Running Head: CASE STUDY 1

Case Study: Born into Addiction and Depression

Jamie Giambattista

Youngstown State University

NURS 4842: Mental Health Nursing

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Abstract:

“Addiction is an issue across the entire lifespan, beginning with babies who are born

addicted, either exhibiting neonatal abstinence syndrome (NAS) produced by prenatal exposure

to opioids in utero or fetal alcohol syndrome (FAS) produced by prenatal exposure to alcohol

(Cleary, 2017, p. 2). In patient R.G.’s case, her life of addiction and depression started as a

consequence of her mother’s decision to use and abuse methamphetamine throughout her entire

pregnancy. R.G. was born addicted to METH; the umbilical cord was cut the withdrawal

symptoms began. R.G. suffered through NAS in a neonatal intensive care unit, without the

support of anyone but staff at the bedside. Her biological mother was arrested; R.G. was taken

and set up for foster care.

The suffering goes beyond the NAS, however. R.G. grew up with many different

repercussions, including neurological, musculoskeletal, and cognitive impairment she would

soon learn would be permanent. The issues did not stop there. “As children and adolescents,

both syndromes (NAS and FAS) have higher rates of mental health disorders” (Cleary, 2017, p.

2). As a young teen, R.G. was diagnosed with major depression and Post-Traumatic Stress

Disorder (PTSD), all linked to her traumatic birth and childhood experiences to be discussed in

this paper.

R.G. did not choose this life of addiction. Although clean for her entire life post-birth,

every day she must fight the urge to regress. Even though never having tried it by choice, R.G.

developed a “permanent sweet tooth” due to this very early fetal exposure of methamphetamine.

This is just the beginning of R.G.’s physical and mental struggles. This case study will highlight

all diagnosed psychiatric illnesses R.G. must cope with daily, social situations that have only

added to her depression and PTSD, possible nursing diagnoses/interventions, and more.
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Patient Background Summary:

Patient R.G. is a 36-year-old female who was admitted to St. Elizabeth’s Downtown

Psychiatric Unit on March 6, 2019, with a diagnosis of depression with suicidal ideation. Earlier

that day, she confirmed thoughts of suicide as well as a plan and means to carry it out. She

stated she had a whole bottle of Dilantin she planned on using. Patient did not end up following

through, but instead admitted herself to St. Joseph’s Hospital on March 5, 2019, where she was

held overnight and then transferred to St. Elizabeth’s the following day. R.G. has a chronic

history of Post-Traumatic Stress Disorder (PTSD), epilepsy, generalized major depression, and

Chron’s Disease. Date of care was Thursday, March 7, 2019.

Patient presented with a relaxed posture and sad, fixed facial expressions, which changed

to mildly angry depending on the topic discussed. R.G. stated having to suffer with lifelong

muscle weakness as a repercussion of being born to a methamphetamine-addicted mother. R.G.

is one of seventeen children, all born to the same biological, METH-addicted mother. All

seventeen children suffered through Neonatal Abstinence Syndrome (NAS) and now live with

the consequences of their mother. R.G., a triplet, suffers from permanent shoulder dystocia and

hip development issues since birth. Other siblings are on the Autism Spectrum. Many have

underdeveloped parts of the brain, impairing them neurologically as well as cognitively. All

went through foster care shortly after birth and grew up with different adoptive families.

Upon admission to the lockdown unit, the patient’s personal belongings were taken and

she was given a gown and socks in place of her clothes. Census was actually rather low this

week, so she was given a room with a single twin bed as well as a private bathroom. There are

many features on the psychiatric floor to promote safety of the patients. For example, all doors

have a sensor running across the top, so that if any weight were to be hung from it, it would
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immediately alarm. The doors are also slanted to prevent hanging as well. All of the bathroom

mirrors, as well as the windows in the room, are made of alternate material rather than glass, so

patients cannot potentially hurt themselves in privacy. The shower curtain is a perforated, break-

away curtain rather than permanently rung across with metal hangers, so that the patients cannot

attempt to use this as a way of hurting themselves.

There are no light switches or outlets within the room. As a matter of fact, patients really

do not need outlets, as their cell phones, iPads, and any other electronics are confiscated prior to

admission. All electricity for lighting is controlled at the main desk to prevent electrical

accidents. Lastly, all suicidal or homicidal patients are given “safety trays” for breakfast, lunch,

and dinner. This includes all plastic silverware and Styrofoam or paper plating, to decrease the

risk of self-harm. All silverware is counted before and after a meal to assure staff that no one is

hoarding any for later self-harm.

Summary of Psychiatric Diagnoses/Expected Behaviors:

R.G.’s primary diagnosis that brought her to the psychiatric unit is depression with

suicidal ideation. According to Townsend, depression is “an alteration in mood that is expressed

by feelings of sadness, despair, and pessimism. There is a loss of interest in usual activities, and

somatic symptoms may be evident. Changes in appetite and sleep patterns are common”

(Townsend, 2017, p. 809).

R.G. also has the ongoing diagnosis of Post-Traumatic Stress Disorder (PTSD). PTSD is

described as effecting, “individuals experiencing or have experiences stress reactions following

exposure to an extreme traumatic event” (Townsend, 2017, p.478). Symptoms differ with each

individual, but some common characteristic symptoms include, “re-experiencing the traumatic

event, a sustained high level of anxiety or arousal, general numbing of responsiveness, intrusive
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recollections or nightmares, or inability to remember certain aspects of the trauma” (Townsend,

p. 478). It is almost always triggered by traumas such as, but not limited to, disasters,

combat/war, serious accidents, witnessing the violent death, or being a victim of torture or rape

(Townsend, 2017).

R.G. fit these diagnoses from what I was able to observe on the day of care. In regard to

her depression, R.G. presented with definite changes in appetite and sleep patterns. She ate less

than 25% of her dinner tray, stating that she was not feeling hungry and the food was

unappetizing to her. Speaking to the sleep patterns, R.G. cut our conversation short stating she

was feeling extremely tired and worn out and she was going to head to bed for the night. I could

tell just from her mood and expressions that she was feeling sad and tired, and definitely through

with speaking to us.

I definitely support her PTSD diagnosis as well, based on how she presented during our

discussion. R.G. spoke about multiple traumatic events in her life which led to her diagnosis and

displayed many characteristic symptoms. One example was a blockage of memory when

questioned about her adoptive father’s murder that she witnessed at a relatively young age.

Stressors/Behaviors That Precipitated Current Hospitalization:

Patient R.G. stated that she has many current stressors in her life. She has five children,

three of which are biological and the other two are shared from her boyfriend’s past relationship.

All of her children, as well as her boyfriend of one year, live in a small town of Oklahoma,

R.G.’s hometown. R.G. moved here years ago to marry a truck driver that drove around here

frequently; they never married, however, because he cheated on her. R.G. decided at that point

to live with her biological brother in the area until she had enough money to move back home to

Oklahoma.
CASE STUDY 6

Her current family situation is not the only thing R.G. is dealing with. In regard to her

family when growing up, as stated above, R.G. was one of seventeen children born

methamphetamine-addicted. Their mother used METH for all pregnancies, and then overdosed

shortly after the youngest’s birth. “Painful experiences associated with maltreatment and the

trauma of being removed from one’s parent(s) may affect the developmental and mental health

of children” (Bruskas, 2008, p. 71). In addition, “most children in foster care, if not all,

experience feelings of confusion, fear, apprehension of the unknown, loss, sadness, anxiety, and

stress” (Bruskas, 2008, p. 74). All siblings, including R.G., were sent through foster care, where

they struggled with specifically anxiety, stress, and sadness, contributing to depression.

Finally finding an adoption family, R.G. was excited but feared the unknown; she soon

found out that her “forever home” had its own issues. Her adoptive father was in the military, so

R.G. moved 62 different times throughout her adolescence, forcing her to form new friends over

and over again. She never could find a constant in her life. Her adoptive mother and father also

split when she was young, so she was shuffled around from house to house to comply with

shared custody.

All of this being said, the biggest stressor that precipitated this current hospitalization was

her adoptive father’s murder trial. One week prior to hospitalization, they decided that they

could not take it any further in court and her father’s murderer was essentially set free. She

stated that her step-mother had murdered her adoptive father four years ago. Everyone knew it

was her who had committed such a brutal crime, but she was apparently never going to pay the

price, after hearing the verdict last week. R.G. was extremely close to her adoptive father, and

this was the final trigger that sent her to a dark place on March 5, 2019.
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Patient/Family History of Mental Illness:

As previously stated, R.G. grew up surrounded by addiction. She was born a triplet to a

single mother who was addicted to methamphetamine (MA). “MA exposure is associated with

increased emotional reactivity and anxious/depressed problems… and attention-

deficit/hyperactivity disorder problems by age 5” (LaGasse, 2012, n.p.) It has been proven that

exposure to methamphetamine at birth contributes to anxiety and depression, as well as

heightened emotions.

R.G. became mildly angry when discussing her past, so I did not get to unveil any

specific family diagnoses known to her. She did tell me that many of her siblings struggle daily

with depression and addiction. Two of her siblings are currently incarcerated for life with

METH-related charges. R.G. appeared relieved when stating that luckily, she “just” deals with

depression and chronic PTSD. She denied ever using substances such as METH or alcohol. She

did, however, say that every day she gets a “sweet tooth” to try it and that it sadly never really

goes away. R.G. also did not specifically speak on her adoptive family’s mental illness

diagnoses. However, after hearing about the murder trial, I concluded that her step-mother had

some issues of her own.

Milieu Activities Attended:

During R.G.’s 72-hour hold, the main plan of care was to give her as many people to talk

to and resources to tap into once discharged. During the date of care, March 7th, R.G. and I

attended an hour-long group therapy session with approximately ten other patients. This session

was specifically for those dealing with substance and/or alcohol abuse and addiction. The group

leader, Alan, facilitated the group professionally and everyone, including R.G., interacted
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appropriately and shared personal stories. We reflected on different entries and passages, and

took turns sharing points of interest where applicable.

This was when I first heard about R.G.’s struggle with addiction, and how unlike others

who fall into addiction, this was in no way her fault. She spoke about the difficulty of staying

clean for so long, with the constant urge to try a drug she never intended to know the effects of.

Alan told R.G. that she was the first client ever that he had personally gotten to help that had

such a unique story of being born addicted. Alan is an ex-user, 14 years clean, who runs

Narcotics Anonymous (NA) and Alcohol Anonymous (AA) meetings locally as well as once a

week for the patients at St. Elizabeth’s. The group was very supportive to everyone and seemed

extremely beneficial, having observed as a bystander.

Ethnic/Spiritual/Cultural Background:

R.G. spoke only about her spiritual background; she grew up Christian in her adoption

family. Her adoptive mother is actually a pastor. R.G. stated many times throughout the

discussion that she does not get along with her adoptive mother for many reasons, but one big

reason is that she is always trying to tell R.G. the right thing to do. R.G. stated that it is

frustrating having a mother as a pastor because she is always trying to steer her in a direction that

R.G. would like to have chosen herself. She does not always feel the support desired from her

adoptive mother. I understood this to be because her mother is trying to make all of her

decisions still even though R.G. is a 36-year-old, independent woman.

Evaluation of Patient Outcomes Related to Care Received:

Patient R.G. seemed to be responding well to care being received. She was receptive

during group therapy, and asked questions appropriately. She seems to be well medically
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managed on her Abilify 5mg daily and Buspar 15mg 3 times/day and has been compliant. R.G.

has remained safe thus far and has not yet attempted to self-harm throughout her hold. She

attends group sessions when requested. She is overall cooperative, calm, and yearning to get the

help that she so desperately needed.

Discharge Plans:

Patient arrived on Wednesday, March 6, and is on an involuntary 72-hour hold. No exact

discharge plans were developed as of Thursday during day of care. However, finding good

outpatient programs and self-help groups locally as well as reaching out to resources in

Oklahoma were spoken of, as R.G. plans to move back to Oklahoma end of March. Planned

discharge date is Friday, March 8, 2019.

Patient Diagnoses Prioritized:

Patient diagnoses listed from highest priority to currently lowest priority:

Depression with suicidal ideation – suicidal ideation is what brought her to be admitted

Addiction since birth – past life, including being addicted from birth, has put her at great risk for

developing behavioral disorders such as depression and PTSD

Chronic Post-Traumatic Stress Disorder (PTSD) – did not speak a lot about; placed depression

and addiction since birth higher because these two are the issues stated by the patient that

triggered/caused her admission

History of seizures – medically managed, no recent seizure activity

Potential Nursing Diagnoses:

1) Risk for self-harm related to hopelessness – This is applicable, as patient’s diagnosis

upon admission was depression with suicidal ideation. Some interventions include:
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encourage patient to speak of potential triggers and help the patient determine appropriate

coping skills that work for them.

2) Impaired social interaction related to lack of local support system – Majority of R.G.’s

immediate family, including her boyfriend and children, all live out of state and locally,

all she currently has is her one biological brother. R.G. does not currently hold a job or

do many leisure activities where she would have the opportunity to socially interact.

Some interventions may include: involve patient in group activities to socialize when

possible and refer client to self-help groups in her local community upon discharge.

3) Ineffective individual coping related to negative role modeling – R.G. grew up with few

people to positively look up to and teach her proper coping skills. Two potential

interventions are: encourage verbalization of feelings, fears, and anxiety and explore

understanding of current situation, previous, and other methods of coping with life’s

problems.

Conclusion:

Although R.G. has faced many hardships throughout her life thus far, it is important to

note that she sought out help herself and did not follow through with her suicidal plan. This is

not to belittle her suicidal ideations, as those with a plan and means to carry out the plan are at a

greater risk for harm than those without. However, R.G. is fully aware of the help that she so

desperately needs. Although stating that she “had a suicidal attempt” that led to her admission to

the psychiatric lockdown unit, she knew she would not carry out the plans she stated. She

vocalized that her children, as well as her boyfriend, are what she fights through her issues for

daily, and essentially lives for.

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Against all odds, R.G. continues to stay clean and attends self-help groups when needed.

She fights her “sweet tooth” daily and stays occupied throughout the day to distract her urge.

She is working toward her ultimate goal of moving home to Oklahoma to be with her five

children and boyfriend, the support system she has been desiring to have for years.

All of R.G.’s diagnoses (generalized major depression, post-traumatic stress disorder, and

addiction-born) definitely correlate with each other. Drug-addicted infants are at such an

immediate disadvantage in life. As supported by evidence-based research studies, her situation

from birth put her at high risk for developing both depression and PTSD. It seems that it was

inevitable, only a matter of time.

It was very disheartening to listen to R.G.’s story. She was the first patient I had ever

met that struggled with such a unique story of addiction. I hope that in reviewing this case study

formulated from my date of care, one is able to shine a new light on issues in the mental health

world related to innocent, drug-addicted infants and the high risks indicated for developing

psychiatric issues in later life.

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References

Bruskas, D. (2008). Children in foster care: a vulnerable population at risk. Journal of Child and

Adolescent Psychiatric Nursing, 21(2), 70-77. doi:10.1111/j.1744-6171.2008.00134.x

Cleary, M., & Thomas, S. P. (2016). Addiction and mental health across the lifespan: an

overview of some contemporary issues. Issues in Mental Health Nursing, 38(1), 2-8.

doi:10.1080/01612840.2016.1259336

LaGasse, L. L., Derauf, C., & Smith, L. (2012). Prenatal methamphetamine exposure and

childhood behavior problems at 3 and 5 years of age. Pediatrics, 129(4).

doi:10.1542/peds.2011-2209d

Townsend, M., & Morgan, K. (2017). Essentials of psychiatric mental health nursing: concepts

of care in evidence-based practice (7th ed.). Philadelphia, PA: F.A. Davis Company.