SUBSTANCE ABUSE CASE (DRUGS/NICOTINE/ALCOHOL)

With Diagnosis and Treatment

Diagnostic Tests:

 Mental Status Examination (DSM V)

 Positron Emission Tomography (PET Scan)
 Magnetic Resonance Imaging (MRI)
 Chest X-ray
 CT Scan
 Spirometry

Validated Screening Tools:

 Tobacco, Alcohol, Prescription Medication, and other Substance Use (TAPS) Tool
 Addiction Severity Index
 Psychiatric Research Interview for Substance and Mental Disorders
 Semi-Structured Assessment for Drug Dependence and Alcoholism

Laboratory Studies:

 Drug Testing/Toxicology Testing: (Alcohol (ethanol) testing, Amphetamines testing, Barbiturates

testing, Benzodiazepines testing, Cocaine testing, Marijuana (THC) testing, Nicotine and cotinine
testing, Opioid testing, Phencyclidine (PCP) testing)
 10-Panel Drug Test 
 Nicotine test (blood or urine)

Medical Management:

 Detoxification
 Opioid agonist-antagonists Medications (e.g. Buprenorphine, Methadone, Naltrexone)
 Sedative-hypnotics Medications (e.g. Barbiturates, benzodiazepines and Hypnotics)
 Combination Therapy (e.g. Naltrexone & Acamprosate)
 Inpatient Rehabilitation
 Outpatient Rehabilitation (e.g. Short-term residential treatment, Therapeutic communities)
 Buproprion (Wellbutrin: antidepressant for smoking cessation)
 Disulfiram (removes the compulsion to drink)

Therapy Management:

 Cognitive Behavioral Therapy (CBT)

 Art therapy
 Spiritual enhancement
 Journal making
 Music therapy
 Livelihood, sports, and community outrage
 Rational Emotive Behavior Therapy
 Contingency Management
 Group Therapy (e.g. 12-step facilitation)
 Motivational Interviewing (MI)
 Dialectal Behavioral Therapy (DBT)
 Matrix Model
 Hypnotherapy
 Neuro-linguistic programming

Nursing Management:

Independent Interventions:
Monitoring Vital Signs, ensuring safety and ease discomfort.

Watch for complications of overdose and withdrawal.

Remove harmful objects from the room, and use restrains only if you suspect the patient might harm
himself or others. 

Observe family interactions and SO dynamics and level of support.

Take anthropometric measurements (triceps skinfold, when available).

Note total daily calorie intake; maintain a diary of intake, as well as times and patterns of eating.

Explore support in peer group. Encourage sharing about drug hunger, situations that increase the desire
to indulge, ways that substance has influenced life.

Assist patient to learn ways to enhance health and structure healthy diversion from drug use
(maintaining a balanced diet, getting adequate rest, exercise [walking, slow or long-distance running];
and acupuncture, biofeedback, deep meditative techniques).

Provide information regarding understanding of human behavior and interactions with others
(transactional analysis).

Provide information to patient and family about the effects of addictive behaviors on the family and
what to expect after discharge.

Assist patient in self-examination of spirituality, faith.

Recommend monitoring weight weekly.

Educate about effects of specific drug(s) used [PCP is deposited in body fat and may reactivate
(flashbacks) even after long interval of abstinence; alcohol use may result in mental
deterioration, liver involvement/damage; cocaine can damage postcapillary vessels and increase platelet
aggregation, promoting thromboses and infarction of skin and internal organs, causing localized
atrophie blanche or sclerodermatous lesions].

Inform the Concern that Psychoactive Substance may alter a person’s Mood, Perceptions, Consciousness
or Behavior.

Dependent Interventions:

Administer IV fluids to Increase Circulatory Volume.

Administer prescribed medications.

Collaborative Interventions:

Encourage involvement with self-help associations (Alcoholics, Narcotics, Anonymous).

References:

Becker WC, Starrels JL. Prescription drug misuse: Epidemiology, prevention, identification, and
management (2021). In: Saxxon AJ, ed. UpToDate. Updated April 6, 2021. Accessed May 24,
2021. https://www.uptodate.com/contents/prescription-drug-misuse-epidemiology-prevention-
identification-and-management

Carney T, Myers B (2019). Effectiveness of early interventions for substance-using adolescents: findings
from a systematic review and meta-analysis. Subst Abus Treatment, Prev, Policy;7(25).
doi:10.1186/1747-597X-7-25

Mayo Clinic (2021). Lab Tests Online/American Association for Clinical Chemistry: Drug Abuse Testing.
Available link from: https://www.webmd.com/mental-health/addiction/what-is-a-toxicology-test
NIDA. 2020, June 2. Addiction Medications. Retrieved from
https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-
research-based-guide/evidence-based-approaches-to-treating-adolescent-substance-use-
disorders/addiction-medications on 2021, July 27

National Institute on Drug Abuse (2017). Bringing the Power of Science to Bear on Drug Abuse and
Addiction. Available link from: https://www.drugabuse.gov/sites/default/files/1923-bringing-the-power-
of-science-to-bear-on-drug-abuse-and-addiction.pdf