Visual Report: Substance Abuse
Ryan Biancardi California State University San Marcos Nursing 480
Substance Abuse Case Study “Jay” is a 28 year old male who has a history of substance abuse. He has aKempted rehab before, but it was unsuccessful. He recently admiKed to his wife and family that he has been using again. He wants to go back to rehab, and he wants his entire family’s support. He doesn’t think he will be able to do it on his own, but he’s also scared and embarassed of what others will think. J.M. has always been an outgoing person with lots of friends. He played baseball and football in high school, and continued to play baseball at junior college. He began smoking marijuana in high school, and would occassionally drink alcohol with friends. He began taking prescription medications in his mid-twenties when a friend offered him one. He thinks this is where his substance use disorder took a turn for the worst. He has recently admiKed to his family about his previous habits, but fears they will turn his back on him, rather than support him.
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Substance Abuse There is no single theory as to how a person develops substance abuse, but rather a
variety of factors that may predispose an individual. These include biological (genetics, biochemical), psychological (developmental, personality) and sociocultural (learning, conditioning, cultural and ethical). There are dierent severities and variations of substance abuse, but generally cause signiďŹ cant cognitive and clinical impairments. These can lead to chronic health issues, as well as psychological and social impairments. People with substance abuse (or substance use disorder), or any mental illness tend to have a certain stigma aKached to them. Often times it is not viewed the same way as an individual with a physical illness. This stigma often times can lead to individuals not seeking medical care and support. This can cause a barrier between the mental health services and the ones who truly need it. It also leads to non-compliance in the treatment program. Families and friends who live or know someone with a mental health disorder also experience the stress related to their condition. It is a complex disorder that requires a great deal of education, support, and communication.
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Meet the Morgan’s “Randy”: Father; 55 years old; Farmer; full-time; paying for Jay’s treatment program; unable to take Jay’s to treatment because of work conflicts. “Donna”: Mother; 55 years old; part time receptionist; active in church, high school sporting events; drove Jay to the treatment facility, told her friends she couldn’t aKend their weekly exercise class because she had to go visit her mom “Sarah”: Wife; 27 years old; marketing consultant; went with Jay and his mom to the treatment facility; concerned Jay’s family will not emotionally support him, especially his father.
“Ma1hew”; “Jeremy”, “Andrew”: Insurance salesman (28; twin); bartender (25); high school senior (18) Jay is very close with all his brothers, in very different ways. Growing up with his twin, they talk often on the phone. Their conversations usually consist of sports and television. His middle brother lives near by and they hang out often. They go to the movies, gym and beach together. He bonds with his liKle brother about sports, as Jay was a big contributor to his upbringing in a sports family.
Meet the Morgan’s Stages of Development: Jay, Ma1hew, Jeremy, Sarah: Intimacy vs. Isolation u If Jay is to continue down a path of substance abuse, he is at risk of becoming socially isolated. During this stage of his life, young adults begin to form intimate relationships, and this important stage in his life is severely compromised if he continues to lie to his family. He is currently taking the initiative to correct his harmful behaviors. His family must support Jay and be there for him emotionally. Mother, Father: Generativity vs. Stagnation u Jay’s mother and father are at a stage where raising a family and creating positive change are important. They also are at the stage where work is important. During this stage, a balance between work and family are important to be able to provide for their family, but also be available to them emotionally. Andrew: Identity vs. Role Confusion u Andrew is at a stage in his life where he is beginning to understand himself. He is also very peer influenced. As he finishes high school and prepares for college, he may not be familiar with certain mental illnesses, such as substance abuse. Education will be a very important aspect of being there for Jay, as well as learning to forgive him.
Culture and Religious Traditions Religion- Jay’.s mother and father are both active with their Christian church. They aKend church every Sunday, and host bible study once a month. They have opened the doors to their home to members of the church who need guidance. However, they have not used the members of the church like they have used them. Their willingness to be the one’s others turn to, while not turning to them in return has created a barrier to their external factors. Culture- The Morgan’s grew up in their relatively small town with 4 boys. They all participated in various sports and had a large social group. This has made them well known with the others in the community. It has also painted them as a solid family who others look up to. Although this culture they surround themselves in has brought them much support and admiration, the family has a hard time admiKing their family also faces challenges and struggles.
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Communication, Strengths and Challenges Communication- Family communication allows beliefs and values to be tied to the past, present and future. Jay has broken some bonds with his family in the past regarding his substance abuse. However, he is currently admiKing his wrongs, and wants to make amends to build a more constructive future. His youngest brother currently feels betrayed by his actions, and doesn’t fully understand the disease process of a person with substance abuse. His father has been more of a financially stable contributor, who lacks in emotional interaction. His mother and wife are focused on the future, and the well-being of Jay. His other 2 brothers are supportive of Jay but don’t know how to shift their relationship from a brother/friend to a therapeutic one. Strengths/Challenges- The biggest challenge the Morgan’s are going to face is the understanding of substance abuse. Unlike other medical conditions that may resolve over time, substance abuse recovery is a never ending baKle. To maintain sobriety, the family must forever understand the challenges and obstacles the individual is going through. The strength of the family is there willingness to support. Because each member of Jay’s family is available one way or another, the goal is to align them regarding the treatment plan and create stability within the family.
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The Family Systems Theory The Family Systems Theory will be implemented for providing care to the family regarding Jay’s
substance abuse. This theory assesses each individual in the family and how they contribute to the family as a whole. The assessment aspect of this theory looks at the previous roles taken on by each family member; both with the individual living the condition, as well as their role in society. One of the most useful assessment tools while using the Family Systems theory is creating a genogram and ecomap. This paints a picture for the nurse of who makes up the family, their role and relationship, and the external influences on the family. The genogram can also be used to see how the individuals in the family influence the entire family and the society they live in. As Jay begins his one month treatment program, the Morgan family must engage in an emotionally stable relationship. They must also be able to communicate as a family, as well as within the various subsystems that make up the family. Although Jay’s wife and mother are emotionally available, the father must begin to be emotionally availabe as well. A distinction must be made between emotionally and financially supportive. In addition, his brother’s must learn to forgive Jay for his past actions, and learn to be there for him therapeutically.
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Interventions u 
Intervention #1- Form a therapeutic relationship with the family, one that is built on trust. As rapport is built, facilitate their involvement in the healing process. Encourage the families to move away from a state of blame and emotional reactivity. Rationale: According to Haefner (2014), helping families focus on communication rather than placing blame promotes behavioral change and a calmer non-reactive climate.
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Intervention #2- Teach family members to observe their paKerns of behavior during stressful times or when tension between family members escalate. Rationale: According Haefner (2014), observation of these pa1erns encourages less emotional and reactive communication.
Source: Stuart Miles via Free Digital Photos.Net
Interventions u
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Intervention #3- Educate the family regarding in-patient treatment programs. Educate them that the treatment program for the individual is about physical recovery, just as much as it is mental recovery. In addition, understand that in-patient is a combination of individual treatment for the patient, as well as family therapy. When the family is not physically at treatment with the individual, reflect on past behaviors before the patient went to treatment (Gifford, 2016). Interventions #4- Encourage the family to continue aKending meetings with the patient after he has completed his in-patient program. The struggles associated with drug addiction are continuous, and aKending meetings with family and friends shows support, and allows the family to continue learning about the disease (Gifford, 2016).
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References Gifford, S. (2016). Family Involvement is Important in Substance Abuse Treatment. Psych Central. Retrieved on October 14, 2016, from http://psychcentral.com/lib/family-involvement-is-important-in-substance-abuse-treatment/ Haefner, J. (2014). An Application of Bowen Family Systems Theory. Informa Healthcare, 35, 835-841. http:/ /dx.doi.org/10.3109/01612840.2014.921257 Kaakinen, J. R., Coehlo, D. P., Gedaly-Duff, V., & Harmon Hanson, S. M. (2010). FAMILY HEALTHCARE NURSING Theory, Practice and Research (4th ed.). Philadelphia, PA: F.A. Davis Company. Townsend, M. C. (2015). Psychiatric mental health nursing Concepts of care in evidence-based practice (8th ed.). Philadelphia, PA: Robert G. Martone.