Follow-on Question: Have These Drugs Ever Been Used In Combination?

No, my client only used one pill of Adderall on a daily basis. However, she increased the dosage to two or three pills whenever she felt stressed out. But she never tried to use the medication in combination with alcohol, cocaine, or even Xanax. The insinuation of such combinations results in an accelerated and disruptive heartbeat. Thus, the implication of such combinations might have resulted in arrhythmia, and high blood pressure, which would have led to the induction of a heart attack or a stroke. It implies if a combination of drugs is applied, this would have led to the worsening of the situation of Zoe. However, all the proposition states how the consumption of drug should be monitored in order to have a check and balance on the health of the patient (Teter et al., 2006).

PSYC FPX 4300 Assessment 1 What’s Your Problem? (Diagnostic Assessment)

Medical Concerns

Zoe is taking Adderall pills daily and 2 to 3 pills when she feels more stressed. She’s completely addicted to it, and addiction is about not controlling and doing something very harmful. Substance use disorder is a problematic form where a person gets used to substance use. Addiction is generally linked with habitual nonmedical tone- administration of medicines. It’s generally outlined by characteristics of inebriation or by characteristics of retreat symptoms. Similar requirements can also be outlined in tours of the brain mechanisms they spark; most addicting medicines cause promotions in extracellular situations of the neurotransmitter dopamine. As a result of habitual input of addicting medicines, dopamine receptors publicized in the brain are dropped, thereby reducing interest in conditioning (Wise & Robble, 2020). The following effects are observed upon the addiction to Adderall.

• The induction of Adderall causes an increase in the concentration of norepinephrine and dopamine in the synaptic cleft, which results because of the inhibition of neurotransmitter reabsorption. 
• Increased intake of the drug causes stimulus to the sympathetic system, which induces an extensive fight-and-flight response in the body resulting in an increased heartbeat, dilated pupils, vasodilation, increased sweating, and activation of the nervous system. 
• The combination of the drug with alcohol produces a dehydration response with increased blood pressure, which can eventually lead to myocardial infarction. 
• Adderall addiction can cause permanent damage to the kidneys. The increased flow of blood leads to the hardening of the blood vessels present in the kidneys, which causes the hardening of kidneys to lead to loss of function. 
• The induction of a fight or flight response leads to a state of constant agitation which can result in anxiety and the development of other psychological disorders (Tardner, 2022). 
• Based on the ICD-10 code, this case can be ranked Z55.9, academic or educational problem disorder, and Z58 which involves the implication of problems related to the external environment of the individual (2023 ICD-10-CM Codes Z55-Z65: Persons with Potential Health Hazards Related to Socioeconomic and Psychosocial Circumstances, n.d.).
• According to the DSM-5-TR, the class of the drugs which are utilized for substance use disorder belong to class stimulants, implied to substance use disorder, and fall in the first criteria where the individual is subjected to large amounts of the substance irrespective of the results. Adderall addiction causes a severity of moderate level resulting in Substance-induced depressive disorders (Hartney, 2022). 

Past Treatment History

Zoe doesn’t have any previous medical records. She’s addicted to Adderall and only consulted to doctor after being forced into the treatment of the problem. The addiction was initiated as a result of her anxious state of mind. Being forced into treatment further triggered the condition, which led to her increased dosage of medication. However, she intends to work on the cause and get rid of the addiction pattern to enjoy a normal and healthy lifestyle.

Environmental Factors

Residence

Zoe is living with her parents and is provided with her room. However, she is facing a tough time with her friend circle, who are also addicted to Adderall. Moreover, her father being an alcoholic has induced this state of constant attentivity and anxiety in her life. The implication of Adderall has further supported the cause. Although the living conditions are bearable, she is worried about the funding of her college, for which she exerts constant pressure on herself for academic validation so that she might be able to receive funding for her future studies.   

Social support system

Zoe’s friends are also addicted to Adderall, and they share it. They are not about to support Zoe. The incidence of her friends being involved in her Adderall addiction makes her more susceptible to the addiction. Moreover, she has no sibling to rely on or communicate with to help her through the condition. Her parents are involved in their own problematic issues, which not only triggers her mental condition but also renders her hopeless of any support system from her parents.  

Family and Family History

Family History of Use

From the information provided, Zoe’s dad is an alcoholic, and her mother uses Xanax. Apart from that, no other addiction is present in their family. However, these could not be considered as driving factors as both drugs belong to different classes. But the insinuation that her father is an alcoholic states her inclination toward the utilization of Adderall as an addiction. The involvement of parents in addictive behaviors is passed down to the children, and they can rely upon even more dangerous substances. A similar pattern is depicted in the stated case, where the child observes the involvement of parents in the excessive use of substances to overcome their anxiety and problems. Zoe applies the same techniques where she consumes high dosages of Adderall in order to get rid of her anxiety. The history of family shows no connection to the implication of Adderall addiction in any of the generations; however, in the present case scenario, the external environment and the physical factors lead to an individual falling prey to the addiction (Alhammad et al., 2022). 

PSYC FPX 4300 Assessment 1 What’s Your Problem? (Diagnostic Assessment)

Family Mental Health History

The provided information states the diagnosis of anxiety for Zoe’s mother. She uses Xanax as a medication to get rid of her anxiety episodes. However, other than that, there is no history of substance abuse or mental health disorders observed in her family. In Zoe’s case, too, there is a clear indication of her coping mechanism being like that of her mother. Moreover, she follows the same example in order to deal with academic stress. 

Current Additional Status to Consider

Educational

Zoe is performing well in school. She is about to join the college. She has a dream of getting into Harvard for a better future. However, her grades come at the cost of her anxiety peeking through the conditions due to the peer pressure which is applied upon the students. Furthermore, she is looking forward to attaining funding for her college. All such factors contribute to her development of anxiety at a young age. A lot of children under academic stress fall prey to the development of addiction patterns. 

Financial

Zoe is not financially obliged to anyone and has no responsibilities. She works part-time at a café but only on her own. No such conditions have been implied by her parents. Her parents help her with every financial matter. She does not have to contribute to the bills and rent as everything is paid for by her parents. Thus, Zoe is not restrained by any sort of financial implications. 

Legal

No legal issues were subjected against Zoe in the past or in the present. 

Motivation for Treatment

As Zoe supposes that she’s okay, but she’s not. She is facing mental complaints. Zoe is depressed by her forthcoming future. She’s formerly doing good in grades, but she isn’t satisfied. It’s all due to an internal complaint because she’s addicted to it. There are two main reviews of DSM- 5, an increase in medicalize gets and a mood that isn’t considered extreme. Her mind isn’t in a condition where she takes effects normally. Zoe is also taking participation in volunteer activities. She wants to prove herself in this world. She’s also the first woman in the family who earned a degree. She most likely sees a doctor after the force of her parents. She thinks it’s okay with Adderall consumption, and she’s satisfied with it.

Clinical Assessment

Adderall is used for hyperactivity symptoms or impulse control. It can cause side effects, including hallucination, dizziness, weight loss, nausea, and stomach pain. Increased level use can cause low blood and efficacy of amphetamines. It can cause a diagnosis of ADHD (M Iqbal et al., 2020). Zoe is dependent on Adderall. She uses more substance quantity when she needs to feel more. Due to the cause of addiction, she experiences more cravings for substance use. In the view of ICD-10 internal diseases and as given in the script, it can be mood change, characteristic internal diseases, delusional complaints, and behavioral complaints due to the use of psychoactive substances. Also, from the view of DSM- 5, they can have different personality diseases. 

Level of Personality Functioning (LPF) represents the entry criterion of the Alternative Model for Personality Disorders (AMPD) in DSM-5. It’s defined as a dimensional general inflexibility criterion common to all personality diseases and conceptually independent of personality types, and it represents manner as identity and manner-direction and interpersonal as empathy and closeness functioning. (Sharp & Wall, 2021). Adderall is also used to counter depression. It is employed to treat issues connected to ADHD. The symptoms of depression can be seen by doctors because, in some cases, Adderall can show the worst reactions (Tardner, 2022). 

Also, the drug associated with addiction is hypothesized to follow a heuristic framework that involves three domains of dysfunction (pathologic habits, negative emotional states, and executive function. The subject of this study is neurochemical dysregulations which are examined in the withdrawal phase of addiction (Koob, 2020). 

Treatment Recommendation

First of all, it is important to motivate Zoe. She’s already good at studying and has clarity for the future. She is just depressed about her upcoming future. Drug users might choose from a variety of therapies. Detoxification is one of them. It is the process to detach the person with a substance use disorder. It removes toxins from the patient’s body, who’s extremely drugged and addicted to substance use (Erkekoglu & Ogawa, 2021). 

Counseling is another method to treat patients effectively through communication and psychological behavior. Behavior Change Counseling (BCC) is best for persons to consolidate any health-related problems through activities to know physical and mental health (Dragomir et al., 2019)

Ethical Consideration

Zoe is young enough to handle things, but the therapist mustn’t share any information regarding her. She has her family and friends, and without her consent, it is unethical to share information about her substance use. Respect for the person is important, and people have the right to decision-making. Ethics are considered important in scientific research. The nature of nursing is mostly focused on the caring, protecting, and advocacy role (Braun et al., 2020). 

Conclusion

It concludes Zoe is a 17-year-old girl suffering from a substance use problem. She’s depressed and under pressure. She’s performing well overall, but she is depressed about going to high school. She uses Adderall daily and 2 to 3 pills when she has to work hard under pressure. She needs a support system and detoxification to overcome her problem. She also needs motivation to perform more. 

PSYC FPX 4300 Assessment 1 What’s Your Problem? (Diagnostic Assessment)

References

2023 ICD-10-CM Codes Z55-Z65: Persons with potential health hazards related to socioeconomic and psychosocial circumstances. (n.d.). Www.icd10data.com. Retrieved January 26, 2023, from https://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z55-Z65

Alhammad, M., Aljedani, R., Alsaleh, M., Atyia, N., Alsmakh, M., Alfaraj, A., Alkhunaizi, A., Alwabari, J., & Alzaidi, M. (2022). Family, individual, and other risk factors contributing to risk of substance abuse in young adults: A narrative review. Cureus, 14(12). https://doi.org/10.7759/cureus.32316

Anonymous. (2020, October 27). Adderall. RxList; RxList. https://www.rxlist.com/adderall-drug.htm#interactions 

Braun, R., Ravn, T., & Frankus, E. (2020). What constitutes expertise in research ethics and integrity? Research Ethics, 174701611989840. https://doi.org/10.1177/1747016119898402 

Dragomir, A. I., Julien, C. A., Bacon, S. L., Boucher, V. G., & Lavoie, K. L. (2019). Training physicians in behavioural change counseling: A systematic review. Patient Education and Counseling, 102(1), 12–24. https://doi.org/10.1016/j.pec.2018.08.025 

Erkekoglu, P., & Ogawa, T. (2021). Medical Toxicology. In Google Books. BoD – Books on Demand. https://books.google.com.pk/books?hl=en&lr=&id=4mwtEAAAQBAJ&oi=fnd&pg=PA311&dq=detoxification+for+drug+addicts&ots=zyNcJi5dKa&sig=_Kp-J-nkclD2ul3n7vcjVQJJyxc&redir_esc=y#v=onepage&q=detoxification%20for%20drug%20addicts&f=false 

Hartney, E. (2022, August 25). DSM 5 Criteria for Substance Use Disorders. Verywell Mind; Verywellmind. https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926

M Iqbal, M., Joarder, A., & Iqbal, M. T. (2020). Adderall Abuse Among College Students. Journal of Anxiety & Depression, 3(1). https://doi.org/10.46527/2582-3264.121 

Tardner, P. (2022, April 5). Adderall and Depression. Https://Www.ijest.org/. https://www.ijest.org/nootropics/adderall-and-depression/ 

Teter, C. J., McCabe, S. E., LaGrange, K., Cranford, J. A., & Boyd, C. J. (2006). Illicit use of specific prescription stimulants among college students: Prevalence, motives, and routes of administration. Pharmacotherapy, 26(10), 1501–1510. https://doi.org/10.1592/phco.26.10.1501

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