Introduction

A new blog concept for my website. These blogs tend to be small and introduce a concept or talks about an experience I had. Bite-size blogs should be a little less than 2 minutes read and may be less than 600 words. Nothing too prominent with a relaxed feel to it and no insane reference list.

In this edition of Bite-Size, I talk about substance dependence I witnessed whilst being on my placement, which made me think of how that patient got into that situation. Addiction must be seen as a very complex disease, and no one should be blamed for their situations. What are the best approaches to solve substance dependence in society?

On my placement, the nurse in charge had to handle a challenging patient at the emergency department (ED). The patient was coming down from a methamphetamine high, where unfortunately the town is known to have heavy methamphetamine usage. The patient was persuaded that she would have access to medications to cope with her current symptoms. Upon hearing that she will be denied access to the medication as the doctor had to see her, which would be in a while, she started to become more and more agitated and demonstrate an aggressive body language. Fear of the unknown and outcomes of this patient's action definitely put all of us at a flight or fight mode and at least made me unnerving as I lacked experience. At this point, we were not sure if she had a knife or if she would become violent and hurt the staff physically.

However, this situation was amazingly de-escalated by the communication skills from the nurse. By using the right words, soothing voice and communicating efficiently, the patient managed to calm down and control herself a bit better. I decided not to make any brisk movement, changed my tone and voice volume to calm and rational, and I made sure there was space so that the patient never felt trapped or overwhelmed. The distance also protects me if anything were to happen. In my next blog, I talk about how to de-escalate tricky situations like these.

In retrospect, this situation made me think of how this particular patient got to that point. What was her story, and how did she get into this situation? At the time, I did not want to blame the patient, but I wanted to help and understand these exposed and vulnerable patients in the best of my abilities. People with low social-economic status (SES) are more likely to be dependent on a substance compared to people with higher SES, which makes solving the substance abuse pandemic a difficult challenge. In the ED, it was found that healthcare workers, particularly nurses, experience high rates of verbal abuse and physical aggression, and that violence in the ED are often under-reported. Substance abuse enhances the chances of verbal and physical aggression in a person due to either intense withdrawals and wanting what they want to get better, and from the actual high of the drug which may cause unpredictable actions from a person.

I see addiction as a complex disease from substance use disorder, which is a combination of behavioural, environmental and biological factors. Genetics plays a huge role and account for about half of the likelihood that an individual will develop an addiction. There is no “generic addictive personality” that is prone to addiction but rather a wide variety of traits that can be grouped into specific behaviours and types. All these traits are not always present, and the vision we get of certain people have been inaccurate of who is a drug addict and what a drug addict should look like. Addiction is influenced by genetics, SES, childhood adverse events, protective factors in life and behaviour. It is worthy to note that you do not need all these influences to become dependent on a substance. For example, some healthcare professionals get dependent on a substance and may not always be due to having a low SES but rather to the environment they work, their behaviour and past experiences. Evidently, some people will have a higher risk of being addictive or developing an addictive personality than others. This is similar to being resilient to mental health disorders, see
The 4P Factor Model and Its Purpose in Psychological Medicine and notice the protective factors that could prevent substance dependence.

Addiction must be seen as a disease which is very intricate and complex, and no one should be blamed for their situations. It is shocking to see how widespread and present addiction is in the population, which includes all social levels, all sorts of professions, gender, race, cultural, age, et cetera. However, there is good news. It has been demonstrated through evidence that Patient-Centered Care (PCC) improves the quality of substance use disorder treatment. PPC involves these important pillars, which are: a holistic and individualised focus to care, shared decision-making and enhanced therapeutic alliance. PCC is thus recommended and necessary to improve the outcomes for patients who are dependent. Treating these patients with care and dignity as well as providing support groups or programs being set up, such as the Needle and Syringe Program, is essential. Society needs to leave villain and criminal perception of people who require help and instead should be taken care of. Patients in need should not be ignored as not being looked after will only make the situation worse. Criminalising addiction or substance abuse is hurting everybody in society.

Published 15th November 2020. Last reviewed 1st December 2021.

Reference

Center on Addiction Authors. Addiction as a disease. Center on Addiction website. https://www.centeronaddiction.org/what-addiction/addiction-disease. Updated April 14, 2017. Accessed May 2, 2020.

Fry L. The impaired student: Substance abuse in medical students. Med Stud J Aust. 2015. https://www.amsj.org/archives/4462. Accessed October 2, 2020.

Gillon R. Medical ethics: four principles plus attention to scope. BMJ. 1994;309(6948):184-188. doi: 10.1136/bmj.309.6948.184

Marchand K, Beaumont S, Westfall J. Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Subst Abuse Treat Prev Policy. 2019;14(37). https://doi.org/10.1186/s13011-019-0227-0

Marisa Crane. What Are the Traits of an Addictive Personality? American Addiction Centers website. https://americanaddictioncenters.org/the-addiction-cycle/traits-of-an-addictive-personality. Updated November 25, 2019. Accessed May 2, 2020.

Partridge B, Affleck J. Verbal abuse and physical assault in the emergency department: Rates of violence, perceptions of safety, and attitudes towards security. Australas Emerg Nurs J. 2017;20(3):139-145. doi: 10.1016/j.aenj.2017.05.001

Stene J, Larson E, Levy M, Dohlman M. Workplace violence in the emergency department: giving staff the tools and support to report. Perm J. 2015;19(2):e113‐e117. doi:10.7812/TPP/14-187