Substance abuse is a serious problem impacting the healthcare system and society as a whole. Substance abuse can refer to the use of illegal drugs, excessive use of alcohol, or the misuse of prescription or over-the-counter medications. Substance abuse often has negative physical, emotional, and social outcomes.
Several factors may contribute to substance abuse including environmental stressors, genetic vulnerability, social pressures, individual personality characteristics, and psychosocial problems.
The severity of this condition can be mild, moderate, or severe depending on the pattern of use and its impact on the person’s life. Signs and symptoms of this condition include:
- Tolerance to or the need for increased amounts of the substance to get the desired effect
- Spending excess time, money or effort to obtain, use, and recover from the effects of using the substance
- Experiencing withdrawal symptoms when the person decreases or stops using the drug, making it difficult to quit
- Withdrawing from social activities and family and friends
- Hiding substance use from friends, family, or co-workers
- Continued use of the substances even when there is awareness of the psychological, physical, or social problems it is causing
Nursing Process
Many patients with substance abuse problems receive acute care for conditions related to substance use. Substance abuse often does not exist alone and it has numerous interrelated concepts. Drug abuse can harm organ systems and continued use can cause specific health problems like liver damage or lung cancer. Injuries may also result from substance abuse causing motor vehicle accidents, physical altercations, and more.
Management of substance abuse disorders will depend on various factors such as the specific substance abused, demographics, and the patient’s overall health. Proper assessment is vital to determine the severity of the condition, enabling the healthcare team to tailor a treatment regimen accordingly.
Detoxification may be indicated along with psychosocial therapies and long-term follow-up management through continued medical supervision and support groups.
Nurses provide support and care to patients suffering from substance abuse problems by treating physical symptoms, offering resources, and managing psychosocial distress.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for substance abuse, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for substance abuse.
Ineffective Denial
With substance abuse, denial is considered a powerful coping mechanism aimed at delaying the truth. It is common for people struggling with addiction to display denial or dismiss consequences in an attempt to continue their substance abuse.
Nursing Diagnosis: Ineffective Denial
Related to:
- Personal vulnerability
- Lack of control over substance use
- The threat of unpleasant reality
- Inadequate emotional support
- Previously ineffective coping skills
- Learned response patterns
- Personal or family value systems
- Cultural factors
As evidenced by:
- Delay in seeking or refusal to seek medical consult
- Uses manipulation to avoid responsibility for self
- Does not admit the impact of the condition on life
- Projects blame and responsibility for problems
- Does not perceive personal relevance of symptoms
- Minimizes symptoms
- Uses dismissive comments and gestures when addressing the condition
Expected Outcomes:
- The patient will report awareness of the substance abuse problem
- The patient will verbalize acceptance of responsibility for their behavior
- The patient will engage in the planning and implementation of the treatment regimen related to substance abuse
Assessment:
1. Assess the patient’s perception of their problem.
This should help determine the extent of the patient’s denial and individual perception of substance use and abuse.
2. Assess the patient’s perspective of substance abuse on their life.
Denial is considered one of the most resistant symptoms of substance abuse. Assess if the patient grasps the significance of their substance abuse and how it affects their relationships, career, finances, and more.
Interventions:
1. Convey an attitude of acceptance while separating the individual from their behavior.
This will help promote feelings of self-worth and dignity for the patient. The nurse must remain non-judgemental when treating a patient with addiction.
2. Provide accurate information about the patient’s condition.
Providing unbiased information will help the patient make informed decisions regarding accepting their problem and choosing an appropriate treatment.
3. Answer the patient’s questions honestly and factually.
This helps promote trust, which is the basis of a therapeutic relationship and necessary when navigating delicate situations.
4. Discuss the consequences of continued substance abuse.
A patient who dismisses the magnitude of the situation may need consequences presented matter-of-factly. Provide factual statistics regarding morbidity and mortality.
5. Provide positive feedback for expressing denial awareness in self and others.
Positive feedback can enhance the patient’s self-esteem and reinforces insight into the patient’s behavior.
6. Encourage and support the patient’s ability to take responsibility for their recovery.
Denial is addressed when the patient can accept their responsibility. Encouragement and support are necessary to turn denial into positive action.
Ineffective Coping
Patients with substance use disorder tend to struggle with ineffective coping when dealing with stressful situations, often resulting in substance abuse.
Nursing Diagnosis: Ineffective Coping
Related to:
- Negative role modeling
- Inadequate preparation for stress
- Inadequate sense of control
- Inadequate social support
- Ineffective stress relief strategies
- Previous ineffective coping skills substituted with substance use
As evidenced by:
- Impaired problem-solving skills
- Impaired adaptive behavior
- Decreased ability to handle stress
- Impaired ability to meet role expectations
- Inadequate follow-through with goal-directed behavior
- Inadequate problem resolution
- Verbalization of inability to cope
Expected Outcomes:
- The patient will recognize instances that cause increased stress and a desire to use substances
- The patient will use appropriate coping and problem-solving skills in place of substance use
Assessment:
1. Assess the patient’s history of substance use.
Patients with substance abuse may be able to recognize instances throughout their life that triggered substance use. This can aid in learning to recognize triggers.
2. Assess family role-modeling of coping through substance use.
Patients whose parents, friends, or guardians struggle with substance abuse may affect how the patient learned to cope. Substance abuse has been shown to have a genetic component.
Interventions:
1. Set limits and confront the patient’s efforts in making excuses.
Patients suffering from substance abuse tend to exhibit manipulative behaviors to get what they want. Following through on the consequences of failure to maintain these limits is necessary for effective treatment.
2. Encourage the patient to verbalize fears, feelings, and anxiety.
This enables a trusting relationship that will help the patient to come to terms with unresolved or unconscious problems in life that contribute to substance abuse.
3. Explore alternative coping strategies with the patient.
The patient may have limited knowledge of appropriate ways to respond to stress. Providing alternative coping strategies will help the patient explore more appropriate options for managing stress, feelings, and relationships without abusing substances.
4. Assist in relaxation techniques, visualizations, and diversions.
This allows the patient to relax and develop new ways to deal with problems and stress. Diversional activities are a useful coping mechanism when learning to replace prior behavior.
5. Encourage support available for the patient.
Support groups and programs for managing substance use are available and will help patients with follow-through care after discharge. The patient may also select a sponsor who they can contact whenever cravings arise.
Powerlessness
Patients who are suffering from substance abuse tend to have a continuing perception of powerlessness because they feel that there is no amount of trying or self-control that is going to change their ways.
Nursing Diagnosis: Powerlessness
Related to:
- Failed attempts at recovery
- Substance addiction with or without periods of abstinence
- Lifestyle of helplessness
- Inadequate knowledge to manage a situation
- Inadequate motivation to improve one’s situation
As evidenced by:
- Ineffective recovery attempts
- Statements of inability to stop behavior or requests for help
- Expresses doubt about role performance
- Continuous thinking about drug or alcohol use
- Alteration in occupational, personal, and social life
- Feelings of anger or guilt
- Verbalizes a lack of self-control
- Passivity or nonparticipation in treatment
Expected Outcomes:
- The patient will verbalize areas where they have control over their substance abuse
- The patient will participate in the therapeutic regimen and group peer support
Assessment:
1. Assess the patient’s emotions.
Hopelessness, depression, or apathy can be an element of powerlessness. It is important to determine the patient’s emotions to help healthcare providers formulate an approach that targets the patient’s feelings surrounding powerlessness.
2. Evaluate the patient’s interest in decision-making.
Powerlessness may cause a sense of disinterest in participation as the patient does not believe they have control over their outcomes. This can be a large barrier that must first be overcome to make progress.
3. Assess the patient’s locus of control.
The locus of control is determined by the extent to which a person associates responsibility (internal control) versus other forces (external control). Patients who have a predominant external locus of control are more susceptible to feelings of powerlessness.
4. Assess the role substance abuse plays in the patient’s sense of powerlessness.
The patient’s dilemma about personal stressors, illness, prognosis, and dependence on others for treatment, support, and guidance can contribute to powerlessness.
Interventions:
1. Show genuine concern.
A patient who is lost to powerlessness may believe they are beyond help. If a healthcare provider can show genuine concern and a vested interest in helping the patient overcome their substance abuse, it can provide a sense of hope.
2. Develop a contract.
A contract can lay out agreed-upon goals which can enhance a commitment to the plan.
3. Role-play assertive behaviors.
A patient who is not used to feeling control over their behavior may need help in creating healthy dynamics. The nurse can assist the patient in acting out scenarios that display assertive and confident responses.
4. Help identify areas of control.
Overcoming substance abuse can seem impossible, especially if the patient has experienced multiple failures. Help them identify areas where they do have control such as implementing other healthy habits, setting boundaries, and reducing contact with those who are a negative influence.
References
- Substance Abuse. Office of Disease Prevention and Health Promotion. Last updated 02/06/22. https://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse
- Substance Use/Misuse. Youth.gov. https://youth.gov/youth-topics/substance-abuse
- What is Substance Abuse? Gateway Foundation. Copyright © 2022. https://www.gatewayfoundation.org/about-gateway-foundation/faqs/what-is-substance-abuse/
- What Is Substance Abuse? Medically Reviewed by Jennifer Casarella on September 29, 2020. https://www.webmd.com/mental-health/addiction/substance-abuse#1
- Yiğitoğlu, G. T., & Keskin, G. (2019). Relationship between dysfunctional beliefs and stress coping methods in drug-addicted patients: A sample of Turkey. Indian journal of psychiatry, 61(5), 508–519. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_285_17
