Monday 15th August 2005
Our series on specialist nursing continues …
This month we look at nurses working to prevent drug and alcohol patients from slipping through the cracks.
It might be the drunken teenager with a broken leg in the ED or the speed addict in the psych ward, but wherever you find drug and alcohol patients in Prince of Wales Hospital, CNC Mary Louise White won’t be too far behind.
She’s the drug and alcohol liaison CNC at the hospital, and it’s her job to identify, manage and educate anyone with any kind of link to substance abuse.
It’s a complicated specialty – there’s a wide range of patients and many also come with all sorts of psychological and social issues. But the most important thing when caring for drug and alcohol patients, says Mary Louise, is to reserve your judgment. Society already judges them harshly and ‘they already judge themselves,’ she said.
Drug and alcohol liaison is a tough job – not only because there’s such a wide range of patients but also because of the revolving cycle of abuse. ‘You do see people who come back again and again to casualty with the same types of harm associated with their substance use,’ she said.
One of the toughest parts of the job is the fact that some patients may never be free from this cycle. ‘I saw a young girl today, she’s only 37. She’s been using alcohol heavily for ten years. I’ve known her for five of those years. She’s getting to end-stage liver failure – at 37,’ said Mary Louise. ‘You go over the same things – the conversations you have with her are very much the same, and they’re never at a point where you would be judgmental but it can be very disheartening.’
Not all her patients are habitual users, however. Mary Louise’s role means younger patients are now getting more interventions before addiction can take hold. ‘I might see a younger patient who’s a bit naive about using alcohol, and might have been at a party and drunk too much,’ says Mary Louise. ‘When they’re brought into the hospital to re-hydrate, that’s the perfect opportunity for me to come in and talk to them about their substance use,’ she said.
Drug trends in Australia – where a certain drug becomes more popular or accessible – have a big influence on Mary Louise’s patients. ‘We’ve seen a huge increase in the use of amphetamines over the past few years – since the heroin shortage occurred,’ she said. While this may mean fewer heroin overdoses, the psychosis and behavioural problems linked with amphetamines can be just as dangerous.
‘There is self-harm associated with amphetamine use. There are people self-harming in a psychotic state, thinking they can fly and jump off buildings, and causing a lot more traumatic harm. It’s not just falling over, it’s people attacking themselves with knives,’ she explained.
When it comes to treatment, the first step is to try and help someone see a link between their substance use and the fact that they ended up in hospital. Patients are then given the choice to get more information or referral to further treatment. ‘You need to give people options, not say, “this is what you need to do”.
Mary Louise says giving these patients a choice isn’t being ‘soft’ but is simply part of the reality of treating substance abuse and addiction as a health problem. ‘You can’t lock a person up and make them not use a substance. In this country, we very much come from a philosophy of harm-minimisation. If the person chooses not to stay on their anti-depressants or stay on their Naltrexone or stay on their Methadone, if they choose to continue to use substances in a harmful way, there’s really not a lot we can do about that,’ she said.
Even if someone has a successful detoxification, it’s really only the start of a life-long battle against addiction. ‘People have to go through enormous changes to give themselves a bit of a buffer against stress that will cause them to relapse,’ said Mary Louise.
Patients often have psychological or social triggers that are beyond the control of any health care provider. The two biggest known causes of drug and alcohol abuse are unemployment and social isolation.
Despite the challenges, Mary Louise enjoys her job and the chance to help people when they are often at their lowest point. She says specialising in drug and alcohol gave her a new perspective, job satisfaction and autonomy she might have missed out on otherwise.
She discovered the specialty by chance when she did a short five-day course while working as a general nurse. From there, she did a diploma in drug and alcohol and later her Masters via correspondence at Newcastle University.
As a grade three CNC, the next logical step is for Mary Louise to become a nurse practitioner. The NP role would allow her to make diagnoses, order tests and prescribe medications like Valium for alcohol withdrawal, Naltrexone or Methadone for opiate addiction.
Specialising, she says, definitely opened doors for her. ‘I would encourage general nurses to go and dip their toe into something different, to do a short course, see what’s out there,’ she says.
Her only other word of advice for other nurses relates to her patients: ‘Don’t judge them,’ she said. ‘Remember, everybody has a story to tell.