"I'm an addict...not psychotic." Aren't they both mental health issues? - page 2

by NurseSheGirl

5,790 Views | 19 Comments

I work for a small, private hospital specializing in mental health conditions for adults and adolescents as well as chemical dependency and rehab. While the acutely psychotic patients are placed on a separate unit, the main unit... Read More


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    addicts seem to come up with a lot of different excuses to not follow through with rehab. when I was a guardian ad litem to a foster baby, the biological mother would tell me one day that she was about to jet off to a rehab, then the next day she would be checked out because "she didn't like the early morning walks" that she was forced to go on. if it wasn't that, then it was the fact that the place didn't have coffee, or cigarettes, or tv. or whatever.
    RNitis likes this.
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    Most addicts will use any excuse if they are not prepared to be clean. Seems as if "I don't want to be among the mentally ill" is a perfect one.
    The major difference I see is that for MOST, once the patient is detoxed, and should they remain clean, they have clear thinking. People who are mentally ill and non-addicted don't always have clear thoughts.
    And that is the ultimate goal, clear thinking.
    "We want everyone here, regardless of the label, to be at their highest functional level. We all have work to do"
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    Quote from salvadordolly
    I worked in a private top of the line detox that was closed and merged with the psych unit. I got the same thing a lot. I would tell them that if they really wanted to recover, they were going to have to learn to tolerate a little discomfort and they may as well get some practice during their detox. Just the pecking order of the psych world - heroin addicts think they're better than crackheads, crackheads think they're better than meth-heads, alcoholics think they're better than drug addicts, and they all think they're better than the mentally ill.
    and then we have the nurses, many who think they are better than the whole bunch.

    There have been a lot of breakthroughs in the studies done on addiction recently, and it's relation to chemical imbalances in the brain...though it seems some are still of the belief that it is a moral failing. I am hearing an awful lot of attitude here about "these people" and how they think. Maybe some are in the position they are in because of a dual diagnosis, but I don't think that classifies all of them as psychotic.

    I think I am starting to understand why they say the best people to work with addicts are those who have been there, and can understand what they are going through.
    iwanna and VivaLasViejas like this.
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    Quote from Geslina
    and then we have the nurses, many who think they are better than the whole bunch.

    There have been a lot of breakthroughs in the studies done on addiction recently, and it's relation to chemical imbalances in the brain...though it seems some are still of the belief that it is a moral failing. I am hearing an awful lot of attitude here about "these people" and how they think. Maybe some are in the position they are in because of a dual diagnosis, but I don't think that classifies all of them as psychotic.

    I think I am starting to understand why they say the best people to work with addicts are those who have been there, and can understand what they are going through.
    While I get what you're saying, that people with no experience with addiction have all kinds of ideas about addiction that may or may not be accurate, but nobody is saying addiction is the same thing as being psychotic. Addiction has been linked to chemical imbalances in the brain - as have psychotic and mood disorders. These things are classified as mental illnesses. People with addictions HAVE A MENTAL ILLNESS. Just like anxiety and depression are not the same thing as schizophrenia, but they are all mental illnesses.
    RNgrrl09, iwanna, BCgradnurse, and 3 others like this.
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    I worked years ago in a VA that had a general psych unit and a 28-day drug/EtOH rehab, and the two programs shared the same dining room (at the same time, so the two populations encountered each other at meals). I worked on both units at different times, and was v. amused to to find that the two populations were equally offended that they were expected to share a dining room with the other group, and to hear on the rehab unit after meals, much grumbling about how "I may be an addict, but at least I'm not CRAZY ..." while, at the same time, clients on the psych unit would be grumbling, "Well, I may have a mental illness, but at least I'm not a drunk or a junkie ..." It seems to be human nature for individuals who are in a difficult situation (particularly being looked down on by other segments of society) to look for some other group to look down on in order to feel better about themselves.

    I agree, also, that many chemically dependent individuals are looking for any excuse to avoid engaging in treatment, and, for some, not liking the folks you're supposed to share a unit with is as good as any.
    canoehead, Lovely_RN, BCgradnurse, and 5 others like this.
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    We live in a country, and perhaps a world, where we separate our MI clients into "crazy" or "jail bird". We fail to accept mental illness and we punish those whose mental illness takes them to drug addiction. Our war on drugs has made this worse on both fronts. Those with psychosis look at medications as drugs and have a good "reason" not to take as prescribed. After all they don't want to be druggies. Those with addiction know that if treated for their addiction those issues that led them into drug use will still be there. We know more and more about serotonin and other brain chemicals and we are learning what inhibits the formation of these chemicals. Stress is a huge factor.

    So, to me, it seems obvious that "druggies" would feel superior to "crazies". "Crazies" would feel better than "druggies" who are breaking laws. In this merry-go-round none understand that they are both sides of one coin: Brain changes. Chemicals gone wild, or non-existent or unbalanced. I look at it as part of denial. We accept it in cardiac patients and we expect it in other diseases such as diabetes. Why would we expect different behaviors just because the illness is harder to measure. Blood pressure and blood sugars are easy to follow. MI requires a great deal more.

    I believe one of the first things we need to do as nurses is to leave our prejudices at the door. We care for people. Every person in hospital will have some psychological problems. They may be easy to spot like a diagnosed Munchhausen's patient. It may be more difficult when things like domestic violence are feared because a woman is not home to do what is needed.

    No one can say our jobs are easy. Chemically dependent clients are challenging. They learn to live by their wits. They can be charming. Some might say they are like snake oil salesmen. Many psychotic people are so self neglecting that they may not be able to do simple tasks like take showers without specific directions. Putting those two differing behaviors together will cause issues. It is not that one is better or worse, they are different ways of mental illness broadcasting itself for all to see.

    The idea of putting these two forces together without proper education is not helpful. You end up with resentments on both fronts. Education and communication are always keys to success. Sometimes we need to step back and see how it could have been handled better and set out written ways to make it happen in a better way.
    iwanna, BCgradnurse, Whispera, and 5 others like this.
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    I am fresh out of nursing school (BSN) and the first thing we learned was alcohol/substance abuse is a mental disorder an addiction. I did my last semester of clinical on a psychiatric ward for 144 hrs. I noticed that a lot of the people there abusing drugs were also in for dual diagnosis or attempted suicide. They had a history of cutting, homelessness, prostitution, etc. It did warm my heart that some of my patients in for drug abuse would help clients with altered mental status and mobility by offering a chair or reaching over the table during arts and crafts to assist other members on the unit. I liked "community meeting" having patients treat one another with respect. Psych nursing can be tough when patients are there for rehab and have denial of their problems. I personally felt like my patients who had drug and substance abuse issues were also highly interested in a great "Social worker" to help them find housing, work, government programs to help them leave the cycle of drugs and move on to become productive members of the community. It is really hard to get off drugs and other vices and ward off depression when you are worrying about where you will get your next meal or sleep. My advice is only to state. "we are here to help you" I appreciate you taking the first step towards recovery and coming here and admitting you have a problem with addiction and would like to change. How are things going, "tell me more" "that must have been really hard for you" " i hear you saying... " using a caring approach that is non judgmental works best.

    It is really disconcerting as a psychiatric nurse when you have 4-5 patients on the floor, you want to talk to all of them, you have patients to be admitted and discharged, you have medications to give, paperwork to chart, mental status exams, recreational time, you need to get breakfast, lunch, dinner to patients and make sure all patients are free from harm and no contraband is there, give patient teaching, meet with doctors to talk about patients status, involvement in committees to prevent falls and provide better safety, take care of high risk patients, and still have time to not loose your own sanity amongst the chaos.

    As a nurse you are not talking to patients like a "therapist" you are not looking at physiological responses like a psychiatrist to order the right adjustment or medications, you are simply giving the medications and assessing if the patient is tolerating them and improving in status.

    Without family support it is really hard to discharge patients wondering if they will be "compliant" and take their medications, follow the care guidelines, stay away from their children if CPS has taken them away, not go home that night and end their own life. Psychiatric patients loose their government funding from programs all the time and the psychiatrist/nurses are left picking up the pieces trying to find good treatment plans


    If a patient on the floor told me I am not "Crazy" or a "psych" patient I came here for rehab and want to leave I would just spend 5 minutes if possible and tell them from the heart....


    I hear you saying that you are uncomfortable here and feel you are not crazy and would be better off leaving. I would like you to just take a moment and picture in your mind what you want for yourself.. what would make/enhance your life ? what is stopping you from achieving those goals?

    Did you know we offer medications/therapy to help with the addictions we have community meetings and teach "coping skills" we provide housing and job training.. etc

    and if they still refuse just be professional and tell them. "we appreciate you coming here, it takes a brave person to want to seek treatment, if you ever feel unsafe or overstressed and would like to get rehabilitation we are here to help." and then give them community numbers to alcoholics anonymous etc that can help. Sometimes taking 5 minutes to show you care can change a persons life.


    Also I noticed on psych floor when you mix patients with substance abuse, depression, etc they tend to have a higher level of mental function and get very "bored" easily because they are not taking sedative like effects from certain psych medications and actually perk up really easily to arts/crafts/ letting them apply their own makeup with psych tech/ recreation time/ books/ music/ magazines.
    salvadordolly, Whispera, Meriwhen, and 1 other like this.
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    How about just saying, "We manage patients here with addictions as well as many other illnesses. We're going to do out best to individualize your care to your specific needs. If you can think of ways to help us with that, please let us know."
    Sadala, elkpark, BCgradnurse, and 2 others like this.
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    I think that substance abuse is multi-faceted and may or may not encompass dual diagnosis with a psychiatric disorder. Psychiatric disorders are multi-faceted and may or may not lead to a substance abuse issue.

    I'm not certain why it matters (to staff) how a patient self-identifies in terms of labels when he or she enters a program for the treatment of either. The treatment is the point. That's why the pt is there.
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    Quote from Sadala
    I think that substance abuse is multi-faceted and may or may not encompass dual diagnosis with a psychiatric disorder. Psychiatric disorders are multi-faceted and may or may not lead to a substance abuse issue.

    I'm not certain why it matters (to staff) how a patient self-identifies in terms of labels when he or she enters a program for the treatment of either. The treatment is the point. That's why the pt is there.
    Substance abuse by itself is a psychiatric diagnosis. I believe a sort of monster was created when the term dual diagnosis came into vogue. Do we say that someone with diabetes and CHF are "dual diagnosis" patients? These are co-morbidities.

    I believe it matters when the greater piece of drug addiction is denial. It is important that the patient be instructed with correct information. This disease of drug addiction is the disease being treated. The person may or may not have co-morbidity of other mental illnesses. Depression is the most likely. One has to be sober and clean in order to properly if this disease is present.

    Those individuals with mental illnesses of Bipolar, Schizophrenia, etc. must be screened for the co-morbidity factor of addiction. If none exists we are looking at different treatments and potential outcomes. For example: A schizophrenic who has hallucinations not caused by drugs or other external things will need medication to control these. Someone who is Bi-P may require a life time of medications to smooth out the mood swings that wreck a life.

    Without the existence of the other diseases an addict needs to use talk therapy in some form such as a psychologist, or other mental health professional or attendance in a recovery program such as AA/NA or other programs that not not always 12 step programs.

    When you put addicts with MI patients it is much easier for them to continue the denial as they "are not like those people". It seems logical to say that the MI might have it easier - except there is resentment that addicts tend to be frequent fliers with limited desire for a lifetime of clean living. Most MI people wish for an end to the symptoms and are frequent fliers as the meds cause so many side effects that they are frequently stopped. They also believe that once the symptoms stop they will not return, a form a magical thinking.

    Patients are all different. MI is like other illness. We see many of the same symptoms in many diseases, that is why residents carry their differential diagnoses books in some form. The symptom of belly pain tells you no more than the symptom of self neglect. A specific diagnosis will lead to appropriate treatment. The belly pain diagnosed by a HCP as an ulcer and treated differently than if it were a hot appendix. So, self neglect is diagnosed as a specific form of MI, perhaps schizophrenia as a result of intrusive voices. Perhaps it is post postpartum depression. The treatments are not the same.

    To place the two people with different diagnoses together will have issues. The person with an H.pylori ulcer will be taking meds that are very harsh. The person with the hot appendix will be cured with a small surgery. There is a resentment likely if you fail to do proper education for both patients. The patient with the ulcer is more likely to stop taking those meds that cause discomfort, and the person with the scar will tend to be more upset by the needs of the ulcer patient.

    It does not mean we cannot teat our patients effectively. We may have to step into the reasoning of patients on a mental health unit and see what they see rather than what our education about the diseases tells us.
    pinkiepieRN and Meriwhen like this.


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