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Substance Use Assessment

Introduction

Substance abuse and drug addiction severely impact the mental health of an individual. It has been deduced that about 50% of individuals that have mental disorders are affected by substance abuse (Rhemtulla et al., 2016). Further, 37% of alcohol and drug consumers are also associated with the development of mental illnesses (Friman et al., 2017). This intricate relationship has been dependent on the fact that drugs and alcohol are often used to cope with the symptoms that are associated with mental illness (Pinedo et al., 2018).

Substance use has also been associated to serve as a trigger for health problems like schizophrenia, depression, anxiety, etc. impacting the overall cognitive function of an individual and inducing behavioral changes like emotional distancing and seclusion (Kazemi et al., 2017). People who develop mental illnesses and also have a dependency on drugs and alcohol may present with noncooperative behavior towards treatment and interventions. This paper presents a case study of Liam (Pseudonym) who is addicted to cocaine and is suffering from chronic depression. This paper also includes the model of change suitable for the wellbeing of Liam and proposes a care plan by setting the improvement goals.

Case Study

Liam is a 35-year-old man who was diagnosed with chronic depression 2 years back when he had a major loss in his business. Post this incident, he developed an addiction to cocaine and has been addicted to the same. Due to persistent addiction, Liam has started showing symptoms of psychosis and mania. He has also developed hallucinations where he perceives that people around him are trying to harm his wellbeing. He was taken to the rehabilitation center for cessation and limiting his drug abuse. Where withdrawal from the drug has led to the severing of his psychological problems. In the course of stay at the center, Liam has been non-compliant with his medications and frequently exhibits violent behavior.

The underlying cause of his trauma is not known as he has abandoned everyone in his close contact that has not been traced post his admission and only major business losses due to economic depression are known and have been speculated to have resulted in his addiction. It has been suggested that Liam will have to stay in the care setting for six more months where his addiction and psychological needs will be essentially catered to, after which he can be released. However, there is a high risk of relapse in the case of Liam which requires essential consideration of the healthcare professionals.

Model of Change

The model of change has been described as a continuous process of behavior change in which an individual transcends from one stage to another in distinct phases. The transtheoretical model of change categorizes six essential stages. These include pre-contemplation, contemplation, preparation, action, maintenance, and termination. In the given case scenario, it can be deduced that Liam is at the stage of “pre-contemplation” where is unaware of the behavioral changes required for his wellbeing (Ligmann-Zielinska et al., 2016). Liam has not presented any significant desires for his behavior change and is undergoing withdrawal from his cocaine addiction in conjunction with psychological illnesses.

He is reclusive and does not want to talk about his traumatic experience. He is also non-complaint towards his medication and fails to address the need for behavior change. With the use of the ASSIST tool, it was identified that Liam was at high risk of harm from sedative medications and had a moderate risk of developing harm of tobacco, opiates, and amphetamines. People in the precontemplation stage have difficulty in accepting behavior change as they have not been able to determine the need for behavioral change in the body. This may impact their overall transition towards change and move to the action stage where they take necessary steps towards their health beneficence and wellbeing.

Patient Goals

The identification of goals for the improvement of health condition is very necessary in every care process. In the given case, the primary goals for the improvement of the health condition of Liam include the successful completion of the drug use cessation program (Liu & Li, 2018). This will help in the complete abortion of cocaine consumption by Liam. Another essential goal for the improvement of health condition is to educate Liam to promote his health and shift him to a stage of contemplation where he is willing to develop healthy behavior and advocate his physical and psychological wellness (Ligmann-Zielinska et al., 2016). The third goal for the care of Liam will be to provide him holistic care that can help in meeting his physical as well as psychological needs. The final goal for the health of Liam will be complete recovery from addiction and movement to the stage of termination where there the chance of relapse is limited (Liu & Li, 2018).

Care Plan

To essentially care for the needs of Liam, it is important to develop a holistic care plan that has a person-centered approach for Liam. This will help in identifying the care needs of Liam and provide him physical as well as psychological assistance (Kiluk et al., 2018). The primary step will be to provide therapeutic assistance to Liam to address his withdrawal and depression. Cognitive behavioral therapy (CBT) will be appropriate in addressing the needs of Liam. Cognitive behavioral therapy is timed and goal-oriented psychotherapy that is used for the management and treatment of the health condition (Bosworth et al., 2017).

CBT has been found to be effective in patients with drug abuse and psychological illnesses as it helps in changing the behavior of the individual to promote health and wellness. This will be of essential importance as it will help Liam transit from the pre-contemplation stage to the contemplation stage where he will be able to consider the need for change (Kiluk et al., 2018). This will promote collaboration and compliance of the patient towards medication and interventions aimed at his overall beneficence and health promotion. CBT functions primarily through psychoeducation and promotes wellness through self-awareness and emotional intelligence.

Another crucial intervention that must be included in the care plan of Liam is motivational interviewing. Motivational interviewing has been found to be highly effective in cases of substance use disorders and psychological illnesses like depression (Bosworth et al., 2017). This intervention is successful as it keeps the autonomy of the patient into consideration and allows them to identify the reasons for the change. This is extremely crucial for Liam as it will help him identify the needs of behavioral change. Motivational interviewing has been found to be highly successful for people with substance use disorders along with mental illnesses (Magill et al., 2017). This intervention ensures that the patient feels comfortable and identifies their need for change. This promotes compliance and also assists in the application of clinical interventions through a participatory approach.

The third component essential in the care plan of Liam is to develop a person-centered approach for holistic care. The person-centered approach has been identified as an essential component of nursing care by the Nursing and the Midwifery Board of Australia (Magill et al., 2017). Person-centered care for Liam will ensure that all his physical and psychological needs are essentially catered to. This will also help in the development of a strong relationship between the patient and the carer that will enhance the communication and therefore improve the overall care given to Liam. Adoption of person-centered care will also help in the identification of the holistic needs of the patient that may include social, cultural, and psychological support (Bosworth et al., 2017). Therefore, based on these, successful interventions can be applied for the complete care of Liam. This will enhance the compliance and participation of the patient in the interventions by promoting trust between the clinician and the patient.

The fourth component for the care of Liam will be to include relapse prevention. Relapse prevention helps in the identification of situations where the patient might be highly vulnerable to relapse (Livingstone-Banks et al., 2019). Through relapse prevention, Liam will be able to achieve confidence and prevent falling back to addiction post completion of his time in the care setting. This will help in overcoming his addiction completely and move his transit to the final stage of the model, which is termination.

Conclusion

This paper summarizes a case study of Liam who is a 35-year-old man suffering from cocaine addiction and chronic depression. The brief case study of Liam has been discussed concerning which the model of change has been provided. This paper identifies Liam to be present at the pre-contemplation stage. The patient goals have also been identified that aim to improve his overall health and wellbeing. A comprehensive care plan has also been developed in consideration of Liam. The care plan identifies that the most essential interventions for the beneficence of Liam will be cognitive behavioral therapy, motivational interviewing, person-centered care, and relapse prevention. These will not only enhance his compliance with interventions and assist in improving his physical as well as psychological wellbeing.

References

Bosworth, H. B., Fortmann, S. P., Kuntz, J., Zullig, L. L., Mendys, P., Safford, M., ... &Rumptz, M. H. (2017). Recommendations for providers on person-centered approaches to assess and improve medication adherence. Journal of General Internal Medicine, 32(1), 93-100.

Friman, M., Huck, J., & Olsson, L. E. (2017). Transtheoretical model of change during travel behavior interventions: An integrative review. International Journal of Environmental Research and Public Health, 14(6), 581.

Kazemi, D. M., Borsari, B., Levine, M. J., Li, S., Lamberson, K. A., & Matta, L. A. (2017). A systematic review of the mHealth interventions to prevent alcohol and substance abuse. Journal of Health Communication, 22(5), 413-432.

Kiluk, B. D., Nich, C., Buck, M. B., Devore, K. A., Frankforter, T. L., LaPaglia, D. M., ... & Carroll, C. (2018). Randomized clinical trial of computerized cognitive behavioral therapy and clinician-delivered CBT in comparison with standard outpatient treatment for substance use disorders: Primary within-treatment and follow-up outcomes. The American Journal of Psychiatry, 175(9), 853.

Ligmann-Zielinska, A., Grady, S. C., & McWhorter, J. (2016). Combining a Spatial Agent-Based Model with a Transtheoretical Model of Health Behavior Change. Handbook of Applied System Science, 49,1-10.

Liu, J. F., & Li, J. X. (2018). Drug addiction: A curable mental disorder?.Acta PharmacologicaSinica, 39(12), 1823-1829.

Livingstone-Banks, J., Norris, E., Hartmann-Boyce, J., West, R., Jarvis, M., Chubb, E., & Hajek, P. (2019). Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews, (10).

Magill, M., Apodaca, T. R., Borsari, B., Gaume, J., Hoadley, A., Gordon, R. E., ... & Moyers, T. (2018). A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change. Journal of Consulting And Clinical Psychology, 86(2), 140.

Pinedo, M., Zemore, S., & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1-8.

Rhemtulla, M., Fried, E. I., Aggen, S. H., Tuerlinckx, F., Kendler, K. S., &Borsboom, D. (2016). Network analysis of substance abuse and dependence symptoms. Drug and Alcohol Dependence, 161, 230-237.

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