Advice for dealing with addicts?

allnurses Guide · Dec 12, 2023

nolongeranurse said:

"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.

I concur with much of what you said however even with incomplete knowledge we have to start somewhere. What we do know is that addictive substances cause a spike in dopamine which binds to the pleasure center of the brain. Then there are the Phyisical aspect of drug use especially whe the DOC is Alcohol or benzos. You really can't know what an addict feels in this phase of their recovery. I've been there done that and believe me it's no picknic.

My comment that I was going to post before my break ended is that any nurse who is treating detox patients is too leave all their pre-conceived notions about this disease at the door and treat them with kindness and compassion.

The detox period is just that and is meant to get the DOC out of the system. In this phase a nurse's task is to get the patient through this with a little discomfort possible. This is not a time to try to teach them coping skills. That comes in the next phase. Addicts are not bad people. They are sick people who desperately need to get well. I agree that the Rehab industry is broken beyond repair. While there's no evidence based studies on the effectiveness of 12 step programs, becoming a member of this community of friends saved my life. I don't go to meetings and have not for the past 15 years. Still sober, still working with these unique group of patients.

When someone comes to me as a new grad of just someone to precept with me I always ask what is it that makes you inetrested in psych. Many say it because it was the only job they could get. They may turn out to be proficient , competent and compassionate nurses but it's not the same as if they had deep interest in psych.

When I see people write things like they want their vistaril like it's candy - well to a detoxing addict it is just like candy. It is almost a placebo and has little effect on a body or mind habituated on heroin , alcohol or benzos.

I ran into a young lady that I detoxed a couple of years ago when chatted, spoke about her recovery and how much her life had changed for the better. "When I saw you, I had to say thank you because you were kind to me."

allnurses Guide · Dec 12, 2023

TerpGal02 said:

. But then I remember that when.someone is in withdrawals, they are really sick, probably the sickest they have felt EVER. I know I can't expect them to be sunshine and daisies.

Bravo

Luke79AU · Feb 2

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)

Wow. If you were on my ward, you'd be out of that area, and likely lose your job.

Read again what you wrote. And what on earth are you working in a detox clinic for?

Also, if a patient is at a nurse station, asking for anxiety or sedative medications, and they are somewhat agitated, it's EXCEEDINGLY obvious that the previous meds have not exerted a sufficient therapeutic effect. Medical have not written you enough of, or effective, drugs. Take it up with them.

wlliamtom · Feb 12

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nolongeranurse · Mar 8

I guess I would like to also say- you are getting paid to be a nurse- so why don't you act like one. I don't know if you realize how you sound. Go back and read your post again. If you don't realize that your post is judgmental, ignorant and you sound like a dumb twit- then quit your job immediately. You are not smart enough to be a detox nurse. If you are able to read your post and understand all the problems with your statements and your complete lack of insight on what your job is as a detox nurse then I know you will never repeat the things that you posted because you would be so embarrassed at how dumb you sound that you would never want any one to know that it was you who wrote that. I am not trying to shame you, I am just telling you the truth

santi_05 · Mar 8

Patient know that you're judging them. One of the most cringe things I've witnessed is other nurses talking to their patients (who have addictions/drug seeking) but it's so obvious from their tone/language that they feel contempt for the patient. I'm just saying that having an addiction doesn't make people stupid.

PsychRNXXX, BSN · Mar 11

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 different opinions about this. My background is behavioral health and includes detox. They do need coping skills yes. But I also take into consideration their tolerances to drugs. I have no issues with the lowest doses of Benadryl, Vistaril and Trazodone. We stopped giving phenergan as a standing order because it enhances the effects of some of the other drugs. A lot of them are taking Subutex or Suboxone and it affects those.
I'm generally sympathetic but we got a lot of "repeat" patients. So each patient has a different story or a different game they are playing with you and the docs. There are people truly physically suffering from detox who are there for their first time. Then there are others who have been there 7 times and think it's a joke. So they are treated differently based on needs.
Usually if they have a PRN ordered and they can have it then I give it to them. 🤷🏼‍♀️ I will not stand there and argue with them though. I also won't let them talk down to me or curse at me. I will walk right away and tell them to come back when they can be respectful. It is tricky to say the least.

nolongeranurse · Mar 15

"Then there are others who have been there 7 times and think it's a joke. So they are treated differently based on needs."

What do you mean by that. Can you explain how they are treated differently?

allnurses Guide · Mar 15

nolongeranurse said:

"Then there are others who have been there 7 times and think it's a joke. So they are treated differently based on needs."

What do you mean by that. Can you explain how they are treated differently?

I to am curious - statistically (I'll have to look up the source) only 15% of all addicts and alcoholics attempt sobriety and less than 10% achieve 5 years sobriety. Less that 1% get to lifetime numbers. So repeaters are to be expected.

PsychRNXXX, BSN · Mar 18

nolongeranurse said:

"Then there are others who have been there 7 times and think it's a joke. So they are treated differently based on needs."

What do you mean by that. Can you explain how they are treated differently?

Maybe I didn't word it very well. All patients are treated appropriately. A lot of the repeaters come for different reasons - homeless, cold, avoiding court or warrants - but we know why they come. You get to know those repeating patients more than the others at this place because it's for acute episodes No long term inpatient care. So you can address more of a specific problem with them. You also will know who is an extreme drug seeker, those borderline or histrionic patients who do things for attention and do things to get a 1:1 sitter all the time, the ones who are going to lie to the providers for different reasons etc. Each person is just different, yes some with definite need, so you assist them with programming individually.

subee, MSN, CRNA · Apr 3

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)

Addictions is not for newbies. That's a place for a maturity. It takes a long time to make peace for yourself when working with people who can have developed manipulation skills to the nth degree. I just reminded myself how awful their lives must be for them. It requires both medical and psych skills.

PsychRNXXX, BSN · Apr 3

hppygr8ful said:

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

Amen! 100% agree. Hands down. Vistaril 25mg is a joke. Even for me. Benadryl 50mg is nothing to them. I can even take that. People using heroine and other hard drugs aren't going to be affected by vistaril and Benadryl, or phenergan for that matter. Trazodone too. People unfamiliar with addiction and such may not know that. They don't teach thorough enough info in psych rotations etc. so for new grads it's hard. There's not time to change their entire life. Active detox - they can't think about that. Give them what eases their anxieties sometimes. Encourage group and learning coping strategies but ...🤷🏼‍♀️ they need to be comfortable doing so. Physically and otherwise. It takes along time to change addiction mentality usually. I could continue but I just agree with this one 100. So there LOL.