“It’s hard enough to find these people. How can we be expected to screen them for metabolic syndrome, too?” Maya, the new nurse at the HOPE ACT team, articulated these words to Rodis, the consultant, who then looked at her, paused and responded, “Quite a dilemma. This is, indeed, one of the most challenging patient populations to work with...Let us look at the why.” Two reasons why have been discussed, both from the perspective of our patients and clients.
While additional tools might help with the implementation of this decision making process, a multidisciplinary team-based discussion around making this decision is a crucial part of this approach. It is well known that the tools do not replace sound clinical judgment, but using these in combination—team discussion, sound clinical judgment and best tools—for immediate decision-making is…
“There has been progress, there have been bumps in the roads and there have been mistakes. Like in any relationship, mistakes happen. The important thing is that we learn from them and use these moments as an opportunity for repair, growth and modeling.”
Whether psychiatrist, Nurse Practitioner, Psychologist, Social Worker or Licensed Mental Health Counselor, several clinicians consult with me on challenging cases, and many times, the initial statement is either, “I feel stuck,” or “this patient got stuck.” However, we are likely to be more successful with our clients by implementing the 6 steps we will explore on this article.
When I was in psychiatry residency, the training director, Dr. Rapaport, once asked me, “What can I do to best support you?” She must have seen something in me because my response to this led to the best gift of all -- Dr. Bernhardt.
Race, racism, discrimination, biases and microaggressions are the topics of some of the most difficult conversations that take place every day in our minds, but most of us attempt to avoid them at all costs; except that the cost is high for our patients and clients of color. They are already stigmatized for their mental health condition, their substance use disorder, and their HIV status, as well as their sexual orientation; they are already stigmatized for homelessness, their lower level of education, and unemployment status; they also bear the burden of a skin color that their ancestors have been told makes them “inferior.”
Patients and clients bear witness to the dangers and adverse effects of K2. How can we capitalize on the principle of social currency and that of peership, to help our patients and clients, like Raj, who uses K2, a dangerous drug with significant adverse effects? After all, this is in line with the principle of harm reduction.
New strategies for substance use assessment will help us master the needed skills, so we can continue to do the best work possible for our patients and clients, helping with relapse prevention, promoting full recovery, paying attention to integrated care, lessening fragmented care, and feeling gratified, as we continue to do this challenging though noble work.
Regardless of nationality, ethnicity, cultural background or beliefs, we all have a set of needs. Theses have to be met for us to be fulfilled. Whether we were born in a home or family that valued formal education or emphasized a religious or spiritual upbringing or something else completely different, the Need Fulfillment Theory applies to all of us. Whether we were born rich or poor, male or female or carry a particular sexual orientation, there is a set of needs that must be met if we are to be fulfilled…
Physical neglect, emotional neglect, and emotional abuse are often overlooked, yet, are highly correlated with substance use disorders and internalized symptoms like anxiety and depression. Furthermore, the sense of self becomes very unstable, which makes the coping mechanisms rather unhealthy, hence the tendency for traits of personality disorder to be present in this patient population.
Contrary to popular belief, while personal efforts can contribute to one’s attendance to appointments, groups, and to one taking medications as prescribed, addiction or substance use disorders are caused by a combination of bio-psycho-social and cultural factors, and the treatment also requires the same multidimensional approach. As clinicians, it is our role and duty to follow this framework in our assessment, treatment, and approach with our patients and clients, and especially in how we communicate with them and talk about them and about addiction, as a whole.
“One more set. Just one more, to complete it to one dozen distortions, and then I will leave you alone,” Vladimir said to me, after I had told him, “We are done talking about cognitive distortions, let’s switch gears a bit.” Vladimir would not take no for an answer. Here is the last set of cognitive distortions or errors that I described to Vladimir. And you can use them, especially, to help your patients and clients.
Split treatment remains a challenge and has been shown to be detrimental to our patients and clients. This becomes more significant when it involves a patient population with several comorbidities. Patients with both mental health and substance use treatment needs are particularly vulnerable to split treatment, and integrating substance use treatment and mental health services is not only advised but also essential if we are to make meaningful changes.
There are several theories and explanatory models for Borderline Personality Disorder. There is much literature on all of them, though I am not going to mention them here. In this article and subsequent ones, I strive to help facilitate an understanding of those with Borderline Personality through the framework of the SWEET 7 Fundamental and Universal Needs, which I will introduce in the rest of this article.
The first five questions, described in the previous article, help with establishing rapport, with joining in, and with understanding and formulating a plan. Once you have reached this point, it is time to go to the next step that will prepare you to problem solve. This step involves having a clear picture of the magnitude of substance use, including the related consequences; assessing the stage of change for your patient and client; and discovering which barriers need to be overcome. Here are the five additional questions to ask when conducting a strategic substance use assessment, as part of this second phase.
And so, it went, five questions to ask as part of your New Strategies for Substance Use Assessment. Next time you meet with your patient or client.
Patterns of use;
You will be able to say like Maryann and Edward, “Things have been feeling different with Raj…we feel we have been making a difference in his life.” You also will avoid falling into the trap of unknowingly and unintentionally failing to provide the right care for your patients or clients with substance use disorder.
To be able to identify our biases and think of ways to practice in a more integrated way, will enhance our advocacy skills while working with individual with substance use disorder. Also, to help lead our agency towards this effective way of thinking: enhancing communication, enhancing clinical outcomes, halting the cycle of fragmented care, and upholding educated expectations. Lastly, we will stop falling into the trap of unknowingly and unintentionally failing to provide the right care for our patients and clients.
You may be failing to provide the right care to your patients and clients with substance use disorder. You may also be using your counter transference and biases to their detriment, unknowingly and unintentionally. Learning the new strategies to working with individuals with substance use disorder will help you avoid falling into this trap. It will also help you promote and practice integrated substance use treatment and mental health care; improve your awareness and advocacy skills on behalf of your patients and clients with substance use disorders; and become a passionate educator to help decrease stigma against substance use disorders.
“You said there were more than a dozen cognitive distortions. You told me about six, and I want to hear about more of them,” said Vladimir. I was happy to oblige, since he already began second-guessing his initial beliefs that CBT was more like a “quick fix” and reductionist view of the brain.
The system has its role to play. It needs to empower clinicians and advocates, patients and clients, if there are interests in decreasing staff turnover and restoring trust. If burnout is to be addressed and prevented and self-care promoted, we all have to work together. And, these efforts must be supported by the system, if we are to reach our goals and continue working effectively and with the passion with which we came into this field.