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Planofcare Substance Abuse
Planofcare Substance Abuse
Planofcare Substance Abuse
Christina Collins
NUR 330
SUBSTANCE ABUSE DISORDER 2
2016, about 20.1 million (7.5%) people aged 12 or older had a Substance Use Disorder (SUD)
related to their use of alcohol or illicit drugs in the past year. Many of those people had both
mental illness and substance abuse disorder co-occurring. SAMHSA states that the DSM-V
defines substance use disorders as those that occur when the recurrent use of alcohol and/or
drugs causes clinically and functionally significant impairment, such as health problems,
disability, and failure to meet major responsibilities at work, school, or home. The critical
healthcare needs of those suffering from substance use disorders are: medical, mental health,
social, spiritual, and environmental. From an epidemiologist standpoint they look at two main
1. What is the nature, extent, and pattern of substance use behaviors and their
associated consequences?
Understanding risk and protective factors are important because it helps the health care team
providing care to those with substance use disorders find appropriate interventions. There are
many risk factors that would lead an individual into a life of substance abuse. Strengthening
those protective factors that would prevent and protect individuals who would otherwise be at
The November 2016 Surgeon Generals report states that prevention works, treatment is
Nursing Assessment
are most commonly addicted to alcohol, marijuana, painkillers, benzodiazepines, cocaine, and
heroin. Ashley Addiction Treatment uses a holistic approach to recovery that treats mind, body,
and spirit (2017). Every individuals addiction is unique therefore the aim of Ashley is to
provide an individualized treatment using one of four core programs in order to achieve sobriety
(2017).
2. Young Adult Program: geared toward age 18-25, which combines traditional
3. Pain Recovery Program: for those who self-medicate with pain killers due to
4. Relapse Program: for those individuals who have relapsed after obtaining sobriety.
The program looks into why the person may be suffering with an addiction and
Ashley Addiction Treatment (Ashley) serves individuals aged 18 and older. Currently the
youngest patient in treatment is eighteen and the oldest patient is sixty-five. Addiction does not
discriminate; the patients come from all walks of life. The patients range from homeless to
SUBSTANCE ABUSE DISORDER 4
Hispanic, and Asian. The most common religions of those served are Christians, Jewish,
Buddhist, Muslims, and Agnostics. The majority of the patients speak English, but Ashley does
provide interpreters for spanish-speaking and deaf patients. Ashley accepts commercial health
insurance, self-pay, and scholarships. Ashley does not accept Medicaid or Medicare insurance.
The predominant form of payment with about 78% of the patients using it is commercial health
insurance, 12.5% using self-pay, and 9.5% receiving scholarships (Ashley Addiction Treatment,
2017).
Healthcare benefits Does a person have them and if so what do they cover? If
Costs. Healthcare is expensive and often times it are those costs that prevent many from
seeking medical care, whether it is behavioral health and/or medical services. Every heath care
plan has different limitations. It is important for an individual to know what their insurance
covers and to choose the best program based on their coverage. For instance, if a healthcare plan
does not cover an appropriate stay for residential treatment, but it may cover an intensive
outpatient program which could also be beneficial. This becomes a daunting task for an
SUBSTANCE ABUSE DISORDER 5
individual who is suffering from an addiction because they are not in the appropriate mind-frame
to understand their needs. This is the time to reach out to family and friends for support and
guidance to help figure out the best plan. For those individuals who do not have insurance or the
ability to self-pay there are programs that provide scholarships. Many times a family will come
together as well to help with the cost of treatment because they want to see their family member
well.
Stigma. For a very long time addiction has been seen as a lack of willpower or a lack of
moral compass. The stigma this perpetuates leaves society with many negative thoughts and in
turn society acts upon those false negative ideas. Society as a whole must change the way we
talk about addiction so that it is explained in terms of the disease that it is. This must start at a
governmental level, which is the past few years has begun to take place. According to
drugabuse.com, stigma impacts willingness to attend treatment and access healthcare, harm
reduction, self-esteem, and mental health. In order to combat stigma individuals can offer:
Compassionate support,
See a person for who they are, not the drugs they use
1. Those with addiction cannot stop using therefore they need to go through
Detoxification.
Detoxification is the first step to sobriety. In order to successfully treat an individual, the
individual must be evaluated based on their current substance use, emotional well-being, medical
November 9, 2017).
managing through acute intoxication and withdrawal to a medically stable, drug-free state (U.S.
Department of Health and Human Services, 2016). To meet the goal of detoxification, the
1. Depending on the drug of choice, use medications supported for use during medically
alone is not effective treatment. It often leads to return to the drug, which is
dangerous because detoxification reduces the individuals tolerance level. If they try
to use the same amounts previously used, there can be serious consequences, such as
overdose. The more time spent in treatment, the rate of relapse decreases.
3. Involve the individuals support group (family, friends, etc.) to support the treatment
process (HHS, 2016). Rationale: Families need healing. Involving family and /or
Evaluation of Plan:
3. Were the individuals family or significant others engaged for support? If so,
how?
Focusing on mental health is an important need to be address for those suffering with
addiction. In 2014 alone, according to a study published by Substance Abuse and Mental Health
Services Administration, of all the adults in the United States, 3.3% had a substance use disorder
and any type of mental illness. Often times those suffering with addiction have unresolved grief,
experienced trauma as a child and/or an adult, PTSD, live in dysfunctional families, as well as
many other factors that may be affecting their mental health, which often times may be the
reason that lead them into an addiction in the first place. Treating mental health once a drug-free
state is achieved is imperative because the individual now has a clear mind to address any issues.
The identified outcomes are attend individual therapy, attend group therapy, and manage
mental health diagnosis with medications if necessary. To meet the outcome goals, the following
treatment program, set up appointment to meet with someone from the psychology
anxiety, and help an individual understand they are not alone. Therapist can provide
motivation, encouragement, and support. When set backs occur, therapist can help
SUBSTANCE ABUSE DISORDER 8
an individual identify the problem, identify the trigger to the set back, provide skills
how to cope in the future if the same problems occurs. Set goals. Individuals gain
gain hope and strength from peers, and listen to structured messages related to many
topics in addiction.
Evaluation of Plan:
1. Has the individual attended individual therapy sessions? With whom? Can they verbalize
what triggers their want to use a certain substance? If there is a craving, what skill was
learned from their therapy? What short-term goals have been set?
2. Has the individual attended group therapy? What kind of group therapy have they
attended? Have they met anyone to call for support when they feel like using? Can they
3. If prescribed medication, has the individual taken the medication as prescribed? If yes,
has the medication given the effect it was prescribed for? If not, can the individual
verbalize why? If the individual has not taken the medication, why not? Can the patient
Every individual is different and his or her treatment plan must be person-centered.
Continuing care following detoxification and either a residential or outpatient program must be
on going. Addiction is a disease and must be treated as a chronic illness in order to maintain life-
long sobriety and prevent relapse. As suggested by the surgeon general report on addiction, the
typical progression for an individual with a substance use disorder would like start with
program, followed by continued care, first in an outpatient program for 2-5 days a week for a
few months, and later 1-2 days a month. The surgeon general recommends an individual with a
serious substance use disorder to stay engaged in treatment for a minimum of one year, which
The identified outcomes for continued care are: continue to attend AA/NA meetings, use
relaxation techniques, maintain spiritual well-being, have a support group to reach out to during
Create a list of people who are part of the patients support group, so that in times
Meditate or use breathing techniques brings clarity, reduces stress, and helps
Attending regular meeting this allows the patient to identify with others who
have had the same problem and incorporate coping mechanisms shared
well-being
The longer in treatment, the rate of relapse is reduced. Find transitional housing
to help the individual prepare for self-management once living on his or her own.
Continue to visit medical doctor for regular check ups to prevent illness.
Follow up with anti-craving medications for opiate and alcohol substance users.
Evaluation of Plan
1. Can the individual state why its important to stay involved with meetings to
prevent relapse?
2. Can the patient produce a list of people they can call upon in their time of
need?
4. Can the individual verbalize hobbies that he or she enjoys participating in?
To evaluate whether the individual has implemented the interventions and met the
goals set forth, the individual would have to follow-up in a month to verbalize what he or she has
been doing related to the plan of care and identify what changes have occurred related to the
interventions. If the individual meets the goals, they would be encouraged to continue with the
current plan of care. If any goals have been unmet, further evaluation would have to be
SUBSTANCE ABUSE DISORDER 11
completed and new goals, outcomes, and interventions instituted. To further support the
individual, community resources will need to be given to help achieve their goals, which can be
found below.
References
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https://www.ashleytreatment.org/addiction-treatment/
https://www.caron.org/proven-treatment/family-engagement
https://www.discovernursing.com/specialty/substance-abuse-nurse#.Wge-x7aZNo7
Kaplan, L. (1997). A disease management model for addiction treatment. (Cover story).
Substance Abuse and Mental Health Service Administration. (2015, September). Behavioral
health trends in the United States: Results from the 2014 national survey on drug use and
2014/NSDUH-FRR1-2014.pdf
Substance Abuse and Mental Health Service Administration. (2015, October 27). Substance Use
U.S. Department of Health and Human Services, Surgeon Generals Office (HHS). (2016). Early
https://addiction.surgeongeneral.gov/chapter-4-treatment.pdf
SUBSTANCE ABUSE DISORDER 13
Villa, L., (2017). Shaming the sick: Addiction and stigma. Retrieved from
https://drugabuse.com/library/addiction-stigma