Dealing with Substance Abuse in Mentally Ill Patients

relations with Substance Ab exp residue in Mentally Ill PatientsAlizah Al-amanIn a course of time the brain has developed in a modal value to ensure our survival. This survival system incorporates brains unique reinforce system liable for satisfying persons essential desires (Horvath, n.d.). Unfortunately, nucleus use is operated within these reward systems that engages an indivi treble in addictive activities. check to Edward (2000) sum total use is the hazardous use of psychoactive contents, including inebriant and extracurricular drugs. It is the dependency that deteriorates indivi two-folds physical and mental health. Consistent with the continuum of chemically mediated responses, means use is a maladaptive coping manifested by frequent use and dependence of tobacco, alcohol and illicit drugs (APA 2000, p. 198 Stuart, 2009). WHO reported that globally 3.86 billion slew are involved in heart debauch in which US has the utmost prevalence whereas in Pakistan it is eve ryday among 6.4 million stack (Stuart, 2009).If substance use coexists with any mental illness its regarded as soprano diagnosis. Literature proposes that roughly 50% of the spate with psychiatric problems excessively fit from substance abuse disorders (chrome et al., 2009). In UK three quarters of drug and 85% of alcohol service users have mood and anxiety disorders (NIDA, 2007). Its a dilemma that which problem occurred first. However precipitating factors like loneliness, family disturbances, psychological illness, analphabetism trigger substance use in psychiatric guests (Donald Gail, 2009). In my stack to resolve the misery of such painful sensation and mental illness people engage in substance abuse which softens them recreation as highlighted in the below mentioned scenario.On my clinical rotation at C0 ward in AKUH, I encountered a middle aged patient with the dual diagnosis of depression and drug abuse. He was a chain smoker since 30 years and recently had angio plasty. According to the patient he developed stomachal ulcers 5 years back for which a local physician prescribed him Inj. Nubain. He wasnt conversant that the drug should be used cashbox certain time as associated with the risk of addiction. Patient continued victorious that medication and developed addiction. The medication not only lessened his pain and make him calm and relieved during his depressive episodes. After angioplasty he was forced for not using that drug which results intense disposition. Patient became contumacious and restless. whence he was admitted in C0 ward but intense craving made his situation worst resulting in tremors, sweating, insomnia, hypertension and mydriasis. When I visited that patient, he expressed I need drug, am very restless, this craving will end my life so to reroute his mind and lessen his suffering, I along with OT members aforethought(ip) to engage that patient in different activities. We taught him some coping strategies and in that location was a mild change observed in his performance and judicial admission after psychotherapeutics and cooping.Glancing the social context in light of scenario, substance abuse is judged as bad deed because it violets societal norms and values by precipitating ferocious acts, poverty, family disturbances etc. In the above case unmanageable behavior lead the admission of the client in ward. In secernate some communities illustrate acceptability too. furthermore Canadian mental health association (2006) and Steve Susan (2003) proposed the comparable fact that patients with dual diagnosis fag end can violence and peace less situation in a fellowship by sevenfold as well as for those who are warmth or living with them. tho substance use is 65% prevalent in mid adulthood and my patients age was in same age group which predisposed him towards this (Stuart, 2009).Furthermore religion exhibits a fundamental role in an psyches life. In Islam alcohol is forbidden thats why researches highlighted less incidence of alcohol abuse in Muslim society whereas higher incidence in westbound gentleman (Haider Chaudhry, 2008, p.82). Beside this in Pakistan opioids and marijuana is predominantly abused (UNODC, 2013). Opioid use primarily grants relieve in mental illness but its insularity encompasses cracking depression, chronic craving, tremors, sleep problems, high BP and dilated pupils as evident in my clients case (Stuart, 2009). what is more marijuana also serves as a source for decreasing negative symptoms in schizophrenic clients however in response it exacerbates their suffering (Archives of planetary Psychiatry, 2011). Survey conducted in Pakistan summarized that 53.6% of the adults smoke nargileh (Sameer et al, 2012 Khan, 2010). This percentage illustrates the acceptability of tobacco and shisha in eastern world that results psychosis in individuals already predisposed for developing it (Archives of General Psychiatry, 2011). Bhang use is also predominately enforced in Indian festivities that generate elated and hallucinating effects as encompasses psychotomimetic substances (Thacore, 1977).In Western world and popish Catholics drug abuse is more socially acceptable in females but referred unmasculine in males whereas the consumption of alcohol is considered masculine (Donald Gail, 2009). In US the complete alcohol use is the 3rd leading cause of death and it also precipitates mental illness by triggering depression, euphoria, mood disorders. Its unavailability would end up leading general depressant withdrawal syndrome. Furthermore 43% of people in US are tobacco abuser however sess opium is marked deviant (Donald Gail, 2009). Tobacco smoke is twice more common in depressive clients while thrice in schizophrenic patients. Besides granting pleasure it amplifies the chances of relapse in psychiatric patients (Ash, 2013). So while assessing the client with dual diagnosis HCWs should take these sociocultural aspects in consideration.When my client attempt to drop the addiction, he felt intense craving. Craving is evidently interpret in the light of neuroadaptive model as prolonged use of drugs induces special(prenominal) alterations in the brain cell or neurotransmitters which regulate neural drives and grant pleasure. During abstinence neuroadaption consequences in imbalance in brain function which results craving and this craving is accountable for relapse in individuals (Eliason et al., 2007).Interventions for such clients could be put to death within individual, institutional and community level. In my patient therapeutic interaction assisted me to perform MSE effectively. Dealing with craving was challenging nevertheless I taught him some coping techniques, mind diversional exercises. In addition the intervention that can be carried out is drug testing and if the patient has severe withdrawal history so referral can be made to detoxification program (Stuart, 2009). Furthermore the nu rse should develop consciousness about the state and feelings of substance abuser in order to eradicate biasness in caring. Assessment of withdrawal symptoms should be carried out every shift.On institutional level integrated intervention for dual diagnosis verified as evidence based practice (Stuart, 2009). My client was treated simultaneously for both depression and substance abuse. further medicines should be administered to alleviate craving as Methadone was been administered to my patient for plummeting his craving. Moreover individual counseling and CBT prove as a constructive barbel for clients reclamation and relapse prevention. Since 2000 AAS is also working for the rehabilitation of substance abusers using the same treatment methodologies such as psychotherapy and drug toxification Besides AAS there should be more rehabilitation centers in those areas where substance abuse is more prevalent in order to affect mental health.Community level interventions would embraces the conduction of school base awareness programs and workshops for eradicating the risk of substance abuse from initial ages and making individuals realize that substance use is not the accurate coping for alleviating mental illness. Developing phantasmal and social norms would converse an obvious message for drug avoidance in mentally ill clients to whom religion serves as a protective factor. Moreover campaign against substance use on national level would gravel as example for people in recognizing the harmful effects of it (Reno et al., 2000). capital punishment of strict Governmental policies and legislation on consumption and sale of alcohol and illicit drugs can help in reducing the occurrence of dual diagnosis. Detoxification and methadone maintenance programs can be arranged in communities with the avail of governmental authorities (Stuart, 2009 Reno et al., 2000).In conclusion, substance abuse can co-occur with mentally illness which impact an individuals life dreadful ly. To derive rid of this is difficult but not impractical. Diverse prevention strategies and earlier detection would assist its control and management. Moreover strong motivation from family, health care providers and especially self can immensely facilitate the individual to cope up and live a healthier life (Harrison, 2006).