A nurse is caring for a client who reports frequent social use of alcohol. The client tells the nurse that they have been reprimanded at work for being late several times after they had been out late drinking. Which of the following statements by the client might indicate that the client has developed a substance use disorder?

A. When attending dialectical behavior therapy: While individuals with borderline personality disorder may experience emotional distress during therapy sessions, attending dialectical behavior therapy (DBT) typically provides skills and support to manage emotions and reduce self-harm risks. Therefore, this situation is not considered the highest risk.
B. When attending narrative therapy: Narrative therapy focuses on helping individuals reframe their stories and experiences, which can be beneficial. While any therapeutic setting can evoke emotions, attending narrative therapy does not significantly increase the risk of self-harm compared to other situations.
C. When discharged from the hospital: This situation is often associated with the highest risk for self-harm. The transition from a controlled environment to the challenges of everyday life can lead to feelings of abandonment, loss of support, and increased stress, making individuals vulnerable to self-harming behaviors.
D. When getting married: While significant life changes, such as marriage, can evoke anxiety, they do not typically represent the highest risk for self-harm. The supportive context of a marriage and the associated positive emotions usually outweigh the potential for increased risk at that moment.

A. The client may increase their substance use dramatically: While stigma and negative beliefs can affect a client’s self-esteem and motivation, believing addiction is the client's fault does not directly lead to increased substance use. Clients may instead feel shame or hopelessness in response to stigma.
B. The client may ask for residential treatment instead of outpatient treatment: This outcome is not directly related to providers believing that addiction is the client's own fault. The client's treatment preference may depend on various factors, including the severity of their addiction and personal circumstances.
C. The provider may choose to abuse substances: While healthcare providers can experience addiction, believing that addiction is the client’s fault does not necessarily lead to the provider themselves abusing substances.
D. The provider may deny care or deliver poor quality of care: When providers hold the belief that addiction is the client's own fault, it can lead to bias, stigma, and judgment. This attitude may result in denying care or providing inadequate treatment, ultimately impacting the quality of care the client receives and hindering their recovery process.