4.3. Treatment principles

From research published over the past decade, Drake et al. [23] outlined ten principles essential for effective treatment of PDD, including engagement strategies, motivational counseling, stage-wise interventions, active treatment, long-term program retention, integrated mental illness and drug addiction treatments, and relapse-prevention strategies. Further comprehensive services such as peer support, family education and interventions, liaison with the criminal justice system, housing, and vocational rehabilitation should also be available, along with specialized programs for those with more complex disorders, cognitive impairment, and treatment resistance, as well as for minority groups [23]. In addition, services need to be flexible in order to cater to actual consumer needs, given their real-life circumstances. Hence, there is likely to be a "window of opportunity" for effective prevention or reduction of drug use shortly after a first psychotic episode.

#### 4.4. Potential treatment models

Sequential, parallel, and integrated service models are applied for persons with drug addiction and dual diagnoses. Firstly, they are treated for one condition by sequential treatment. Secondly, person with dual diagnoses was treated by the parallel model at the same time [23].

Integrated treatment is a combination of treatment modalities from the psychiatric and mental health-care team that focus on conditions simultaneously and work with the coordinated interaction between service providers, or they are working together as one team in the hospital [24, 26]. The integrated programs require mental health staff to coordinate a range of approaches, such as detoxification, medication management, CBT, and MI—which is often problematic due to limited resources and the absence of well-defined guidelines.

5.2. Personal protective factors

medications as prescribed.

Facebook, and mobile phone.

tions.

5.3. Environmental protective factors

neighborhood or town, and the larger community [5].

social interventions are recommended for the nursing role.

5.4. The environmental potentiates and stressor

ment, and stressful life events.

These factors include (i) coping skills and self-efficacy and (ii) antipsychotic drug and selfefficacy: for this study, the researcher used the terms of medical use self-efficacy to describe self-efficacy as confidence in one's ability to perform a given task such as taking antipsychotic

Nursing Care for Persons with Drug Addiction http://dx.doi.org/10.5772/intechopen.73334 57

Nurse should be concerned that the strength of self-efficacy for appropriate antipsychotic use plays an important role to take antipsychotic, continue on treatment program, and balance neurotransmitters in the brain, especially dopamine and norepinephrine, which decrease psychotic symptoms. Thus, psychoeducation of medication self-efficacy program is needed.

Moreover, coping is a behavioral and cognitive effort to cope with situations that are appraised as stressful in PDD's life and the pressure from family members because they often lack the information-processing skills to process optimum behavioral alternatives and the social skills to put these strategies into action [27, 29–31]. For this reason, nurse should enhance coping skills, medication self-efficacy, information-processing skills,and social skill in PDD by designing program interventions that possibly help to make information-processing skills easier than the past by implementation via information system and interactive system such as website,

These factors include effective family problem-solving and supportive psychosocial interven-

Effective family problem-solving refers to the ability of family members to solve their problems, not only the individual problems of PDD but also the problems of all family members, which are always related to the conditions of each individual's life, his or her household, the

Social support: stress factors can exacerbate the psychotic symptoms. Therefore, the support from family, friends, medical specialists, or clinical practitioners represents the key components in helping persons to raise the protective factors for the reduction of symptoms severity. Supportive psychosocial interventions: the combination of pharmacotherapy and psychosocial intervention has been recommended for treatment of PDD to reduce psychotic symptoms, and the individuals can be effectively engaged and continue the treatment [32]. In order to meet the goals of intervention in terms of reducing the stress of the patient, provide support for relapse prevention, promote adaptation of patient to living in the community, and facilitate continued decrease in symptoms and consolidation of remission, social support and supportive psycho-

According to the model, the environmental potentiates and stressor compose of the critical or emotionally over-involved attitudes toward the patient, an overstimulating social environ-

In summary, recommendations for treating PDD covered three broad areas: screening, assessment, and planning; psychosocial and pharmacological treatment; and systems of service provision, with the fundamental issue being that of coordinating across federal and state departments and across area health services and individual agencies. The initial focus when developing treatment plans must be on encouraging a therapeutic alliance with the PDD and on offering MI, CBT, contingency management, skills training along with education and support for family and caregivers, relapse prevention, case management, and promoting positive health support from others (including family members and non-substance-using friends). Furthermore, the use of atypical antipsychotic medications may facilitate adherence since they are associated with fewer side effects and have been shown to benefit persons with PDD. Regardless of whether services follow integrated or parallel models, multidisciplinary treatment team should be well coordinated, take a team approach, have specialist-trained personnel (including 24-hour access), include a range of program types, and provide for long-term follow-up [4, 20, 25].
