Client Identification And Its Effects On The Brain 's Reward Pathway Essay

The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.

First, for providers to use opioids as the first option in prescribing pain killers needs to be addressed. Knowing that opioids are very addictive should sway providers to look for other options for their patients before looking towards opioid type drugs. Second, once a patient is prescribed opioids for pain management, there needs to be limitations placed on how many pills the patient can have at one time. There also needs to be a limitation placed on the amount of time a patient can use any form of opioids. Third, once a patient’s prescription runs out, they often times start looking to find that same high by buying these drugs illegally off the streets. Therefore, after a patient stops using an opioid medication, they need to have some type of specialty care available to them (mandatory if used for a prolonged period of time) to address any potential withdrawal symptoms; care that can provide counseling and or medications that enable the patient to be weaned off of the drug. Fourth, the need to identify why patients are not seeking recovery is crucial. Not many opioid addicts seek treatment; the first step in recovery is to seek help. Fifth, determining how to get opioid addicts into a recovery program will help exponentially to get people away from opioid use and on the road to recovery. Sixth, opioid addicts do not have high success rates for continued recovery after leaving a treatment program. Identifying the needs of the addicts after treatment is one of the most important elements to staying clean and

Client was considered to be in semi-compliance with treatment during this reporting period. Client attended two secheduled groups with two absences. UA were negative for all tested substances. Client reported participating in self-help meeting regularly; verification was provided. Treatment attendance needs to be improved in 30 days.

Client reported feeling down within the last month and using heroin to cope. Client also reported feeling better and motivated towards the end of the month. Client completed a Beck Depression Inventory in which he scored a 6 indicating normal ups and downs. Client VA records confirm a diagnosis for PTSD and the medication list includes, Sertraline and Setraline HCL, as well as methadone to which the client appears compliant. Client reported he is medication compliant. Client denied any S/I or H/I.

Problem # 5 Illicit opiate use Goal(s): to be free from illicit drugs. Status: Active Objectives/Progress: Pt. has struggled with continued use of illicit drugs (marijuana, opiates and amphetamines) and his last quarter UDS reflect a pattern of heavy substance use. Pt. was encouraged to work with the medical staff to achieve a stable dosing level. Pt. is regularly taking his medication as prescribed by AMS Doctor and he stated his current prescribed methadone 90 mg is working "well". During the last quarter, Pt. made progress on developing a therapeutic relationship with his new AMS counselor for the upcoming quarter. Also, Counselor focused therapy session on establishing rapport and building trust with him. Pt. is currently in the contemplation stage of change because he more open to receiving information about his negative habits and willing to use educational interventions which he agreed with this assessment. Pt. was reinforced for any statement that reflected acceptance of his chemical dependence and acknowledgment of the negative consequences that opiates has had on his life. During the upcoming quarter, Counselor will assist Pt. to discuss and weigh the pros and cons of continuing his addictive

Since the 19th century the United States has struggled with the control of opioids and how to properly treat the people who become dependent on them. By the 1980s studied revealed that the potential of drug dependence, also known as iatrogenic addiction, was relatively low for patients who were prescribed opiates for treatment (Beauchamp, 2014, p. 2023) - In the mid 1990s, Perdue Pharma introduced OxyContin, a Schedule II prescription opioid analgesic, to the pharmaceutical market (Boerner, 2016, p. 20). Since the release of OxyContin, a substantial number of Americans have been prescribed opiates for medical treatment. Society’s view on prescription opiate use has slowly shifted from being a normative treatment method recommended by healthcare professionals, to being viewed as deviant. Prescription opioids have played a large role in increased rates of incarceration, fatal and non-fatal opiate overdose, transitions to illicit drugs and HIV infection in the United States (Boerner, 2016, p. 21). Prescription opiate use is seen as deviant when the drug is misused for non-medical purposes.

Out of the 60 participants 14 were women, 42 came from treatment settings, 18 came from criminal justice settings and 5 did not attend the follow-up 6-month interview. During the 6-month treatment trial, 95% of the participants used opioids on one or more occasions while the other 5% reported completely refraining from using opioids during treatment. The average frequency of opioid use was 24 days during the entire 6-month period. The overall frequency of opioid use was reduced from an average of 2.4 (using the 0-3 frequency scale) before Naltrexone implantation to 0.9 after 6 months of treatment. Heroin was the most commonly used opioid among the 60

Opioid Use Disorder (OUD) is a chronic and potentially life-threatening disease, and the main feature of which is addictive and compulsive opioid use (Drugs & Crime, 2010). Opioid drugs include some of the prescribed pain relievers as well as illicit drugs, such as heroin, codeine, oxycodone, etc. In the United States, about 9.5 million adults use pain relievers for nonmedical purpose, 1.6 million adults meet diagnostic criteria of pain reliever use disorders, and 0.56 million have heroin use disorder (Hedden, 2015), at a huge social and financial cost (Alan G. White et al., 2011). Furthermore, the relapse rate of OUD patients in treatment is high (Davstad et al., 2007).

This writer met with the patient to address her non-compliance with treatment, referring to her attendance to the cocaine group and her AWOLs. This writer explained to the patient about the purpose of the clinical intervention as the patient continues to test positive for cocaine, opiates, and fentanyl. The patient appeared to be surprised to learn about the fentanyl results in her UA's and believes that her "dope" could have been laced. The patient is aware of her non-compliance and made excuses by reporting that she tends to oversleep as she often times cannot hear her alarm from her cellphone. In addition, when the patient AWOL from the clinic, she tends to relapse and her most recent was relapse was on 5/29/2017-3 bags of heroin by inhalation.

Opioid medications are frequently prescribed for severe pain. Opioids includes the pain medications like oxycodone, hydrocodone, morphine, and fentanyl as well as the illegal drug heroin (American Society of Addiction Medication, 2016). Many people rely on these drugs to relieve their pain from surgery, active cancer, chronic pain and end of life care (WebMD, 2017). Studies from the 2012 National Health Interview show that over 11% of adults report having chronic pain (Dowell, Haegerich & Chou, 2016). The opioid epidemic is a significant issue for nursing on the main respect that there is currently a problem with over- prescribing of narcotics and the millions of people addicted to opioid medications

After Ms. Lee broke up with her girlfriend she started using illicit drugs and every time after that usage she would retreat back to drugs. The cycle is often hard to break without proper support and treatment. The DSM-5 categorizes Opioid Use Disorder (OUD) into twelve categories to determine if a client has an opioid disorder. The client has to have at least two impairments in a twelve month period in order to be classified as OUD.

No treatment history was reported. Client reported that she was prescribed medication for ADD, but was terminated on Oct 2015 due to the loss of job and health insurance. Client reported that she has continued to use methamphetamine to cope with her mental health conditions since Jan 2016. No thought of self-harm/suicidal/homicidal ideation was reported. Client indicated her mental health "Poor". "I use meth and heroin. So I don't have to deal with my depression, anxiety, and other issues in my life." "I do go to gamble

PATIENT ASSESSMENT The case study patient is a 41 year old female, originally from Nebraska, where her family still resides. She currently works part-time and just recently started going back to college part-time for drug counseling. The patient’s interest in drug counseling is from past recreational drug and tobacco use for over 25

SUBSTANCE ABUSE UPDATE: Client has a history of alcohol abuse. Client reports she drinks one or two cans of beer once a week. intoxicated. Once again CM tries to refer the client to a substance abuse program. Client refuses

Opiate use disorder is an epidemic, and continues to be a growing problem. It is defined as the overuse of opiate medication, which can be prescribed or obtained illegally (Lin, Bohnert, Price, Jannausch, Bonar, and Ilgen, 2015). Sobriety continues to be a struggle for patients. This is true for those who have completed inpatient treatment as well. The documented pattern in this disorder is that multiple relapse episodes is a direct indicator of fatality (Ohannessian, 2014). Increased perception of acceptable pain levels have been shown to be an important indicator of opiate use (Lin, et al, 2015). Further review of the literature shows accountability can also be a key factor in increasing sobriety rates (Weiss, et al, 2014). The Advanced Practice Nurse (APN) is equipped to combine these findings using a therapeutic relationship with the patient (Thorkildsen, Eriksson, & Råholm, 2015). The trusting relationship has the potential to increase patient compliance with clinic sessions as well as openness to share emotional and physical triggers that may lead to relapse. This is a holistic approach to care that can potentially save many lives. The role of learned helplessness in patients dealing with recurrent pain has been shown to lead to misuse of pain relieving medications (Sheftell & Atlas, 2002) Given the addictive nature of opiates, this misuse can be a leading risk factor for