Harriet is a 51-year-old married woman with a past history of alcohol and cocaine abuse. She has been attending AA and NA meetings regularly and does not report urges to drink or use drugs during the 4 years you have been her psychiatric mental health nurse practitioner. She needs carpal tunnel surgery and the typical regimen during recovery is oxycodone 15 mg per day.
What information would be most critical for the group leader to collect in the first visit?
What is the primary goal for the treatment of this patient’s family problem, based on the US clinical guidelines?
Discuss one curative factor the group would observe during the initial, middle and termination phases in group therapy?
Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?
At least 500 words. Minimum of 2 APA citations from last 5 years.
### Managing Substance Use Disorder in a Patient Needing Pain Management: A Case Study
#### Introduction
Harriet, a 51-year-old woman with a history of alcohol and cocaine abuse, is seeking support in preparation for carpal tunnel surgery. She has been attending Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings regularly and has remained abstinent for the past four years. The proposed postoperative regimen includes oxycodone, a potent opioid with a high risk of addiction. This presents a unique challenge for her psychiatric mental health nurse practitioner (PMHNP) in balancing effective pain management with the risk of relapse.
#### Critical Information for the Group Leader
During the first visit, the most critical information for the group leader to collect includes:
1. **History of Substance Use and Relapse Triggers:**
– Detailed history of alcohol and cocaine use.
– Specific triggers and situations that previously led to substance use or relapse.
– Previous strategies that have been effective in managing cravings and preventing relapse.
2. **Current Support System:**
– Involvement in AA and NA, including the frequency of meetings attended.
– Support from family and friends.
– Availability of a sponsor or a close contact within the AA/NA community.
3. **Pain Management Concerns:**
– Previous experiences with pain management, especially using opioids.
– Current pain levels and non-opioid pain management strategies tried.
4. **Mental Health Status:**
– Current mental health condition, including any co-occurring disorders such as depression or anxiety.
– Any current psychiatric medications and their effectiveness.
#### Primary Goal for Treatment
The primary goal for the treatment of Harriet’s family problem, based on US clinical guidelines, is to **prevent relapse while managing her postoperative pain effectively**. This involves creating a comprehensive pain management plan that minimizes the use of opioids and includes close monitoring and support. It is crucial to address both the physical aspect of her pain and the psychological risk factors associated with her history of substance use.
#### Curative Factors in Group Therapy
Group therapy can be highly beneficial in this context. One curative factor observed during different phases of group therapy are:
1. **Initial Phase – Universality:**
– In the initial phase, Harriet would benefit from understanding that she is not alone in her struggles. Universality helps in reducing feelings of isolation as she connects with others who have similar experiences.
2. **Middle Phase – Cohesion:**
– During the middle phase, the development of group cohesion will be crucial. This sense of belonging and trust within the group can provide Harriet with the necessary support to manage her pain and anxiety about relapse.
3. **Termination Phase – Altruism:**
– In the termination phase, Harriet might experience altruism. Sharing her journey and strategies for managing pain without relapse can empower her and provide hope and practical advice to other group members.
#### Referrals to Local Agencies
Based on Harriet’s needs, here are three agencies in [Your City] that would support positive health outcomes:
1. **[City] Pain Management Clinic:**
– **Rationale:** Specializes in non-opioid pain management techniques. Provides multidisciplinary approaches including physical therapy, acupuncture, and cognitive-behavioral therapy for pain management.
2. **[City] Substance Use Disorder Treatment Center:**
– **Rationale:** Offers comprehensive support for individuals with a history of substance abuse. Provides relapse prevention programs, individual counseling, and group therapy sessions specifically tailored for patients at risk of relapse due to medical treatments.
3. **[City] Mental Health Services:**
– **Rationale:** Focuses on integrated mental health services. Can provide psychiatric evaluations, ongoing therapy, and support groups that can help address the mental health aspects of Harriet’s condition.
#### Conclusion
Harriet’s case highlights the importance of a comprehensive approach to pain management for individuals with a history of substance use disorder. By collecting detailed information on her history and support system, setting clear treatment goals, leveraging group therapy, and referring her to specialized local agencies, her PMHNP can help ensure effective pain management while minimizing the risk of relapse.
#### References
1. American Psychiatric Association. (2021). **Practice guideline for the pharmacological treatment of patients with alcohol use disorder.** American Journal of Psychiatry.
2. Centers for Disease Control and Prevention (CDC). (2022). **Guideline for Prescribing Opioids for Chronic Pain.**
[Your City], [State].
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