At the time of assessment, Mr X was an in-patient on the orthopedic ward, having been admitted to hospital following a Motor Vehicle Accident (MVA). He sustained a fractured pelvis and leg. Subsequently, he was currently immobile due to traction. .
In relation to Mr X's substance use, he reports smoking nicotine since the age of 16years. He admitted to smoking "at least" 50, 16mg cigarettes per day, for the past five years. He last smoked 24hrs prior to my assessment with him. Mr X denied any other substance use, stating, "It's bad enough that Im hooked on the smokes, let alone anything else".
Mr. X informed that he had attempted to cease smoking "many times" over the past five years, but was unsuccessful as the "cravings were too bad", stating "I just gave into them". .
The American Psychiatric Association (2003) supports the fact that nicotine dependence is a serious disorder and, although over 80% of smokers express a desire to stop smoking and 35% attempt to stop each year, less than 5% are successful in quitting (unaided). .
Furthermore, Mr X reports a 12-month history of depression, following the death of his father and financial difficulties following the loss of his employment. He is currently on Zoloft for his depression. .
Due to the extent of Mr X's injuries, and his immobility he felt that now was an ideal time to cease smoking "for good".
Symptom Experience from the Patients Perspective:.
My initial contact with Mr X was about 24hrs after his last cigarette. The nursing staff had informed me during the referral process that he had been very demanding and "was going to be a real problem".
On entering the room and introducing myself, Mr X loudly yelled "I either need a F*** smoke or you to do something to stop these f*** cravings!!!" He continued to say; "I just cant handle this anymore". I asked him to explain what it was that he could not "handle".
"Look at me Im a f*** mess, Im sweating, shaking, my mind is racing, I cant f** think straight.
