Multiple Substance and Mental Health Problems, Potential Risk of Harming Other People due to Irritability, Anger, Physical Threats - Case Study Example

Substance abuse Name: Student number: Question 1: There is evidence from the case study that Harry meets the criteria for a substance abuse disorder. Criterion A1: Harry has recurrently used alcohol and Cannabis and he goes to work late and when he is drunk. His boss has even threatened to fire him, and yet he does not stop taking alcohol or even cannabis (American Psychiatric Association, 2011). Criterion A4: Harry has continued to take alcohol and Cannabis, after arguing and separating with his girlfriend who left him because he is always intoxicated (American Psychiatric Association, 2011). His girlfriend said she cannot cope with him always being pissed and intoxicated all the time, and told Harry to quit. However, Harry is unable to quit and he admits that he has been using alcohol and cannabis since he was a teenager aged 16, and now he is 27 years old (Forsthe, & Adams, 2009). Harry confesses to drinking 2-3 Bundaberg rums in one day, and smoking 30 cones of cannabis daily. Harry states that he uses alcohol and cannabis (being stoned and smashed) helps him to forget (Hall, & Degenhardt, 2009). He also goes ahead and says that there is no point of stopping since his life is out of control and that it cannot be fixed. Criterion A 3: Harry has ever been sent to a juvenile detention because of assault and destruction of property. On the day he appeared at the accident and emergency department, he had been brought in by police after he was involved in a fight at a night club with a fellow patron. He was very argumentative and irritable. Using the DSM IV TR criteria for substance abuse, Harry indeed meets the criteria for a substance abuse disorder (American Psychiatric Association, 2011). Question 2: In Australia, Cannabis sativa is ranked the most widely used drug that is illicit (Siegel, 2012). Research shows that all Australians aged from 22 years and above, one thirds of them have used or tried using cannabis (about 5.8 million or even 33.5%) (Dragt, Nieman, Becker, et al., 2010). About 300,000 Australians are known to use cannabis in every week, and those who smoke it daily are approximately 210,500 (Siegel, 2012). This rate of cannabis use in Australia puts Australia as having one of the highest rates of cannabis prevalence in the world. Cannabis use is mostly prevalent in teenagers and people below the age of 30 (Leung, 2012). Most people who have ever used other types of drugs are likely to start using cannabis, so is children exposed to parents taking cannabis while growing up. Pregnant women who smoke cannabis increase the likelihood of their children to smoke the same by the time they are at the age of 14 (Mason, Hitch, & Spoth, 2009). Social network is a big contributor to the smoking of cannabis in Australia. Research shows that smoking cannabis is the highest among the illicit drugs in Australia. Therefore, most people are exposed to people who are smoking cannabis, hence the influence and increased smoking of cannabis. In Australia, 25.1% of people suffering from psychotic disorders have a history of cannabis use. Among the people aged between 14 and 22, who receive treatment in Australia, about 49% nominate cannabis as the principal drug (Dragt, Nieman, Becker, et al., 2010). A study done in 2001 showed that about one out of 10 (9%) patients cited cannabis as the reason why they had gone for treatment. In 2005- 2005 research done by the National Hospital Morbidity data, 2,771 people were admitted for cannabis related disorders in Australia. For people who have used cannabis by the age of 15, their chance of developing illnesses like schizophrenia by 300% (more than three times). The risk of suffering from psychosis increases by 700% for heavy users of cannabis (McLaren, Silins, Hutchinson, Mattick, & Hall, 2010). Question 3: Harry has a substance use disorder which he developed as a result of continuous smoking of cannabis as well as continuous and uncontrollable taking of alcohol (Leung, 2012). Research shows that one reason why people tend to start taking cannabis and alcohol is being exposed to people who take the same (Temple, Brown, & Hine, 2011). Peer influence especially among the teenagers is a major contributor to the use of cannabis (Mason, Hitch, & Spoth, 2009). Substance abuse begins at teenage, and the percentage of people who take alcohol and cannabis reduce with increase in age. Harry confesses that all his friends smoke cannabis; therefore, it is a social issue (Viana, Querol, Alastuey, et al., 2010). Most people who end up having substance abuse disorder are likely to have experienced violence during childhood, or had parents who abused drugs (Mason, Hitch, & Spoth, 2009). Harry had an abusive father who abused his mother, and later abandoned him and the mother at the age of 14. Harry may have taken the footsteps of his father, whom he says that used to like the drink, and therefore, Harry is just like him (Hall, & Degenhardt, 2009). The fact that Harry started smoking cannabis at the age of 16 has led him to have a drug abuse disorder, and he even smokes 30 cones of cannabis daily, as well as 2 to 3 Bundaberg rums daily (Siegel, 2012). The continuous use of cannabis and alcohol in the name of forgetting, as Harry says, has not only increased his dependence on them, but has also made him to suffer from a drug abuse disorder (Temple, Brown, & Hine, 2011). Question 4: From the history and confession of Harry together with the assessment done Harry was found to have multiple substance and mental health problems. There are three major risks identified. The first one is that there is a risk of harming other people because of the irritation, anger, physical threats as well as outburst (Temple, Brown, & Hine, 2011). The second is that there is a potential problem from sudden withdrawal from cannabis and alcohol. The third problem is that Harry can commit suicide since he sees his situation as hopeless since his life is out of control and cannot be fixed. Question 5 and 6: 1: Potential risk or problem of harming other people due to irritability, anger, physical threats as well as outburst (Forsthe, & Adams, 2009).. Intervention 1: Educate the patient what a mental disorder is, as well as its manifestations like anger outbursts and physical threats. Let the patient know about the outcomes of continuous alcohol and cannabis use (Mason, Hitch, & Spoth, 2009). Rationale: letting the patient know about the risks and problems posed by alcohol and cannabis use may play a very major role in changing the practice of the patient, hence opt to stop drug abuse (Forsthe, & Adams, 2009). Intervention 2: Creating an environment that is safe. This environment is one that do not consist any factors that may in any way stimulate the patient. The environment need be quiet, and with a soft light. Any item that is fragile or can break like glass should be avoided. Rationale: The environment plays a major role in mood change. A quiet and good environment can therefore relieve any irritable mood, and this can result to reduction in harm (Hall, & Degenhardt, 2009). Intervention 3: Take the patient through anger management therapy. Show the patient understanding and patience. Monitor the progress made by the patient in terms of managing the anger and irritation (Mason, Hitch, & Spoth, 2009). Rationale: Anger management therapy will help the patient to control his irritation and anger. This in turn will help the patient concentrate while he is being given help by professionals (Forsthe, & Adams, 2009). 2: Potential problem from sudden withdrawal from cannabis and alcohol (Mason, Hitch, & Spoth, 2009). Intervention 1: Careful assessment of the patient. Monitor all the signs shown by the patient, and identify all signs caused by cannabis and alcohol withdrawal like trembling, headache, sweating, restlessness and sometimes hallucinations (Hall, & Degenhardt, 2009). The patient also need be separated from other patients. Rationale: Carefully assessing the patient will always put the nurses on the alert, and therefore, notice the slightest symptoms as they occur, hence any illness can be discovered and managed early enough. This can help the nurse administer the nursing interventions in time. Intervention 2: Drug therapy should be administered. Correct administering of drugs at the right time, the right drugs, the right dose and of course in the right route to the right patient. Ensure that the patient takes the medicine and swallows them, and then observe for efficacy and any possible improvement (Forsthe, & Adams, 2009). Rationale: use of alcohol and cannabis for a long time can cause changes in the structure as well as the functioning of the brain, for instance physical dependence and tolerance. Seizure can occur in case of sudden withdrawal (Leung, 2011). Administering drug therapy can prevent nutritional and electrolyte imbalance and this can prevent brain damage. Intervention 3: Maintain adequate hydration. Oral hydration should be encouraged, but if not possible, administer intravenous fluid as ordered with five rights (Leung, 2011). Any signs of phlebitis should be observed. Infused volume on the fluid should be checked and documented on the fluid balance chart hourly. Rationale: Excessive sweating, decreased appetite as well as diarrhoea, are possible symptoms which arise from alcohol and cannabis withdrawal, and they can lead to dehydration (Hall, & Degenhardt, 2009). Dehydration on the other hand reduces metabolic rate and can cause failure of major organs. 3: The third problem is that Harry can commit suicide since he sees his situation as hopeless since his life is out of control and cannot be fixed (Mason, Hitch, & Spoth, 2009). Intervention 1: Talk to the patient and assess active suicide. Encourage the patient to tell his story, and in the process, express understanding. Rationale: Effective communication between a patient and a nurse helps in building trust, and the nurse can be able to talk the patient out of the hopelessness (Mason, Hitch, & Spoth, 2009). Intervention 2: Make sure there are no dangerous weapons like knives, needles, ropes that the patient can lay hand on and use them to harm him. Rationale: By ensuring that there are no dangerous weapons around, the patient may reduce the suicidal thoughts or even give them up. Intervention 3: Constantly observe the patient. Always document the observations and hand them over to the next staff in charge. Rationale: Constant observation can help a nurse detect any change in mood and suicidal intentions soon enough to help the patient. Handing over the documentation ensures that there is proper transition, and proper attention and observation will be provided to the patient throughout (Hall, & Degenhardt, 2009). References American Psychiatric Association. (2011). American psychiatric association: substance- related disorders, in diagnostic and statistical manual of mental disorders. (4th ed.). American Psychiatric publishing: New York. Dragt, S., Nieman, D., Becker, H., et al. (2010).Age of onset of cannabis use is associated with age of onset of high-risk symptoms for psychosis. Can J Psychiatry, 55(3):165–71. Forsthe, L. & Adams, K. (2009). Mental health, abuse, drug use and crime: does gender matter? Australian Institute of criminology: Australia. Hall, W. & Degenhardt, L. (2009). Adverse health effects of non-medical cannabis use. Lancet, 374(9698): 1383–91. Leung, L. (2011). Cannabis and its deprivatives: review of medical use. JABFM, 24(4): 452- 462. Mason, A., Hitch, J. and Spoth, R. (2009). Longitudinal relations among negative affect, substance use, and peer deviance during the transition from middle to late adolescence. Substance use and misuse, 44 (2009): 1142-1159. McLaren, J., Silins, E., Hutchinson, D., Mattick, R. & Hall, W. (2010). Assessing evidence for a causal link between cannabis and psychosis: a review of cohort studies. Int J Drug Policy, 21(1): 10–9. Siegel, M. (2012) Marijuana use most rampant in Australia, study find. The New York Times, accessed on August 15, 2013 at http://www.nytimes.com/2012/01/07/world/asia/marijuana-use-most-rampant-in- australia-study-finds.html?_r=0 Temple, E., Brown, R. & Hine, D. (2011). The ‘grass ceiling’: limitations in the literature hinder our understanding of cannabis use and its consequences. Addiction, 106(2): 238–44. Viana, M., Querol, X., Alastuey, A., et al. (2010). Drugs of abuse in airborne particulates in urban environments. Environ Int, 36(6): 527–34. Read More