Substance Abuse Disorder Patient Essay
Substance Abuse Disorder Patient Essay
These drugs that are converted from opium are: morphine, heroin, codeine, oxycontin, to name but a few. Unfortunately, each of these narcotics are habit forming, meaning they have the power to become addicting if a person takes them over a period of time. Why is it that some people become addict to alcohol or other drugs, while another person does not? According to the National Institute on Drug Abuse (NIDA), “addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain-they change its structure and how it works. These brain changes can be long lasting and can lead to the harmful behaviors seen in people who abuse drugs” (Drug Abuse). Keep this in mind when you are a health care professional dealing with patients that have an addiction. They may have initially chosen to take that first drink, but alcohol changes their brain. Also, you may find more patients in your office that are addicted to prescription drugs. They may have been injured in a car crash or broke their leg then were prescribed prescription pain killers such as Vicodin by the doctor that you work for. This patient has a different brain make-up and is now feeling that dependent on that drug. Many people that suffer from substance abuse also will suffer from a form of
Dual diagnosis between drug abuse and mental illness is very common. The two problems affect and interact with each other. The number of people diagnosed with a mental illness and substance went from 210,000 to 800,000 between the years of 1998-2003. (Druss MD, Bornemann, Fry-Johnson MD, McCombs PhD, Politzer, & Rust MD, 2006) Substance abuse is the most common and clinically important dual disorder among adults with severe mental illness. Substance Abuse Disorder Patient Essay.Studies show that fifty percent of people with mental illness also have a substance abuse problem. (Saisan, Smith, & Segal, 2010) And more than half the persons with a substance abuse diagnosis also have a diagnosable mental illness. (Saisan, Smith, & Segal, 2010)
Clinicians believe that mental illness and substance abuse are biologically and physiologically based. “Although substance abuse and mental health disorders like depression and anxiety are closely linked, one does not directly cause the other.” (Saisan, Smith, & Segal, 2010) Both conditions can mirror each.
PROBLEM STATEMENT:
More and more people are suffering from a combination of substance abuse and mental health problems. Alcohol and/or drugs are often used to relieve the symptoms of a mental illness, side effects from their medications or just to cure symptoms they are having at the time. Alcohol and drug abuse can increase original risk for mental disorders and can make symptoms of a mental health problem worse. Substance abuse and mental illness commonly co-occur due to genetic factors, environmental factors, a brain disorder and/or a development disorders. “Co-occurring disorders, two disorders or illnesses occur simultaneously in the same person, they are called dual diagnosis or co morbidity.” (Topics in Brief, 2007) Treatment for this dual diagnosis has not been well designed. Clients have to go a treatment facility for mental health treatment and a different facility for substance abuse treatment. This kind of treat is not successful because this leaves the client trying to cope/manger a disorder on their own. It is almost impossible for them to manger the other disorder because if they could quit on their own they would not need treatment.
It can be hard to diagnose a person with a dual diagnosis of mental illness and substance abuse. One of the things that makes diagnose hard is denial by the patient. “Substance abuse and mental disorders commonly co-occur because of overlapping genetic vulnerabilities, overlapping environmental triggers like stress, involvement of similar brain regions, and drug abuse and mental illness are developmental disorders.” (Topics in Brief, 2007) Having a dual diagnosis put a person at greater risk for relapse. Violence and suicide attempts are also more prevalent among the dually diagnosed population. Substance Abuse Disorder Patient Essay.
BACKGROUND:
The problem of dual diagnosis became clinically clear in the early 1980s. (Drake R. P., 2001) Substance abuse and mental illness hinders your ability to function, handle life and have a healthy social life.
Mental illnesses are mental conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning. “The World Health Organization has reported that four of the 10 leading causes of disability in the US are mental disorders.” (National Alliance on Mental Illness, 2010) Some of the major and the most common mental illness that occur with substance abuse are manic depression, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, generalize anxiety disorder and antisocial personality disorder. It is reported that about 57.7 million Americans experience a mental health disorder in a given year. (National Alliance on Mental Illness, 2010)
Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not need to sustain life or to make it better. “One in four US deaths can be attributed to alcohol, tobacco, or illicit drug use.” (Innovatory Combating Substance Abuse, 2010) The commonly abused drugs by people with a mental illness are alcohol, cocaine and/or marijuana. Substance abuse complicates some aspect of care for a person with a mental disorder. It provides challenges for the counselor to engage the individual in treatment.
About “50% of individuals with severe mental disorders are affected by substance abuse.” (Saisan, Smith, & Segal, 2010) “Thirty-seven percent of alcohol abusers and 53% of drug abusers also have at least on serious mental illness.” (Saisan, Smith, & Segal, 2010) See the chart below. The risk of developing a drug abuse problem while having a disorder goes as high as 15.5% for antisocial personality disorder and as low as 02.1% for phobias. “The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.” (Saisan, Smith, & Segal, 2010) When a person has a dual diagnosis of substance abuse and mental illness the clinician has to determine what are the symptoms/signs of the substance abuse and what are the symptoms/signs are from the mental illness.
Disorders with Increased Risk of Drug Abuse
Disorder
Risk
Antisocial personality disorder
15.5%
Manic episode
14.5%
Schizophrenia
10.1%
Panic disorder
04. 3%
Major depressive episode
04.1%
Obsessive-compulsive disorder
03.4%
Phobias
02.1%
Source: National Institute of Mental Health.
(Drug Abuse and Mental Illness Fast Facts, 2006)
At least 60% of people fighting substance abuse or mental illness are fighting both at the same time. (Bouchex, 2007) Patients with mood, anxiety or drug disorders are about twice as likely to be diagnosed with the other as well. Figure 1 (Topics in Brief, 2007) The prevalence of these dual diagnoses does not mean that one condition caused the other, even if one appeared first. The high rates show the need for better treatment and treatment centers able to deal with both at the same time. Substance Abuse Disorder Patient Essay.
WORKING DIAGNOSIS:
Substance abuse can cause mental disorders due to the fact that,
“drug abuse can cause a mental illness,”
“mental illness can lead to drug abuse,”
“drug abuse and mental disorders are both caused by other common risk factors”
all three can contribute to the establishment of specific dual diagnosis of mental disorders and addiction. (Topics in Brief, 2007)
FRAMEWORK/METHOD OF ANALYSIS:
I began my search using Google and searched using the terms “Substance abuse and Mental Illness”. This resulted in nine articles that were relevant to my topic all of which I used as references.
I then went to the Pub Med Central database and searched using the term “substance abuse and mental illness” and found many articles. I used four of those articles as references. The other references were found on website such as National Institute on Drug Abuse and the National Drug Intelligence Center.
ADDITIONAL INFORMATION (LITERATURE REVIEW):
This review looks at progress made in understanding the relation between drug abuse and mental illness. Volkow found that the relationship between substance abuse and mental illness “is likely to reflect common contributing factors and brain substrates.” (Volkow, 2001) One of the main factors substance abuse and mental illness have in common is stress. A question that still remains is the role that drug abuse has on causing psychosis in individuals with no previous psychiatric histories. Stimulant drugs induce psychosis because they increase extracellular dopamine concentration in the brain. However it does not explain why psychosis can continue after the stimulant drug is no longer present in the brain.
Regier, et al, broke his study down into specific mental disorders. This review found that of people with schizophrenia forty-seven percent has some form of substance abuse problem. People diagnosed with schizophrenia have a 4 times as likely then people who do not have schizophrenia to have a substance abuse problem. (Regier, et al., 1990) The odds for people diagnosed with anxiety disorders to have a substance abuse proplem were more than fourteen percent. Substance Abuse Disorder Patient Essay.
It is believe that substance abuse may trigger mental illness in vulnerable individuals. Evidence show a “complex explanation in which well-known risk factors- such as poor cognitive function, anxiety, deficient interpersonal skills, social isolation, poverty, and lack of structured activities combined to render people with mental illnesses particularly vulnerable to alcohol and drug abuse.” (Drake, 2009) People that already have a mental disorder probably appear to be extremely sensitive to the effects of alcohol and other drugs, due to having a form of brain disorder.
Drake, et al, explains the term dual diagnosis as misleading because people with a dual diagnosis are diverse and tend to have multiple illnesses rather than just two illnesses. Drake discusses how researchers have established some identical finding. First, co-occurrence is common. “Second, dual diagnosis is associated with a variety of negative outcomes, including higher rates of relapse, hospitalization, violence, incarceration, homeless and serious infections such as HIV and hepatitis.” (Drake R. P., 2001) Third, the mental health and substance abuse treatment system delivers fragmented and ineffective care.
RESTATEMENT OF WORKING DIAGNOSIS (Hypothesis):
There is evidence that substance abuse can lead to a mental disorder but also a mental disorder can also lead to a substance abuse, it is not known which comes first. Like the saying which comes first the chicken or the egg. It is said that having one of the diagnosis makes you vulnerable to the other.
MANAGERIAL/POLICY RECOMMENDATIONS:
Why people who are having a mental disorder are so prone to drug abuse raises a lot of questions due to the limited research done on the topic. The research so far is inconsistent and has failed to address a number of issues. There is a need for more research as well as more treatment center that are equipped to deal with dual diagnosis. The patient has two brain diseases that influence one another, and which both need treatment, at the same time. This is when dual diagnosis treatment is need. It is an approach used by clinicians to treat individuals affected by two co-occurring or coexisting conditions simultaneously. Dual diagnosis affects a person physically, mentally, spiritually, emotionally and socially. There is a need for an all-inclusive approach that identifies both disorders, evaluates both disorders, and at the same time treats both disorders. Substance Abuse Disorder Patient Essay.Many treatment centers now only treat one or the other. Substance abuse treatment are not recommended or designed to handle a mental illness and vice versa. Awareness about the problem needs to be made public, so that people know the signs to look for and how to approach the person about their disorder correctly. Patients also need to be aware of the help that is available to them and support groups like Dual recovery Anonymous. There also needs to be better training for the counselors and physicians so that they will be able to better and accurately diagnosis patients. For recovery to be successful you must treats a client’s addiction and mental health problem.
So, a quick summary of the case study; Lloyd is a 23-year old single male who chose to move to the big city instead of going to college. He has been working as a plumber’s assistant for the last couple of years and will soon get his union membership. As it is, he makes pretty good money when jobs are around. He also made a comment saying HIV is clearly a Republican plot to wipe out the Liberal Democrats.
Since he works as an independent contractor, he has no insurance. Consequently, paying for his medication that his doctor has prescribed has been sporadic at best. He has prescriptions for AZT and protease inhibitors, but he has not been able to take them consistently because they are too expensive. Sometimes it will feel like multiple stab wounds in my gut that go on for hours. It really has me scared. He’s seen his doctor and she prescribed some Demerol? and an antacid. He’s pretty sure it’s related to his HIV. I would recommend him to get further help and give him plenty of options that may help Lloyd with the substance abuse and the suicide. Also help for the alcohol abuse. I also would recommend speaking with a counselor more, so he can get more and more how he is feeling and doesn’t bottle it up. Also, would speak with him and see if he wants to find options on how he can pay for his medicine. I believe Lloyd could be a heroin addict. Since we are not told whether Lloyd is also at risk with his sexual partners, whether he does or does not use safe sex precautions, you’ll have to assume is likely that this is how Lloyd contracted the HIV virus. This is a big problem or Lloyd and probably is hurting him inside to, its something he will have to live with for the rest of his life. He will need to learn how to cope with HIV, maybe go to groups and meet other people with the same situation and maybe get ideas on how to cope with it. One option would be an abstinence based on the patient heroin detoxification treatment program.
So, I recommend him looking for the right program for him to feel comfortable in. Another option would be a 21 day methadone out-patient detox program, or an out-patient medical detox and aftercare program or an outpatient methadone maintenance program. Any of these programs will also have case managers that will have HIV treatment resources for Lloyd to receive proper HIV care, such as how he could cope with living with HIV. I do feel the real challenge will be working with Lloyd. Is himself being safe with others. Lloyd’s statements and his attitude may suggest that he might be exposing others to his infection. Which could open a whole new problem. . but out of all this the First thing is he will have to decide whether he is interested in and motivated to get treatment, to get help with all that is going on. If he shows some degree of motivation. Without motivation he wont be able to get the full treatment he deserves. This can be an extremely tricky situation. Given the issues in this case, it would be more trouble for the counselor not to jump at Lloyd’s talk of suicide. To explore it with him in a natural matter.Substance Abuse Disorder Patient Essay. This issue will also test your personal beliefs and feelings about suicide. But as code of ethics you can’t let your personal beliefs get in the way or how you feel.
The important thing here is that your feelings and beliefs are not projected onto Lloyd and do not muddy the therapeutic waters. The reasons for not reacting at this point are; even though he has known about his HIV status for the past year, his comments tell me he has not really grieved over this news and how it has impacted his life and dreams, instead he makes up excuses and who to blame and tries to avoid it like it never happened. He is dealing with his HIV status by denying his own mortality with a “live fast-die young” attitude pretty much. He also projects responsibility and blame for the disease on a “Republican plot”. To react at his talk of a Republican plot and suicide could put you in a tough spot. Lloyd uses a number of street terms you may or may not be familiar with. How would you handle a client like Lloyd who uses street terms you may not recognize or understand? Why do you think Lloyd is using these terms? I would use context clues around the subject he is speaking about or jot down the word and then later on look more into the work, or you could ask him to explain the word.
A career in nursing can be the most rewarding occupation most people can think of. It truly takes a unique person with a strong sense of discipline, diligence, responsibility, and a love for mankind to take on such a role. While nursing for most is very rewarding, it is also an occupation that can very easily overwhelm employees and requires most of the time more so then none, a great tolerance to stress. For some when the stress becomes overwhelming, it may lead to addiction, especially in the medical profession where prescription drugs are readily on hand. The addicted/under the influence nurse affects many people including their colleagues. Most importantly, under the influence nurses pose a serious risk to their patients. There is a major controversy in the medical field because not all states in the U.S. handle these matters in the same way. Some policies use a disciplinary method in regards to substance abuse others remove the nurse from practice and give them a chance at rehabilitation, a chance to save their licenses, and for their problem to remain confidential. Adopting a nationwide policy to address substance abuse among nurses will ease the role of the professional nurse dealing with this controversy. The sooner this situation can be addressed and reconciled in the most productive and effective way, the sooner nurses can achieve delivery of the best quality of care possible to their patients. Substance Abuse Disorder Patient Essay.
Approximately 10 to 15% of all nurses may be under the influence or recovering from alcohol or drug addiction. Nurses are not at a higher risk then other people but their pattern of dependency is like no other because they have greater access to narcotics in their work environment.(ISNAP 2012)
The decisions that nurses make are at times a matter of life and death, and it is imperative that nurse and healthcare providers are attentive and alert to what they are doing at all times with no exceptions. All the combined stressors that may often come with this profession, along with the other stresses of personal life may lead a person to feel as though they will do what they have to so they can make it. Sadly for some this can lead to disappear and addiction. In the healthcare setting where medication is widely accepted as a cure to ailments and is readily accessible, nurses are at high risk to develop substance issues. Although the incidence of addiction among nurses is about the same as the general population, there is a higher rate of prescription-type medication abuse as opposed to street drugs. Nurses may administer medications on a daily basis, thus may feel more comfortable self-medicating.
One of the most important roles of a registered nurse is to assure the patient is getting the safest and most appropriate care possible. If a nurse is providing care while under the influence they are failing to fulfill this role. There is also a legal and moral responsibility of all nurses to report suspicions of abuse because the number one role of the nurse when dealing with an impaired colleague is to protect the patient. There may not be many signs or symptoms in the beginning, however as it progresses, it becomes more clear that something may not be right.(Bettinardi-Angres K,& Bologeorges 2011)
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Impaired nurses become unable to provide safe and appropriate patient care. Today addiction is considered a disease, but the addicted nurse still remains responsible for actions when working. The most common substances abused by healthcare professionals are alcohol, cocaine/crack, Ritalin, marijuana, inhalants, ultram, methamphetamines, ecstasy, hallucinogens and stadol, sleeping pills, antidepressants, morphine, Demerol, Percodan, vicodin and codeine. However, coworkers should never underestimate the need or desire for drugs from a substance-abusing nurse. The nurse might use whatever drug is available to satisfy the addiction while at work.(Monroe & Kenaga, 2011)
Nurses must be aware and proactive on the signs and symptoms that represent substance abuse. It may be difficult to suspect a co-worker of substance abuse, and the fear of retaliation may keep some nurses from taking action, it’s important to take the necessary steps to confront or notify the chain of command of your suspicions.
Educate yourself on the facility policy and procedures for employee substance abuse. Through documentation of any changes in the suspected impaired nurses’ behaviors is important. You may choose to urge the nurse to seek help and avoid any desire to enable the impairment.
The legal aspects to report an impaired nurse vary from state to state, but nurses have a moral and ethical duty to their patients, colleagues, the profession, and the community to take action. Documents such as the American Nurses Association Code of Ethics for Nurses provide a framework for patient safety.(Vernarec 2012)Substance Abuse Disorder Patient Essay.
Nurses who will have the courage to seek treatment have a good opportunity for a successful recovery. Treatment can be effective to improve health, social, and occupational well-being. Many organizations offer alternative treatment programs instead of termination. As of 2012 37 states offer some form of a substance abuse treatment program to direct nurses to treatment, they monitor the nurses’ re-entry to work, and continue their license according to the National Council of State Boards of Nursing.
Alternative programs monitor and support the recovering nurse for safe practice. Strong recovery programs offer a comprehensive individualized treatment plan. However, boards of nursing have a responsibility to safe guard the public, so they may suspend the nursing license of an identified impaired nurse if they suspect he or she may pose a danger to patients.(ISNAP 2012)
The American Nurses Association (ANA) is a strong supporter of alternative or peer assistance programs that monitor and support safe rehabilitation and the eventual return to the professional workforce. While relapse is high, the goals for the substance-abusing nurse is to seek treatment, reach recovery, and re-enter the workforce.(ISNAP 2012)
Poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired professionals to ask for help. Providing early intervention and assistance is essential in helping colleagues and students recover from an addictive disorder and providing a non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions.(Monroe & Kenaga, 2011).
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The nursing profession is all about caring and educating not only for the patient, but also anyone who needs assistance and it is important for everyone to understand that those who are suffering with addiction have an illness, which requires treatment and evaluation. Substance Abuse Disorder Patient Essay.
References
Bettinardi-Angres K, Bologeorges S. Addressing chemically dependent colleagues. J Nurs Regulation. 2011;3(2):10-17.
ISNAP Indiana State Nurses Assistance Program. Retrieved July 7, 2012 from http://indiananurses.org/isnapsite/warning_signs.php.
Monroe, T., & Kenaga, H. (2011). Don’t ask don’t tell: substance abuse and addiction among nurses. Journal Of Clinical Nursing, 20(3/4), 504-509. doi:10.1111/j.1365-2702.2010.03518.x
Vernarec, E. Impaired nurses: Reclaiming careers. The Carter Center. Retrieved July 7, 2012 online from http://www.cartercenter.org/news/documents/doc591.html?printerFriendly=true. Substance Abuse Disorder Patient Essay.
