Week 4: Substance-Related and Addictive Disorders

I can’t believe that stupid horse lost! My inside man told me it was a sure bet at 20:1 odds. I thought for sure that I would be able to make back the money I lost yesterday. What am I going to tell my wife? That was the money for the mortgage payment…well, the last three mortgage payments. She does not know I have been spending my days at the track. I lost my job at the company because a few hundred dollars went missing. I just need a break. I know this next horse will be my winner!

Michael, age 37

Substance abuse and addiction affects persons in all walks of life; every ethnic and economic group is affected in some way by addiction or substance abuse. In your practice as a PMHNP, you will encounter patients with substance abuse and dependence. Some of the people who present for treatment are at a low point in their lives and want to turn things around. They may present for other conditions such as depression or bipolar disorder, anxiety, PTSD, or personality disorders. One of the most common ways of self-medicating a mental illness is with alcohol and illicit drugs. Marijuana is a common substance used by clients to treat various symptoms. To effectively treat clients with addictive disorders and substance use disorders, the provider needs to examine their own values and thoughts about the use of substances.

This week, you will analyze clients presenting for treatment of substance-related and addictive disorders and evaluate effectiveness of therapeutic approaches for clients diagnosed with substance-related and addictive disorders.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 20, “Substance Use and Addictive Disorders” (pp. 616–693)

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

 

Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/

 

To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Note: For more information about buprenorphine, see https: //www.samhsa.gov/medication-assisted-treatment/qualify-nps-pas-waivers

Required Media

Optional Resources

• Chapter 46, “Alcohol-Related Disorders”
• Chapter 47, “Sedative-, Hypnotic-, or Anxiolytic-Related Disorders”
• Chapter 48, “Opioid-Related Disorders: Opioid Detoxification”
• Chapter 49, “Opioid-Related Disorders: Antagonist Treatment”
• Chapter 50, “Opioid-Related Disorders: Agonist Maintenance Treatment”
• Chapter 51, “Hallucinogen-Related Disorders
• Chapter 52, “Cannabis-Related Disorders”
• Chapter 53, “Club Drug Addiction”
• Chapter 54, “Stimulant-Related Disorders”
• Chapter 55, “Nicotine-Related Disorders”
• Chapter 56, “Individual Therapy for Substance Use Disorders”
• Chapter 57, “Cognitive, Behavioral, and Motivational Therapies for Substance Use Disorders”
• Chapter 58, “Group Therapy for Substance Use Disorders”
• Chapter 59, “Family Therapy in Substance Abuse Treatment”
• Chapter 60, “Network Therapy for Substance Use Disorders”
• Chapter 61, “Pain and Addiction”
• Chapter 62, “Gambling Disorder”

Bechtold, J., Simpson, T., White, H. R., & Pardini, D. (2015). Chronic adolescent marijuana use as a risk factor for physical and mental health problems in young adult men. Psychology of Addictive Behaviors, 29(3), 552–563. doi:10.1037/adb0000103

Note: You will access this article from the Walden Library databases.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2013b). TIP 48: Managing depressive symptoms in substance abuse clients during early recovery. Retrieved from http://store.samhsa.gov/product/TIP-48-Managing-Depressive-Symptoms-in-Substance-Abuse-Clients-During-Early-Recovery/SMA13-4353

Note: This document is available as free download.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2013b). TIP 42: Substance abuse treatment for persons with co-occurring disorders. Retrieved from http://store.samhsa.gov/product/TIP-42-Substance-Abuse-Treatment-for-Persons-With-Co-Occurring-Disorders/SMA13-3992

Note: This document is available as free download.

Borchardt, D. (2017). National Academy of Sciences pushes for rescheduling of marijuana. Forbes. Retrieved from https://www.forbes.com/sites/debraborchardt/2017/01/18/national-academy-of-sciences-suggests-removing-barriers-to-cannabis-research-basically-deschedule/#22269c753f76

Discussion: Clinical Supervision – Kaltura

Substance use disorders are complicated psychiatric and medical conditions that involve physical addiction as well as psychological or emotional dependence. Substance use disorders are some of the most difficult to treat. It takes a great deal of patience on the part of the provider and the client. It may take several attempts before a client is successfully able to “kick the habit.” Your guidance and patience can help the client to persevere through difficult times during the journey to recovery.

Clinical Supervision is an essential component of your development as a psychiatric mental health nurse practitioner. It provides an opportunity for professional collaboration as you share experiences with and gain insights from colleagues. For this Clinical Supervision, consider a client with a substance abuse disorder whom you do not think is adequately progressing according to expected clinical outcomes.

Students will:

• Analyze clients presenting for treatment of substance-related and addictive disorders
• Evaluate effectiveness of therapeutic approaches for clients diagnosed with substance-related and addictive disorders
• Recommend treatment plans

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

• Review this week’s Learning Resources concerning treating patients with substance-related and addictive disorders.
• Reflect on a client you are currently counseling or have previously counseled at your practicum site who has been diagnosed with substance-related and addictive disorders.

By Day 3

Post a 3- to 5-minute Kaltura video in which you do the following:

• Describe the client. Note: Do not use the client’s actual name.
• Explain your therapeutic approach with the client, including the perceived effectiveness of your approach.
• Identify any additional information about this client that may potentially impact expected outcomes.
• Provide specific recommendations for the client to help them in determining why they are not progressing and what your suggested treatment plan consists of. It is useful to consult the Prochaska and DiClement model.

Note: Nurse practitioners must have strong oral communication skills. This Discussion is designed to help you hone these skills. When filming your Kaltura video, be sure to dress and speak in a professional manner.

View a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues by suggesting an alternate therapeutic approach. Support your feedback with evidence-based literature and/or your own experiences with clients.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 4 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 4 Discussion

Assignment 1: Week 1 Practicum Journal Entry: Certification Plan

By Day 7

Submit your Assignment. Refer to Week 1 for additional guidance.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 4 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 4 Assignment 1

Assignment 2: Week 2 Practicum Journal: Safe Prescribing

By Day 7

Submit your Assignment. Refer to Week 2 for additional guidance.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn2+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment 2 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment 2 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn2+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 4 Assignment 2 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment 2 draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 4 Assignment 2

Assignment 3: Week 3 Practicum Journal: Decision Tree

By Day 7

Submit your Assignment. Refer to Week 3 for additional guidance.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn3+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment 3 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment 3 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn3+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 4 Assignment 3 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment 3 draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 4 Assignment 3

Practicum Reminder

Time Logs: You are required to keep a log of the time you spend related to your practicum experience and enter every patient you see each day. You can access your time log from the Welcome Page in your Meditrek account. You will track time individually for each patient you work with. Please make sure to continuously input your hours throughout the term.

Making Connections

This week, you analyzed clients presenting for treatment of substance-related and addictive disorders and evaluated effectiveness of therapeutic approaches for clients diagnosed with substance-related and addictive disorders.

Next week, you will, once again, become “captain of the ship” as you take full responsibility for a client with a bipolar disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans. You will use the decision tree format to justify your rationale for diagnosis, pharmacological treatment, and psychotherapy of a patient with a mental illness. You also will evaluate the results of your Fitzgerald University Exit Comprehensive Exam and, based on those results, develop a plan of action to prepare for the certification exam.

To go to the next week:

Week 5