We deal with an increasing number of difficult or disruptive patients. These individuals present behavioral problems ranging from harming themselves to those that abuse others.

At some facilities, such behaviors can interfere with the ability of the staff to care for the patient in question and for other patients.  In addition, threats or actual physical abuse jeopardize the health and safety of both patients and staff.

Difficult interactions between an individual and staff is often because the patient feels a  staff member is ignoring his or her physical complaints. The patient feels he or she has nothing to gain from the proposed treatment, thus having a reason to resent the provider and the treatment.

However at NYCACTS, using a compassionate, intuitive, and nonjudgmental approach, we put the patient at ease, which in turn helps identify the underlying issues he or she may have with trust and security.

We prefer to get a patient’s consent and try to engage the support of family or significant others.   This can help change the patient’s negative attitude about proceeding with treatment.

We understand that patiently listening to concerns is crucial to identify core issues responsible for difficult or inappropriate behaviors.  At some facilities the staff sometimes overlooks this point and they are quick to label patients as difficult.  That is not the case here.

Uncovering deep-rooted feelings of fear, intimidation, and noncompliance with treatment can be challenging and needs to be addressed immediately.  The causes can be health issues, lost work,  living situation, medical care, education, and more.  So being able to bring about a change in any of these adverse conditions can change one’s attitude and behavior toward the treatment team.

“Difficult” patients fear loss of control and have issues with self-image, trust, and security.  We can often gain their trust and connect with them by finding common ground.  Once we establish this connection, they are more willing to listen to us.

Sharing our experiences and success stories can help patients realize that they are not alone and in turn this can instill confidence in their ability to overcome their negative feelings about their illness.

Contrary to most patients’ expectations, our staff has an advantage with difficult patients.  Although such patients sometimes view the staff as the enemy and perceive medical staff as neutral parties, prescription-seeking patients might think they can bully our medical staff into prescribing controlled substances or increases in doses.  This will not happen unless there is a very good medical reason for it!

There is more to managing difficult patients than relying on pharmacotherapy. 

What if you have both medical/addiction and mental problems?

When someone has both a medical condition with a mental health issue such as depression, bipolar disorder, or anxiety, it is called a “dual diagnosis.”  Dealing with alcoholism or drug addiction can be included and is never easy, and it’s even more challenging when the patient is also struggling with mental health problems; but there are treatments that can help.

With proper treatment and support, you can overcome a substance abuse problem and/or medical condition, once you get the symptoms of the diagnosis under control and reclaim your life.

Complicating the situation, the two problems affect each other and interact. When a mental health problem goes untreated, a substance abuse problem can develop with prescribed medications and can get worse as well.  And if alcohol or drug abuse develops or increases, mental health problems usually increase too.

Recovery depends on treating both an addiction problem and/or the mental health problem.

There is hope.  Recovering from co-occurring disorders takes time, commitment, and courage. It may take months or even years.  But people with substance abuse and/or mental health problems can and do get better.

Combined treatment is best. Your best chance of recovery is through integrated treatment for both the medical and mental health problems.  This means getting combined mental health and addiction treatment from the same treatment provider or team.  NYCACTS provides that option.

Relapses are part of the recovery process.  Don’t get too discouraged if you relapse.  Slips and setbacks happen, but with hard work, most people can recover from their relapses and move on with recovery.

Here are some suggestions:  

  • Use your innate parenting skills to convey a caring attitude while simultaneously setting limits.
  • Seek supervision.
  • Don’t deceive patients by making false promises or impossible claims.
  • Document meticulously.  If indicated, terminate the medical-patient relationship, but be aware of rules regarding abandonment.
  • Be the patient’s best advocate!
  • Managing difficult patients is not impossible.  As with anything else, practice makes one better.
  • Overall, caring for difficult patients can be a rewarding and unique learning experience. It can help you explore our own emotional responses, facilitate greater self-awareness, and serve as an excellent confidence-building exercise.
  • Peer support can help. You may benefit from joining a self-help support group. They give you a chance to lean on others who know what you’re going through and learn from their experiences.


Signs and Symptoms of Common Co-occurring Disorders

The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.

  • Feelings of helplessness and hopelessness
  • Loss of interest in daily activities
  • Inability to experience pleasure
  • Appetite or weight changes
  • Sleep changes
  • Loss of energy
  • Strong feelings of worthlessness or guilt
  • Concentration problems


Common Signs and Symptoms of Mania

  • Feelings of euphoria or extreme irritability
  • Unrealistic, grandiose beliefs
  • Decreased need for sleep
  • Increased energy
  • Rapid speech and racing thoughts
  • Impaired judgment and impulsivity
  • Hyperactivity
  • Anger or rage

Call 718-762-6640 or 212-510-7906 for immediate help