A male client admitted to psychiatric unit for treatment of substance abuse says to nurse, “It felt so wonderful to get high.” Which of following is most appropriate response?

Correct Answer: B. “You told me you got fired from your last job for missing too many days after taking drugs all night.”

Confronting the client with the consequences of substance abuse helps to break through denial. Present reality by spending time with the client to facilitate reality orientation because your physical presence is the reality. Be simple, direct, and concise when speaking to the client. Talk with the client about concrete or familiar things; avoid ideological or theoretical discussions. The client’’s ability to process abstractions or complexities is impaired.

• Option A: Making threats isn’t an effective way to promote self-disclosure or establish a rapport with the client. Motivational counseling works according to the idea that motivation for change is dynamic rather than static. Professional uses may influence change by developing a therapeutic relationship to increase therapeutic alliance, developing insight, and coping skills to resolve ambivalence, and change health-related behavior.
• Option C: Although the nurse should encourage the client to discuss feelings, the discussion should focus on how the client felt before, not during, an episode of substance abuse. Encouraging elaboration about his experience while getting high may reinforce the abusive behavior. Persons may withdraw from their environment with regressive behavior, fail to engage with others, or even notice physical illness and pain. Social exclusion and homelessness may ensue. In the longer term, psychosis and its potential disruption of the capacity to fulfill social roles can result in further burdens.
• Option D: The client undoubtedly is aware that drug use is illegal; a reminder to this effect is unlikely to alter behavior. Drug addiction exacerbates social alienation and increases potential for violent lashing out and low self-esteem, along with poor coping skills. Under these circumstances, emotional, social, or symptom-related cues can provoke recourse to available substances and suicidal ideation. They may also contribute to psychosocial instability, self-image issues, and achievement motivation. In some cases, social hostility and rejection may result.