Psychiatric Mental Health Nursing by Videbeck

420 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

dence or with early-onset alcohol dependence. It is also

in clinical trials for treatment of methamphetamine

addiction (Psychopharmacology Update, 2002).

Dual Diagnosis
The client with both substance abuse and another psy-
chiatric illness is said to have a dual diagnosis.Dual
diagnosis clients who have schizophrenia, schizoaffec-
tive disorder, or bipolar disorder present the greatest
challenge to health care professionals. It is estimated
that 50% of people with a substance abuse disorder
also have a mental health diagnosis (Jaffe, 2000c).
Traditional methods of treatment for major psychi-
atric illness or primary substance abuse often have
little success in these clients for the following reasons:

• Clients with a major psychiatric illness may
  have impaired abilities to process abstract
  concepts; this is a major barrier in substance
  abuse programs.


• Substance use treatment emphasizes avoid-
  ance of all psychoactive drugs. This may

not be possible for the client who needs

psychotropic drugs to treat his or her

mental illness.

• The concept of “limited recovery” is more
  acceptable in the treatment of psychiatric ill-
  nesses, but substance abuse has no limited
  recovery concept.


• The notion of lifelong abstinence, which is
  central to substance use treatment, may
  seem overwhelming and impossible to the
  client who lives “day to day” with a chronic
  mental illness.


• The use of alcohol and other drugs can
  precipitate psychotic behavior; this makes it
  difficult for professionals to identify whether
  symptoms are the result of active mental
  illness or substance abuse.
  Some have suggested that dual diagnosis clients
  present challenges that traditional settings cannot
  meet. Only a few units specialize in the treatment of
  dual diagnosis clients, and their work is demanding
  with a high rate of recidivism. Only treatment that is

Table 17-1

DRUGSUSED FORSUBSTANCEABUSETREATMENT

Drug Use Dosage Nursing Considerations

lorazepam

(Ativan)

chlordiazepoxide

(Librium)

disulfiram

(Antabuse)

methadone

(Dolophine)

levomethadyl

(ORLAAM)

naltrexone

(ReVia, Trexan)

clonidine

(Catapres)

thiamine

(vitamin B 1 )

Folic acid

(folate)

Cyanocobalamin

(vitamin B 12 )

Monitor vital signs and global

assessments for effectiveness;

may cause dizziness or

drowsiness

Monitor vital signs and global

assessments for effectiveness;

may cause dizziness or

drowsiness

Teach client to read labels to

avoid products with alcohol

May cause nausea and vomiting

Do not take drug on consecutive

days; take-home doses are not

permitted

Client may not respond to nar-

cotics used to treat cough,

diarrhea, or pain; take with

food or milk; may cause

headache, restlessness,

or irritability

Take blood pressure before each

dose; withhold if client is

hypotensive

Teach client about proper

nutrition

Teach client about proper

nutrition; urine may be dark

yellow

Teach client about proper

nutrition

Alcohol withdrawal

Alcohol withdrawal

Maintain abstinence from

alcohol

Maintain abstinence from

heroin

Maintain abstinence from

opiates

Blocks the effects of

opiates; reduces alcohol

cravings

Suppresses opiate

withdrawal symptoms

Prevent or treat Wernicke-

Korsakoff syndrome in

alcoholism

Treat nutritional

deficiencies

Treat nutritional

deficiencies

2–4 mg every 2–4 hours

prn

50–100 mg, repeat in

2–4 hours if necessary;

not to exceed

300 mg/day

500 mg/day for 1–2 weeks,

then 250 mg/day

Up to 120 mg/day for

maintenance

60–90 mg 3 times a week

for maintenance

350 mg/week, divided

into 3 doses for opiate-

blocking effect;

50 mg/day for up to

12 weeks for alcohol

cravings

0.1 mg every 6 hours prn

100 mg/day

1–2 mg/day

25–250 mcg/day