The purpose of this assessment is to determine students knowledge on withdrawalmanagement and to identify risks for a person living with a substance
The purpose of this assessment is to determine students knowledge on withdrawalmanagement and to identify risks for a person living with a substance use disorder exitingresidential treatment and to advise of harm minimisation and prevention strategies to reducerisks.
Criteria:
The Case study on Emily will be provided in Canvas Assessment 1 folder. The case study is modified from Marel et al. (2019, pp. 42, 161).
In this assessment, you are required to consider Emilys case study and discuss withdrawal management as part of your alcohol and other drug assessment. Then in order to provide holistic healthcare, consider the physical, mental health and psychosocial-related problems which may affect Emily following successful detoxification and discharge from residential rehabilitation.
You are also required to recommend appropriate harm minimisation strategies relevant to any potential harms identified.
All sections need to use person-centred language as outlined in the marking rubric.
Use the following headings:
Introduction (approx. 100 words): Provide a logical succinct overview of the main points.
Withdrawal management (approx. 500 words): Discuss withdrawal relevant to the main substances in the case study, including onset, signs, symptoms and problems related to poly-substance use. Critically evaluate withdrawal scales you would use to monitor withdrawal.
Responding to and managing risks and needs (approx. 500 words): Considering the potential risks of recent release from hospital or residential health setting, identify and discuss:
two (2) physical health-related risks,
two (2) mental health-related risks and
two (2) psychosocial-related risks related to AOD use that could affect Emily following discharge.
Interventions (approx. 300 words): Identify and describe relevant AOD-related or comorbidity-related strategies to manage two of the risks identified above. Justify your choice.
Conclusion (approx. 100 words): Present a summary of the main points of the essay.
References: Use APA 7th referencing style. NOTE: all sections of this assessment require supportive contemporary high-quality literature/evidence, except for the introduction.
Case Study
Emily is a 42-year-old woman, presenting to her local AOD service for her tenth admission for inpatient detoxification/managed withdrawal from heroin, alcohol, and cannabis. Emily has been using heroin since she was 17 years old and has sometimes shared needles. Although heroin has always been her main drug of concern, Emily also drinks heavily and smokes cannabis daily, particularly on days when she cannot obtain heroin. She occasionally uses stimulant drugs but doesnt particularly like the effect.
In addition to her nine previous attempts at inpatient detoxification, Emily has been on a methadone program on three occasions. The first time, she stayed on methadone for 10 years before being imprisoned for her involvement in a break and enter. Emily stayed clean for the duration of her sentence, but returned to use soon after she was released. Emily had also tried going cold turkey, and detoxing by herself numerous times, with the help of non-prescribed benzodiazepines and buprenorphine - none of which were successful. Her longest period of abstinence since she started using was two years after the birth of her first child, who is now 16 years old. Emily has four children, ranging in age from 416 years, all of whom are in foster care. Emily relies on the Disability Support Pension to pay the rent on her Department of Housing flat, which she shares with her current boyfriend. There are occasional episodes of domestic violence from him towards her which she does not disclose. She has never been able to hold down a job for more than a few weeks because she often sleeps in and cannot get into a daily routine.
Emily is highly motivated to stop using all drugs so that she may have more contact with her children and hopefully one day have them returned to her custody. Emily was coping with withdrawal relatively well until one night when a male client accidentally walked into her room in the detox unit when trying to find the bathroom. Emily was awoken by the feeling that someone was watching her and could hear heavy breathing. His shadowed appearance in the half-light caused her to become hysterical and she lashed out violently. Staff quickly arrived and calmed Emily and removed the male client who was swearing at her and calling her a crazy bitch.
The following morning, the incident was reported during staff handover. The mental health nurse identified seeing Emily as a priority. The mental health nurse told Emily that she had heard about what had happened the previous night and asked whether she was okay. Emily was still a little shaken but said that she was okay now, adding that she was just startled and probably overreacted. She explained that it had reminded her of a time when one of her previous boyfriends had come into their bedroom one night and started beating her. The mental health nurse asked whether she was hurt at the time, to which Emily replied that she was hospitalised and required surgery for internal injuries. Emily appeared reluctant to talk about it. She said that she tried not to think about it and avoided any possibility of running into him again by avoiding areas which he frequented. Despite her efforts to forget about it, she often has bad dreams, flashbacks to the incident, and trouble sleeping, which meant she sometimes needs to take large amounts of benzodiazepines to sleep. She used street benzodiazepines as she had found GPs were reluctant to prescribe them. She found her supplier rather intimidating but had no other source; occasionally he suggested that he could introduce her to some people who would pay her well for services. While in rehab she had tried to block his number on her phone but he always seemed to use a different one and still got through to her. She thinks he has passed her number on to other people too as she does not recognise some of her missed callers.
After this brief talk with Emily, the mental health nurse made a time to see her later in the day. During this session, the mental health nurse asked more questions about how Emily felt after she was beaten and how this had affected her. The mental health nurse assured her that she had done nothing to deserve being treated this way, and that her reactions were completely normal. Emily was shaking as she described the incident in more detail, and later confided that she was also sexually assaulted during this attack something that she had not previously disclosed.
While Emily was an inpatient, the mental health nurse took the opportunity to talk with her a little more about her past trauma, continuing to normalise her symptoms, providing psychoeducation and self-management techniques, and exploring the relationship between her trauma-related symptoms and her substance use. The mental health nurse suggested that Emily might like to try a residential rehabilitation program for women only, where her trauma-related symptoms could also be addressed. Emily had previously been reluctant to enter residential rehabilitation but accepted the prospect of a women-only service.
The mental health nurse organised for a telephone assessment with the residential program, and Emily entered the program following her detoxification. While the program was hard, Emily benefited greatly from the trauma-informed approach taken by the service. Importantly, Emily felt safe and over time gradually opened up more about her life. She engaged in a combination of group and individual therapy. Her individual therapy in particular focused on providing integrated treatment for both her PTSD and AOD use.
It was during one of these sessions that Emily made a link between the onset of her substance use and previous traumatic events. Unbeknownst to the therapist or any other treatment provider, Emily had been sexually abused by a male relative from the age of 5 to 11 years when she left home to live with her grandparents. Emily drank Pholcodine cough medication when she was little as it made her feel better when she was upset. She also reported using her fathers diazepam. After moving to her grandparents house, which also involved a change of schools, she starting hanging out with new friends who liked to drink and smoke cannabis. Her substance use and truancy from school caused continual fights with her grandparents, who told her to leave when she was 16 years old. Emily quit school without getting her Year 10 School Certificate and moved into a shared house with people who introduced her to heroin around age 17. Within a year she had developed a habit.
As Emilys treatment progressed, she began to open up about numerous assaults, including rape, which had occurred in the context of the drug-using environment, but did not report any PTSD symptoms in relation to these experiences. While she was clean she was also involved in a car accident. She suffered major injuries and was not able to get into a car for 2 12 years. She reported residual trauma symptoms, and had previously worked with a psychologist on this. Her therapy continued to concentrate on the domestic violence, from which she was currently experiencing the most distress, and later the sexual abuse she experienced as a child. Emily was aware that it would likely take a long time for her to come to terms with what she had experienced. Emily successfully completed the residential rehabilitation program, and continued to receive ongoing psychological treatment for her PTSD and substance use.
Her current partner is still using various drugs though at this time Emily remains clean. She is looking for jobs but her criminal record precludes many applications. She has enrolled in an online TAFE course but her boyfriend resents the time she needs to spend studying. She is always on time and present for any meetings arranged with her children by the Department of Child Justice. The rent for her flat has just gone up and her boyfriend is reluctant to pay his full share due to his increasing drug use. Emily values her fortnightly appointments with the psychologist but sometimes wishes she had someone she could talk to more often about how she is feeling. She misses the intense support provided in rehabilitation. She is beginning to feel afraid of her boyfriend and wonders if they will stay together but she does not know how to get him to leave the flat which is in her name. She wishes she could find a sympathetic GP as she has been told that she should have regular LFTs though she is not sure why or what they are. There was no doctor on staff at the rehabilitation centre and the program was officially drug free which included all prescribed medication. Suddenly stopping the venlafaxine which she had taken for a year was difficult but she said nothing to staff at the time. She tries to maintain a positive outlook but as the weeks pass it is becoming increasingly difficult.
Assessment 1 - Case StudyCriteriaRatingsPoints
Introduction (10%)
4 to >3.36 pts
High Distinction
Outstanding introduction that contextualises the essay topic. Main points are well- developed and engaging.
3.36 to >2.96 pts
Distinction
Excellent Introduction engaging to the reader and provides a clear and logical overview of the main points of the essay.
2.96 to >2.56 pts
Credit
Appropriate introduction providing a logical overview of the main points of the essay.
2.56 to >1.96 pts
Pass
Adequate introduction with main points, however, may not follow a logical order.
1.96 to >0 pts
Fail
Fails to provide an introduction with main points or incomplete or incoherent.
0 pts
No marks
Did not attempt this section.
/ 4 pts
Withdrawal management (20%)
8 to >6.72 pts
High Distinction
Outstanding discussion on withdrawal, critically evaluates differences in withdrawal between the main substances including onset, signs and symptoms for all substances. Discusses poly-substance use linked to the case study. Outstanding critical evaluation of relevant withdrawal scales to monitor withdrawal for each substance and is linked to the case study. Person-centred language is very clear and relevant guidelines and peer-reviewed articles cited in-text.
6.72 to >5.92 pts
Distinction
Excellent discussion on withdrawal, clearly explained relevant to all substances linked to the case study including onset, signs and symptoms for all main substances. May not discuss poly-substance use linked to the case study. Excellent critical evaluation of relevant withdrawal scales to monitor withdrawals for each substance and is linked to the case study .Person-centred language is clearly evident and relevant guidelines and peer-reviewed articles cited in-text.
5.92 to >5.12 pts
Credit
Appropriate discussion on withdrawal, linked to the case study including onset, signs and symptoms for all main substances. Appropriate critical evaluation of relevant withdrawal scales to monitor withdrawal for each substance and is linked to the case study. Person-centred language is evident and relevant guidelines and peer-reviewed articles cited in-text.
5.12 to >3.92 pts
Pass
Adequate discussion on withdrawal and may be related to the case study and mostly include onset, signs and symptoms for all main substances. Adequate discussion of relevant withdrawal scales to monitor withdrawal for each substance and is linked to the case study Person-centred language is somewhat evident, and adequate guidelines and peer-reviewed articles are cited in-text. .
3.92 to >0 pts
Fail
Fails to discuss withdrawal and symptoms, signs and onset; with no linkage to the case study. Lacks discussion on how to monitor withdrawal for each main substance linked to the case study. Use of person-centred language absent. Lacks relevant guidelines and peer-reviewed articles
0 pts
No marks
Did not attempt this section.
/ 8 pts
Responding to and managing risks and needs (20%)
8 to >6.72 pts
High Distinction
Outstanding, accurate and logical identification and description of main harms following release provided, two (2) for each area of risk identified, including physical, mental health and psychosocial-related harms and accurately prioritised with very clear links to case study. Person-centred language is evident, and discussion supported with contemporary high-quality evidence.
6.72 to >5.92 pts
Distinction
Excellent identification and description of main harms following release provided, two (2) for each area of risk identified, including physical, mental health and psychosocial-related harms and is clearly linked to case study. Person-centred language is evident, and discussion supported with contemporary high-quality evidence.
5.92 to >5.12 pts
Credit
Appropriate identification and description of main harms following release, two (2) for each area of risk identified, including physical, mental health and psychosocial-related harms and is linked to case study. Person-centred language is evident, and discussion supported with high quality evidence.
5.12 to >3.92 pts
Pass
Adequate identification and discussion of harms following release provided, two(2) for each area of risk identified, including physical, mental health and psychosocial-related harms. Some risks may not be relevant and may not link to the case study. Person-centred language is evident, and discussion supported with evidence.
3.92 to >0 pts
Fail
Lacks identification and/or discussion of harms following release, two (2) for each area of risk identified, including physical, mental health and psychosocial-related harms with no linkage to case study. Person-centred language is absent, and discussion is not supported with evidence.
0 pts
No marks
Did not attempt this section.
/ 8 pts
Interventions (20%)
8 to >6.72 pts
High Distinction
Outstanding identification and description of two person-centred relevant AOD-related or comorbidity-related strategies to manage two of the risks identified above with justification of choice.
6.72 to >5.92 pts
Distinction
Excellent person-centred Identify and describe relevant AOD-related or comorbidity-related strategies to manage two of the risks identified above with justification of choice.
5.92 to >5.12 pts
Credit
Appropriate and clearly identified description of person-centred relevant AOD-related or comorbidity-related strategies to manage two of the risks identified above with justification of choice.
5.12 to >3.92 pts
Pass
Adequate identification and description of person-centred relevant AOD-related or comorbidity-related strategies to manage two of the risks identified above with justification of choice.
3.92 to >0 pts
Fail
Lacks description of two (2) relevant AOD-related or comorbidity-related strategies to manage two of the risks identified above with justification of choice.
0 pts
No marks
Did not attempt this section.
/ 8 pts
Conclusion (10%)
4 to >3.36 pts
High Distinction
Outstanding conclusion, well-developed and engaging. No inclusion of new information. A succinct and meaningful final comment.
3.36 to >2.96 pts
Distinction
Excellent conclusion of main points is present and no new information is included. A concluding final comment is included.
2.96 to >2.56 pts
Credit
Appropriate conclusion of main points and no new information included. A concluding comment is included.
2.56 to >1.96 pts
Pass
Adequate conclusion of the main points and may introduce new information. A concluding final comment may be absent.
1.96 to >0 pts
Fail
Lacks a summary of the main points and final comment is incomplete.
0 pts
No marks
Did not attempt this section.
/ 4 pts
Academic Writing and Expression (10%
4 to >3.36 pts
High Distinction
Outstanding academic writing. Introductory sentence used at the start of paragraphs. Main subject matter is developed within each paragraph. Concluding sentence used at the end of paragraphs. Exemplary spelling, grammar and syntax with no errors. Meets all UON style requirements.
3.36 to >2.96 pts
Distinction
Evidence of superior academic writing skills. Correct use of paragraphs. Discussion in each paragraph provides sufficient depth to demonstrate understanding. Superior spelling, grammar, and syntax < 5minor errors. Meets all UON style requirements.
2.96 to >2.56 pts
Credit
Evidence of sound academic writing. Paragraphs are 5-7 sentences in length and sentences are clear and concise. Minor errors in syntax, spelling and grammar. Meets all UON style requirements.
2.56 to >1.96 pts
Pass
Adequate communication of information .Attempts to use paragraphs. Some sentences maybe too long/short. Meets almost all UON style requirements
1.96 to >0 pts
Fail
Language hinders the effective flow of ideas and meaning. Sentences lack structure and are consistently too short or too long. Multiple errors in spelling, grammar and style. Presentation and style is not consistent with UON style requirements.
0 pts
No marks
N/A
/ 4 pts
Literature Sources and References (10%)
4 to >3.36 pts
High Distinction
Outstanding high-quality contemporary sources: at least 10 high quality resources which are appropriate, contemporary and from a range of journals and databases. Complies with all the referencing style requirements. There are no errors in referencing throughout.
3.36 to >2.96 pts
Distinction
Excellent high-quality contemporary sources: 10 high quality resources which are appropriate, contemporary and from a range of journals and databases. APA referencing style is consistently accurate. Less than 5 minor referencing errors.
2.96 to >2.56 pts
Credit
Sources are appropriate, mostly contemporary and from a narrow range of journals and databases. Complies mostly with referencing style requirements. Some referencing errors in in-text citations or referencing list. 6-10 minor referencing errors.
2.56 to >1.96 pts
Pass
Sources are mostly relevant however there are too few to demonstrate wide reading. Attempts to use APA style but is not consistent. Greater than 10minor errors in reference list and in-text citations. References included in reference list not intext and/or vice-versa.
