Substance related disorders and dual diagnosis

Wherever nurses work they will come across people who have problems with substance use or abuse, whether the substances are licit or illicit. The same can be said of people who have problems with their mental health; they will be found in all areas in which nurses work. Nurses and other health professionals may also have times in their own lives when they experience difficulty with their own mental health or substance use. Problems with the use of substances and with mental health might occur separately or concurrently. It is important that all nurses understand the nature of these issues in order to offer the best care possible. This chapter explores issues of substance use, substance-related disorders and dual diagnosis (mental health problems coexisting with substance-use disorders). It begins by outlining the use of alcohol and other drugs (AOD) in Australia and New Zealand, and highlights the costs of AOD use (excluding tobacco) to the individual, family and community. The pharmacological dimension of psychoactive drugs is explored, terms are defined and the diagnostic criteria for substance abuse are presented. The skills needed to ask the right questions to obtain the best information and to provide a comprehensive AOD assessment are detailed. Specific interventions such as early interventions, brief interventions and harm reduction are explored. The processes for assessing and working with clients who are intoxicated or withdrawing from substances are described