Case Report
iMedPub Journals 2018
Journal of Healthcare Communications
www.imedpub.com ISSN 2472-1654 Vol. 3 No. 1:11
DOI: 10.4172/2472-1654.100122
Substance Abuse Disorder Patient Case Margarita Israilova*
Health Sciences Department, LaGuardia
Community College, USA
Abstract
Substance abuse has been increasing among the younger population, especially *Corresponding author:
among adolescents in the United States. In Mattson, the number of emergency Margarita Israilova
room visits and deaths related to substance abuse overdoses have increased to
300 emergency room visits per day. Substance abuse is defined as maladaptive [email protected]
patterns of behavior that involves dependency on anything that an individual
may ingest that alters mood, cognitive status, or a behavior pattern. The article Assistant Professor, Department of Health
presents a case study demonstrating the chronic opioid abuse by a 25-year old Sciences, LaGuardia Community College,
male who was previously diagnosed with depression and anxiety and presents USA.
with withdrawal symptoms to the detoxification center for treatment. The
individual was admitted for five days detoxification unit with plan to continue with
the additional 28-day in substance abuse rehabilitation program, located in New
Tel: 718-482-6078
York. Upon discharge from inpatient substance abuse care facility, patients are
offered outpatient treatment programs that suits best for the individual person.
All the manifestation symptoms are related to the substance abuse.
Citation: Israilova M (2018) Substance Abuse
Keywords: Substance abuse; Drugs; Alcohol; Substance abuse risk population
Disorder Patient Case. J Healthc Commun
Vol.3 No.1:11
Received: November 23, 2017; Accepted: December 02, 2017; Published: December
10, 2017
Introduction Case Presentation
Medical diagnosis and population substance abuse A 25-year-old Caucasian male presents to the outpatient
detoxification and rehabilitation facility, for opioid and alcohol
problem detoxification. For the past two weeks, this patient has being
According to Volkow and Collins [1], there is a rapidly-developing using 15 bags of heroin intravenously, two 48-ounces cans of
drug addiction and drug overdose epidemic in the United States. beer, and has inhaled one hundred dollars’ worth of cocaine per
Substance abuse and overdose is an ongoing major issue that day. According to the patient, the main reason for his seeking
contributes to over 90 deaths per day in the American population. medical attention is to avoid going to jail. The patient has a history
Substance abuse, or drug addiction, is a disease that affects the of law violations and has been monitored by a probation officer
human brain by causing harmful behavioral changes such as once a week. The probation officer worked with the patient and
increased irritability, hostility, feeling drowsy or sleepy during his family to arrange the probation treatment program instead of
the daytime and failing to handle day-to-day responsibilities such jail. The patient voluntarily agreed to be evaluated for admission
as work and/or school. The individuals can become addicted to to the outpatient treatment facility.
illegal drugs as equally as they can to pharmaceutical or prescribed
drugs [2]. The majority of the lethal drug complications are History
related to drug overdoses. The drug overdose mortalities include
the use of synthetic opioids such as fentanyl and carfentanil. Mr. W is a 25-year-old single male who was referred for treatment
Unlike morphine byproduct heroin, fentanyl and carfentanil by his probation officer. Mr. W is currently unemployed, and
lead to lethal overdoses much faster than heroin. Fentanyl and lives with his friends in a different location each day because his
carfentanil are added into the street drugs heroin, cocaine, and relationship with his family deteriorated due to addiction, he is
marijuana in order to amplify the effect of other drugs. Fentanyl is no longer welcomed in the family house. According to Mr. W, he
50 times and carfentanil is 5000 times more potent than heroin [1]. is not homeless “I always find a place to crash for a night”. Mr.
W states that he has been using marijuana from age 15 but it is
Substance abuse disorders can affect females and males of any
not his drug of choice any longer. He was introduced to heroin by
race, ethnicity, socioeconomic and financial statuses.
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Journal of Healthcare DE MEDICINA
Communications 2018
ISSN
ISSN 1698-9465
2472-1654 Vol. 3 No. 1:11
his best friend about five year’s age during very stressful times face. Eyes: pupils are constricted bilateral, round, reactive to light
in his undergraduate school. He states that his parents and two and accommodation, sclera is red and teary. Ears with normal
sisters are aware of his addiction problems and do not support ear canal and tympanic membrane. Runny nose no erythema of
him at all. However, his grandmother understands him more than nostrils and normal septum. Dry oral mucous membranes, poor
anyone, and supports him financially in order to prevent him dentations, and missing back tooth. Neck supple with midline
from stealing. Mr. W states that “If you do not admit me today, I trachea and no lymphadenopathy or jugular vein distention.
will go and get high, and I do not care what happens to me after.” Heart rate is regular but mild tachycardia (104), no murmurs,
rubs or gallops, bilateral dorsalis pedis pulses 2+. Anterior and
History of present illness posterior lungs sounds are clear to auscultation bilateral, no
Mr. W presents for opioid and alcohol detoxification and wheezing, crackles or rhonchi. Bilateral upper extremities with
rehabilitation. He has no past medical history or any multiple tattoos and fresh needle track marks in the antecubital
hospitalizations for medical conditions. However, he states that area and popliteal space in the lower extremities. Bilateral hand
he was found unconscious by his mother in August 2016, and tremors with extended arms, no edema noted on upper or lower
was hospitalized at Hospital due to a heroin overdose. He left the extremities. Bilateral feet with dry, cracking and peeling skin,
hospital against medical advice after two days of admission. He patient states that it is very itch at times. Bilateral toenails and
denies any history of head injury, trauma, asthma, hypertension, fingernails with in normal limits, no cyanosis or clubbing of nails
diabetes mellitus, or seizures. He is not on any prescribed noted. In general, Mr. W is able to make his needs clear, however
medications. In addition, he denies any history of food, drug or his speech is very rapid, and his pupils are constricted/pinpoint
latex allergies. Mr. W also denies any surgical history. (1 mm).
Psychiatric history Diagnostic tests
Mr. reports that he has struggled with severe anxiety and mild The diagnostic tests of urine toxicology and breathalyzer test
depression from an early adolescent age. He stated that he for alcohol are usually performed by nurses during the initial
cannot remember the time when he was free of anxiety without assessment, prior to examination of the patients by physicians or
using some kind of drugs. According to the patient, he was never the nurse practitioners. The urine toxicology is routinely collected
hospitalized for anxiety or depression. However, he states that he in all patients prior to admission to the detoxication unit in order
did have suicidal ideations in the past, but not suicidal attempts. to establish substances use. The breathalyzer test measures
He denies any history of self-inflicted cuts or injuries. He has the amount of alcohol in the patient’s breath. Depending on
been prescribed benzodiazepine (Xanax) a medication for anxiety the results of urine toxicology and breathalyzer patients are
and seroquel, antipsychotic (an atypical type for depression, but treated accordingly. After the nursing assessment, each patient
stopped taking both medications two years ago. “I am not crazy is examined by a healthcare provider who prescribes routine
and don’t want to be hooked on it.” Currently he is not under blood work such as Complete Blood Count (CBC), Complete
either a psychologist’s or psychiatrist’s care and does not take any Metabolic Panel (CMP), Rapid Plasma Reagin (RPR) for syphilis
psychiatric medication. and urine analysis. Patients are not admitted to the detoxication
or rehabilitation units if they have abnormal blood test results,
Review of systems such as severe anemia, electrolytes imbalance, and abnormal
Mr. W reports that he was not feeling well, because he took his blood count. Furthermore, patients with chronic medical
last bag of heroin at five in the morning. He denied recent visual conditions and /or mental health history are required to have
changes, eye pain, discharge or inflammation. Denies a history of a medical and/or psychiatric clearance in order to be admitted
shortness of breath, wheezing, chest pain, or chest palpitations to the detoxication or rehabilitation facility. In addition, each
or arrhythmia. Mr. W states that he is very nauseous and had admitted patient is tested for tuberculosis (TB) or a chest x-ray is
diarrhea in the morning, but denies abdominal pain. Mr. W is ordered if the patient has a history of a positive tuberculin skin
very restless, states that he has pain in his back, rated five out test in the past. According to National Institute on Drug Abuse
of 10 and just feels uncomfortable sitting in the chair although [3], individuals who use illicit drugs are at high risk for developing
he denies a history of joint disease. Denies skin rash, moles, or active, communicative, and sexual transmitted diseases such as
changes in skin pigmentation. Denies any urinary incontinence, TB, hepatitis C, syphilis and human immunodeficiency virus (HIV).
urgency or frequency. However, he states that his appetite has
decreased during the past year and has been constipated for the Diagnosis
past week. Denies use of any over-the-counter medications for The medical diagnosis is one of the important step in order to
his constipation. direct the course of treatment for the addict. Each illicit drug
withdrawal has a set of treatment protocols. For example, opioid
Physical exam abuse dependence with withdrawal diagnosis is treated with
Well developed and nourished, slightly disheveled White male. methadone or suboxone, five to seven days depending on the
Patient is alert and oriented to person, place, time and situation. urine toxicology result, and the amount of opioid use reported by
Easily irritable, angry and very talkative. Vital signs are: BP 130/88 the addict [4]. However, a person with the diagnosis of, Alcohol
(left arm, sitting position) HR 104 RR 22 Temp. 98.8 Fahrenheit. dependence with withdrawal, does not need to have a positive
Normocephalic, atraumatic, short hair and symmetric flushed breathalyzer test in order to be treated with Librium or Ativan.
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Journal of Healthcare DE MEDICINA
Communications 2018
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ISSN 1698-9465
2472-1654 Vol. 3 No. 1:11
Daily alcohol abuse reported by the patient and clinical Institute of dopamine neurotransmitters, which leads to biological and
Withdrawal Assessment (CIWA) score, is sufficient enough to chemical imbalances. In addition, according to Mattson et al.
start the alcohol treatment protocol [5]. [2], the number of emergency room visits and deaths related
to substance abuse overdoses have risen from 105,982 in 2011
Review of the Literature to 300 emergency room visits per day, and prescription opioids
have been the major contributor to causing drug overdose deaths
According to the Substance Abuse and Mental Health Services
among different age groups.
Administration [6], substance abuse among individuals aged
12 years and older continues to be a national concern. The The main pharmaceutical treatment options for opioid abuse are
SAMHSA 2016 report states that the number of heroin users methadone and suboxone (buprenorphine). The literature review
in 2016, (475,000) demonstrates the highest heroin use when demonstrated that Alcoholics Anonymous and/or Narcotics
compared to the 2002 to 2013 statistical data. In addition, Anonymous support groups focus on spirituality and religion in
the 2016 SAMHSA report demonstrated that marijuana is the order to help the addicts to recover from addiction [10]. The
widest gateway drug used to progress to other substances, such Twelve-Step Recovery Program provides a structured plan for
as alcohol, cocaine, heroin, among 12 years and older [7]. In drug abstinence and a great sense of community among the
addition, over prescriptions of controlled substances is drastically individuals who are also struggling with addiction. In conjunction
escalated, not just among pain-management specialists but with pharmaceutical treatment Cognitive-Behavioral Therapy,
among different medical providers. For example, United States Multidimensional Family Therapy, Individual Therapy and
for Non-Dependence Reports demonstrates that Alabama was Integrative approaches are utilized for long term substance abuse
the highest opioid prescribed state in 2016 and 11.7 billion treatment effectiveness. However, literature reveals that there is
opioid pills were prescribed nationwide [8]. The Centers for no specific treatment available according to the age groups. The
Disease Control and Prevention (CDC) [9] report states that the treatments that are mentioned above are used regardless of age
opioid medication prescription to the general population by or gender.
physicians had drastically risen in 2006, reaching a record of
72.4 opioid prescriptions per 100 individuals. But by 2016, the Discussion
amount of opioid prescriptions dropped to 66.5 per 100 people
The findings of the literature review revealed that the substance
[9]. However, the deaths related to prescription drug-abuse is still
abuse disorder is very prevalent among the individuals between
overwhelming.
the ages of 12 and older, of any gender or socioeconomic group.
Findings of literature review In addition, the literature discussed the different substance abuse
preferences among different ages and gender groups. These
According to the literature review, the highest prevalence of the findings clearly indicate the strong awareness and prevention
substance abuse is found among adolescents, aged 12 years and implications needed at the practical level. The literature review
older in the areas of: patterns of drug use, the sequence of drug use revealed the great need to implement existing research findings
progression and treatment approaches and outcomes. The most into the practice setting. The literature review revealed the great
common initial substance that is abused in the given population proposition to implement existing research findings into the
is cannabis (marijuana) and ethanol (alcohol), these progress practice setting.
to more illicit drugs such as heroin, fentanyl and carfentanil [6].
According to the authors literature review, substance abuse Conclusion
preference differs by age and gender. For example, Compton,
Men, Sethi, Sigman, the abuse of prescription opioid medications This case study report incorporated the review of state and
is on the rise and estimated to be higher among females. In organization reports and peer- reviewed journal articles on the
fact, the prevalence rate is 30% higher than males, between the substance abuse disorder among the high-risk age population.
ages 20 to 39. However, the main drugs of choice for males are The majority of the publications address the substance abuse
nonprescription drugs cocaine and heroin. problem in the United States, however there is a great gap
between the research availability and the implementation of it
Substance abuse has negative consequences on both the physical in the practical setting. In order to prevent substance abuse, the
and psychological well-being of the drug user. The brain undergoes educational interventions need to be effective and consistent
changes depending on the type of substances and the amounts among all levels of healthcare providers. In addition, patients,
used, the frequency of usage and the dosage. The Mental families, universities, colleges and community leaders need
Health Services Administration [2] recognizes drug addiction as to have available access to substance abuse treatment and
a chronic disease that affects the pleasure reward centers of the prevention materials.
brain, the limbic system that is responsible for the production
References behavioral health statistics and quality report. substance abuse and
mental health services administration.
1 Volkow DN, Collins SF (2017) The role of science in addressing the
opioid crisis. N Engl J Med 377: 391-394. 3 https//www.drugabuse.gov/publications/research-reprots/medica-
tions-to-treat-opioid-addiction
2 Mattson M, Lipari NR, Hays C, Van Horn LS (2017) The center for
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Journal of Healthcare DE MEDICINA
Communications 2018
ISSN
ISSN 1698-9465
2472-1654 Vol. 3 No. 1:11
4 Substance Abuse and Mental Health Services Administration (SAM- 7 Ahrnsbrak R, Bose J, Hedden LS, Lipari NR, Park-Lee E, et al. (2016)
HSA) (2017) Medication assisted treatment for opioid addiction in Key substance use and mental health indicators in the United States:
opioid treatment program: a treatment improvement protocol Tip results from the 2016 national survey on drug use and health.
43. 12-4214.
8 Compton P, Mena G, Sethi P, Sigman S (2017) An analysis of the im-
5 Stobart Gallagher MA, Gomez AE (2017) Alcohol withdrawal. Trea- pact of opioid overprescribing in America: a passion for delivering
sure island (FL): StatPearls Publishing. improved patient care pharmaceuticals, Inc.
6 Substance Abuse and Mental Health Services Administration (SAM- 9 http://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-sur-
HSA) (2016) Results from the 2016 national survey on drug use and veillance-report.pdf
health: summary of national findings (NSDUH).
10 www.asam.org
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