422 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
ily life, although this is not always the case. They gen-
erally describe some crisis that precipitated entry
into treatment such as physical problems or develop-
ment of withdrawal symptoms while being treated for
another condition. Usually other people such as an
employer threatening loss of a job or a spouse or part-
ner threatening loss of a relationship, are involved in
a client’s decision to seek treatment. Rarely do clients
decide to seek treatment independently with no out-
side influence.
GENERAL APPEARANCE AND
MOTOR BEHAVIOR
Assessment of general appearance and behavior usu-
ally reveals appearance and speech to be normal.
Clients may appear anxious, tired, and disheveled if
they have just completed a difficult course of detoxifi-
cation. Depending on their overall health status and
any health problems resulting from substance use,
clients may appear physically ill. Most clients are
somewhat apprehensive about treatment, may resent
being in treatment, or feel pressured by others to be
there. This may be the first time in a long time that
clients have had to deal with any difficulty without
the help of a psychoactive substance.
MOOD AND AFFECT
Wide ranges of mood and affect are possible. Some
clients are sad and tearful, expressing guilt and re-
morse for their behavior and circumstances. Others
may be angry and sarcastic or quiet and sullen, un-
willing to talk to the nurse. Irritability is common be-
cause clients are newly free of substances. Clients
may be pleasant and seemingly happy, appearing
unaffected by the situation especially if they are still
in denial about the substance use.THOUGHT PROCESS AND CONTENT
During assessment of thought process and content,
clients are likely to minimize their substance use,
blame others for their problems, and rationalize their
behavior. They may think they cannot survive with-
out the substance or may express no desire to do so.
They may focus their attention on finances, legal is-
sues, or employment problems as the main source
of difficulty, rather than their substance use. They
may believe that they can quit “on their own” if theySam, age 38, is married with two children. Sam’s father
was an alcoholic, and his childhood was chaotic. His fa-
ther was seldom around for Sam’s school activities or
family events, and when he was present, his drunken
behavior spoiled the occasion. When Sam graduated
from high school and left home, he vowed he would
never be like his father.
Initially Sam had many hopes and dreams about be-
coming an architect and raising a family with love and
affection, and he pictured himself as a devoted and lov-
ing spouse. But he’d had some bad luck. He got into
trouble for underage drinking in college, and his grades
slipped because he missed classes after celebrating withCLINICALVIGNETTE: ALCOHOLISM
his friends. Sam believes life has treated him unfairly—
after all, he only has a few beers with friends to relax.
Sometimes he overdoes it and he drinks more than he
intended—but doesn’t everybody? Sam’s big plans for
the future are on hold.
Today Sam’s boss told him he would be fired if he
was late or absent from work in the next 30 days. Sam
tells himself that the boss is being unreasonable; after
all, Sam is an excellent worker, when he’s there. The last
straw was when Sam’s wife told him she was tired of his
drinking and irresponsible behavior. She threatened to
leave if Sam did not stop drinking. Her parting words
were, “You’re just like your father!”◗ SYMPTOMS OFSUBSTANCEABUSE
- Denial of problems
- Minimizes use of substance
- Rationalization
- Blaming others for problems
- Anxiety
- Irritability
- Impulsivity
- Feelings of guilt and sadness or anger and
resentment - Poor judgment
- Limited insight
- Low self-esteem
- Ineffective coping strategies
- Difficulty expressing genuine feelings
- Impaired role performance
- Strained interpersonal relationships
- Physical problems such as sleep disturbances
and inadequate nutrition