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Substance Use Case Scenario

Mark is a 14-year-old boy whose father became concerned when he overheard a telephone conversation in which Mark was discussing the purchase of “a forty bag” with a close friend. Later that evening when Mark was out, his mother and father searched his room. They found a plastic bag with a small amount of marijuana, a “roach clip,” cigarette papers, several small white pills, and about $100 in cash. These items were tucked in a shoebox in the back corner of Mark’s closet. When confronted later that evening, Mark responded angrily, “This is none of your business. You guys like to drink now and then, my friends and I like to smoke weed. And I can’t believe you searched my room. Stay out of my life!” Mark’s father requests that you see his son and perform “a drug test” to see how bad the problem is. To pacify his parents, Mark reluctantly agrees to see you.

Past Medical History: Mild asthma successfully controlled with an albuterol inhaler. No hospitalizations, surgeries, or known drug allergies.

After you explain to him the risks and limitations of urine drug testing, Mark’s father agrees that it need not be done. Specifically, you tell him, “We already know he’s smoking marijuana, and tests for other drugs are very limited unless he’s using every day. I usually can get better information through a confidential interview.” Then you meet with Mark to obtain more history about his substance use.

Psychosocial History: Mark is in eighth grade at a private academy known for academic excellence.

During seventh grade he maintained a “B” average, although this declined slightly during the last term. This year, he states he has a “D” average in everything but Spanish, which he is failing. Although he was a starting player on his middle school’s basketball team last year, he is not planning to play this year because, “Running fast makes me wheeze.” 

You and Mark have the following conversation with regard to his substance use: 

“So tell me a little about your experience with alcohol.” Mark says that he drinks occasionally at parties, but “more than three beers makes me throw up.” 

You then ask about marijuana. “Well, I first started about a year ago. One of my friends turned me on to some mad cool weed. We partied pretty much every weekend through the end of school, and then during the summer we partied like every day,” he replies. 

You then ask “Have you ever tried to cut back on your use?” “Well, after the summer, when school started, I thought I’d better cut back to just weekends,” Mark responds. “How did that work out?” you ask. “Well, it was OK,” he answers, “but a couple of months ago I decided it was cool to smoke on weeknights. I sometimes have a blunt with my friends before class, too. It makes me more creative.” He denies using any other drugs. 

When asked about the white pills his parents found, he states, “I was just holding them for a friend of mine.” “Are you sure?” you respond. “Because I sometimes hear that from my patients, but it isn‟t always the whole story. 

Remember Mark, what you say here is kept confidential, but I need to hear the whole story in order to be helpful to you.” Mark then says “I took some “OCs” (oxycodone) pills from my parents‟ medicine cabinet. I was going to share them with a friend.” Last year, he was provided oxycodone combination tablets for several months after sustaining a compound ankle fracture. He says “I got to like how they made me feel.”

You then ask the CRAFFT questions. “Have you ever ridden in a car driven by someone (including yourself) who was „high‟ or had been using alcohol or drugs?” Mark reports to having a minor car accident after leaving a party where he had been drinking several beers. “It was no big deal. No one got hurt.” 

“Do you ever use alcohol or drugs to relax, feel better about yourself or fit in?” “Yeah, sure, it helps me relax,” he replies. 

“Do you ever use alcohol or drugs when you’re alone?” “Sometimes late at night. It helps me get to sleep,” he says. 

“Do you ever forget things you did while using alcohol or drugs?” “Nope.” 

“Do family or friends ever tell you that you should cut down on your drinking or drug use?” “Just my parents,” he says with a scowl. 

“Have you ever gotten into trouble while you were using alcohol or drugs?” “No, not really,” he replies. “But I did have one close call. We got pulled over by a cop one time when I was driving home from a party. He didn’t find anything, though, so he had to let us go.”

Based on your assessment, you feel that Mark’s use likely lies somewhere between problematic use and a substance use disorder although his failed attempt to abstain from cannabis use raises concern over the latter. Mark and his parents would benefit from a referral to a substance use specialist. Mark refuses the referral, saying “I don’t have a problem. My parents are the problem.” 

 

What is the nursing care plan for this patient ?

Substance Use Care Plan

Nursing Diagnosis #1 

 

Nursing Goal

 

Nursing Interventions
Intervention Evaluation 
Area of Focus: Safety
1.  •
2. 
3. 
4. 
Area of Focus: Resources & Support
5.  
6. 
7. 
8.

Nursing Diagnosis #2 - 

 

Nursing Goal

 

Nursing Interventions
Intervention Evaluation 
Area of Focus: 
1.  
2.
3.
4.
Area of Focus: Support for Caregiver(s)
5.  
6.
7.
8.

 

 

SCIENCE
HEALTH SCIENCE
NURSING
PSYN 3145

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