Should mental health nursing be grouped with addictions nursing?

Specialties Addictions

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CASTLEGATES

424 Posts

Specializes in Addictions, Acute Psychiatry.

Post acute withdrawal syndrome can mimic schizophrenia, bipolar, PTSD, explosive d/o and others. This is why it's not recommended for addictionologists to stamp any new diagnoses on patients until they're finished wit PAWS. It can last anywhere from 2mos to 2yrs. Addiction is a disease, just like cancer. What do we do with a cancer patient who breaks his leg in an accident? We tend to place them in the unit where the most acute need determines where they go. This is the same with addictions at the psychiatric campus where I work. It's not fair to place addicts in a locked ward with people hallucinating, etc. Actually we had to learn this. A patient pursued this the legal route (when we did detox in a locked unit with psych) and the findings were--this was, in fact unreasonable and unjust to lock detox with acute psych (who can get violent), so no more detox patients into the locked units where I am (unless mental illness is the primary need). This is how triage, care, anything works (squeaky diagnosis gets oiled first) :) ha ha!

Regarding the previous comments above: "The rest of them I couldn't care less what happens to them. They are generally, from my exp, ungrateful, needy, selfish, and just aholes?":madface: Whoa Nelly! Did I just read an professional RN calling a diagnosis group aholes :nono:???

If you read no further; three letters E.A.P.!

I don't feel it's remotely appropriate, or acceptable to name-call any diagnosis group. I had to do a double-take. If a patient is doing something where I feel I'm going to react emotionally, or negatively, I've completely lost my ability to help that person (and I need to move out of that area to a different specialty ASAP). My self actualization, nor does my career depend on patient gratitude (they're not on our units to please US)! My job is focused on saving lives from a continuous, progressive and fatal disease. It's not a moral character disorder where patients are (enter negative name here). Again, it's an AMA AANP ASAM diagnosed disease. Has anyone called diabetics idiots, or aholes because they did xyz to further their illness, became obese, cheated, etc. I take care of them, because they come to me asking (asking) for help. Withdrawals (acute and post-acute) make patients insane. Some are more difficult than others (psychiatry 101 for anger, manipulative redirection, anger management, safe handling, etc). It's my job to come to them armed with all this information, so they understand what's happening to them. I always tell them, "Although you feel like you're completely losing your mind, YOU"RE NOT." When they act manipulative, panic, angry, etc. I calmly let them know "It will get better, trust me, it will."

In nearly all cases, once in recovery after PAWS, many can decrease or stop psych meds (obviously supervised, but these are the outcomes of recovery). It's nice to see the majority of professionals here taking it upon themselves to learn the most they can, ask legitimate questions and enjoy learning about a rapidly progressing specialty. Wouldn't it be great if we had staff who liked working with the most challenging patients, as well? I love my "druggies and drunks." The more manipulative, the better (because we have something to talk about, and I have an inroad to help them). I don't need any thank you's (my ego isn't fragile, and I already get paid as a thank you; never mind I'd do it for free).

Last of my soap box chat...patients and other staff see, and react to body language, facial expressions and word choices that exude the feelings one harbors against addiction, races, religion, orientation, etc. People can see, feel and sense that, whereby the practitioner becomes therapeutically ineffective (and creates a toxic environment of the unit, as this behavior can be contagious).

Safety Coach RN

103 Posts

Specializes in Behavioral Health.
Post acute withdrawal syndrome can mimic schizophrenia, bipolar, PTSD, explosive d/o and others. This is why it's not recommended for addictionologists to stamp any new diagnoses on patients until they're finished wit PAWS. It can last anywhere from 2mos to 2yrs. Addiction is a disease, just like cancer. What do we do with a cancer patient who breaks his leg in an accident? We tend to place them in the unit where the most acute need determines where they go. This is the same with addictions at the psychiatric campus where I work. It's not fair to place addicts in a locked ward with people hallucinating, etc. Actually we had to learn this. A patient pursued this the legal route (when we did detox in a locked unit with psych) and the findings were--this was, in fact unreasonable and unjust to lock detox with acute psych (who can get violent), so no more detox patients into the locked units where I am (unless mental illness is the primary need). This is how triage, care, anything works (squeaky diagnosis gets oiled first) :) ha ha!

Regarding the previous comments above: "The rest of them I couldn't care less what happens to them. They are generally, from my exp, ungrateful, needy, selfish, and just aholes?":madface: Whoa Nelly! Did I just read an professional RN calling a diagnosis group aholes :nono:???

If you read no further; three letters E.A.P.!

I don't feel it's remotely appropriate, or acceptable to name-call any diagnosis group. I had to do a double-take. If a patient is doing something where I feel I'm going to react emotionally, or negatively, I've completely lost my ability to help that person (and I need to move out of that area to a different specialty ASAP). My self actualization, nor does my career depend on patient gratitude (they're not on our units to please US)! My job is focused on saving lives from a continuous, progressive and fatal disease. It's not a moral character disorder where patients are (enter negative name here). Again, it's an AMA AANP ASAM diagnosed disease. Has anyone called diabetics idiots, or aholes because they did xyz to further their illness, became obese, cheated, etc. I take care of them, because they come to me asking (asking) for help. Withdrawals (acute and post-acute) make patients insane. Some are more difficult than others (psychiatry 101 for anger, manipulative redirection, anger management, safe handling, etc). It's my job to come to them armed with all this information, so they understand what's happening to them. I always tell them, "Although you feel like you're completely losing your mind, YOU"RE NOT." When they act manipulative, panic, angry, etc. I calmly let them know "It will get better, trust me, it will."

In nearly all cases, once in recovery after PAWS, many can decrease or stop psych meds (obviously supervised, but these are the outcomes of recovery). It's nice to see the majority of professionals here taking it upon themselves to learn the most they can, ask legitimate questions and enjoy learning about a rapidly progressing specialty. Wouldn't it be great if we had staff who liked working with the most challenging patients, as well? I love my "druggies and drunks." The more manipulative, the better (because we have something to talk about, and I have an inroad to help them). I don't need any thank you's (my ego isn't fragile, and I already get paid as a thank you; never mind I'd do it for free).

Last of my soap box chat...patients and other staff see, and react to body language, facial expressions and word choices that exude the feelings one harbors against addiction, races, religion, orientation, etc. People can see, feel and sense that, whereby the practitioner becomes therapeutically ineffective (and creates a toxic environment of the unit, as this behavior can be contagious).

Ok, I had to laugh at the PAWS reference. :cheeky: I'm pretty sure I suffered the effects of PAWS longer than two years...I remember my counselor(long term treatment) and I talking about my acute PAWS attacks I suffered from and how long would I be going through them and he said "well, what if they never go away?". That's when I simply had to accept the fact I can't handle stress like a "normal" person.

I'm doing acute psych now but I'd love to be an addictions nurse eventually. I'll be celebrating 28 years of continuous sobriety on July 11th, this year(God willing).

Carlarina1

3 Posts

I joined up just so I could commend 'Castlegates' on his/her excellent post which shows professionalism, empathy, humor and a generally great attitude. We could all learn something from nurses like you and I bet you'd be great to work with too.

AussieRN36

10 Posts

I think the mental health clinicians should be trained in addiction & recovery. There seems to be such a lack of understanding coming from the staff, and it results in this transference and counter-transference feedback cycle. It's unhelpful because it puts everybody on the defensive. My work place treats both and there isn't any more issues coming from the addiction patients than there is the psych patients. I detect a lot of stigma and to be frank I'm sick of hearing the subjective handovers coming from staff in relation to the addiction patients.

yhl1975

134 Posts

People with a mental illness are twice as likely to have a substance use problem compared to the general population. At least 20% of people with a mental illness have a co-occurring substance use problem. For people with schizophrenia, the number may be as high as 50%.

Similarly, people with substance use problems are up to 3 times more likely to have a mental illness. More than 15% of people with a substance use problem have a co-occurring mental illness.

Institute for Health Metrics and Evaluation (2015). Global Burden of Diseases, Injuries, and Risk Factors Study, 2013. Data retrieved from GBD Compare | Institute for Health Metrics and Evaluation

Chesney, Goodwin and Fazel (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13: 153-60

Mental health clinicians obligated be trained in addiction & recovery.

RNOTODAY, BSN, RN

1,116 Posts

Specializes in NICU, ER, OR.

Worth seriously considering, since an inordinate number ( I don't know the percentage) of addicts also have a psychiatric disorder/ diagnoses as well, and if , for example anxiety isn't treated or addressed simultaneously, which quite often leads people to medicate with drugs-- then recovery might not happen.

Specializes in ICU.

most addicts have a dual diagnosis... normally you don't really start abusing substances unless you have underlying issues... normally.. lol

Luke79AU

21 Posts

Yes! Definitely here in Australia 

Why?
- The Mental Health Acts afford many protections and rights. AoD operates by it's own rules. This can't continue. It's obscene. Patients held incommunicado, things that you'd never get away with in psych.
- Substance use disorders are in the DSM manuals because the APA dictates them and mental disorders, as they are.
- It would de-stigmatize addiction, and illustrate that these are all disorders of the mind. The APA thinks so, and I'm not even one psychologist.

Luke79AU

21 Posts

CASTLEGATES said:

Post acute withdrawal syndrome can mimic schizophrenia, bipolar, PTSD, explosive d/o and others. This is why it's not recommended for addictionologists to stamp any new diagnoses on patients until they're finished wit PAWS. It can last anywhere from 2mos to 2yrs. Addiction is a disease, just like cancer. What do we do with a cancer patient who breaks his leg in an accident? We tend to place them in the unit where the most acute need determines where they go. This is the same with addictions at the psychiatric campus where I work. It's not fair to place addicts in a locked ward with people hallucinating, etc. Actually we had to learn this. A patient pursued this the legal route (when we did detox in a locked unit with psych) and the findings were--this was, in fact unreasonable and unjust to lock detox with acute psych (who can get violent), so no more detox patients into the locked units where I am (unless mental illness is the primary need). This is how triage, care, anything works (squeaky diagnosis gets oiled first) ? ha ha!

Regarding the previous comments above: "The rest of them I couldn't care less what happens to them. They are generally, from my exp, ungrateful, needy, selfish, and just aholes?":madface: Whoa Nelly! Did I just read an professional RN calling a diagnosis group aholes :nono:???

If you read no further; three letters E.A.P.!

I don't feel it's remotely appropriate, or acceptable to name-call any diagnosis group. I had to do a double-take. If a patient is doing something where I feel I'm going to react emotionally, or negatively, I've completely lost my ability to help that person (and I need to move out of that area to a different specialty ASAP). My self actualization, nor does my career depend on patient gratitude (they're not on our units to please US)! My job is focused on saving lives from a continuous, progressive and fatal disease. It's not a moral character disorder where patients are (enter negative name here). Again, it's an AMA AANP ASAM diagnosed disease. Has anyone called diabetics idiots, or aholes because they did xyz to further their illness, became obese, cheated, etc. I take care of them, because they come to me asking (asking) for help. Withdrawals (acute and post-acute) make patients insane. Some are more difficult than others (psychiatry 101 for anger, manipulative redirection, anger management, safe handling, etc). It's my job to come to them armed with all this information, so they understand what's happening to them. I always tell them, "Although you feel like you're completely losing your mind, YOU"RE NOT." When they act manipulative, panic, angry, etc. I calmly let them know "It will get better, trust me, it will."

In nearly all cases, once in recovery after PAWS, many can decrease or stop psych meds (obviously supervised, but these are the outcomes of recovery). It's nice to see the majority of professionals here taking it upon themselves to learn the most they can, ask legitimate questions and enjoy learning about a rapidly progressing specialty. Wouldn't it be great if we had staff who liked working with the most challenging patients, as well? I love my "druggies and drunks." The more manipulative, the better (because we have something to talk about, and I have an inroad to help them). I don't need any thank you's (my ego isn't fragile, and I already get paid as a thank you; never mind I'd do it for free).

Last of my soap box chat...patients and other staff see, and react to body language, facial expressions and word choices that exude the feelings one harbors against addiction, races, religion, orientation, etc. People can see, feel and sense that, whereby the practitioner becomes therapeutically ineffective (and creates a toxic environment of the unit, as this behavior can be contagious).

So well said. I hope you teach and mentor many junior RNs

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