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

Qteapi · Sep 28, 2015

That they are full of tricks to get a controlled high in the beginning and you have to be on your p's and q's no matter how "nice" they are to you....just saying what I am saying

Jules A, MSN · Sep 28, 2015

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.

SoundRN7 · Sep 29, 2015

Not everyone with a mental health diagnosis abuses drugs but everyone who abuses drugs has an underlying mental health issue.

Davey Do · Sep 29, 2015

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.

Mandychelle79, ASN, RN · Sep 29, 2015

That if they aren't ready nothing i say will change their mind

that they come in with a chip on their shoulder because of how they have been treated by other healthcare professionals

how to assess them for withdrawal symptoms and know when they are padding their scores

how sometimes the best way to break the ice is man you look like crap, let me get you assessed and call the dr to get you something to help.

how saying yeah we detox with clonidine really upsets some people (only have one doc who can start sub). And then remind them to ask for other prns to help with the symptoms.

how shocked they are when they realize I know a heck of a lot about what they are going through and can't get away with some things they are used to doing.

that they easiest was to gain their trust is to respect them and treat them like it's any other disease.

And my favorite.... They have taught me that some herion users will state their use in grams to make it sound like they are using a lot to be able to do the sub detox. I now know how many bags are in a gram so i have a better grasp of what they using and know that a half gram is not nearly as much as what they are trying to pass it off as half gram sound like a lot more than 5 bags when most of our clients do 20-30 bags per day.

Meriwhen, ASN, BSN, MSN, RN · Sep 29, 2015

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.

Mandychelle79, ASN, RN · Sep 30, 2015

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.

Jules A, MSN · Sep 30, 2015

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.

Mandychelle79, ASN, RN · Oct 1, 2015

We don't do benzos for opiate withdrawal either. We have separate assessment scales based on what the pt is coming off of. The only times the assessment score comes into play is 10 or above for Ativan for etoh/benzos withdrawal or above 6 for clonidine but we can treat the other symptoms based on or repirt

blackribbon · Oct 6, 2015

CIWA for alcohol withdrawal isn't just based on patient reporting...there is a very specific rating scale that allows for visible/tangible signs to be included in the scoring. For example, I actually touch the patient to determine the extent of paradoxical sweats...if I don't feel any, then they get scored accordingly. And if in doubt, I'd rather give a little bit more than have a patient have a seizure....but again, a patient under CIWA protocol actually getting IV ativan is usually in a med/surg bed being closely monitored since based on the score we can be taking vitals and drug administration every 15-30 minutes (score climbing).