Comprehensive Care Strategies for Substance Use Disorders: The Emily Case Study
Introduction
The Emily case study focuses on substance use disorders, major depressive disorder, and psychosocial aspects of the patient. Drug dependence history, including heroin, alcohol, and cannabis use, as well as domestic violence and child abuse history in her case, highlights the patients condition. Particular attention should be paid to withdrawal management and support after the completion of rehabilitation programs to ensure her physical and mental health along with preventing her relapse. This particular evaluation will look at ways of addressing withdrawal signs, establish the potential issues after Emilys discharge, and suggest measures to help her avert the use of substances during rehabilitation.
Withdrawal management
Managing withdrawal in poly-substance users calls for the identification of withdrawal symptoms and their onset periods to be treated for each substance.
1. Heroin Withdrawal: Heroin withdrawal usually starts about 6-12 hours after the last use, becomes most severe 24-48 hours after cessation, and lasts 7-10 days. They include anxiety, myalgia, sleeplessness, intolerance to heat, and gastrointestinal disturbances (Volkow, 2020). Long-term usage and the attempts Emily made in the past for elimination led her to have more significant and protracted withdrawal signs.
2. Alcohol Withdrawal: Alcohol withdrawal may start within 6-12 hours after the last drink and may peak at a period of 24-72 hours. The manifestations vary from moderate (trembling, anxiety, insomnia) to severe (hallucinations, seizures, DTs). Based on the presented symptoms, particularly Emilys tendency to drink a lot, withdrawal can be severe, and withdrawal complications such as seizures can be lethal.
3. Cannabis Withdrawal: The process of withdrawal starts between one and two days after the enthusiast has stopped using cannabis and takes 2 to 6 days to reach its peak and between 2 and 14 days for cannabis withdrawal to manifest fully (Brezing & Levin, 2018). Some of the indicators include aggression, nervousness, insomnia, and loss of appetite.
4.Poly-Substance Use: The combined withdrawal symptoms come about as a result of the interaction of multiple substances, and as such, it is expected that poly-substance users experience withdrawal symptoms that are brought about by different substances (Connor et al., 2022). This may worsen the existing condition, and the worst affected are likely to be prone to develop complications.
Withdrawal Scales
Several assessment scales have been developed and can be used to properly assess withdrawal symptoms to ensure that responsive care is given to patients. The Clinical Opiate Withdrawal Scale (COWS) is necessary to determine the patients withdrawal severity as well as to monitor the progression of withdrawal symptoms (Canamo & Tronco, 2019)). Some symptomatic signs are sweating, nervousness, bone and joint pains, runny nose, and stomach upsets, among others.
Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is essential when assessing the degree and probability of intensity of withdrawal symptoms from alcohol (Steel et al, 2021). This scale embraces all symptoms such as nausea, tremors, paroxysmal sweats, anxiety, agitation, sensations of touch abnormities, hearing, sight abnormalities, head, orientation and obscurity of the sensorium. The identification of the severity based on CIWA-Ar makes clients assessment realistic when determining if they should be given benzodiazepines to prevent the development of severe conditions such as seizures and delirium tremens.
For cannabis withdrawal, despite being less popular, there is also the Cannabis Withdrawal Scale (CWS) that helps in measuring particular withdrawal symptoms that are characteristic of cannabis users when they quit cannabis (Connor et al., 2022). Some of the symptoms which the CWS ascertains are irritability, anxiety, sleep problems, changes in eating habits, and discomfort. It is, therefore, essential, when treating people with an addiction to closely keep an eye on these symptoms in an attempt to render complete care.
Description
Evaluation of the transition after discharge from residential rehabilitation makes it clear that such patients are at a high risk of relapse. Concerning the identified risks, Emily experiences possible physical, mental and psychosocial complications.
Physical Health Risks:
1. Relapse and Overdose: Fortunately, detoxification is usually not a long process and can last for between one to two weeks; however, with Emilys background of substance use, she is likely to relapse. After detox, therefore, the patient, will have a much lower tolerance to substances such as heroin (Clarke et al., 2020). This is a significant time when attention and care should be paid to the patient to avoid relapse and grave consequences.
2. Liver Function and Hepatitis: Emilys history of heavy alcohol consumption and a history of needle sharing places her at risk for liver diseases. Preventive blood tests involving LFTs should be conducted frequently to ascertain the first indications of liver injury while there is still time for medical treatment (Simon et al., 2022). Supervision of liver function may partly enable her to prevent or reverse some of the effects of substance use on her liver as she continues to use drugs.
Mental Health Risks:
1. Post-Traumatic Stress Disorder (PTSD): These include physical child sexual abuse, domestic violence as well as other assaults, which make Emily vulnerable to PTSD. This condition can affect her mental state notably and make her develop symptoms such as flashbacks, nightmares, and instances of anxiety (Yamashita et al., 2021). Substance use can also result since PTSD will make Emily use drugs to help cope with the condition. Mental health, including trauma-based treatment such as EMDR or trauma-focused cognitive behavioural therapy, helps treat such complications and prevent relapse due to PTSD.
2. Depression and Anxiety: Withdrawal and the pressure of staying sober result in the worsening or development of depression and anxiety disorders (Ramadas et al., 2021). These feelings have been managed through substances; thus, Emily will require further treatment of these mental health disorders after her discharge. Leaving behind a life of drugs and substance abuse can be quite a challenge, and without the right help, people with an addiction are likely to relapse and go back to substance abuse.
Psychosocial Risks:
1. Unstable Housing and Financial Stress: The financial problems in Emily's life include living on Disability Support Pension only and her boyfriend's refusal to pay for the rent. These can complicate the process of her healing since stress raises the chances of relapse, and triggering events may be abundant (Davis et al., 2019). Financial instability also leads to housing insecurity; she may experience a worsened situation that raises her likelihood of relapse.
2. Domestic Violence: Domestic violence that persists threatens the wellbeing wellbeing of Emily, more so her physical and psychological wellbeing. It can lead to further trauma, and this is a relapse formula in dealing with the abuse since violence can be recruited. Domestic violence also poses a threat to the safety of the plaintiff's home; hence, a was a threat to Emily as she tried to recover.
Interventions
Relapse Prevention:
1. Medication-Assisted Treatment (MAT): MAT is advantageous, especially in treating opioid use disorders and the probability of relapse (Maglione et al., 2018). For example, naltrexone has application in alcohol dependence, as it would also help to minimize recurrence by relinquishing alcohols rewarding properties.
2. Cognitive-Behavioral Therapy (CBT): CBT allows the patient better to navigate her triggers as well as her cravings, treat any inherent mental disorders, and work on emotions, respectively (Ramadas et al., 2021). In particular, through the help of a therapist, Emily can distinguish such thought patterns and actions that lead to using substances and learn how to overcome them. That is why this therapeutic approach is helpful for people who have been diagnosed with co-occurring disorders, for example, PTSD and SUD because it helps them to learn how to deal with both disorders at the same time.
Domestic Violence and Housing Support:
1. Safe Housing Initiatives: Therefore, ensuring Emily what would become of her when she left the hospital is a safe and suitable environment would greatly help her recover. Services like transitional homes and womens emergency shelters can provide a safe place devoid of domestic violence (Miller-Archie et al., 2019). Safe housing will not only shelter Emily from any further abuse but will also help her remain sober as a way of continuing with the treatment. Some supportive housing services include case management and linkages to other services that might assist her in finance and the law.
2. Legal and Social Services: Legal services may help Emily with problems connected with domestic violence, like getting protection orders and working with the police (Maglione et al., 2018). These services can enable Emily to make informed decisions that would help to resolve the relationship or living situations that cause stress and trigger a possible relapse.
Conclusion
Emilys case reemphasises the need to implement a comprehensive treatment in withdrawal management as well as aftercare services post-rehabilitation. These include medication-assisted treatment as well as Cognitive Behavioral Therapy, which might help the patient avoid relapse, safe and affordable housing programs to assist her to avoid remaining in a violent relationship, and legal aid services to help her acquire stable housing. Therefore, it is crucial to provide proper care and non-pharmacological treatment that would include a complex and traumatic approach to address both issues, the substance use disorder and the trauma causing her condition, to enhance the recovery rate of Emily and her overall well-being.
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