Psych nurses: What have you learned from working with substance abusers?

From a care standpoint the alcoholics and people dependent on benzodiazepines are the ones you need to watch as they are at risk of seizure and death. The patients with opiate dependence who are acting as if they are dying are usually not. Read up on cluster B traits both antisocial and borderline as I don't think one can sustain an addictions lifestyle without them.

Last, although it can be frustrating to continue to attempt to provide patient education keep in mind that you will never accurately be able to predict who might actually be ready to consider sobriety. Please treat them all as if they have that potential. Hopefully over the course of your career you will have helped at least one lost soul.

Good enquiry, E.Renez! Great responses!

There is "more than"... For me, I learned and established within myself that if I, or anyone else, want to change or improve behavior, we must practice adopted principals in all our affairs everyday, all the time over and over again. We will always fall back into the habit of addiction or the behavior associated with our predisposed genetic template without working on our recovery constantly.

As Qteapi pointed out, Addicts know how to manipulate their media to achieve a desired result and are well practiced at their Art. They use what they know works.

Jules identified a major area of concern: Withdrawal from alcohol and/or benzodiazepines can be a life-threatening situation.

Modgoth makes a good point: When I worked in inpatient chemical dependency treatment, a Psychiatrist evaluated Patients for possible underlying mental illness symptoms. Some required psych treatment, some didn't.

In addition to all of the above...

Resist the urge to play MD and decide for yourself what PRNs that the patient should and shouldn't have. Detox is very uncomfortable to the patient both physiologically and psychologically, and for many detoxes there is a significant health risk. PRNs (along with scheduled meds) are there to address those problems. You may think you're helping the patient with their recovery by telling them NO and giving them a lecture about coping skills when they ask for their PRN Librium, but the truth is that you're not. If the patient meets the parameters for a PRN, give it to them. If you think a patient's PRN habits are maladaptive, tell the MD about it and let him/her decide if medication changes are warranted.

Also, patients themselves need to understand that detox is both physically/mentally uncomfortable, and that medications will not make it entirely pain-free.

The only time I have issues believing they need is when their subjective report does not match at all with the objective: n/v but eating full meals, covered in sweat (per pt) but clothing dry, palms dry, no sweat on brow, highly anxious but sitting calmly with peers until time for assessment, etc. We have been told to score the objective chart the inconsistencies, and Medicare when appropriate. Only Ativan/clonidine have a score associated to anxious, here's a vistaril, achy here's some aleve, upset stomach crackers and ginger ale and I'll ask doc for something. Still upset they don't meet criteria.

I hear ya, been there, done that but the bottom line for me as a RN was that it wasn't worth getting into a pissing match over especially if it was ordered. I would notify the provider and see if they wanted to change the orders but other than that I gave what was ordered. Note however I don't ever order benzos for opiate withdrawal symptoms, no need and yup vistaril and or clonidine will have to suffice.