Introduction to Case Study

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Key Words: Addiction, Adoption, Alcoholism, Back Injury, Central Nervous System, Divorce, Muscles, Muscular System, Opioid Addiction, Opioid Crisis, Skeletal System, Support Groups, Vertebrae

Discipline Breakdown

Meet Paul

• Born 1971 – affluent area of Toronto
• Had a nanny for his early years
• Boarding school
• Home for summer and school vacations
• One brother with Down syndrome

Paul’s Story Continues

• Large allowance
• Started drinking alcohol in his senior year
• Partied a lot and his grades suffered
• Finished high school
• Accepted to a university in Quebec
• Started using marijuana and hashish during his 2^nd year
• Cocaine and alcohol daily by 3^rd year
• 1993 - dropped out of university
• Parents sent him to rehabilitation centres a number of times
• Became estranged from his parents after failed rehab attempts

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Paul’s First Marriage

• 1999 – met his wife in a rehabilitation facility
• Understood each other
• Support for each other’s sobriety
• 2002 – they had adopted twin girls
• 2008 – his wife left him

“Wake-up call”

• 2009 – joined Narcotics Anonymous
• Remained estranged from his parents

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Paul’s Second Marriage

• 2010 – started dating Nancy
• Working for a construction company
• The physical work helped him stay “clean”
• 2012 – married a second time
• 2018 – work accident, fell 2 stories off scaffolding

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PART A: BACK INJURY�Paul’s Health

• 2018 – diagnosed with back ligament and muscle injury
• Three torn discs – one quite large
• Follow-up CT scan in 6 weeks
• Due to substance abuse history, prescribed muscle relaxant & NSAID
• Not receiving adequate pain management
• Tylenol #3 prescribed only when absolutely necessary
• Dispensing stipulation of 4 tablets each day

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Back Muscle Anatomy

Back Pain

When to see a doctor:

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Causes of Back Pain

• Muscle or ligament strain
• Bulging or ruptured discs (leaking)
• Arthritis
• Osteoporosis

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Which of these causes are associated with Paul’s case?

Risk Factors for Back Injury

• Age
• Lack of exercise
• Excessive weight
• Diseases
• Improper lifting
• Psychological conditions (depression & anxiety will increase risk)
• Smoking

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Which of these risk factors are associated with Paul’s case?

Prevention

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PART B: DRUG ADDICTION�Over The Next Few Years

• Paul was often agitated, sweating, complaining of back pain
• Self-medicating with alcohol and prescription drugs
• Long-term disability
• Return to work program
• Taking mother-in-law’s post-op medications
• Denied having a “pill problem”
• Stated he was feeling overwhelmed with everything going on in his life

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What is drug addiction?

• Repeated drug use can lead to brain changes & overwhelms receptors
• Provide a shortcut to the brain’s reward centre
• Naturally producing dopamine is reduced

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The Brain’s Reward System

Addictive drugs provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine

The hippocampus lays down memories of this rapid sense of satisfaction, and the amygdala creates a conditioned response to certain stimuli

The reward system may be more vulnerable

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Why?

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Substance Detection

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Medlab

Gas Chromatography

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N-propanol peak (internal standard)

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Ethanol peak (indicates ethanol is present in sample)

Medlab

Before Paul’s recent relapse, he worked odd jobs, but struggled to pay the bills and manage his cocaine habit. Paul’s parents wanted nothing to do with him. His first wife left him in 2008, taking their adopted twin girls with her. This seemed to be the wake-up call Paul needed to get his life in order. He joined Narcotics Anonymous in 2009. When Paul relapsed in 2018, Nancy called Paul’s old NA sponsor for suggestions on what to do. Paul was angry at the world, blaming everyone else for how his life turned out.

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Paul’s relapse

Overcoming his Drug Addiction

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Nursing

PART C: Cardiovascular Risk

• Paul overcame his drug addiction and faced challenges with chronic back pain

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• Understood the importance of health and scheduled a routine check-up as he approached middle age

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• Doctor inquired about prior opioid use and expressed concern about Paul's cardiovascular health

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• Highlighted potential increased cardiovascular disease (CVD) risk due to substance misuse history

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• Screening process revealed elevated CVD risk

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Risk Factors For CVD

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Physical Inactivity Relapse Related to Opioid Use and CVD

• Long-term opioid usage is linked to both anatomical and functional alterations in the brain

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• Patients with OUDs have benefited from supplementary physical activity programs.

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• Exercise acts initially as a factor of internal activation and self-regulation

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• For the maintenance of opioid use, exercise prescriptions are advised as an adjunct to traditional therapy

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Prevention

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