Substance Abuse

Most of the patients at St. Elizabeth's have a severe mental illness, homelessness, and substance abuse issues (most often crack or alcohol). Since I had done research on substance abuse for the majority of my time at GMU, I was interested in how substance abuse interacted with psychotic disorders. Specifically, I was interested in if the drugs reduced some symptoms of mental illness. If we were able to see what these drugs did for people, perhaps we could fill that void with something less damaging.

From the research I found, there is no clear picture. For some, cocaine can ameliorate some of the negative symptoms; however, it can also exacerbate the positive symptoms--especially at high doses. Unlike what I had been told in school, the only drug that was statistically shown to lead to greater instances of mental illness was marijuana, and that connection was fairly week. (This is excepting drug-induced psychosis).

Another research area I explored was the idea of using harm reduction with many of the patients. This concept, glossed over in the readings, is in dire need at the hospital. Our clients have often prostituted themselves to support their habit, use in unsafe locations, and are in abusive relationships (often with a pimp). However, there are no services on the ward for those who do not wish to give up this lifestyle immediately or completely. It is merely assumed that when a person is on the ward, their natural goal will be to completely abstain from all substances. (Fortunately, we do have a psychiatrist who emphasizes that if they do relapse, they should continue taking their medication and can still seek help at the hospital.) Formally, there is no education on safe sex practices or safer/reduced drug use.

I was in the process of deveoping a plan to implement a harm reduction group on our ward; however, I could not find materials on harm reduction and domestic abuse. Since our clients are often in exploitative, abusive relationships, this would have been key. Also, I feel that the gender dynamic may have been inhibiting in creating an open environment to share experiences. The hospital itself would have likely been the largest obstacle, in that harm reduction does not fit well into the medical model of treatment and can be construed as endorsing continued substance use or prostitution. It would have made a nice thesis topic, though.