Advice for dealing with addicts?

allnurses Guide · Jun 14, 2017

My own experience as a recovering addict/alcoholic and as a current psych nurse with my fair share of detoxing patients has taught me that the first rule of addictions nursing is to put all your pre-conceived notions aside and treat you patients as sick people with an illness. You have to understand that they will not change overnight. They are in detox in order to get the DOC out of their system. The job of the nurse with a patient in detox is to keep them comfortable so that they can step into the next phase of treatment which is rehab. The detox nurse's job is not "To teach an addict how to live without their drug of choice." The average nursing student receives less than 7 hours of training in addiction rehab and detox. I know for a fact that I would not be here today with over 15 years of sobriety under my belt if I had been treated with the kind of callousness that I read about in some of these posts. The hallmark trait of any addict is manipulation followed by a sense of entitlement and resentment towards the world in general.

I once had an addict tell me when I came on shift tell me that his nurse was rude, mean and never smiled. In conversation with the patient I was able to help him reflect on how his own behavior and attitude may have contributed to the issue at hand. "Stiil," he said " If that's what being sober is like why would I want to be sober?" I always strive to put the care of my patients ahead of their personalities .

As for giving meds is concerned - Of course I always defer to my training and nursing judgement but if I have an order and it's time and the patient is not altered or obtunded and is symptomatic I'm going to give them the med. They are more likely to come to group and participate in their treatment if they are comfortable. BTW 25mg of Vistaril for the kind of anxiety addicts have is like giving a baby aspirin to treat a brain tumor. It is mostly a placebo.

Hppy

cmknight001 · Feb 26, 2018

Find another job.

allnurses Guide · Feb 28, 2018

Disagree ... I've taken phenergan and it made me feel like I was on Vicodin for a couple hours before it knocked me out. It's not a scheduled med but its naive of you to think people don't abuse phenergan lol. I recently cared for a patient who admitted to being addicted to and abusing neurontin.

Any drug has potential for abuse! Heck I used to get high as a kite on Benadryl. That still does not give one permission to go against Dr's orders. We run a very high quality medically supervised and we use both COWS, CIWA and CIWA-B protocols. Depending on the scores and we tend to be generous when scoring they get everything in the orificenal at the indicated time. Detox is basically a step down and most will go on to 30-60-90 day programs where there will be total abstinence. So we need to ease them to that point. They have to have hope that something better awaits. Addicts may be annoying but they are not bad people. They are sick people who need to get well. We all must stop at times and remember that : "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will or knowledge".

Addicts in detox often lack the necessary strength, will or knowledge to get well on their own.

Hppy

Neats, BSN · Mar 2, 2018

Working in the prison system and with the elderly who are used to their meds (they do not even realize they are addicted) and having 5 half sister addicted to anything they could stick in their mouth has taught me a thing or 2 about addiction and behavior in general. As a nurse I would abide by the orders, have great boundaries and never would I acknowledge the patient who is lying on the couch wanted me to wait on them. I would also ensure their care plan addressed the PRN medication concerns. I am the nurse who is anal about everything, stand by the rules and have a regimented schedule, this is how I survive with working with patient like this.

I will not say it is not my job to...it is my job to be an advocate for my patient even if it is to get them to stop asking for PRN medication. I would not withhold unless there was a direct observational reason to. There are many things people get addicted to. Just do your job and do not get sucked up in to their drama. Once you start feeling the way you are feeling about holding the PRN medication you are caught up in their drama. Let it go.

These medications like others have wrote about can be made into cocktails and from what I have been told you get an Ecstasy high for about 3 hours. They mix the medications with with baby powder, farina, Aspirin, Naproxen, Tylenol, really any base they can get their hands on, and snort it. They actually have prison recipes to make this stuff. One man had a recipe tattooed on his back that included clonidine.

I cannot control this I can only continue to educate and provide healthcare to them if they need it. Addiction is a terrible. The behaviors one develops with addiction is terrible. The person who has these must learn to live with their choices, many end up in nursing homes aging way faster than their peers. Most have burned so many bridges they have no one, all I can do is be the best human I can be and thank my spiritual guide I am not like that.

lilia123 · May 4, 2019

I did not see the nurses posts here as judgemental. Sometimes i want to vent and I go to these forums. I give the PRN's as requested because I don't want to see people unable to sleep at night, or have such high anxiety. I know that what they are doing (withdrawal) is very difficult, and i do believe PRN's help them. It takes a lot of compassion and understanding to work in this field. Remembering my upbringing and my own self medication helps me to try to be a comfort. But some days its harder, I just remind myself that its not personal, they are dealing with so much, the same with their families.

Pinky Nepal · May 9, 2019

On ‎1‎/‎25‎/‎2013 at 9:16 PM, krob0729 said:
I am so mentally drained somedays that I often wonder what in the heck i'm doing working a rehab hosp. Especially when you see your frequent flyers. It's like "why do I bother"? You know they are going to be back next month, then, I find myself not wanting to give them PRN's because I think if they actually went through detox the hard way, they might not want to put their bodies through that. Then here comes that one patient that you can see in their eyes and soul that they want to get clean. They won't even take the prescribed Norco for pain because they want off of all drugs. Then my hope is renewed. All I know is that being a Psych nurse is a whole different animal that what I'm used to.

We have tons of frequent flyers too. With that population, the point is all about harm reduction. Reduce hospital visits and promote risk reduction for the client and community at large. When I worked detox, we were VERY into a harm reduction model. Sadly, now that I work a regional psych facility, we're ignoring the help we can provide to people who are never going to find abstinence. I think it's partly because the majority of staff and management don't have specific addictions training

Pinky Nepal · May 9, 2019

Could we please stop calling our patients "addicts"? They are clients with addiction issues. Language is important. Respect and dignity.

Bscn-Med Surg · Jul 14, 2019

IF you want to know about the science behind Addiction, read the article National Geo Sept 2017, about why the brain become addicted to pleasure & pain killer drugs. Then you will learn how to cope with these wonderfully manipulating people. Because they are 'special', they get away with a lot. The brain thusly the person are weak. Its like dealing with a 2 year old..Terrible two's. YOU have to be strong..Its not your fault THEY have become addicted.

nolongeranurse · Dec 1, 2023

as a former nurse and a person who deals with substance abuse, I am just going to be brutally honest with you for your own good,

Your first post you sound young and naive and kind or like a priss.. no offense. All young nurses who work in detox sound like that because that's just the way it is.

You are judging your patients. Everything you said in the first post screams "Judging" It's OK. Everyone does it. We all judge one another. You are judging them, and they are judging you too. I also want to let you know they think you are a pain in the *** also. In your first post you were just being honest and saying what you thought and everyone started getting on your case and then you realized what you sounded like and realized that a lot of people took offense to what you said - so then you started talking about how you were just concerned with you client's wellbeing and you loved them and just wanted to guide them into recovery with all of your positive thoughts and actions didn't sound real convincing-but that's OK. I think you just need to stop taking yourself so seriously and realize that you are just a nurse in a detox ward giving out Benadryl. I know you went to college, and you are a professional, but no one really cares about your schooling in detox. They are just trying to get through withdrawals as comfortably as possible and they have learned that drugs can help with that. I don't think you are going to over sedate too many people with your Benadryl- so just stop being so controlling and give it to them and then they will leave you alone so you can do your charting.

nolongeranurse · Dec 1, 2023

After reading some of the comments on this thread I can see that the nursing profession has a long way to go in the care and treatment of people who use substances.

One person actually made the comments that drug users were monsters. Monsters? Really?

Other statements made on this thread described drug users as manipulative, rude, draining, disrespectful, unable to cope, weak, like a two year old, liars. One person stated that she just thanked God she wasn't like them and another nurse said they aren't like normal people.

One nurse said when patients asked for medication she tells them, "We don't want you to suffer, but unfortunately detox isn't pain-free. We're trying to help you learn to live without these meds." The other nurse agreed, "That's good. I'll have to use that one" Another nurses posted that she thought it was a good idea for the patient to be uncomfortable because maybe they "wouldn't do that to their body again".

I don't think I would feel very good about being in detox if some nurse gave a flippant remark to me when I reported experiencing pain or told me that they had decided that they were not going to help me or try to make me comfortable. I am not sure why a patient would go to detox other than the hope of seeking a more comfortable withdrawal than they could experience at home. Apparently, patient comfort is not a focus of several of the detox nurses on this thread.

Many of the nurses stated that it was a good idea just to ignore their patients and not acknowledge them. There were several complaints that patients asked and begged for medications and the nurses stated that they ignored the patients, argued with them, yelled at them and kept walking while patients were begging them for medications.

A few nurses stated that they were not waiting on patients, and they were not servants. No one on the thread acknowledged that detox is a service that patients pay for, and no one questioned why nurses were refusing to provide nursing services to the patients who were paying for these services.

Nursing has always been portrayed as a caring profession but apparently that is not alway true.

allnurses Guide · Dec 10, 2023

garnetgirl29 said:

I'm in a detox clinic & this is my first nursing job & first experience in addictions. We have standing PRN orders for 25 mg Vistaril Q6H PRN, Phenergan (must see vomit),75-150mg Trazodone for sleep or 50mg Benadryl for sleep. My clients want the vistaril like it's candy, and are lining up at the nurses station every 6 hrs (or less) to get it. It's ridiculous, but it's that addicted mentality, I know. I'm trying to be as therapeutic as I can & try to tell them that they do not need another vistaril just because the 6 hours is up. Some walk away, but others are VERY adamant. I had 4 argue with me last night because I would not give trazodone & vistaril or benadryl & vistaril at the same time at bedtime. I tried to explain that trazodone also helps with anxiety & they don't need both or that benadryl & vistaril are both antihistamines and I cannot give that much at once. Now, my standing orders do not say anything about giving meds together, but my gut and nursing judgement tell me that's just too much. Also, they beg me for phenergan all the time, and I have two whom I'm sure are making themselves vomit to get it. One (heroin addict) was begging my for phenergan IM. I offered mylanta and that really ****** her off or phenergan suppository, but she said she had diarrhea & couldn't do that.

So, can anyone give me some advice on handling these situations? I'm often the only nurse on & don't have anyone to back me up. I don't feel that handing out meds every time they ask is doing them any good. It gets exhausting when they are constantly knocking on my door and shouting out med orders while I am delivering scheduled meds to others. (I ignore the shouts because that's just rude and I am no one's servant).

These people are here to detox and learn coping skill (well, not everyone has good intentions), but I want to know that I'm doing right by not handing out a med when I don't think it's legitimately needed.

Now, some of these people who are demanding Vistaril from me are already on Buspar or other anti anxiety meds. How do you handle drug seekers?

Sometimes I wish we didn't have Vistaril or Phenergan to offer.

Also, a few weeks ago, we had a client who was soliciting others to get Vistarils for him cuz he wanted to snort them. What wold be the effects of snorting a vistaril? (this client was kicked out)

I have been detoxing patients for close to 15 years so I know what you're talking about that are concerning to me. I was right with you until you made the statement "it's that addict mentality.” Any person taking care of addicts needs to understand the disease process as well as how the addiction actually changes one's brain chemistry. I'm on my break and it's almost done but I will finish my comments when I get home.

nolongeranurse · Dec 11, 2023

"Any person taking care of addicts needs to understand the disease process as well as how the addiction actually changes one's brain chemistry.”

The problem with that statement is that no one has unbiased, evidenced based knowledge on how addiction actually changes one's brain chemistry. Very little about how the brain works and its chemistry is known and because everyone is different and every drug is different, no one can say how an individual's brain is affected by substance use. Aging, environment, genetics, developmental factors all affect the brain. There is no proof that people are effected by substances the same. . What we do have is a money driven industry who has pretended that they know how to treat substance use for the last 100 years with very little to show for it. The rehab industry has failed 10 x the people that it has successfully treated and when people are not "recovered" they are blamed for not cooperating with the AA based programs that dominate the field with absolutely no proof of effectiveness. I highly suspect that a person with substance abuse would be better treated by going to a luxury spa for a month rather than an overpriced rehab facility. After reading your comments it's appears they would at least be treated better there.