Patients With Substance-Related and Addictive Disorders

WK8 Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders


DSM-V Substance Abuse Disorders Diagnosis Video


NOTE: The following is a link for the main video for this assignment. Incase you are unable to open it, I included the Abstract and the transcript for your understanding of the video content. Thanks


Substance Use Assessment A-1 video link: Use



Upon questioning, Chris admits to having had suicidal thoughts as a result of his addiction to Heroin. In his answers, we learn that he has been using since he was a child and became homeless after his parents kicked him out of their home. He was recently released from prison, having been incarcerated for stealing in order to pay for his drug use. After relapsing and nearly overdosing, he would like to receive help.

Release Date



16 minutes





00:00:15SymptomMedia Substance Use Assessment A-1

00:00:30OFF CAMERA What type of substances do you use?

00:00:35CHRIS Um, I’ve pretty much used them all, but my drug of choice would be heroin.

00:00:45OFF CAMERA How many days per week or month do you use heroin?

00:00:50CHRIS Um, well, it depends how much cash I have, but if I have enough, probably like, um, four to five times a day, if I could. I’m, I’m trying not to do, to do so much anymore.

00:01:15OFF CAMERA How much of your preferred substance do you average using and how often?

00:01:25CHRIS Um, I’ve been, I’ve been clean for the last six months and, and it’s just in the last week or so that I’ve fallen back. Um, (clears throat) before that it was a lot. Um, but this week it’s been probably like once or twice a day.

00:01:50OFF CAMERA What is the lowest amount you use in a setting and how often?

00:02:00CHRIS Um, it depends. It really depends on who I’m with and if I have to see my family that day.

00:02:10OFF CAMERA What is the highest amount you use in a setting and how often?

00:02:15CHRIS Like, when Jimmy’s around I’ve used a lot. Um, I don’t really measure it out. When he’s around he’ll just give it to me. He gave me 10 hits of brown the other day.

00:02:30OFF CAMERA Can you estimate how much money you spend on, per week or month, using, to buy heroin?

00:02:40CHRIS All the money I have. I don’t have that much. Probably like $500 a week.

00:02:55OFF CAMERA How often do you become intoxicated or markedly high or stoned or altered?

00:03:00CHRIS Every chance I get.

00:03:05OFF CAMERA How often do you have blackouts, which is not remembering due to a substance?

00:03:15CHRIS Not so much anymore. I used to have more but I don’t remember the last time that I did.

00:03:20OFF CAMERA How often do you pass out or become unconscious due to a substance?

00:03:30CHRIS Um, not very often.

00:03:35OFF CAMERA How often do you use a substance and drive while under the influence?

00:03:45CHRIS Uh, I don’t have a car anymore but when I did, pretty much every time I was high.

00:03:55OFF CAMERA How often do you ride in cars driven by someone who is under the influence?

00:04:00CHRIS A decent amount, I would say. Yeah, if I’m trying to get around. If I’m with Jimmy or Marcus, they’re usually always high and I know, I know that’s bad.

00:04:15OFF CAMERA Has anything bad happened to you while you were having any blackouts or were passed out due to heroin?

00:04:25CHRIS Yeah, I got, I got busted for robbing a neighbor’s house and I was high as a kite. That, that was really bad.

00:04:40OFF CAMERA Can you describe any aggression, neglect, or bad behaviors that you remember doing while, while, um, using a substance? Or being influenced over one?

00:04:55CHRIS I get – if I haven’t done it in a while, um, I start to get really sick and that’s when I get angry. Um, I’ve definitely lashed out at my, my family before, my mom and dad, um, and it gets kind of bad sometimes.

00:05:20OFF CAMERA Can you describe any aggression, neglect, or bad behaviors that other people reported to you that you did but you do not remember doing due to a substance?

00:05:35CHRIS I, uh, my, my son, Jamie, got taken away from me. Um, my mom had, had to call the police because I was high and I don’t remember.

00:05:55OFF CAMERA Can you describe any sexual events you participated in which you would not have participated in if you had not been using a substance?


00:06:10CHRIS I don’t really want to talk about that.

00:06:10OFF CAMERA Mm hmm, that’s okay. Can you describe your feelings after the event?

00:06:25CHRIS Sick, I, uh, I felt empty first and then as I slowly, as I remembered more I, I, I didn’t like the person that I was.

00:06:45OFF CAMERA Do you have any substance related legal charges?

00:06:50CHRIS I, uh, I’ve been to jail five times and I’m still paying for it. Every cent I don’t use to get high, I, uh, my family has to pay for it. I have to pay for it, it’s never ending.

00:07:10OFF CAMERA How has substances impacted your health, including sleep and appetite?

00:07:20CHRIS I don’t really do either of much, much of either. I, I, uh, I spend money to get high so I, I’ll take food if it’s given to me but I don’t really go out and buy anything. And, in terms of sleep, um, I don’t sleep well.

00:07:50OFF CAMERA How has the substance, how has substances impacted your relationships?

00:08:00CHRIS It’s pretty much ruined all of my relationships. My family, my son, I pretty much only have Marcus and Jimmy, and they’re fucking … They’re not good for me.

00:08:20OFF CAMERA How has substances impacted your school work or work or social life?

00:08:30CHRIS I didn’t make it to the end of high school. So, there’s that. And can’t get a fucking job, not with a record.

00:08:45OFF CAMERA Um, and social life?

00:08:50CHRIS My social life is fucking Jimmy. I go with him. I go wherever he’s going. I try to see my family. They shut me out. They won’t, they don’t want to see me anymore.

00:09:05OFF CAMERA Do you, or did you, have relatives who used the same substance or different substances?

00:09:15CHRIS No.

00:09:20OFF CAMERA In childhood, did your role models avoid substances or use substances? And what did you learn from your role models?

00:09:30CHRIS (sighs) My friend Shawn was the one who got me into it and, um, we were, we were always trying to, to pal around with his older brother and he, uh, his older brother was the one who would score it and give it to us. I didn’t have very many friends and so I kind of just went with the flow.

00:09:55OFF CAMERA Can you describe any self harm or suicidal actions you took related to substance abuse?

00:10:00CHRIS That’s why I’m here. I was ready to kill myself. I took fucking 24 milligrams of Subutex so that I wouldn’t feel it.


00:10:25OFF CAMERA Can you describe accomplishments in life you would have made or, um, if, if you had not used substances to the extent that you have?

00:10:35CHRIS When I look at Shawn, who fucking got me into it and he went to rehab and to college and is probably married, a couple of kids, it could have been me. He has money and I don’t. So, there’s a lot of could’ve, would’ve, should’ves.


00:11:15OFF CAMERA What have you attempted to limit or stop your substance use?

00:11:25CHRIS I’m trying to do that right now. That’s why I’m here and, like I said, I was in County for six months. And I had to be clean and it was going really well. And I thought it would stick and I just couldn’t. But I’m trying.

00:11:50OFF CAMERA What have you learned about the medical and psychological causes of your substance use and what do you plan to do about the causes?

00:12:00CHRIS I’ve fucking, I’ve heard all of that shit. I, I know, and it’s, people think that if they tell you to change, but it’s not as black and white as that. You can’t just do it. And I know it’s bad and I really want to change that, but I can only do so much, I don’t know how.

00:12:30OFF CAMERA What do you want your family, friends, co-workers, and other people to know about your substance use?


00:12:40CHRIS That I’m sorry, especially my mom. That I love them and I know what I’ve done to them and it kills me.

00:12:55OFF CAMERA Who are people who will support you in limiting or stopping substance use?

00:13:05CHRIS Fucking Jimmy. It’s always Jimmy.

00:13:15OFF CAMERA Who are people who will try to keep you using substances? Can you describe any solutions to that?


00:13:30CHRIS Jimmy’s the one who will keep me from doing it. And, and I mean I know, I don’t even, I don’t even want to hang out with him anymore but he, I don’t know. I don’t have any money or any place to go and he, he helps me out, so it’s hard.

00:13:50OFF CAMERA Can you describe which bad experiences from substance use will motivate you to continue medications or treatment and limit or stop your substance abuse?

00:14:00CHRIS Well there, there have been a couple. Having Jamie taken away was a big one. But then the, I, I stole my mom’s earrings and I sold those and I remember when she got them. They were a gift from my dad and she loved them. She wore them every single day and I always remember her and those earrings and I stole them. I pawned them and they didn’t even get me anything, but I don’t know if she’d forgive me for that.

00:15:05OFF CAMERA What do you hope your substance use will be like a year from now?

00:15:10CHRIS I hope it’s gone. I hope that, that there’s a reunion with my family and that I’m out of it.



Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

An important consideration when working with patients is their cultural background. Understanding an individual’s culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations.

For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.

To Prepare:

  • Review this week’s Learning Resources and consider the insights they provide.
  • Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
  • By Day 1 of this week, you will be assigned to a specific video case study for this Assignment. View your assigned video case, keeping the requirements of the documentation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 8

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment?
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).


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