I am in the midst of considering a position for inpatient psych where initially it seemed that I would be in the thought disorder ( anxiety, depression) wing. Recently, I am feeling some pressure to consider doing the AOD unit. Can someone explain what this exactly is ? Are most patients dual dx in these setups? What are the challenges of this population group vs the depression/anxiety wing? I do have interest in taking the addiction medicine boards next year but i am not sure i am ready to jump into this unit till i have some clarification on what it entails and what i might be in for.
Had not encountered AOD as a standard acronym before but was able to look it up with some difficulty. Leaving aside how on Earth depression and anxiety are now considered thought disorders, I can comment based on my experience with our inpatient dual diagnosis unit (I am assuming it is at least ostensibly a dual diagnosis unit because how else do you justify psychiatric admission and not a 28-day regar to payors?)
Challenges:
Managing a lot more GABAergic withdrawal
Opioid withdrawal and initiate Suboxone or nah?
Suboxone maintenance - will they support you continuing this on folks who come in or are you going to be required to make them more miserable?
High churn
High rate of people seeking admission for reasons not clearly connected to a psychiatric diagnosis
Higher rate of criminal justice involved people who think they can hide from their PO in the hospital
Higher rate of real-deal antisociality
Often a bit rowdier
Patients with old-school AA attitudes about meds (almost always the ones who could really benefit from them)
Lower proportion of people with a stable social situation on discharge
Lower proportion of people with homes to go back to
Frequently being lied to
Some people love this work. Definitely a lot of space to do good for a lot of people but I think you can expect a lot of people in the hospital who do not really have a change-focused agenda.
