Essay Task: Identify and appraise innovations that your work setting has adopted that applies to MH nursing. Using peer reviewed evidence, critique the effectiveness of this innovation.
Introduction
Within this essay it will be talking about unit adopted interventions and analysing the effectiveness of such methods, as well as the potential negative ramifications of such interventions. The interventions being discussed within this essay are drug and alcohol detox programs designed specifically for my current area of work. This essay will be addressing the different types of groups that are offered to consumer’s on the unit, from more commonly used innovations to less commonly implemented. It will also be discussing the possible benefits and the potential negative results of each of these interventions.
Working within a drug and alcohol detox setting comes with many confronting and difficult aspects, from consumer’s going through severe withdrawal symptoms to drug induced psychosis and critically ill consumer’s. Often the consumer’s detoxing from substances are given a strict schedule of groups to attend during their detox period. Although providing such a structured group regime is beneficial for prompting improved structure within the consumer’s everyday life, it also holds potential to be a hindrance to recovery of consumer’s. With such an intensive group schedule it can create a disinterest in consumer’s attending them. Research shows that consumers going through withdrawal don’t benefit from a strict regime and group therapy, as they’re needing to take time to rest and come down from their particular substance. This process could take a number of days to achieve, whereas consumer’s are expected to abide by the structured program by day two of their admission. Groups for consumers while in detox are a vital part of the recovery model for substance use, providing education and knowledge is an essential factor in ensuring that consumers feel their ready to face the challenges of the outside world once leaving the unit. (“Groups and Substance Abuse Treatment”, n.d.). The delivery of these groups is important in that they need to gain consumer interest, attention, be insightful and easy to follow as well as educational at all phases of the withdrawal process.
AA Groups
Alcoholics Anonymous (AA) meeting groups are run by an outside source to the unit and are apart of the scheduled programs on the unit, this service adopts a collective group discussion method on past experiences with substances and how they overcame their addiction/s, AA not only caters to consumers with alcohol dependencies, but also other substance abuse. This uncommon knowledge creates a hindrance with reaching out to a larger demographic clientele with other substance dependencies. This type of service isn’t exactly innovative to the service, but offers some innovative ideas when it comes to relapse minimisation and building supportive factors through individuals with a lived experience. Some of the positive effects this type of service has on consumer’s within the unit are: providing knowledge and strategies on coping without drugs in one’s life, understanding how supportive figures are crucial to maintaining abstinence from substance use. Providing information on how AA works on the individual’s ‘whole being’ rather than just the cause of the addiction (Orey, 2015). While AA holds potential for many positive and innovative ideas for consumer’s, it also fosters the ability to have a negative effect on consumer’s. AA predominantly revolves around group discussions, it can become a sensitive area for some consumer’s, causing triggers, or invoking feelings of embarrassment and/or failure. This can result in outcomes like relapse behaviours, based on ‘recent clinical exposure, a theme appears prevalent is some consumer’s state they’re only attending AA meetings due to a drug court order and have nil interest in being their apart from avoiding jail time. Vulnerability of consumer’s who attend AA is often high, with some reports showing their risk of abuse or relapse can increase and often many consumer’s feel that AA has a strong undertone of religious beliefs which in some cases can cause hesitation in attending groups (Vourakis, 2013).
Innovative Groups
There are a number of Innovative groups specifically designed to my area of work which focuses on Harm reduction, support and recovery, peer support worker involvement, mindfulness and how to better cope with cravings, as well as some other less commonly used methods of abstinence like education on rubber band therapy. These groups provide a number of different coping methods, From relapse minimisation and improved consumer outcomes.
These groups are run mostly by the allocated nurse of shift, provide consumers with education and understanding of how drugs work and what effects they have on the body with short and long term abuse, what supportive factors are beneficial and what can cause relapse behaviours. Consumer’s often feel more dedicated about sticking to their plan of recovery when they are given education and feel more supported to better understand the negative effects of substances abuse.
Harm Reduction Groups
The harm reduction group focuses on different techniques in reducing the risks of harm to consumer’s self. It discusses and educates consumer’s on the negative effects that substances have on the body as well as the risks associated with substance related activities like sharing of used needles. It discusses how these risks can worsen with increased use of the substances or risky substance using behaviours. It details the services that can assist with reducing these risks like needle exchange programs and opioid overdose prevention training (Espelt et al., 2017). Consumers often find this type of group to be beneficial and insightful to their recovery plans and goals. This group also holds the potential for negative effects on the consumer, at times consumer’s feel overwhelmed with the discussion of substance abuse, addiction behaviours and the effects on the body. This discussions can unknowingly cause consumer’s to become increasingly anxious or feel like they do not wanting to attend any future groups on the topic (Logan & Marlatt, 2010).
Support and Recovery Groups
This group focuses on consumer support factors and how they can be an important influence for consumer recovery. It provides consumer's with the necessary tools to better build support networks in order to help strengthen their chances of abstaining from substance abuse in the future. The potential negative aspects of this group is when a consumer is lacking in their supportive factors, estranged from family and friends, or their only friends are substance user’s themselves. This can make the consumer feel excluded and give them a sense of failure, its important to tailor this type of group to the correct consumer base and provide additional support services to the consumer’s who don’t have these support factors (Miller, 2018).
Coping with Cravings Group
The Coping with cravings group which is run by the allocated nurse for that shift, helps the consumer’s in developing an understanding of cravings, what cravings are, what factors can increase cravings, like: triggers and situations, how cravings can be minimised and what impact cravings can have on the body and brain of the consumer. This group is beneficial in that it helps to educate the consumer to better understand why they have cravings for substances, how to reduced cravings through the use of pharmacological and non-pharmacological interventions and what supports are available in the community to them post discharge (Pennelle, Milios, Brown & Koelzer, 2018; Melemis, 2015). This group can also result in a negative impact on consumer’s who are suffering with cross addiction, withdrawing safely from one substance could create a dependence for another. For e.g. Consumer’s withdrawing from heroin may be placed on a methadone program in order to effectively and safely withdraw from this drug, however, in doing so, some consumer’s develop a dependence to the replacement substance. Often other treatments are utilised to help with minimising this dependence, like Cognitive Behavioural Therapy (CBT) and a titration of the substance (“Understanding the Challenges of Cross Addiction”, 2012). This group is updated often with new relevant material and information to remain an innovation part of the detox experience for the consumer’s.
Peer Support Workers
The use of peer support workers with drug and alcohol management has been an essential part for improving the outcome of consumer’s going through the detoxification process. Through the use of peer support workers, talking about their experiences of substance abuse, dependency and their recovery has been proven to instil hope in the consumer’s (Repper et al., 2013). Consumer’s often feel more comfortable being able to speak with someone who has had similar experiences to them (Tracy & Wallace, 2016). This innovation continues to be an important part of the detox program and during my time working on this unit, I have seen the positive effects it has had on consumer’s.
Needle Syringe Program Education
Needle Syringe Program Education is provided to consumer’s who require this intervention, normally decided upon by the head consultant or registrar. This education is provided to consumer’s at higher risk in order to help in reducing potential risk factors if relapse occurs whilst the consumer is in the community. The implementation of the Needle Syringe Program (NSP) is used to minimise risks associated with intravenous drug and other paraphernalia use, providing a clean, safe environment for consumer’s whom administer drugs intravenously, reducing risks of drug overdose, infections from blood borne viruses, as well as other potential infections. Educating the consumer’s on this service assists in lowering the risks in the event that relapse does occur for them. Other services that the NSP provide are: blood and sexual health screening, vaccinations, used needle disposal equipment, treatment for blood borne viruses and other viruses associated with intravenous drug administration, first aid and wound care secondary to needle use, advice on proper vein care. Support program referrals for consumer’s wishing to seek assistance with their addiction. This information is often only given to consumer’s on the unit who request to find out more about the services that are offered with the NSP. This education is beneficial in providing the consumer’s with important information in the event of a relapse episode, helping to minimise the potential risks (“Monash Health Drug and Alcohol Service”, 2015; Fernandes et al., 2017). The hindrance of this program is that often consumer’s feel uncomfortable seeking more information about this service as they feel they will be looked down upon and judged by clinicians. According to the Centers for Disease Control (CDC) and Prevention released 2016 data detailing 9% of all newly diagnosed Human Immunodeficiency Virus (HIV) infections for the year where secondary to consumer’s who are intravenous drug users. Hepatitis C has also increased in infection rates by 150%. in 2016 (Elkins, 2017).
Rubber Band Education
This form of education I’ve observed to be implemented minimally within my time working on this unit. Education is given to consumer’s willing to try this method out. The method of rubber band therapy, is where the consumer/s wear a rubber band on their wrist and are to self-administer a light snapping motion of the rubber band when the consumer is experiencing negative feelings, cravings and thoughts and want to deter from the negative stimuli. The goal of this therapy is the associate the negative behaviour or thoughts with an unpleasant outcome, this can help in fostering a deterrence from such behaviours (Jaffe, 2012). The effectiveness of this method depends largely on consumer factors such as: their ability to adhere to the deterrent strategy and their will-power to abstain from substances once they’re discharged back into the community, education on the continuation of this practice whilst experiencing these negative thoughts and feelings as long as required for the consumer is important. According to some studies, Rubber band therapy is effective, it demonstrates left field thinking and presents a case where further research is needed on the topic, in order to better determine its place within detox therapy. Practitioners with highly valued credentials have discussed success they’ve had using this therapy (Mastellone, 1974). There are many online articles ("August 2007 – The Rubber Band Method: Changing Limiting Behaviors", 2007), which talk about the high rates of success and numerous self help books and YouTube videos ("Stopping The Runaway Train Of Anxiety", 2015). But without crucial evidence, its use cannot be exclusively refuted or validated. However relapse rates remain high, secondary to post discharge and poor adherence to the deterrent (Foa, 2010). Research on the effectiveness of this method remains limited, some organisations view rubber band therapy as a form of punishment and feel it causes ethical concerns. The education of this practice is only provided to consumer’s who request to be informed about it and who have an understanding of the purpose of this technique.
Evolving Rehabilitation Centres
Although rehabilitation centres aren’t a new innovative approach to drug and alcohol services, they are continuing to renew their services and their approach to better helping consumer’s suffering with drug and alcohol addiction. Within my current work setting, we are often introduced to new services for rehabilitation and rehabilitation-like services like day programs and other referral services (Lam, 2015). These new services are often innovative to the services we provide here on the unit.
Conclusion
It’s important for clinician’s working within a drug and alcohol detox to stay up to date with the ever-evolving innovations and new styles of group therapy and consumer education. In order for clinician’s to effectively provide consumer’s with the most beneficial and relevant information currently available, Clinician’s need to continue to educate themselves on new trends of care. Education for consumer’s wanting to abstain from substances is essential in order to achieve a higher chance of maintaining recovery and abstinence. With the implementation of such group interventions listed within this essay, you as the clinician have a higher chance at successfully passing on your knowledge to consumer’s, which, in turn, will better equip them with the tools needed for life long abstinence and sobriety.