Alcohol addiction and other substance abuse

Scenario 1
Ritchie Metcalf is a 66-year-old Caucasian man whose wife has encouraged him to seek treatment. He has never been in therapy before and has no history of depression or anxiety. However, his alcohol use has recently been getting in the way of his marriage and interfering with his newly retired life. He describes drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. He notes that this amount “doesn’t give me the same buzz as it used to.” He denies ever experiencing “the shakes” or any other withdrawal symptoms if he skips a day of drinking.

Ritchie comments that his wife, Sandra, is his biggest motivation to decrease his alcohol use. She tells him that he gets argumentative and irritable when he drinks, although he usually does not remember these incidents. Twice, he has fallen while intoxicated, causing bruises both times and once hitting his head.

Questions
From your perspective as Ritchie’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.

What screening tool could you use for Ritchie?
What assessment questions would you ask regarding his alcohol use?
If Ritchie and Sandra want to use medication to help with alcohol cravings, what are his options? Create a table that compares and contrasts at least three medications for alcohol use and/or cravings. Choose one medication, explain why you recommend it for Ritchie, and list the prescribing information. Are there any special considerations in prescribing it for Ritchie?
Ritchie and Sandra are both interested in community support groups. Please list one community support group that Ritchie could attend in your area and one community support group for Sandra in your area.
What type of individual therapy would be appropriate for Ritchie?

Scenario 2
Tonnesha Arletten, a 15-year-old African American female, presents to your office with her mom and step-dad.

Mom reports, “Tonnesha here knows better, but she’s been smokin’ and I know it. I found two packs of cigarettes last week in her backpack. At first, she tried to deny they was hers, but I’ve also smelled it on her clothes lately and I finally got her to admit to it.”

Tonnesha shrugs. “Yeah, I’ve been havin’ Xaneya’s older brother buy them for me. I smoke mainly on the weekend and after school. I’ve been smoking since I was 11. It’s cool. I could stop if I wanted to.”

Mom breaks in, “But I don’t think she will without help. What about some patches or gum?”

In your initial post, address the following:

Would Tonnesha meet DSM-5 criteria for nicotine abuse, dependence, or misuse? Why? Use the DSM-5 to support your answer.
What treatments are there for nicotine addiction? What option would be most appropriate for Tonnesha, given her age and use?
To what extent do you think vaping/e-cigarettes will replace smoking, particularly for teens? (If you feel comfortable, you may also address vaping in your video.)

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