Alcohol and Substance Abuse

1. Write a paragraph describing your possible reactions to a drug-dependent patient.

a. Would your response be different depending on the substance (e.g., alcohol versus heroin or marijuana versus cocaine)? Give reasons for your answers.

b. Would your response be different if the substance-dependent person were a professional colleague? How?

2. Rosetta Seymour is a 15-year-old who has started using heroin nasally.

a. Briefly discuss the trend in heroin use among teenagers.

b. When Ms. Seymour asks you why she needs to take more and more to get “high,” how would you explain to her the concept of tolerance?

c. If she had just taken heroin, what would you find on assessment of physical and behavioral-psychological signs and symptoms?

d. If she came into the emergency department with an overdose of heroin, what would be the emergency care? What might be effective long-term care?

3. Tony Garmond is a 45-year-old mechanic. He has a 20-year history of heavy drinking, and he says he wants to quit but needs help.

a. Role-play an initial assessment with a classmate. Identify the kinds of information you would need to have to plan holistic care.

b. Mr. Garmond tried stopping by himself but is in the emergency department in alcohol withdrawal. What are the dangers for Mr. Garmond? What are the likely medical interventions?

c. What are some possible treatment alternatives for Mr. Garmond when he is safely detoxified? How would you explain to him the usefulness and function of AA? What are some additional treatment options that might be useful to Mr. Garmond? What community referrals for Mr. Garmond are available in your are

4. Cherie is brought to the emergency department after slashing her wrist with a razor. She has previously been in the emergency department for drug overdose and has a history of addictions. Cherie can be sarcastic, belittling, and aggressive to those who try to care for her. When the psychiatric triage nurse comes in to see her, Cherie is initially adoring and compliant, telling him, “You are the best nurse I’ve ever had, and I truly want to change.” But when he refuses to support her request for diazepam (Valium) and meperidine (Demerol) for “pain,” she yells at him, “You are a stupid excuse for a nurse. I want to see the doctor immediately.” Cherie has borderline personality disorder.

a. What defense mechanism is Cherie using?

b. How could the nurse handle this situation while setting limits and demonstrating concern?

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