Detox against their will.....

Nurses General Nursing

Published

This just kills me and maybe someone can bring some light to this.

Why do we, as healthcare workers, force people to detox when they don't want to? I see so many repeat offenders (aka frequent fliers) in our unit that keep coming in for the same thing, ETOH abuse that obviously don't want to detox.

Why do we waste our tax money on these people forcing them to do something they don't want to do? :banghead: :banghead::banghead::banghead::banghead:

Why can't we just give them a beer in the ER and send them along their merry little way and stop holding up our rooms for people who legitimately need them?

Specializes in ICU, Telemetry.

If I get a pt with a hx of ETOH or substance abuse, and they tell me they want help to get clean and stay that way, I will move heaven and earth to get them into treatment.

However....

Those of us in the trenches know that most of these folks don't want to get clean, they want to be patched together enough to go right back to whatever self destructive behavior put them in the hospital in the first place.

And why do we treat them in the ER instead of turning them around at the door? EMTALA. What are the two "prongs" of EMTALA? That they a)present at the ER or any other part of the campus and that they b) request treatment/assessment. Well, if someone is brought to the ER by the county/police/fire/EMS and they are drunk/stoned, they are covered by EMTALA, as ETOH/substance abuse is classified as a disease process, even if it's the cops or EMS who "present" the pt and "request treatment."

I'm just waiting to be sued by one of our frequent flyers for the cost of his drugs because I ruined his high....:banghead:

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Isn't that enabling?

Seriously, my honest question is, "Who cares?"

WHY do people need to be clean and sober? Why do we refuse to acknowledge that this is the way people either choose to or must live?

Most of the people being discussed in this thread are obviously derelicts, and incredibly damaged, probably with underlying mental health and behavioral issues that would make their recovery incredibly difficult and impossible to maintain.

We have thrown the mentally ill out onto the streets with inadequate caregivers and housing and a pittance from SSI that doesn't cover even the barest necessities.

They are self-medicating to stay whatever demons drive them. Personally, they do not get me angry and they don't try to spit at me - but I am a recovering alcoholic with a heroin-addicted niece and a schizophrenic sister. Mental debilities don't run in my family, they gallop. But i understand the incredible frustration of dealing, day in and day out, with this population. It is impossible not to ever take it personally.

But enabling? Who cares. It gets them through another miserable day. And until we are ready, as a society, to pay the MONEY that it would cost to really help these poor souls, let them at least subsist in peace.

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Seriously, my honest question is, "Who cares?"

WHY do people need to be clean and sober? Why do we refuse to acknowledge that this is the way people either choose to or must live?

Most of the people being discussed in this thread are obviously derelicts, and incredibly damaged, probably with underlying mental health and behavioral issues that would make their recovery incredibly difficult and impossible to maintain.

We have thrown the mentally ill out onto the streets with inadequate caregivers and housing and a pittance from SSI that doesn't cover even the barest necessities.

They are self-medicating to stay whatever demons drive them. Personally, they do not get me angry and they don't try to spit at me - but I am a recovering alcoholic with a heroin-addicted niece and a schizophrenic sister. Mental debilities don't run in my family, they gallop. But i understand the incredible frustration of dealing, day in and day out, with this population. It is impossible not to ever take it personally.

But enabling? Who cares. It gets them through another miserable day. And until we are ready, as a society, to pay the MONEY that it would cost to really help these poor souls, let them at least subsist in peace.

Yeah dude, **** 'em.

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Yeah dude, **** 'em.

Is that really what you took from my post?

My.

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OK I don't think I'm going to change anybody's mind here, but it does seem to me that when we went through the deinstitutilization of chronically mentally ill we ended up just pushing some people with problems out of state hospitals and jails and into ER's. So in terms of cost...either way we are going to pay for it. So maybe it's time to get serious about trying to developing a system that might truely address the problems, these folks have and that protects society and the persons involved.

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Specializes in Ortho, Case Management, blabla.
Isn't that enabling?

Not if we bill them $20 for a $1 can of beer

Seriously, my honest question is, "Who cares?"

WHY do people need to be clean and sober? Why do we refuse to acknowledge that this is the way people either choose to or must live?

That's a great thought, except most of the people that are drunks happen to be on either A)social security B)medicaid C)self pay (and 99% won't pay it before they die of liver cirrhosis). Their lifestyle choices are affecting my wages and my paycheck deduction. If you don't care, then great. I care. I donate 1% of my yearly earnings to the indigent fund at my hospital and it's kind of lame to think that money goes to frequent flyers. I don't really mind, but at the same time I'd rather it goes to some poor kid that needs a heart transplant or something.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I mainly took the OP as a venting type post.

It is frustrating to put a person through all of that drama only to let them back out on the streets without an aftercare program to help them if they choose to. Often when people go back to their "playgrounds and playmates" they are doomed.

On the other hand, while it may be enabling, if someone comes in with a broken jaw and can have surgery and leave in one day post-op, instead of maybe four or six that they are detoxing, then I'm all for giving them some beer if they want it. A couple of our docs even go out and buy it for them, as does our manager, although we first try to get the family to supply it. It just makes sense to me for the practicing alcoholic with no interest in stopping drinking to keep the DTs at bay.

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Specializes in tele, oncology.

Aerorunner,

I can totally identify with where you are coming from....have even had the same sentiments myself at times. I have to try to keep in mind that we are not purposely detoxing them, just dealing with the symptoms of withdrawal while healing other body systems at the same time. I do wish that so many of these other body systems weren't falling apart due to said ETOH use, however! I think that the same sentiments apply equally to ETOHers and drug users as it does to our noncompliant DM, COPDers, etc. I do hate that they keep using up our limited resources for the same thing over and over again, while others are waiting for their bed.

Luckily, my hubby (who is not in the medical field), who I complain to all the time about such stuff, tries to keep me grounded. He helps out tremendously with trying to get back to the non-jaded, non-cynical nurse that I started out as. It can be frustating sometimes, but sometimes he's right on the money.

He has pointed out to me before that I am there to not just heal bodies, but spirits...even if I consider it to be a "hopeless cause", I may just be able to help one or two people overcome their problems by being as supportive as I can be during their time of distress. Maybe, by being able to show them compassion during this time, I'll say or do the one thing that they'll be able to hold onto during their fight to be sober or compliant. Because of discussions I've had with my hubby, about my compassion or lack thereof, I try to point out to them non-judgementally and gently that what they are doing to themselves is affecting everyone they love..."I can tell that your wife loves you very much, she's been by your side every time you've come here. It's going to devestate her when your disease finally gets the best of you. Would you like for me to get you information on support groups or people you can talk to to help you be around longer to love her back?" Sometimes it ticks them off, sometimes they ask me to bring them the info. I hate to sound idealistic and naive, but if even one person chooses to go call one of those numbers and get what they need to be more compliant, whether it's diabetes or ETOH use, think of all the people impacted.

I'm not trying to make myself sound good, b/c I honestly fail at maintaining compassion for these patients more often than I suceed at it, but I think it answers your question of why we should keep doing it. In an ideal world, all of our drunks would take the local AA number, skip off to meetings, and never touch a drink again. I know we don't live in that world, so I'll settle for thinking that maybe one or two of them will.

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Specializes in ER/Trauma.

I have carried out MD orders that said : "Beer 1-2 cans PO Q dinner". We've stocked Budweiser and Black Bush Whiskey in our fridge on the floor.

I once joked with the MD (Urologist. Great guy, brillian Doc) that I was going to make him my primary doc. When he asked why, I said "Any doc who prescribes beer to his patients can't be that bad!" :D :chuckle

Sorry. Just thought I'd share a light hearted incident with y'all.

cheers,

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Specializes in MSN, FNP-BC.
I have had a couple of post op patients who due to some complication during surgery had to go to ICU and prolong their stay.

These patients were not entirely honest about how much they drink in their pre-op assessment, and would start going into withdrawl. Nobody tried to detox them against their will on purpose.

I've had that happen as well and I agree that is completely different.

The scenarios I'm refering to are the repeat drunk who comes in, fell at home and had one broken arm on the first admission and now has two broken arms. The only reason they were admitted was to detox. The broken arms could have been addressed on an outpatient basis rather than in a critical care unit.

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Specializes in MSN, FNP-BC.
I don't believe in forcing sobriety upon anyone. The individual has got to be the one to make that choice. It's a hard situation. Yes, alcohol addiction is a disease but there are many factors as to why someone has this disease and I don't think it's always because someone wanted to be drunker than a doornail for the rest of their life.

I couldn't agree more. I grew up in a family of alcoholics and saw the devastating effects that the drug has on the person and those surrounding them. That's why it bothers me so much. They aren't going to get clean unless they want to.

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Specializes in ED.

I agree that the forced detox we do in hospitals is unnecessary for the most part. Detox can be very dangerous, and extends the hospital stay for many patients. While I think it is our job to provide education about addiction, and to do everything possible to provide detox for those who want it, most of these patients are adults and know very well the consequences of their choices. Most of these patients will just get out of the hospital and head for a drink after being detoxed. How much good do we do when we detox a patient against their will and then send them back out into the world with (probably) no aftercare, support system, etc? How much good are we doing when we are forcing them into seizures, delirium, incontinence, etc? Even if we're medicating them, it still happens. Call me cynical, but it just doesn't make sense. We sometimes have patients admitted from the ED with orders for a beer a few times a day. They used to put them on ETOH drips. For someone who is not ready to deal with their addiction, it just makes more sense to me.

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