Substance abuse a mental health case

a capstone project presentation Leeah javier

 Male, 15-year old ~ part Hawaiian with Patient overview... a history of poly-substance abuse and conduct disorder. Admitted on December 2013 due to multiple elopement at FTC and attempts to strangle himself. Diagnoses: Polysubstance abuse, depression and conduct disorder

He is currently for residential treatment until substance abuse program is in place

life in a nutshell...what happened?

Physically abused
Daily use of Marijuana

5 7 9 10 11 12 12

Police involvement Alcohol use Robbery and Assault

Meth, cocaine, ecstacy

Sexually active

Multiple detentions, suspensions and disrespecting authorities

dsm-iv substance abuse Axis l) Substance Abuse A maladaptive pattern of substance

use leading to clinically impairment or distress as manifested by one (or more) of the following and occurring within a 12-month period: A) Criterion (1): recurrent substance abuse use resulting in a failure to fulfill major role obligations at work, school or home. ( In the patients case: poor school performance, substance-related absences, suspensions or expulsions from school) Criterion (2): recurrent substance-related legal problems (arrests for disorderly conduct) Criterion (3): continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (arguments with spouse, physical fights B) The symptoms have never met the criteria for substance dependence for this class of substance (per clients medical chart: Patient has history of poly substance abuse from seven years of age. This resulted in

Concept map

Contributing factors

FAMILY - BOTH PARENTS HAVE HISTORY OF SUBSTANCE ABUSE AND INCARCERATION ~ PHYSICALLY ABUSED AS A CHILD ENVIRONMENT - PEER PRESSURE AND WRONG FRIENDS

What are the patients 4 highest needs/problems?

PRIORITY ASSESSMENT
1. P: AGITATION/AGGRESSION
E: Client stated thinking of running away but no elopement attempted S: Explained implications of actions; provide clear behavior expectations and failure to comply. Administer PRN medications

2. P: SAFETY E: Client has history of suicide (putting a gun to his head and strangle self) S: Assess for mental status and establish rapport through therapeutic communication

3. P: CRAVINGS
E: Client states I want to smoke, I have cravings. S: Explore coping skills, i.e. journaling, basketball and exercise

Intervention & Frequency

Scientific Rationale This information provides foundation for individualizing a teaching plan based on the patients abuse and dependency on more than one substance. Substance abuse may co-exist w/ other psychiatric or cognitive problems that may result in dual diagnosis (Gulanick & Meyers, 2011)

Evaluation

Assess substance abuse history including type of substances use, amount and most recent episode of use of each shift.

Client stated that he has been not been using any substance since his admission to the facility, however he occasionally experience cravings

Evaluate the patients usual coping style by interview and counseling techniques

Establishing attainable goals and to determine coping methods that can be used to achieve them. (Fortinash, 2012)
All relationships are affected by the substance life also need support and information. (Gulanick & Meyers, 2011)

Client identifies existing coping skills and newly acquired coping methods

Identify the patients supportive relationships use behavior; significant people in the abusers

Client stated that his family especially his son is the most important thing in his life. His motivator to get better and get on with life.

Behavioral therapy such as individual or group counseling and 12-step programs

Cognitive-behavioral and motivational therapies support the patients readiness to begin treatment and make behavior changes, help the patient recognize and cope with situations that stimulate substance abuse 12-steps provide guiding principles for the process recovery. (Gulanick & Meyers, 2011)

Client expressed desire to join AA-meetings and stated that he already found a sponsor that will also serve as his mentor. Though he admits to occasional aggression and cravings, he is determined to get better.

RESOURCES