High expressed emotion, severe mental illness and substance use disorder

Abstract

This article discusses the behavioural attitudes of high expressed emotion as a major contributor to relapse in patients dually diagnosed with severe mental illness and substance use disorder. There are a number of research studies and authoritative texts on this particular problem and discussions identify the role expressed emotion plays in this condition. However, the majority of literature concentrates on how high expressed emotion affects the person's mental illness causing relapse rather than any effect on their substance misuse. This article outlines severe mental illness and substance use disorder; identifies the components of expressed emotion and how this may contribute to relapse; management and care in this condition; the treatment and avoidance of expressed emotion by the family and the professional; and issues of nurse education, training and support.

Is There a Family Profile of Addictive Behaviors? Family Functioning in Anorexia Nervosa and Drug Dependence Disorder

“…Studies of the families of patients with drug dependence disorders have indicated a low level of parental social support (Godley, Kahn, Dennis, Godley, & Funk, ; Wills, Resko, Ainette, & Mendoza, ), low parental monitoring (Chassin, Curran, Hussong, & Colder, ; Eitle, ), and a high level of conflict (Godley et al, ; Jacob, Leonard, & Randolph‐Haber, ; Wills, Sandy, Yaeger, & Shinar, ). Interpersonal conflicts with the family have been associated with drug dependence disorders (Karow, Verthein, Krausz, & Schafer, ), and a high level of EE in parents has been found to be a major factor in the potential for relapse in patients with drug dependence disorder (Watts, ). Empirical studies have shown that the parents of patients with drug dependence disorders underestimate their children's drug use and overestimate how much parental control they have over their children (Green et al, ; Yang et al, ).…”

An exploratory study investigating the impact of the procedures used to manage patient substance misuse on nurse–patient relationships in a medium secure forensic unit

“…High expressed emotion is often found in carers of people with mental health problems and exists when carers express criticism, hostility and emotional over‐involvement towards the person with mental health problems (de Mamani 2010). It has been found to be a major contributing factor to relapse in dually diagnosed patients with severe mental illness and substance misuse disorder (Watts 2007). It is, therefore, of vital importance that clinical leaders at the study unit remain aware of this issue and address it with staff through clinical, group and managerial supervision.…”

The functions of hospital‐based home care for people with severe mental illness in Taiwan

“…The clients’ parents’ expressed emotion (EE) was mentioned by some clients in this study. High expressed emotion (HEE) has been identified as a major cause for people with severe mental illness to relapse (Watt 2007). The components of HEE include criticism, hostility and emotional over‐involvement.…”