Case Study of Terry: Treating Substance Abuse Disorders

This case study focuses on Terry, a patient suffering from substance abuse disorders. It discusses the identification, screening, and treatment procedures for such patients, emphasizing the importance of drug and alcohol tests. The study also explores the different services available for Terry's recovery and provides insights on mental health nursing and effective communication strategies for treating patients with substance abuse disorders.

Running head: CASE STUDY OF TERRY
CASE STUDY OF TERRY
Name of the student:
Name of the university:
Author note:

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CASE STUDY OF TERRY
Introduction:
The case study shows that patient named Terry suffers from depression and was not
properly educated and hence cannot manage symptoms successfully. He had thereby developed
the habit of taking substances to cope with issues increasing the chance of suffering from
substance abuse disorders. The assignment would focus on different aspects of treating such
patients in detailed manner. This would first explain the identification and screening procedures
needed for understanding the severity of risks and symptoms associated with the patient and
following these treatment plans and referrals should be done. It would also talk about the
different services available in community of Terry and referring him to the best one. This would
then be followed by different important aspects that healthcare professionals need to follow for
ensuring quality care to such patients.
Importance of drug and alcohol test:
Drug and alcohol assessment helps in informing a comprehensive care as well as the
management plan that can successfully meet all the important needs of the individuals (Ennis et
al., 2015). Such assessments initially focus on the different causes of the presenting intoxications
and secondarily are seen to aim in establishing the drug and alcohol use frequency of the patient,
risks and levels. There is increased number of evidences that high prevalence of co-occurring
mental health and alcohol and other drug problems often referred to as the dial diagnosis
(Shipley et al., 2016). It has been found that dual diagnosis that is found to be highly associated
with poor outcomes of treatments, severe suffering and high service use (Gullo et al., 2015).
These present an important challenge for the healthcare professionals across healthcare centers.
The increased number of incidences of the poor clinical health outcomes including the

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significant number of fatal sentinel events in the mental health consumer populations shed light
on the needs and requirements for increased detection and management of co-occurring problems
(Dowling et al., 2017).
Part 1: Assessments and screening of the issues of Terry:
Catchment based intake services act as the primary end point for new clients like Terry
to the alcohol and other drug treatment system and this help the existing clients in moving
through the system. Clients who enter the treatment system need to be triaged by the intake
services as well as comprehensively assessed by their treatment providers (Patel et al., 2016).
Through this process, firstly, the healthcare professionals would be able to identify the severity
of the alcohol and amphetamine drug use of the patient as well as the different broader life issues
(Gullo et al., 2015). Secondly, they also learn to identify the high-risk people for whom an
immediate response is urgent. Third, it helps in identifying people who need further care
interventions (Wilson et al., 2017). Fourth, they also help in obtaining a baseline measure
against which outcomes needs to be mapped over time. Effective tools and guidelines are found
to be available for supporting clinical judgments and high quality joined-up services (Shipley et
al., 2016).
The first part of the assessment would be the intake tool. The intake tool mainly helps the
healthcare professionals in identifying the level of risk and needs of the person and help in
determining the appropriate treatment options (Ennis et al., 2015). Such tools help the
practitioners in supporting and engaging the clients and determining whether comprehensive
assessment and additional treatments and support are required . They also help in notifying
whether bridging support or brief intervention would help in the interim. In this step mainly

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screening is done (Gullo et al., 2015). Screening mainly helps in identifying and then starting
fruitful as well as appropriate interventions in patients who are drinking and using drugs above
the low-risk levels. In such cases, the recommended approaches mainly include the concept of
that of quantity frequency estimation that mainly the “how much often” questions. This is then
followed by structured questionnaires (Shipley et al., 2016).
The healthcare professionals attending Terry should first ask him quantity frequency
estimation questions that would mainly ask the important questions. It needs to be assessed that
whether the patient is drinking and using drugs at low levels. This should be done with the
AUDIT tool (Alcohol use disorder and identification test). Ten questions need to be answered by
the patient as the initial form of assessment. For patients drinking over low-risk levels, they
would be provided brief interventions. If he is found to be drinking in the moderate to severe
levels and also include dependence on alcohol, they would necessitate more complete assessment
and concentrated treatment approaches. Once classifying the alcohol use of Terry, further
assessments need to be conducted. (CASE BASED ANALYSIS AND SO NO REFERENCES)
From the scenario, it seems that Terry is abusing substance like amphetamine and alcohol
to a high extent and he might need comprehensive assessment. These are the additional
information that is required by the healthcare professionals to develop ideas about present health
scenario of Terry. The comprehensive assessment tool helps the treatment providers in
determining the level as well as the type of treatment and support required by the presenting
client (Islam et al., 2018). Usually in the beginning of the assessment, baseline data would be
collected from Terry that would include amphetamine use as well as health and well being and
this should be done with the help through a self-completion form (Zugai et al., 2015).. The
comprehensive tool is designed for the utilization in conjunction with the self-completion form

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and from the information collected during the screening session. This helps in ensuring that the
comprehensive treatment need of /terry are adequately understood (Patel et al., 2016)..
The comprehensive assessment would be mainly including specific details about Terry.
The first part would be the presentation part. This would include presenting problems of Terry
and the role of drinking and drug use in the presenting problems. The second part would be the
information on alcohol and drug use. This part would enquire quantity, frequency, pattern of
drinking and other drug use (Islam et al., 2018).. It would then enquire about the last use of
alcohol and other drugs and the different features of dependence (Gullo et al., 2015).
Dependence of Terry also requires to be highlighted by his inability in controlling the use despite
harms from alcohol and amphetamine use and even tolerance and withdrawal symptoms. If the
dependence is found to be present, professionals would then assess the likely withdrawal severity
and also the history of withdrawal complications like seizures, delirium, hallucinations. His
motivation would be assessed in changing pattern of alcohol and other drug use (Zugai et al.,
2015). The third part would be the consequences of alcohol and other drug use. Information
would be asked to Terry regarding any physical health problems (like gastro-intestinal,
cardiovascular, neurological, liver, trauma), mental health problems like (risk of suicide,
anxiety, psychosis and depression), and other social functioning (employment, relationship,
housing, financial and legal) and risks to self and others (violence, occupational, driving,
occupational risks, child protection and falls) (Newbury et al., 2016). The fourth part would be
mainly effective examination (by suitably trained health professionals. This mainly comprises of
mental state condition of Terry that would comprise of general presentation, cognition, mood,
memory, , perception, insight speech, thought (CASE BASED ANALYSIS NO REFERENCES).

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This is followed by proper investigations like considering breath blood tests, alcohol test, (LFTs,
FBC, U+Es) and investigations for other specific conditions.
This would be then followed by setting goals for the treatment that would mainly include
abstinence versus that of the reduced drinking and amphetamine use and other health concerns
followed by effective risk management plan (Islam et al., 2018).. This would include harm to self
or others, medico-legal requirements and serious physical and mental illness (Zugai et al., 2015).
This is then followed by treatment plan like the need for brief interventions or controlled
drinking strategies or that of like intensive interventions like detox, relapse-prevention strategies,
psychosocial interventions and management of other co-morbidties. This would also require
involvement of other welfare and health services and other family carers (Gullo et al., 2015).
Part2:
A wide range of governmental and non-governmental services are present that the
healthcare professionals can refer to Terry to get specialized services helping him to recover
from the substance use disorder. Queensland government has initiated the Alcohol, Tobacco and
Other Drugs services program called ATODS that provides information to patients as well
clinical assessments, counseling as well as the treatment and referral for individuals, families and
groups with a varied range for alcohol and other drug related programs (Health.qld.gov.au,
2018). This service also provides a range of services like health promotion and even workforce
development. One of their services is through North Ward services. All referral are mainly found
to be processed through Intake services at North Ward (Health.qld.gov.au, 2018). Another of
their initiative is the Needle and the syringe Program where services are provided to people at

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many different locations like that in the Townsville hospital present at 100 Angus Smith Drive,
Douglas. Different community based residential service treatment can also be suggested to Terry
(Health.qld.gov.au, 2018). These are seen to include Salvation Army Townsville Recovery
Services as well as by the Ferdy's Haven Drug and Alcohol Rehab. Besides Lives Lived Well is
another support organization that can help Queensland communities residents help with their
issues of alcohol and drug disorders (Health.qld.gov.au, 2018). They aim in taking a holistic as
well as compassionate and harm minimization approach that helps people in living their lives
well. Terry can speak to one of their professional counselors over phone and can get further
guidance about the procedure that he needs to follow to get support treatment (CASE BASED
ANALYSIS SO NO REFERENCES).
One of the most helpful support organizations that can help Terry is the The Salvation
Army – Townsville Recovery Services. Townsville Recovery Services can be explained as the
alcohol and other drug and gambling treatment services that are operated by the Salvation army..
The first service that it provides is the withdrawal management (Atca.com.au, 2018). Case
managed detoxification from alcohol and different other drugs are provided and the program is
fully funded and require no-cost on behalf of the patient. This service has 8 beds. Therefore,
Terry can take the help of this service, get admitted and undergo treatments for detoxification
from the effects of alcohol and drugs. Another service provided by them is the Bridge program
which is actually a residential alcohol, other drug as well as gambling treatment service for both
men and women aged 18 years and over and they have 44 beds for this (Atca.com.au, 2018).
This program is mainly recovery oriented residential treatment service program. If Terry is not
being able to get admitted to the 8 bedded system, he can also look for his chances under the
Bridge program and he would be able to get help and guidance to live quality life. They are

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mainly delivered in the context of modified therapeutic community (CASE BASED ANALYSIS
SO NO REFERENCES). They are seen to incorporate a wider range of interventions as well as
recovery therapy models that include one-on-one case managements as well as cognitive
behavioral therapy (Atca.com.au, 2018). Moreover, 12 step recovery and even motivational
enhancement strategies are also applied. Terry is having suicidal ideation because of his
relationship issues that arose from his addiction. Motivational enhancement strategies would
motivate him to develop his lifestyle choices and health behaviors that would help him live better
quality lives. This service also provides spiritual support as well as recreational activities,
healthcare and family involvement and vocational education and training. Such services would
be helpful for Terry to overcome her substance abuse disorder successfully (CASE BASED
ANALYSIS SO NO REFERENCES).
Part 3:
In mental health nursing, the interpersonal interaction between the client and the nurse is
the core of the practice, making the therapeutic relationship a fundamental element in mental
healthcare individuals (Shipley et al., 2016). One of the most important elements that I ensure
while caring for mental health patient is maintaining effective communication strategies as they
help in establishing a bond with the clients. Studies opine that mental health patients are
criticized and judged by people in different ways that affect their self esteem, self-respect and
self-confidence (Ennis et al., 2015). Therefore, maintaining a non-judgmental body language
and interaction procedure is my primary perspective that I believe in. my communication mode
remains based on empathy and compassion where the patient feels that he is not judged and
rather he believes that the nurses are genuinely understanding their situation and trying to help
them. Studies suggest that empathy and sympathy help not in developing therapeutic

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relationship with patients but also empowers them and make them confident in overcoming their
issues (Cleary et al., 2016). Another important arena that I also believe important is active
listening skills. When clients see that they are listened patiently by nurses, they feel supported.
They feel that the nurses are interested in knowing their perspectives without judging them
(Millar et al., 2016). I therefore ensure maintaining effective listening skills to make patients feel
satisfied and reveal their personal opinions, pain and suffering so that they feel relieved. I also
believe in knowing the patient in details to provide individualized care. Uniqueness is an aspect
of therapeutic relationship with patient. Studies opine that when people are seen as individuals
with their lives beyond their mental illness, it becomes successful in making patients feel valued
and respected (Ennis et al., 2015). I also believe that developing is supportive environment is
important s this makes patients feel safe and comfortable. Active support through giving
suggestions and feedbacks, reflecting concern in vice, conveying hope and providing patients
with reassurance are methods that provide support to mental patients (Dowling et al., 2016) .
All these help me in establishing therapeutic relationship with mental health patients.
Conclusion:
From the above discussion, it can be seen that patients might gradually develop substance
abuse disorder when suffering from depression. It is important for healthcare professionals to
undertake screening and comprehensive assessment to identify his alcohol consumption rate and
different risks associated with it. Following these, care plans need to be developed after goal
settings and they need to be referred to community centers for further treatments. Nurses need to
ensure that they establish therapeutic relationship with patients through effective communication
and attributes that enhance best care service to patients.

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References:
Atca.com.au (2018), The Salvation army – The Townsville Recovery services, Retrieved from:
http://www.atca.com.au/referrals/queensland/the-salvation-army-townsville-recovery-
services-trs/
Cleary, M., Sayers, J. M., Lopez, V., Shattell, M. M., & Cleary, M. (2016). Hope and mental
health nursing. Issues in mental health nursing, 37(9), 692-694.
Dowling, N., Hall, K., Staiger, P. K., Pelling, N., & Burton, L. (2017). Substance-related and
addictive disorders. Abnormal Psychology in Context: The Australian and New Zealand
Handbook, 229.
Ennis, G., Happell, B., & Reid‐Searl, K. (2015). Clinical leadership in mental health nursing:
The importance of a calm and confident approach. Perspectives in Psychiatric
Care, 51(1), 57-62.
Ennis, G., Happell, B., & Reid‐Searl, K. (2015). Enabling professional development in mental
health nursing: the role of clinical leadership. Journal of psychiatric and mental health
nursing, 22(8), 616-622.
Gullo, M. J., Connor, J. P., & Kavanagh, D. J. (2015). A clinician's quick guide of evidence-
based approaches: Substance use disorders. Clinical Psychologist, 19(1), 59-61.

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Health.qld.gov.au (2018), Alcohol, Tobacco and Other drugs, Retrieved from:
https://www.health.qld.gov.au/townsville/services/atods
Islam, M. M., Oni, H. T., Lee, K. K., Hayman, N., Wilson, S., Harrison, K., ... & Conigrave, K.
M. (2018). Standardised alcohol screening in primary health care services targeting
Aboriginal and Torres Strait Islander peoples in Australia. Addiction science & clinical
practice, 13(1), 5.
Millar, S. L., Chambers, M., & Giles, M. (2016). Service user involvement in mental health care:
an evolutionary concept analysis. Health Expectations, 19(2), 209-221.
Newbury-Birch, D., McGovern, R., Birch, J., O'Neill, G., Kaner, H., Sondhi, A., & Lynch, K.
(2016). A rapid systematic review of what we know about alcohol use disorders and brief
interventions in the criminal justice system. International Journal of Prisoner
Health, 12(1), 57-70.
Patel, V., Chisholm, D., Parikh, R., Charlson, F. J., Degenhardt, L., Dua, T., ... & Lund, C.
(2016). Addressing the burden of mental, neurological, and substance use disorders: key
messages from Disease Control Priorities. The Lancet, 387(10028), 1672-1685.
Shipley, S. L., Caltabiano, N. J., & Graham, D. G. (2016). Psychiatric Comorbidity in Tropical
Far North Queensland. eTropic: electronic journal of studies in the tropics, 1(1).
Wilson, H., & Magor-Blatch, L. (2017). Apply what you know: Treating alcohol and drug
problems. InPsych: The Bulletin of the Australian Psychological Society Ltd, 39(5), 8.

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Zugai, J. S., Stein-Parbury, J., & Roche, M. (2015). Therapeutic alliance in mental health
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