Anne is a 32-year-old female who presented to care after a random drug screening at work was positive for cocaine

Anne is a 32-year-old female who presented to care after a random drug screening at work was positive for cocaine


Anne has a mild case of substance abuse. She is also working, her job requires full concentration, and she does not want to lose it. The PMHNP should advise Anne all the following as strategies for abstaining from cocaine, except:

In counseling patients with substance abuse disorders, behavioral strategies should always be discussed first. Substances of abuse may have a profound impact on mood and psychiatric symptomatology. Patients should cease use when the social, physical, and psychological strains of continued use begin to outweigh the immediate pleasures derived from their use. The PMHNP would only advise against offering one strategy over another if none are appropriate for the patient.

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The patient has difficulty with cocaine cessation because she does not want to stop using it. She admits that her use is an issue, but she does not believe there is any alternative to using the drug. Treating the patient for comorbid mental health disorders will likely improve her ability to cease cocaine use and may also prevent relapse. It is important to work with the patient to identify new coping skills that can help her deal with negative emotions or situations without using drugs.

Because drug testing is legal in the workplace and because of the known dangers of addiction, it is important to discuss this with your employer. As a PMHNP, you should advise Anne to speak up about her addiction. She needs to tell her employer about it for two reasons. First, she will need support from her employer; second, having an ally may help her keep her job if she decides to seek treatment rather than lose it.

The nurse practitioner (NP) advocates strongly, and advises the client to use all of the following methods, except:

STEP 1: Begin counseling Anne regarding the risks of continued use.

Encourage methadone maintenance or therapeutic doses of naltrexone, dispensed in an office setting.

2. Refer the patient to a self-help group (e.g., Narcotics Anonymous).

3. Obtain psychosocial testing to help identify potential stress factors and sources of conflict that might play a role in her cocaine use.

4. Consult with the patient’s primary care physician about fostering a closer working relationship with the patient to improve overall communication.

The nurse practitioner (NP) must keep the concepts of harm reduction and the stages of change in mind when working with this patient. Harm reduction involves abstinence, although it also includes reducing the harmful consequences of use and finding ways to postpone using drugs so that abstinence can be achieved. The NP recognizes that she is at risk for relapse because she has been abusing cocaine every day since her last evaluation.

Advise her to make a contract about drug use

Set a quit date; set a daily/weekly goal to get through the first few weeks without using; use nicotine replacement therapy; avoid people you know use and places where you used in the past; enroll in a self-help group such as Narcotics Anonymous

Recommendation to abstain from all drugs.


Anne is a 32-year-old female who presented to care after a random drug screening at work was positive for cocaine. She was initially resistant to therapy, maintaining that her use is not a problem and she could stop at any time. Upon further discussion in session, it appears that she uses cocaine every day at work, sometimes 2–3 times, other days more. She also uses it occasionally at home and most weekends. During her third session, she admitted that it is a financial burden, and she basically cannot afford any other form of recreation. She understands that if she uses again she will lose her job, and she admits that she loves her job and that cocaine is not worth losing it. When counseling her about cessation strategies, the PMHNP advises all the following except:

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