A 22-Year-Old Man Is Found Unresponsive on His Bedroom Floor

A 22-year-old man is found unresponsive on his bedroom floor.  His girlfriend calls emergency medical services, and paramedics arrive within 10 minutes.  She says that the patient has been using heroin and points to track marks on his right arm.  Temperature is 37.8 C (100 F) , blood pressure is 90/40 mm Hg, pulse is 65/min, and respirations are 6/min.  The paramedics provide supportive care and administer naloxone on the way to the hospital.  The patient's condition stabilizes in the emergency department.  The toxicology screen is positive for opiates and cannabis.  Once he becomes more alert, additional information, including a substance abuse history, is obtained.  The patient says, "I've been using heroin for the last 9 months and drinking since I was 16.  I like to use pretty much any drug I can get my hands on; I don't see what the big deal is."  He has never tried to stop using and has never been to a drug-detoxification or drug-rehabilitation program.  He recently lost his construction job as he was "too high to show up."  His girlfriend is considering leaving him if he does not get help.
Which of the following statements or questions is the most appropriate for initiating a discussion about the patient's substance use?

A) A substance rehabilitation program will give you the best chance to beat this problem.
B) Does losing your job and the possibility of your girlfriend leaving motivate you to stop using?
C) What is your plan for preventing relapse?
D) What will you lose or gain if you give up drugs and alcohol?
E) You almost died; you need to think about how continuing to use could devastate your family.

Correct Answer:

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