Emily is a 42-year-old Woman Local AOD Case Study

Assignment Task

Purpose

The purpose of this assessment is to determine students' knowledge on withdrawal management and to identify risks for a person living with a substance use disorder exiting residential treatment and to advise of harm minimisation and prevention strategies to reduce risks.

The Case study on Emily will be provided in Canvas Assessment 1 folder. The case study is modified from Marel et al. (2019, pp. 42, 161). In this assessment, you are required to consider Emily's case study and discuss withdrawal management as part of your alcohol and other drug assessment. Then in order to provide holistic healthcare, consider the physical, mental health and psychosocial-related problems which may affect Emily following successful detoxification and discharge from residential rehabilitation.

Case Study

Emily is a 42-year-old woman, presenting to her local AOD service for her tenth admission for inpatient detoxification/managed withdrawal from heroin, alcohol, and cannabis. Emily has been using heroin since she was 17 years old and has sometimes shared needles. Although heroin has always been her main drug of concern, Emily also drinks heavily and smokes cannabis daily, particularly on days when she cannot obtain heroin. She occasionally uses stimulant drugs but doesn't particularly like the effect.

In addition to her nine previous attempts at inpatient detoxification, Emily has been on a methadone program on three occasions. The first time, she stayed on methadone for 10 years before being imprisoned for her involvement in a break and enter. Emily stayed clean for the duration of her sentence, but returned to use soon after she was released. Emily had also tried going cold turkey, and detoxing by herself numerous times, with the help of non-prescribed benzodiazepines and buprenorphine - none of which were successful. Her longest period of abstinence since she started using was two years after the birth of her first child, who is now 16 years old. Emily has four children, ranging in age from 4-16 years, all of whom are in foster care. Emily relies on the Disability Support Pension to pay the rent on her Department of Housing flat, which she shares with her current boyfriend. There are occasional episodes of domestic violence from him towards her which she does not disclose. She has never been able to hold down a job for more than a few weeks because she often sleeps in and cannot get into a daily routine. 

Emily is highly motivated to stop using all drugs so that she may have more contact with her children and hopefully one day have them returned to her custody. Emily was coping with withdrawal relatively well until one night when a male client accidentally walked into her room in the detox unit when trying to find the bathroom. Emily was awoken by the feeling that someone was watching her and could hear heavy breathing. His shadowed appearance in the half-light caused her to become hysterical and she lashed out violently. Staff quickly arrived and calmed Emily and removed the male client who was swearing at her and calling her a 'crazy bitch'.
The following morning, the incident was reported during staff handover. The mental health nurse identified seeing Emily as a priority.

The mental health nurse told Emily that she had heard about what had happened the previous night and asked whether she was okay. Emily was still a little shaken but said that she was okay now, adding that she was just startled and probably overreacted. She explained that it had reminded her of a time when one of her previous boyfriends had come into their bedroom one night and started beating her. The mental health nurse asked whether she was hurt at the time, to which Emily replied that she was hospitalised and required surgery for internal injuries. Emily appeared reluctant to talk about it. She said that she tried not to think about it and avoided any possibility of running into him again by avoiding areas which he frequented. Despite her efforts to forget about it, she often has bad dreams, flashbacks to the incident, and trouble sleeping, which meant she sometimes needs to take large amounts of benzodiazepines to sleep. She used street benzodiazepines as she had found GPs were reluctant to prescribe them. She found her supplier rather intimidating but had no other source; occasionally he suggested that he could "introduce" her to some people who would pay her well for "services". While in rehab she had tried to block his number on her phone but he always seemed to use a different one and still got through to her. She thinks he has passed her number on to other people too as she does not recognise some of her missed callers. After this brief talk with Emily, the mental health nurse made a time to see her later in the day. During this session, the mental health nurse asked more questions about how Emily felt after she was beaten and how this had affected her. The mental health nurse assured her that she had done nothing to deserve being treated this way, and that her reactions were completely normal. Emily was shaking as she described the incident in more detail, and later confided that she was also sexually assaulted during this attack.

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