3.3. Impact on socialization

Short-term impact may devastate the lives of persons and severely disrupt families. Persons may withdraw from their environment with regressive behavior, fail to engage with others, or even notice physical illness and pain [3]. Social exclusion and homelessness may ensue. In the longer term, psychosis and its potential disruption of the capacity to fulfill social roles can result in further burdens. Severe, untreated symptoms may result in social, familial, and occupational dysfunction. Severe symptoms are likely to result in patient stigmatization of self and loved ones, inadequate clinical care and rehabilitation, and the stigma of shame and family burden. Many family members hide their relationships or consider the illness to be a source of stigma when a relative suffers from PDD. Those in contact with dual-diagnosis persons may also experience distress, tension, and conflict within these relationships. Interpersonal conflicts are often associated with dual diagnoses [3, 15, 17, 18].

mesolimbic tract cannot reverse dopamine antagonism; D2 receptors remain blocked, and hallucinations and delusions decrease. Pharmacotherapy remains the main effective treat-

Nursing Care for Persons with Drug Addiction http://dx.doi.org/10.5772/intechopen.73334 53

Supportive psychosocial therapies have been used as adjuncts to pharmacotherapy [20] and psychoeducation programs to alleviate residual symptoms; improve social functioning, quality of life, and medication adherence; and reduce relapse and rehospitalization. Details of

Motivational counseling works according to the idea that motivation for change is dynamic rather than static. Professional uses may influence change by developing a therapeutic relationship to increase therapeutic alliance, developing insight, and coping skills to resolve ambivalence and change health-related behavior. Professional nurses follow five motivational

Bellack and DiClemente [footnote] outline a treatment protocol acknowledging that behavioral change is a longitudinal process consisting of several stages. "Escalating symptoms and other warning signs must be recognized, cravings coped with, coming up with healthy alternative activities developed, drug addiction lapses normalized, lapse or relapse plans developed, and cognitive restructuring counteracting positive beliefs about substance use devised." Barriers to significant personal changes include lack of motivation, impaired cognition, and social skill limitations. Low motivation, energy levels, and mood, common within this group, may arise from medication, illness, or constrained life circumstances. They provide obvious challenges for engagement, goal setting, and therapy continuance. Deficits in attention, concentration, and abstract thinking, as well as thought blocking, may impede information processing, problem-solving, and realistic planning. Underdeveloped social interaction skills required to meet people and maintain relationships may result in the absence of a healthy social support system to sustain persons through change processes, as well as in difficulties resisting pressure

ment for PDD.

4.2. Supportive psychosocial interventions

supportive psychosocial intervention follow:

• Expressing empathy through reflective listening

• Avoiding argument and direct confrontation

4.2.1.2. Cognitive behavioral therapy (CBT)

from substance-using peers (Table 1).

• Identifying discrepancies between patient goals or values and behavior

4.2.1. Individual approaches

approach principles:

• Coping with resistance • Supporting self-efficacy

4.2.1.1. Motivational approaches

#### 3.4. Impact upon treatment adherence

Rates of treatment noncompliance may decrease, reducing motivation for change and making engagement more difficult. Persons may drop out of long-term programs, retard progress, and destabilize illnesses, contributing to psychosocial instability [16, 19].
