Training Title 82
Name: Lisa Tremblay
Gender: female
Age: 33 years old
T- 100.0 P- 108 R 20 180/110 Ht 5’6 Wt 146lbs
Background: Lisa is in a Naples, FL detox facility thinking about long term rehab. She is
considering treatment for her Hep C+ but needs to get clean first. She has been abusing opiates,
approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”),
and 1/2 gallon of vodka daily. She has past drug paraphernalia possession arrest. Her admission
labs. abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS
positive for opiates, THC. Positive for alcohol or other drugs. BAL .308; other labs within
normal ranges. She reports sexual abuse as child ages 6-9 perpetrator being her father who went
to prison for the abuse and drug charges. She is estranged from him. Mother lives in Maine, hx
of agoraphobia and benzodiazepine abuse. Older brother has not contact with family in last 10
years, hx of opioid use. Sleeps 5-6 hrs., appetite decreased, prefers to get high instead of eating.
Allergies: azithromycin
Symptom Media. (Producer). (2017). Training title 82 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-82

NRNP 6635 Case History Report – Week 8: Substance‑Related and Addictive Disorders
Training Title 82: Lisa Tremblay
1. Introduction
Patient: Lisa Tremblay, 33‑year‑old female.

Context: Case study from Symptom Media video (2017).

Clinical Focus: Substance‑related and addictive disorders, polysubstance abuse, medical comorbidities, trauma history.

Importance: Demonstrates the intersection of opioid, alcohol, and cannabis abuse with medical complications (Hepatitis C, abnormal liver function tests), trauma, and family psychiatric history.

2. Demographics and Background
Age: 33 years old.

Gender: Female.

Vitals: T 100.0 (febrile), P 108 (tachycardia), R 20, BP 180/110 (hypertensive crisis).

Height/Weight: 5’6”, 146 lbs (BMI ~23.6 → normal).

Residence: Naples, FL detox facility.

Medical History: Hepatitis C positive, considering treatment after sobriety.

Psychiatric History: No formal treatment reported, but extensive substance abuse.

Family Psychiatric/Substance Use History:

Father: sexual abuse perpetrator, imprisoned for abuse and drug charges.

Mother: agoraphobia, benzodiazepine abuse.

Brother: opioid use, estranged.

Social History: Estranged from father, limited family support.

Legal History: Arrest for drug paraphernalia possession.

Allergies: Azithromycin.

3. Substance Use Profile
Opioids: ~$100 daily use.

Alcohol: ½ gallon vodka daily; BAL 0.308 on admission (severe intoxication).

Cannabis: 1–2 times weekly, medical card.

Other Substances: UDS positive for opiates, THC, alcohol.

Pattern: Polysubstance abuse with preference for intoxication over eating or self‑care.

4. Medical Findings
Labs:

ALT 168, AST 200, ALK 250 → elevated liver enzymes.

Bilirubin 2.5 (elevated).

Albumin 3.0 (low).

GGT 59 (elevated).

BAL 0.308 (severe intoxication).

Interpretation:

Liver dysfunction consistent with alcohol abuse and Hepatitis C.

Risk of cirrhosis, hepatic encephalopathy.

Physical Symptoms: Decreased appetite, poor nutrition, sleep disturbance.

5. Psychosocial Stressors
Trauma History: Sexual abuse ages 6–9 by father.

Family Dysfunction: Parental psychiatric/substance issues, estranged brother.

Legal Issues: Arrest for drug paraphernalia.

Social Isolation: Limited support, estranged from family.

Occupational/Financial Stress: Likely financial strain due to daily opioid use.

6. Clinical Presentation (Substance Use Disorder Features)
Reported Symptoms:

Daily opioid and alcohol use.

Preference for intoxication over eating.

Sleep disturbance (5–6 hours).

Decreased appetite.

Behavioral Indicators:

Poor self‑care.

Legal issues.

Trauma history influencing coping.

Risk Factors:

Family history of substance use and psychiatric illness.

Trauma exposure.

Medical comorbidities.

7. Mental Status Examination (MSE)
Appearance: Likely disheveled, malnourished.

Behavior: Guarded, anxious, possibly irritable.

Speech: Normal rate/volume, may be slurred with intoxication.

Mood: Depressed, anxious.

Affect: Constricted, flat.

Thought Process: Logical but preoccupied with substances.

Thought Content: Focused on obtaining substances, trauma history.

Cognition: Alert, oriented ×3 but impaired judgment.

Insight/Judgment: Poor, prioritizes intoxication over health.

8. Differential Diagnosis
Alcohol Use Disorder (severe).

Opioid Use Disorder (severe).

Cannabis Use Disorder (mild).

PTSD: Trauma history, avoidance, hyperarousal.

Major Depressive Disorder: Decreased appetite, poor sleep, low mood.

Medical Causes: Hepatitis C, liver dysfunction.

9. Diagnostic Considerations (DSM‑5)
Substance Use Disorder Criteria:

Impaired control.

Social impairment.

Risky use.

Pharmacological criteria (tolerance, withdrawal).

Lisa’s Case:

Meets criteria for severe alcohol and opioid use disorder.

Cannabis use disorder possible but less severe.

PTSD and depression comorbidities likely.

10. Assessment Tools
AUDIT: Alcohol use severity.

DAST‑10: Drug abuse screening.

CAGE Questionnaire: Alcohol dependence.

PCL‑5: PTSD screening.

PHQ‑9: Depression screening.

Liver Function Tests: Monitor medical comorbidity.

11. Treatment Plan
Pharmacological:

Detoxification:

Benzodiazepines for alcohol withdrawal (CIWA protocol).

Methadone or buprenorphine for opioid withdrawal.

Hepatitis C treatment after sobriety.

Nutritional supplementation (thiamine, folate).

Psychotherapy:

Trauma‑focused CBT.

Motivational interviewing.

Relapse prevention therapy.

Group therapy (12‑step programs).

Lifestyle Interventions:

Structured routine.

Sleep hygiene.

Nutrition counseling.

Exercise.

Supportive Measures:

Family therapy (if possible).

Case management.

Community support services.

12. Monitoring and Follow‑Up
Regular psychiatric visits.

Medication monitoring (side effects, adherence).

Liver function monitoring.

Suicide risk reassessment.

Collaboration with primary care and hepatology.

13. Challenges
Polysubstance Abuse: Multiple substances complicate detox.

Medical Comorbidity: Hepatitis C, liver dysfunction.

Trauma History: Sexual abuse, unresolved PTSD.

Family Dysfunction: Limited support.

Legal Issues: Past arrest.

Stigma: Mental health and substance use stigma.

14. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.

Consent: Informed consent for treatment.

Safety: Suicide and overdose risk management.

Cultural Sensitivity: Address stigma, respect autonomy.

15. Case Summary
Lisa Tremblay: 33‑year‑old female with severe alcohol and opioid use disorder, mild cannabis use, trauma history, and medical comorbidities.

Likely Diagnosis: Severe polysubstance use disorder with comorbid PTSD and depression.

Treatment: Detoxification, pharmacological support, psychotherapy, lifestyle interventions, supportive care.

Outcome Goal: Sobriety, improved functioning, prevention of relapse, treatment of Hepatitis C, improved quality of life.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Lisa’s age? a) 31 b) 33 c) 35 d) 37

Where is Lisa receiving detox treatment? a) Miami, FL b) Naples, FL c) Orlando, FL d) Tampa, FL

What chronic medical condition does Lisa have? a) Diabetes b) Hepatitis C c) Asthma d) Hypertension

How much vodka does Lisa consume daily? a) 1 pint b) ½ gallon c) 1 gallon d) 2 liters

What is Lisa’s BAL on admission? a) 0.108 b) 0.208 c) 0.308 d) 0.408

What substance does Lisa spend ~$100 daily on? a) Cannabis b) Opioids c) Cocaine d) Benzodiazepines

What family history is relevant? a) Father with sexual abuse and drug charges b) Mother with agoraph