is considered as too much engagement in drugs and alcohol, Harry has been defeated to change this trend, arguing that his problem is uncontrollable and cannot be fixed.
Epidemiology of Cannabis Use in Australia
A survey conducted by the Australian National Household in 2011, revealed that 7.2% of Australian Citizens were regular users of Cannabis and had used the same for over five years. Apparently,2.2% of these users had met the DSM IV criteria for cannabis use. 31.7% of the present users had met the DSM IV criteria for disorders related to cannabis use. Addicts had a likelihood of having seen a health practitioner related to the problem in comparison to those who had not reached this stage. The increase in Cannabis use is more of depicted by the high number of individuals seeking treatments from this disorder. Since 1990s, this rate of cannabis patients has more of tripled making the substance to be of great concern in the nation.
There are some individuals who turn to drugs in order to cope with, deny or hide some psychological disorders. Health related conditions such as Schizophrenia might also make one to start using drugs. It has also been acknowledged that the consumption of other illicit drugs, alternative medications, and overdoses may also lead to use of marijuana (Health Grades, 2011). Other reasons as to why individuals engage themselves in abusing marijuana include but not limited to: pressure from their peers, inquisitiveness, and entertainment or fun. Many users of this substance have posted that they experiences euphoria after taking the drug. That is they get aroused sexually, it relaxes their moods and that they find it easier to socialize with their friends most of whom are adherents of this drug. According to Losken et al, (2006), the less stringent legal discipline, the low cost and easy access of the commodity has ultimately led to high rate of use among individuals in recent perspective. (Schuckit, 2008).
Research shows that Australia is among the top nations in the world with regard to the usage of illicit drugs such as cocaine, amphetamines and cannabis. The cannabis users in this country account for 3.9% of the world population within the age of 15-64 years. This has subsequently created a disease burden which have become very significant in the country and therefore, calling into question the efficiency of policies that control the usage of this drugs( Lancet2009). Cohen et al, (2006) found out that cannabis use accounted for 0.2% of all the diseases occurring in Australia. Other adverse effects related with this drug include accidents and damage risks. Some of the diseases caused by cannabis intake include respiratory dysfunctions, cardiovascular effects, mental and psychological problems, and unproductivity in work or home places.
Factors that Led to Harry’s Substance Use
One of the factors that led to Mr. Harry to engage in drugs is influence from his colleagues. In fact, he argues that he does not find anything wrong with his drug habit since all of his colleagues are also doing the same. Pressure from colleagues or group mates may motivate an individual in doing things to make him or her fit into that specific group. When an individual belongs to a group of friends, he or she may become influenced into developing certain habits, which he may not have harbored in the first place. Many of those who use illicit drugs get tempted probably from their friends who make them to belief that such activities are both fun and “cool”. Individuals feel that they have to involve themselves in particular activities to be accepted in a certain group (Michigan University, 2013). Based on these facts, it is probable that his colleagues, whom they associated with regularly, influenced Mr. Harry to engage him on drugs.
Information obtained from the National Institute on Drug Abuse Wesite postulates that an individual’s background plays a role in his or her involvement on illicit drugs. Taking the case of Mr. Harry, his own father was an alcohol addict, and therefore, provided poor role model to him. Children whose parents engage themselves in drugs or alcohol have a probability of also involving themselves in these things. In accordance to the American Council for Drug Education (2010), there is more likelihood of a male child to involve himself in drugs if there is a drug user in the family, in comparison with one who has no drug user in a family. The style of parenting is a major factor in this situation. Children coming from families that have guidelines that are conflicting may be prone to illicit drugs as compared to children in families with clear guidelines. More spectacular is the fact that children with parents who themselves are drug abusers are more likely to engage in the same vice.
Major Problems experienced by Harry
- Addiction and Overdependence- Harry says that his problem cannot be fixed nor controlled by any one. Instead, his alcohol and drug abuse has been increasing over time.
- Accidents and Damages: Mr. Harry has been involved in a number of accidents and damages that result from the intake of drugs. A good example is the present case, which brought him to hospital after being involved in fights in a drinking spree. Substance intake has also caused his body to be seriously injured after being tossed, pissed and smashed by various objects including stones.
- Loss of productivity: This is well depicted in Mr. Harry when he reports late in his place of work, his productivity has ultimately gown down and there is a risk of him losing his source of livelihood.
Nursing Interventions for the Above Problems and their Rationale
Concerning drug addiction, the health practitioner will have to set up a meeting of the affected person, together with some members of his family and friends. The nurse with assistance of the family members and friends will try as much he could to explain to the client the dangers of drug abuse, citing his own example. Everybody attending this meeting will have a chance to put his or her points across. The affected member will then be given a chance to attend a rehab center on the immediate note. He will be informed the significance of attending a rehab center as one that will add value to his life (Orchid, 2012). For Harrys case, he will be shown on how drug and alcohol addiction has made her girlfriend to desert her, how his employer has threatened to fire him in case he does not change and how his own body is deteriorating from being beaten and smashed by stones.
According to Stone and Pearson, (2009), nurses have a major role in prevention of accidents and damages involving the drug addicts. Among the ways, they can do so is to advice the client on the best initiative to undertake while in situations that appear dangerous to their health. For instance, Mr. Harry should be advised to avoid nightclubs while under the influence of drugs. The health worker should identify and present to the patient the accident risks associated with the use of alcohol and drugs and give advice on how to avoid such.
With regard to low productivity, the nurse will be responsible for informing the client the risks involved in his lack of seriousness to his job. He should motivate him to work hard so that he can support himself and future family, otherwise he together with the family will suffer if he loses employment. Helping the client personally and psychologically will be of benefit to him or her not only in improving on his work performance but also other aspects of life (Rogers, 2007). Change in humanity is an aspect that is acknowledged by many. People experience change within and around them. However, when the behavioral functioning and the psychology status develop a problem, nurses can take the role of therapists and counselors in providing help at this time (Seligman, 2009). The great concern for this practitioner is to alter some aspects of their thoughts, behavior and feelings so that they could lead full live with a sense of happiness and peace. For drug and alcohol abusers, some of the things that need to be altered are obvious. They include reducing or totally avoiding the amount of these substances consumed in order to change their life pattern. Therefore, intervention in psychotherapy will ultimately result into behavioral changes including the functional areas such as emotions and cognition (Miller, 1986).
American Council for Drug Education (2010). Drug Abuse – ACDE. Organization Ut 74th Street New
York, NY 10023 1-800-488-DRUG
Cohen G, Fleming NF, Glatter KA, Haghigi DB, Halberstadt J, McHugh KB,
(2006).Epidemiology of substance use. Baltimore, Md.: Williams & Wilkins,:23-46. Health Grades ( 2011). Causes of Cannabis dependence