Steve is a 42 years old male who was brought into the mental health unit yesterday by the police after he physically threatened to hit his boss at work for firing him. For the last several months, Steve has been showing up late at work, unable to complete his allocated duties, has been involved in verbal altercations with his workmates and was observed to sneak in alcohol and drink it at lunch time. His boss warned him to seek help for his problems otherwise he will lose his job, however, Steve always denied having a drinking problem and eventually was fired from work. On admission assessment, Steve was irritable, argumentative, with slurred speech, poor judgement and his breath smelled of alcohol. Steve admits to consuming 3-4 drinks of alcohol every night when he finishes work. He states “it relaxes me and makes me feel good”. He states in the past two weeks since losing his job and after his wife and kids left him he has been drinking heavily usually “half a bottle of whisky every night”. In the past, his wife threatened to take the children and leave
him if he does not stop drinking, but she did not leave because she felt obliged to keep the family together. However, two weeks ago, she couldn?t cope anymore and decided to leave. She was scared for the safety of kids and for her life due to his increased anger outbursts and physical threats.
In taking Steve?s family history, he stated “I’m like dad, we both love alcohol and there is nothing wrong in that”. Upon further questioning, Steve reveals to you that his father used to shout and yell at him and witnessed him hitting his mother when he was drunk. Steve had a poor relationship with his father as a child, he always felt insecure, threatened and scared. He grew up with constant worry, feelings of worthlessness, fear and guilt. Steve revealed to you that he drinks alcohol to help him forget about his painful past and to cope with the stress he was having at work. He also tells you that he has been drinking heavily lately because he misses his wife and kids and he feels lonely and bored with his life. In carrying out a risk assessment, Steve expressed feelings of guilt, hopelessness and despair. He tells you “I am a failure and no good for anyone...I lost my wife, my kids and my job....I wish I were dead”. Steve is to be admitted as Mentally Disordered under the NSW Mental Health Act 2007 for a period of observation and assessment.
Using the Case Study, please answer the following:
1. Using the DSM-IV-R criteria for Substance Abuse provide evidence from the case study that indicates that STEVE meets the criteria for a Substance Abuse disorder
2. Investigate and outline the epidemiology of Alcohol use in Australia. Your answer needs to cover the following areas: prevalence/incidences, possible causes, hospitalisation rates & burden of disease.
3. Discuss the possible causes and psychodynamics behind the development of STEVE?s disorder.
4. STEVE is currently experiencing multiple Alcohol and Mental Health problems. In point form list three 3 MAJOR problems or risks related to the information provided in the case study.
5. Outline and describe three 3 nursing interventions in the management of each of the three 3 problems or risks you have identified in questions 4.
6. Provide a rationale for each of the nine 9 nursing interventions with reference to current
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