Acute medical hospitals are difficult environments for patient's with drug and alcohol abuse issues to function in. Hospital staff have strict routines and operate with the assumption that patients who are seriously medically unwell, will comply with treatment in a socially appropriate manner. This often is not the case and therefore behavioural guidelines are required to be clearly communicated.

A 28 year male with a forensic history is admitted to an acute medical hospital ward in order to receive six weeks of intravenous antibiotics to treat his life threatening endocarditis. The patient uses one gram of heroin a day and has a girlfriend who refuses to leave the ward at night. The patient is verbally abusive and threatening to staff which exacerbates when his girlfriend is present.

A written ‘statement of care’ was provided to the patient after a team clinical review that provided an outline of his physical condition, the requirements of his treatment and what the expectations of his behaviour were while he was inpatient. Also included, was a plan outlining clearly what would be the alternative to hospital treatment if he was unable to receive the care being offered.

The patient was commenced on methadone and received adequate intravenous antibiotic therapy to adequately treat his infection. The ‘statement of care’ proved useful and the addiction medicine service received positive feedback from the intervention and the policy was developed.

This paper will explore the departmental procedure policy for the hospital addiction medicine service, on how to negotiate a 'care partnership’ between the treating team and the patient. The result not only reduces the incidence of clinical aggression but also improves patient outcomes as it provides a response to address complex systems, relations and medico-legal issues, which often arise in reaction to these acute clinical and behavioural management issues.