O patients with anxiety disorders should also pay

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oPatients with anxiety disorders should also pay particular attention to their physical health. Regular, balanced meals; exercise; and sleep are ways to decrease and manage stress levels. Patients should avoid excessive consumption of caffeine and sugars.Personality disorders and substance abuseoPersonality disorders are frequently present in those who abuse alcohol and other substances. Antisocial personality and borderline disorders carry a high risk of having a comorbid substance abuse problemInterventions oMedication is important! Medication for a known mental disorder should never be discontinued on the grounds that the patient is using substances. Nonadherence with prescribed meds is associated with problems after discharge, including relapse.oErrors in treatment can include treating temporary psychiatric symptoms resulting from withdrawal as if they were a permanent feature of the individual, withholding needed medication for a psychiatric disorder, or setting arbitrary limits on medication based on a belief that medication for all psychiatric symptoms should be suspended for a time.oSubstance abuse counseling is slower and less confrontational than many traditional substance abuse programs so it may be beneficial topatients with CODoPatient education is an essential element in treating COD. Patients need to learn about their specific mental disorder, substance use and abuse, and their effects. Relapse prevention and recovery should be highlighted. Education can be conducted in individual sessions, but group sessions encourage interaction among patients. Sharing their experiences with their peers, patients can enhance these presentations.oSelf-help groups such as AA and NA may be appropriate for patients with CODContinuum of careoAn integrated approach that combines mental health and substance abuse interventions at the clinical site has been shown to be the most effective. In an integrated system, the same team provides coordinated mental health and substance abuse interventions and guides the patient toward learning to manage these intertwined disorders. When the mental health and substance abuse systems are truly integrated, patient outcomes are positiveoOften, patients with COD can be treated effectively in community mental health settings if their symptoms are stable, they are following their treatment plan, they are compliant with the use of psychiatric medications, and they remain alcohol and drug free. Patients are hospitalized when they have a need for detoxification, exacerbation of comorbid psychiatric or medical disorders, suicide or homicidal ideation, or an illness that prevents abstinence or outpatient treatment.oThe first priorities of hospitalized patients with COD are gathering data from a physical examination and nursing assessments, stabilizing psychiatric symptoms, and treating withdrawal symptomsEarly stages of recovery from substance abuseo

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