Double Trouble – Hawaii Nurses CE


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Double Trouble

Aloha, Colleagues!

I have been thinking about how, as nurses, we are connected to a broad scope of people: Patients, families, co-workers, people in the community, friends,  friends-of-friends.   While we are connected to them, they often seem to have nothing in common with each other.  Take Howard, a wealthy real-estate magnate I have known for years, and Sherry, a sometimes-houseless woman I grew up with.  Howard is polished and personable, Sherry is not.  Yet they have more in common than you would think.  Howard is bipolar and drinks a fifth of scotch every day.  Sherry is an opioid abuser who has been diagnosed with schizoaffective disorder.  My two friends occupy opposite ends of the continuum of mental illness, substance abuse, and functionality.

Both mental illness and substance abuse are increasing in Hawaii and beyond. The number of patients with these co-occuring disorders is higher than ever.  According to the National Survey on Drug Use and Health, 9.2 million American adults experienced both mental illness and a substance use disorder last year.

Co-occurring Disorders, (also known as Dual Diagnosis) is a term for when an individual experiences a mental illness and a substance use disorder simultaneously. Either disorder—substance use or mental illness—can develop first. People experiencing a mental health condition often turn to alcohol or other drugs as a form of self-medication to improve their mental health symptoms. However, research shows that alcohol and other drugs worsen the symptoms of mental illnesses.

Opioids have become and continue to be a serious problem.  Every day, more than 130 people in the United States die after overdosing on opioids.1 The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Center for Disease Control and Prevention (CDC) estimates that 1.7 million people in the United States are addicted to opiates and that opioid overdoses increased 30 percent from July 2016 through September 2017. The total economic burden of prescription opioid misuse in the United States is $78.5 billion a year. I don’t understand the concept of a “billion” but I imagine that amount of money would go a long way to feed the hungry, house the houseless, and educate our young people. Consider the human pain and suffering associated with co-occuring disorders and imagine how much better we would do without them!

Treating the dually diagnosed is difficult on many levels.  Ideas about assessing and caring for patients with both  mental illness substance abuse are often conflicting, as are the respective cultures of recovery.  Providing integrated care often seems difficult, if not impossible, and conflicts between and among staff are common. Mental health and substance abuse recovery treatment  have different theories and cultures, and integrating patent care can challenging. 

Yet, solutions to these problems have been identified.   An  international effort led by Nurses Karen-Leigh Edward and Ian Munroe in Australia, and Dr Ken Minkoff at Harvard Medical School works to help nurses and other health care professionals integrate the two cultures to provide comprehensive assessment and safe, effective care for the dually diagnosed.   

Patient-centered care is essential to care of the patient with co-occuring disorders.  Simply speaking, this involves “Meeting the person where they are and standing by these fundamentals:

  • Supporting  the patient’s self-efficacy by empowering them for seeking treatment
  • Basing interventions and goals on a comprehensive, patient-focused assessment
  • Taking a non-judgmental approach
  • Recognizing & validate all positive changes
  • Identifying patient strengths
  • Understanding the patient’s social, religious, and cultural context.

For more information, please visit

Or consider joining us in Waikiki on November 13, 2019 for our timely and informative nursing continuing education conference, “Addiction & Mental Health:  Assessment & Intervention”

Mahalo for all you do!

Leslie Jane

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