• Category:
  • Document type:
    Case Study
  • Level:
  • Page:
  • Words:


Q1. DSM-IV TR criteria of Substance Abuse;

  • Failure to meet certain requirements at work due to substance abuse, Mr. Harry has been reporting late in his working place. Of late his boss has even threatened to fire him due to his inability to his execute duties as required (Ali, Miller & Cormack, 2011).

  • Regular use of substances in such a way that is physically harmful, when his friends take him to the hospital they stated that Mr Harry has not been himself over the past six weeks. He has increased his use of alcohol and drugs as he smokes 30 cones of cannabis daily and drinks 2-3 Bundaberg rums (Gracey, 2009).

  • He has had frequent legal issues as he reveals that he has been to juvenile detention for a period of 6 months and he was charged with assault and damaging the property

  • He frequently uses substances regardless of having periodic social problems with his friends. Mr Harry was involved in a fight and argument with a fellow patron while they had gone drinking with his friends and injured his forearm in the process.

Q2. Epidemiology

Recent research in Australia has indicated that, cannabis use has remained irregular and experimental (Watson, Fleming & Alexander 2010). It’s mostly used by a portion of population that is in its mid and late teens. In 2010, 25% of Australians were reported to use cannabis weekly, further 19% reported daily use of the drug. According to latest survey, the data reveals that nearly one tenth out of one third of cannabis users who used it at the age of twenty continue to do it in their late thirties. Nonetheless, most young people reported patterns of use that were really harmful to their health due to regular use and dependence. However, cannabis use has been associated with a number of risks which includes; impaired mental health, low levels of academic achievement among the students, high rise of criminal offences, delinquency as well as chancy sexual behaviours. According to the study, users who were identified having diverse symptoms due to dependency on cannabis were not fully diagnosed for these disorders.

Q3. Factors behind the development of Harry’s substance use disorder

Recent research in Australia showed that stress was one of the factors that contributed to substance abuse (Watson, Fleming & Alexander, 2010). Going by the challenges Mr. Harry has faced ranging from being abandoned by his father and later his girlfriend may explain his development in substance use disorder. He described existence of a poor relationship between him and his father who later left them alone with his mother at the age of 14.He further states that he was so scared of their father as he used to mistreat his mother a lot. This is supported by a study conducted in 2010 in Australia that showed that depression was more likely among the divorced and the separated. These groups of people were more involved in cannabis use as compared to those who were in stable marriages.

This is supported by the study conducted in 2010 and data obtained from the Australian Household Surveys between the years 2003-2009 also suggested that lifetime use of cannabis and alcohol were more prevalent to the divorced or separated as well as those who never had children. Unemployed people and orphans also tend to follow suit as seen in Mr Harry’s experience where he was basically raised by her mother after being abandoned by their father.

  • Peer Influence

While defending his substance use disorders, Harry puts it that his friends also smoke 30 cones of cannabis daily and drinks 2-3 Bundaberg rums and he has never seen anything wrong with them. He states that he has increased his substance usage for the past 6weeks. Basing on the survey conducted in 2010, it was evident that those who used prescribed drugs or medicines in greater amounts than required or extend the prescribed usage were more likely to succumb to substance use disorders (Agrawal & Lynskey, 2009). Those reported taking overdose for a number of times extending five in the previous 12 months, or took up to drinking 12 drinks in overall, accompanied by more than three drinks per any given occasion in the previous year. It was evident that the requirement of occasions exceeding five was adequate for development of substance use disorder. However, it was argued that for those who used drugs less than five times the risk was minimal.

Q4. Major problems or risks associated with substance abuse.

  • Delinquency

This can be described as criminal behaviour especially among young people. Mr Harry admits that at the age of 15 he was sent to juvenile detention. This was due substance abuse where he could not control his behaviours. The reason for his detention was assault and damage of property (ADF, 2009).

  • Depression

Mr Harry broke with his girlfriend at the age of 16 and the moment he is intoxicated he keeps on ringing her all hours of day and night. His reason for substance abuse is that it makes him forget and states that his life is out of control.

  • Criminal offending

Mr Harry was involved in a fight and argument with a fellow patron while they had gone drinking with his friends and injured his forearm in the process.

Q5. Nursing interventions for problem or risk identified above.

  • Delinquency

Nursing intervention can be defined as an action taken by a single in nurse. It may involve procedure or activity aimed at achieving a desired outcome regarding a certain diagnosis or medical care for which an individual nurse is liable (Dennis, et al.2009). In case of delinquency the nurse may intervene by counselling, Patient advocacy and administration of medication, the three interventions may be useful in solving Mr Harry’s substance use disorder given that he was not so much into drugs when he was 15.The nurse may undertake to provide counselling and educate Mr Harry on dangers of drug abuse. If the situation is critical the nurse may administer some medication to him.

  • Depression

Three nursing interventions in case of depression could assessment, diagnosis and outcome identification. During the assessment of substance use disorder the nurse would look for signs and symptoms (Hall & Pacula, 2011). Seek to know the cause of stress in Mr Harry’s case study such as family and relationship problems. Having identified the underlying factors coupled with signs and symptoms he can diagnose the disorder and monitor the outcome to Mr Harry’s case and his response to the disorder.

  • Criminal offending

Mr Harry was involved in a fight and argument with a fellow patron while they had gone drinking with his friends and injured his forearm in the process. He was taken to hospital by the police. The nursing interventions could be identified as planning, evaluation and implementation. The nurse undertakes to evaluate the extent to which the patient has been using drugs so as to determine the associated substance use disorder ((Drake & Shaner, 2010). Once the evaluation is done, the nurse undertakes planning on how to deal with that disorder and implements his/her plans.

Q6. Rationale for each nursing intervention related to the identified problems

  • Assessment-

The rationale of assessment is for the nurse to determine and get to know what the root cause of a problem is. For instance, he would wish to ascertain the reason as to why Mr. Harry has increased substance usage for the past 6 weeks (Hall, 2011).

  • Diagnosis

The rational for diagnosis is to help the patient recover quickly from substance use disorder. For example the nurse may prescribe certain drugs to Mr. Harry to ease the depression.

  • Outcome Identification

After prescription of drugs to enable Mr. Harry recover from substance use disorder the nurse may seek to know the effects of drugs. That is, whether they are helpful to him by identifying the outcome.

  • Planning

After assessment of Mr. Harry substance use disorder such impaired mental health the nurse may undertake to plan the best course of action to help Mr. Harry.

  • Implementation

For instance, when the nurse comes up with an intervention plan to diagnose a disorder such as depression, there must be implementation to ensure the working of the plan.

  • Evaluation

When the patient with substance disorder such as depression is brought to the hospital the nurse need to evaluate the extent to which the problem has affected the patient.

  • Counselling

The nurse may also intervene by counselling a patient with substance use disorder. For instance in case of delinquency the nurse may create awareness of rowdy behaviours brought about by use of drugs.

  • Patient advocacy

The nurse may undertake to sensitize Mr Harry about the dangers of alcohol and cannabis abuse and the possible harmful effects to his health.

  • Administration of medication

In case the side effects may interfere with the general health of the patient, the nurse may intervene by administering some medication to the patient. For example, in case of injury like Mr Harry’s forearm injury.


Alcohol and Drug Foundation (ADF; 2009). Women and substance use: An Australian

literature review and annotated bibliography. South Melbourne, Victoria: Alcohol and Drug


Ali, R., Miller, M. & Cormack, S. (2011). Future directions for alcohol and other drug

treatment in Australia. NCADA Monograph Series No. 17. Canberra: AGPS

Agrawal, A., & Lynskey, M.T. (2009). The genetic epidemiology of cannabis use, abuse and dependence. Addiction, 12, 801–812.

Dennis, M., Godley, S.H., Diamond, G., Tims, F.M., Babor, T.,Donaldson, J. et al. (2009). The Cannabis Youth Treatment (CYT) study: Main findings from two randomized trials.

Journal of Substance Abuse Treatment, 7, 197–213.

Drake, R., Essock, S., & Shaner, A. (2010). Implementing dual diagnosis services for clients with severe mental illness.Psychiatric Services, 2, 469–476.

Gracey, M. (2009). Substance misuse in Indigenous Australian Australia. Addiction Biology,

1, 355-362

Hall, W. (2011) .The public health implications of cannabis use, Australian Journal

of Public Health, 19, 235–242.

Hall, W., & Pacula, R.L. (2011). Cannabis use and dependence: Public health and public policy. Cambridge: Cambridge University Press.

National Council of State Boards of Nursing (2011). Clinical instruction in PrelicensureNursing Programs. Retrieved August 18, 2012, from

Watson C., Fleming J., Alexander K. (2010), A Survey of Drug Use Patterns in Northern Territory Aboriginal Communities: 2003–2009. Northern Territory Department of Health and Community Services, Darwin.