"I'm an addict...not psychotic." Aren't they both mental health issues?

[NurseSheGirl]

I work for a small, private hospital specializing in mental health conditions for adults and adolescents as well as chemical dependency and rehab. While the acutely psychotic patients are placed on a separate unit, the main unit of the hospital contains a mixed population (chemical dependency and stable psych patients). I can't count how many times I've had detox patients sign themselves into our facility only to leave AMA because they didn't realize they were signing themselves into a "Psych Ward". What the heck do they think chemical dependency is exactly? A condition of the mouth?

It just gets on my nerves when people with addictions are so quick to judge others as if they have never heard of the term "Dual Diagnosis"...and if they are looking for a facility like Betty Ford or something you would see on Celebrity Rehab...don't you think they would do their homework and maybe research the facility they're signing themselves into? Its not like drug use magically manifests from nowhere. Most of them are dual in my opinion anyway...where their drug use stems from self-medicating ptsd, abuse, depression, anxiety, bipolar disorder, etc.

Just wondering if anyone else out there has dealt with this issue and can give me some advise on what to say to these people. The only thing I've come up with so far is that everyone is admitted for their own personal reasons. Some people are there to get off drugs while others are there because they need them. Any other helpful suggestions?

[MrChicagoRN, RN]

Addicts live in a world of magical thinking and denial.

You might try something along the lines of them not worrying about labels so much, and just focus on the issues that led them to seek help.

[Meriwhen, ASN, BSN, MSN, RN]

And it doesn't help that there is still a strong stigma attached to mental illness in general. You'll find many people will more readily admit to criminal or questionable activity than they will to having a mental illness.

[mpmayer]

Addiction is a physiologic illness centering in the brain..you guys better read some current research

[NurseDirtyBird]

So are bipolar disorders and psychotic disorders. Still mental illness.

[salvadordolly]

I worked in a private top of the line detox that was closed and merged with the psych unit. I got the same thing a lot. I would tell them that if they really wanted to recover, they were going to have to learn to tolerate a little discomfort and they may as well get some practice during their detox. Just the pecking order of the psych world - heroin addicts think they're better than crackheads, crackheads think they're better than meth-heads, alcoholics think they're better than drug addicts, and they all think they're better than the mentally ill.

[Altra, BSN, RN]

Regardless of the labels, or the plushness of the facility ... I would think that there is a high "drop out" rate at rehab in general because ... it's hard.

[RNitis]

What I've noticed in my lifetime is: It doesn't matter what you say/don't say, do or don't do. If an addict doesn't want to follow through, they'll find any excuse and most likely it'll be someone elses fault before their own.

[VivaLasViejas, ASN, RN]

Being both bipolar AND a recovering alcoholic, I'd have to say that dual diagnosis stinks no matter how you slice it.

[pinkiepieRN]

I think that these substance abuse patients could probably use a bit of education (and the benefit of the doubt for the first time that they say "oh I'm not a psych patient"). It's true that most patients with a substance abuse issue have an underlying Axis I diagnosis as well, but it's easy for one to think or say "I 'just' have a problem with drugs, refusing to acknowledge that substance abuse is a physiological and complex brain disorder in and of itself, just like schizophrenia or bipolar disorder. I'm not making excuses for these patients who think they're 'better' than another patient with depression or anxiety but the pathology and presentation is a bit different between substance abuse and say, a mood disorder or a psychotic disorder.

[mariahlily]

addicts seem to come up with a lot of different excuses to not follow through with rehab. when I was a guardian ad litem to a foster baby, the biological mother would tell me one day that she was about to jet off to a rehab, then the next day she would be checked out because "she didn't like the early morning walks" that she was forced to go on. if it wasn't that, then it was the fact that the place didn't have coffee, or cigarettes, or tv. or whatever.

[jadelpn, LPN, EMT-B]

Most addicts will use any excuse if they are not prepared to be clean. Seems as if "I don't want to be among the mentally ill" is a perfect one.

The major difference I see is that for MOST, once the patient is detoxed, and should they remain clean, they have clear thinking. People who are mentally ill and non-addicted don't always have clear thoughts.

And that is the ultimate goal, clear thinking.

"We want everyone here, regardless of the label, to be at their highest functional level. We all have work to do"