Psychiatric Mental Health Nursing by Videbeck

17 SUBSTANCEABUSE 429

continued from page 428

The client may be able to see the relatedness of

the events or a pattern of behavior while dis-

cussing the situation.

Anticipatory planning may prepare the client to

avoid similar circumstances in the future.

The client is more likely to experience frustration

or dissatisfaction, which can lead to substance

use when he or she has excessive amounts of

unstructured time.

Scheduled events provide the client with some-

thing to anticipate or look forward to doing.

Visualization of the schedule provides a concrete

reference for the client.

A journal can provide a focus for the client and

can yield information that is useful in future

planning. The client also may record information

that would otherwise be forgotten or overlooked.

The client may have little or no knowledge of

social interaction skills. Modeling the skills

provides a concrete example of the desired skills.

Positive feedback will encourage the client to

continue socialization attempts and enhance

self-esteem.

Purposeful activity makes better use of the

client’s unstructured time and can enhance the

client’s feelings of worth and self-esteem.

Problems for clients who have dual diagnosis are

complicated and long-term, requiring ongoing and

extended assistance.

If drinking or substance use occurs, discuss the
events that led to the incident with the client in a
nonjudgmental manner.

Discuss ways to avoid similar circumstances in
the future.

Assess the amount of unstructured time with
which the client must cope.

Assist the client to plan weekly or even daily
schedules of purposeful activities: errands,
appointments, taking walks, and so forth.

Writing the schedule on a calendar may be
beneficial.

Recording a journal of activities, feelings, and
thoughts may be helpful to the client.

Teach the client social skills. Describe and
demonstrate specific skills such as eye contact,
attentive listening, nodding, and so forth. Discuss
the kind of topics that are appropriate for social
conversation such as the weather, news, local
events, and so forth.

Give positive support to the client for appropriate
use of social skills.

*Refer the client to volunteer or vocational
services if indicated.

*Refer the client to community support services
that address mental health and substance
dependence-related needs.