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Ebook Dual diagnosis nursing: Part 2

(BQ) Part 2 book “Dual diagnosis nursing” has contents: Models of care and dual diagnosis, relapse prevention in dual diagnosis, motivational interviewing, dual diagnosis - interventions with carers, and other contents. | DDNC15 8/17/06 3:10 PM Page 150 15 Dual Diagnosis In Acute In-patient Settings J. Gallagher & S.J. Scott Introduction Substance misuse in society has reached epidemic proportions and this increase is inevitably reflected in patients with mental health problems who are admitted to psychiatric wards (Williams & Cohen, 2000). As pointed out by Gafoor & Rassool (1998) the number of individuals who have coexisting substance misuse and psychiatric disorders within the UK is increasing. Krausz (1996) emphasises this point by stating that: ‘the coincidence of severe mental illness and addiction is and will be one of the most important clinical challenges in psychiatry in the coming years which will also point to structural weaknesses in the treatment system between psychiatric and addiction treatment’. Progress towards community based mental health provision has led to an increase in pressures and demands on acute in-patient settings (Baker, 2000) due to raised bed occupancy (up to 104%) and the changing nature of the patients served. Patients with serious mental illness and those with complex behavioural and social problems, including substance misuse, are now the norm within acute in-patient settings (Sainsbury Centre for Mental Health, 1998a). The aims of this chapter are to examine the prevalence of dual diagnosis in in-patient settings and describe the identification and assessment of substance misuse in acute care settings. Barriers to engagement and treatment are also discussed. In-patient settings Within acute in-patient settings schizophrenia is common, accounting for 60% or more of the population (Baker, 2000). Co-presenting substance misuse within this group is up to three times that in the average population at roughly 37% (Cantwell et al., 1999) and is more prevalent in younger clients (Hambrecht & Hafner, 2000). Cantor-Graae et al. (2001) reported higher lifetime prevalence rates of 40–60%. Due to this high level of co-morbidity between substance .