A nurse responds to "Safety first"
My post described problems in addressing substance abuse. A registered nurse writes:
"I work in an emergency department in a relatively small community and as a result I'm frequently "in the front lines" in situations that are threatening and potentially violent. More often than not those situations involve alcohol or drugs. My thoughts are directed toward the part of your commments regarding the patient who can recite all the reasons for not abusing substances. They know. They are first in line to know. Education is not the problem.
"Knowing is not going to change their need to use. Why? Because they fear not using, having the comfort it provides, less afraid of the harm they are experiencing from using than the stark void they see facing them when they aren't high. How do you address that?
"On rare occasions, say a teen with a significant adult present or an adult who is currently not high, I have tried this approach. I acknowledge their dependence, their need and validate it by telling them that using is a coping mechanism, a type of self medication, something that, in the short term, makes them feel better, helps them escape or obliterate pain, a thing everyone wants when they are faced with sadness, pain, fear.
"But now they have two problems: the original problem and a new one, dependence or addiction. If, at this point, you can give them some hope of help with the original problem, be it therapy, non-dependence support, then perhaps you can create in them a reaoson to fight their addictions/using. Asking someone to give up the only option for pain control that they have ever used (drugs/alcohol) is akin to asking them to shed sunglasses in the face of blinding glare because they might better be able to see. We walk away shaking our heads and saying well, they're just self-destructive, or some like comment and feel superior to them in that we value ourselves enough to not use by distancing--us vs. them. Our own sort of self protection. I'm not naive, I know that a certain amount of distance is necessary in order to have objectivity.
"I cannot tell you if any of my efforts have produced positive results, the only thing I know for sure is that having taken the opportunity to make these comments I have satisfied my own need for expressing compassion when the opportunity was there, which it often is not. Thank you for giving me a forum, via this e-mail, to make concrete some of my own musing."
"I work in an emergency department in a relatively small community and as a result I'm frequently "in the front lines" in situations that are threatening and potentially violent. More often than not those situations involve alcohol or drugs. My thoughts are directed toward the part of your commments regarding the patient who can recite all the reasons for not abusing substances. They know. They are first in line to know. Education is not the problem.
"Knowing is not going to change their need to use. Why? Because they fear not using, having the comfort it provides, less afraid of the harm they are experiencing from using than the stark void they see facing them when they aren't high. How do you address that?
"On rare occasions, say a teen with a significant adult present or an adult who is currently not high, I have tried this approach. I acknowledge their dependence, their need and validate it by telling them that using is a coping mechanism, a type of self medication, something that, in the short term, makes them feel better, helps them escape or obliterate pain, a thing everyone wants when they are faced with sadness, pain, fear.
"But now they have two problems: the original problem and a new one, dependence or addiction. If, at this point, you can give them some hope of help with the original problem, be it therapy, non-dependence support, then perhaps you can create in them a reaoson to fight their addictions/using. Asking someone to give up the only option for pain control that they have ever used (drugs/alcohol) is akin to asking them to shed sunglasses in the face of blinding glare because they might better be able to see. We walk away shaking our heads and saying well, they're just self-destructive, or some like comment and feel superior to them in that we value ourselves enough to not use by distancing--us vs. them. Our own sort of self protection. I'm not naive, I know that a certain amount of distance is necessary in order to have objectivity.
"I cannot tell you if any of my efforts have produced positive results, the only thing I know for sure is that having taken the opportunity to make these comments I have satisfied my own need for expressing compassion when the opportunity was there, which it often is not. Thank you for giving me a forum, via this e-mail, to make concrete some of my own musing."
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