Meth cycle

Double-Helix, BSN, RN · Apr 25, 2017

That must be very frustrating. I don't know what the laws are in your state regarding involuntary treatment programs or declaring someone incompetent to make their own medical decisions, but short of those options, you can't force someone to get help if they don't want to. I assume that psych and social work has been involved with the patient during hospitalizations?

SouthpawRN · Apr 25, 2017

I don't think there is a hospital, EMS or FD that does not have at least 1 patient like this. Its sad and also frustrating. If this is in the USA, its another example of why we need a free universal healthcare system. Where is the patient's motivation to get better, try and get a job and a life etc. the hospital will take a part of every paycheck he ever earns to pay his hospital bills... Mental health and substance abuse programs are expensive and the free ones are so overloaded it could be years till they can be placed in a program. Gets off soapbox...

**NICU Guy, BSN, RN** · Apr 26, 2017

its another example of why we need a free universal healthcare system.

He already has free healthcare, he is on disability. How is free universal healthcare a solution?

Where is the patient's motivation to get better, try and get a job and a life etc. the hospital will take a part of every paycheck he ever earns to pay his hospital bills...

This patient's respiratory drive is gone. In what world will this guy get better and get a job and forget about the hospital recouping very much money for all of his ER and ICU stays. Medicare is so generous in it's reimbursements.

Getting off my soapbox.

SouthpawRN · Apr 26, 2017

Sorry, My comment was in general terms and not just specific to one patient. You illustrate my point. All these folks end up on lifetime welfare and SSI etc. But people don't consider these costs when they talk about the cost of health insurance. If we treat mental health and addiction the way we treat medical conditions, there might be a lot more success stories and hopefully less of these frequent flyers in the hospitals.... Which costs more? lifetime of frequent flyers who end up in prison , lifetime of government support, or the revolving hospital door? Or universal care for mental, rehab, addiction and medical care with eventual job training and placement etc?

City’s Annual Cost Per Inmate Is $168,

pro-student · Apr 26, 2017

Unfortunately, there is likely little you can do about this individual. You may be familiar with the Transtheoretical Model of Behavior Change but the jist is that someone really has to want to change. There are things we can do at each step to help encourage change. For instance, at the Pre-Contemplation stage we might encourage friends and family to share their concerns with their loved one or talk to a patient to try and elicit their own motivations. In the Contemplation stage we can provide education and resources and let them know they will have support.

http://socialworktech.com/wp-content/uploads/2012/01/Social-Work-Tech-CoC-bw.png

These are all thing that I'm sure have taken place. Not that continuing is going to hurt anything. You never know what will finally tip the scale for someone. But for some, it just doesn't happen. It really sucks and it's one of the hardest things as a caregiver to watch someone shrug off the help we can give them. But ultimately, if you don't have buy in from the patient, nothing is going to change.

AnnieOaklyRN, BSN, RN, EMT-P · Apr 26, 2017

Hi,

Does the patient have a valid DNR in place? That would be the key or is he on hospice services?

I would do some research in your state and if the patient is willing to sign a DNR, then I would encourage that, or the family if the patient is no longer able to make decisions for himself. Make sure they don't just have a will or some other piece of paper. In most states EMS can only honor a valid state provided DNR form which you would need to get from his physician or social work.

The biggest missing peace of information here is as to whether or not the patient also wants to call it quits and if he is still mentally capable of making decisions about his own healthcare. Some physicians may not be willing to sign the DNR if the patient's issues are caused by a problem that can be cured (Meth use) and not from a terminal illness, although in my opinion addiction is in fact a terminal illness for most.

You can force a patient into detox, but that doesn't work unless they truly want to stop. It would be like taking cigarettes away from a smoker for two weeks who has no intentions of quitting.

Good luck.

Annie

**canoehead, BSN, RN** · Apr 29, 2017

It's possible that he doesn't have enough working brain cells left to make the huge change that getting sober would entail. Where I work, they can make a ream of bad, self destructive decisions, and still be considered competent, and there's nothing you can do. I think people use drugs to run from problems, and when he gets sober enough to look at his life, the drive to get high kicks in. As long as his Dad keeps finding him and calling 911, and as long as there is no DNR order, there is no choice on the healthcare end. If Dad had a rehab primed to accept him after a hospital stay, and you could do an intervention, get consent, and get him there during/after one of his hospital stays, and never let him hit the street, maybe it would take. Or jail, would Dad be willing to report him and give him an alternative of jail vrs rehab?

Penelope_Pitstop, BSN, RN · Apr 29, 2017

The family's words may indicate that they wish his struggle to end, even if it results in his demise; however, the father's actions show otherwise.

I've worked in behavioral health and a lot of my clientele were dual diagnosis.

Families who "mean it" tend to draw their bottom lines and hold them - typically they offer no support at all towards the loved one (yes there is still love) once that point is reached.

I've encountered many people of all ages whose families have written them off completely. Maybe they need to do this with him (maintain boundaries, not necessarily banish him) because sad as it is, there is clearly some element of enabling at foot here.

Because he has to want to get better. If he doesn't, there isn't anything can be done. Doubtful that a psychiatrist will find him without capacity to make decisions.

It's rough to witness.