Forum 4: Assignment on Adam 17 yo Adolescent patient you are assigned to on an outpatient rehab unit.

Adam is a 17 year old single male who was born in Los Angeles, California, where he still lives with his mother and his brother. His dad is a sales rep and is on the road during the week.

“When he’s home on the weekend he just drinks and watches the ball games on TV When he gets drunk he yells at me and my mom and throws stuff around the house. He drinks all the time that he’s home but he can’t hold his booze. Like he’s a total lightweight. Mom also drinks. Watch out when they both get ‘lit.’ Man, things really fly. We’ve had the cops out several times. I just take off when they start gettin’ into it. I started drinking and smoking when I was 13, in the eighth grade. It was a total drag, not that any of the other grades were any better, but all the kids were talking about high school and the classes they were going to take, and me, I was just trying to figure out were I was gonna get money for my next pack of cigarettes. Now I smoke about a pack a day, plus a couple of joints too. I have a cup of coffee in the morning before school and that’s it. At night I’ll drink 3 or 4 beers plus a few shots of vodka. On the weekends is when I really get down to partying. I’ve played around with lots of stuff. You know, trying to see what’s out there. I’ve tried pot, coke, mescaline, XTC, mushrooms. I’ve even shot up a few times. It’s no big deal. When I’m partying, I like to mix things up a bit. Maybe do some tequila and mushrooms, depends on what’s going on and who’s around. If I drink too much I black out. I’ve even OD’d a few times. But, hey, it wasn’t any big deal or nothing. I do like speed though. If any drug is my favorite, aside from cigarettes and coffee, it’d be ‘speed.’ I saw a doctor when I was eight. My folks took me. They said I was out of control. The doctor said I had attention deficit disorder and gave me Ritalin? . It helped a little, I guess. I don’t know much about it. Right now, except for partying, I don’t take any medication. Then there’s my brother, a complete math ‘geek’. Always gotten good grades, never been in trouble; responsible, dependable, healthy and clean. He’s a parent’s dream and I’m his evil twin brother.”

Questions for Forum 4: Adam

1. Based on the information Adam gave you, what other information would you need to determine his level of drug use?

2. Based on what Adam has told you, what screening method will you use? Where does he score on the screening method that you have chosen? Give the rationale for this score.

3. What in Adam’s family history might lead you to suspect that there may be a genetic component to his drug abuse problems and should be evaluated further? Is there a genetic correlation in substance use disorder? What does the literature state?

4. What does the term “dual diagnosis” mean? What in Adam’s medical history might lead you to suspect that he may have a dual diagnosis problem?

5. What environmental factors contribute to substance use disorders? What in Adam’s environment might lead you to believe that environmental factors may also play a role in his drug use?

6. What types of treatment plans and nursing interventions would work best for this adolescent patient? Please provide suggestions based on your literature review.