Running head: SUBSTANCE ABUSE DISORDER 1

Substance Abuse Disorder: From Addiction to Recovery

Christina Collins

Delaware Technical Community College

NUR 330
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Substance Abuse Disorder: From Addiction to Recovery

According to Substance Abuse and Mental Health Services Administration (SAMHSA) in

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

questions when considering prevention of substance use disorders.

1. What is the nature, extent, and pattern of substance use behaviors and their

associated consequences?

2. What risk and protective factors influence these behaviors and

consequences (SAMSHA, 2017)

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

risk to developing a substance use disorder is imperative to prevention.

The November 2016 Surgeon Generals report states that prevention works, treatment is

effective, and people can recover from substance use disorders.

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Nursing Assessment

Defining the community.

Ashley Addiction Treatment (Ashley) is a rehabilitation facility situated on a 147-acre

campus in Havre de Grace, Maryland (Ashley Addiction Treatment, 2017). The

population/community is comprised of individuals who suffer from addiction. These individuals

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).

The four core programs are:

1. Primary Program: intensive individualized and group therapy

2. Young Adult Program: geared toward age 18-25, which combines traditional

therapy an experimental therapy

3. Pain Recovery Program: for those who self-medicate with pain killers due to

chronic pain and,

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

facilitates developing appropriate coping mechanisms (2017).

Defining the population.

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
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multi-millionaires. Predominate ethnicities served at Ashley are African Americans, Caucasian,

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).

Disparities and/or Barriers to Treatment

Several barriers to treatment for addiction are:

Healthcare benefits Does a person have them and if so what do they cover? If

no healthcare, ability to cover the cost.

Ambivalence and/or lack of motivation toward treatment

Home environment and family support

Concerned what others think stigma of addiction

Individuals do not know where to go for help

Recommendations to address barriers

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
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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,

Listen without judgment,

See a person for who they are, not the drugs they use

Avoid hurtful labels, such as junkie or crack-head and

Replace negative attitudes with evidenced-based facts

Plan of Care: Need/Problems addressed

The three identified needs/problems addressed are:

1. Those with addiction cannot stop using therefore they need to go through

detoxification (medical stabilization)

2. Mental health wellness, and

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3. Continuing care following treatment for addiction.

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

well-being, and a bio-psychosocial assessment completed (A. Owens, personal communication,

November 9, 2017).

The identified outcome of detoxification is to first stabilize an individual by medically

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

interventions used will be:

1. Depending on the drug of choice, use medications supported for use during medically

managed withdrawal. Rationale: Withdrawal management is effective in preventing

immediate and serious medical consequences when discontinuing substances.

2. Prepare and facilitate individual for further treatment. Rationale: Detoxification

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

significant support people helps them achieve better understanding of addiction,

allows them to forgive, and to begin to working on healthier relationships (Caron

Treatment Centers, 2017)

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Evaluation of Plan:

1. Did individual reach a stable, drug-free state?

2. Did individual continue into an extended treatment plan following detoxification?

3. Were the individuals family or significant others engaged for support? If so,

how?

Mental Health Wellness.

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

interventions are recommended:

1. Provide individual with name and phone numbers of psychiatrist or if part of

treatment program, set up appointment to meet with someone from the psychology

department. Rationale: Unresolved issues can affect an individuals ability to

engage in treatment. Communicating with a trained professional can relieve stress,

anxiety, and help an individual understand they are not alone. Therapist can provide

motivation, encouragement, and support. When set backs occur, therapist can help
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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

self-knowledge and insight into their addiction.

2. Attend group therapy meeting. Provide information or set-up attendance.

Rationale: Learn coping techniques from others, practice communication skills,

gain hope and strength from peers, and listen to structured messages related to many

topics in addiction.

3. If diagnosed with a metal illness take medication. Rationale: Medication can

provide relief to the negative effects of mental illness allowing an individual to be

present focused in their life and treatment.

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

verbalize any strengths gained from their group therapy meetings?

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

verbalize why the medication is important?

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Continuing Care following treatment.

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

detoxification, which usually last 3 -7 days, followed by 1 -3 months in a residential treatment

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

can involve several different programs of varying intensity.

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

times of high stress, possible transitional housing if necessary.

The interventions chosen to help the individual succeed are:

Create a list of people who are part of the patients support group, so that in times

of need they are readily accessible helps to prevent relapse

Meditate or use breathing techniques brings clarity, reduces stress, and helps

patient to become present focused.

Attending regular meeting this allows the patient to identify with others who

have had the same problem and incorporate coping mechanisms shared

Talk to a therapist reduce stress and maintains mental stability

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Participate in hobbies free of addictive substances and attend church weekly

substance-free hobbies eliminate the temptation and church encourages spiritual

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.

Continue to see psychiatrist to maintain medication management for mental

illness treatment plan.

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?

3. Can the individual verbalize how to find meetings?

4. Can the individual verbalize hobbies that he or she enjoys participating in?

5. Is the individual continuing to maintain medical and mental health care?

Evaluation of Goals/Community Resources

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
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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.

Dover Behavioral Health Ashley Addiction Treatment

725 Horsepond Road 800 Tydings Laane
Dover, Delaware Havre De Grace, Maryland
1-855-609-9711 1-866-313-6310
www.doverbehavorial.com www.ashleytreatment.org

Caron Treatment Center Aquila of Delaware

845 North Park Road (Adolescents and Young Adults)
Wyomissing, PA 1812 Newport Gap Pike
1-800-854-6023 Wilmngton, Delaware
www.caron.org 302-999-1106
www.aquilaofde.com
Brandywine Counseling and Alcohol Anonymous
Community Services https://www.aa.org
www.brandywinecounseling.com/get-
help/
1-302-656-2348

Narcotic Anonymous http://delaware211.org

www.na.org Access to community resources
in Delaware
Delaware Crisis Intervention
Services provide phone support,
mobile outreach and walk-in crisis
services, 24 hours/day, 7 days/week
1-800-652-2929
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Ashley Addiction Treatment. (2017). Addiction Treatment. Retrieved from

https://www.ashleytreatment.org/addiction-treatment/

Caron Treatment Centers. (2017). Family engagement. Retrieved from

https://www.caron.org/proven-treatment/family-engagement

Johnson & Johnson. (2017). Substance Abuse Nurse. Retrieved from

https://www.discovernursing.com/specialty/substance-abuse-nurse#.Wge-x7aZNo7

Kaplan, L. (1997). A disease management model for addiction treatment. (Cover story).

Beahvioral Health Management, 17(4), 14.

Substance Abuse and Mental Health Service Administration. (2015, September). Behavioral

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2014/NSDUH-FRR1-2014.pdf

Substance Abuse and Mental Health Service Administration. (2015, October 27). Substance Use

Disorders. Retrieved from https://www.samhsa.gov/disorders/substance-use

U.S. Department of Health and Human Services, Surgeon Generals Office (HHS). (2016). Early

intervention, treatment, and management of substance use disorders. Retrieved from

https://addiction.surgeongeneral.gov/chapter-4-treatment.pdf
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Villa, L., (2017). Shaming the sick: Addiction and stigma. Retrieved from

https://drugabuse.com/library/addiction-stigma