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 causes negative physical, emotional, and social outcomes.
Long-term use of a substance creates dependence and, in some cases, intense cravings. When the patient stops using the substance, withdrawal symptoms are unpleasant enough that the patient seeks relief by resuming drug use, leading to a cycle of addiction.
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 degree of dependence, motivation to quit, genetics, craving severity, and coping abilities.
In this article:
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Ineffective Coping
- Ineffective Denial
- Powerlessness
- Risk for Suicide
Nursing Process
Many patients with substance abuse problems receive acute care for conditions related or unrelated to substance use. Substance abuse often does not exist alone, and it has numerous interrelated concepts. Substance misuse can occur in relation to a chronic health problem or debilitating pain. Drug abuse can harm organ systems and continued use can cause serious health problems like liver damage or lung cancer. Injuries may also result from substance abuse stemming from motor vehicle accidents, physical altercations, and more.
Management of substance abuse disorder will depend on various factors such as the specific substance abused, demographics, and the patient’s overall health. Detoxification may be indicated along with psychosocial therapies and long-term follow-up through continued medical supervision and support groups.
Nurses provide support to patients suffering from substance abuse disorder by treating physical symptoms, offering resources, and managing psychosocial distress.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to substance abuse.
Review of Health History
1. Ask the patient and their family about general symptoms.
Signs and symptoms of substance abuse 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 stopping or decreasing use, making it difficult to quit
- Intense urges for the drug to cope with emotions or situations
- Participating in dangerous or illegal activities to obtain drugs
- 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
2. Investigate the substance being abused.
Substance use disorder may include the following substances:
Illegal substances:
- Cocaine
- Heroin
- Marijuana
- Methamphetamines
- Opiates
- Club drugs (methylenedioxymethamphetamine, also known as MDMA or molly)
- Hallucinogens
- Inhalants
Legal substances:
- Nicotine
- Alcohol
- Prescription drugs (opioids, stimulants, barbiturates, hypnotics, ketamine, or benzodiazepines)
Common misused or abused over-the-counter medications include:
- Cough and cold medicines like dextromethorphan or pseudoephedrine
- Weight loss or diet pills, including laxatives
- Stimulants like caffeine pills
- Pain relievers such as acetaminophen
- Antihistamines like diphenhydramine
3. Determine the last intake, amount, and how the patient takes the substance.
Withdrawal symptoms from substances like alcohol or benzodiazepines can have fatal effects. When a patient presents to the emergency department, it’s important to note the type(s) of substances used, the method of administration (oral, injection, inhaled, etc.), when it was last taken, and the dose/amount (if known). This information allows for the appropriate administration of antidotes and interventions.
4. Note the patient’s history of use.
Identify how long the patient has been using. Substance abuse has an impact on brain development and can have an early influence on impulsive and dangerous behavior, not to mention physiological effects on the body.
5. Assess for a history of psychiatric conditions.
Substance abuse commonly co-occurs with mental health conditions such as anxiety, depression, PTSD, schizophrenia, bipolar disorder, ADHD, antisocial personality disorder, and more. Patients with these conditions may already be prescribed anxiolytics or sedatives that have the potential to be misused.
6. Review the patient’s medical history.
The nurse should perform a thorough review of the patient’s medical history, including their medication regimen. Observe for chronic conditions that may cause pain requiring the use of opioid analgesics, such as fibromyalgia, cancer, multiple sclerosis, or injuries and recent surgical procedures.
7. Interview family, friends, or co-workers surrounding the patient.
People closest to the patient may note the following changes consistent with drug use:
- Missing school or work or displaying a drop in performance
- Lack of motivation or energy
- Change in appearance such as weight loss, red eyes, or poor grooming
- Secretive behavior or withdrawing from friends and family
- Frequent requests for money without an explanation
8. Determine the patient’s risk factors.
Several factors may contribute to substance abuse, including environmental stressors, genetic vulnerability, social pressures, individual personality characteristics, and psychosocial problems.
9. Attempt to understand the benefits of substance use.
While many patients abuse drugs for the high, there are other reasons, such as coping with anxiety or stress, managing pain or insomnia, or using stimulants to focus and increase productivity. It’s important to determine the patient’s motivation for use to develop relevant interventions.
10. Assess for previous attempts to quit or seek treatment.
Assess if the patient has ever attempted to cut back or stop using a drug or if they have received treatment through inpatient rehabilitation, detox programs, or outpatient clinics. This information can be used to assess success, failures, or barriers to treatment.
Physical Assessment
1. Conduct a physical examination.
Clinical results are often dependent on the substance, frequency of use, and time since last use.
Marijuana use often presents with:
- Red eyes
- Dry mouth
- Poor coordination
- Slowed reaction time
- Anxiety
- Paranoia
Benzodiazepines, hypnotics (sleeping aids), barbiturates, and opioids depress the central nervous system and may cause:
- Drowsiness
- Slurred speech
- Mood changes
- Lack of coordination
- Bradypnea
- Hypotension
Meth, amphetamines, and cocaine are stimulants causing:
- Increased energy, alertness, or excitement
- Rambling speech
- Dilated pupils
- Hallucinations
- Irritability
- Paranoia
- Insomnia
- Damage to nasal mucous membranes (from snorting drugs)
- Gum disease or tooth decay from smoking meth
MDMA or gamma-hydroxybutyric acid (GHB) may cause:
- Sedation
- Confusion
- Memory loss
- Hallucinations
- Paranoia
- Chills
- Tremors
- Muscle relaxation
- Reduced inhibitions
- Bradycardia
- Hypotension
2. Evaluate the patient’s mental health.
Substances may be used as a method to cope with mental health conditions such as anxiety, depression, or post-traumatic stress disorder (PTSD). The nurse should assess for a mental illness diagnosis, prescribed medications, a history of self-harm or suicide, violent behaviors, and any psychiatric hospitalizations.
Diagnostic Procedures
1. Obtain laboratory tests.
If the patient presents with acute symptoms of drug use, obtain a blood alcohol concentration (BAC) level and urine drug screen. Additional labs are taken to assess for acute or chronic health concerns from drug use and include:
- Complete blood count (CBC)
- Basic metabolic panel (BMP)
- Liver function test
- Hepatitis panel
- HIV antibody screen
- Pancreatic enzyme levels
2. Establish substance use disorder based on DSM-5 criteria.
A diagnosis is established if the patient meets two or more of the 11 criteria throughout the past 12 months based on The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Severity is also identified depending on how many criteria points are met.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions related to substance abuse.
1. Administer medications as ordered.
The only substances for which there are FDA-approved prescription therapies are opioids, alcohol, and nicotine.
Medications used to treat nicotine use disorder include:
- Bupropion
- Varenicline
- Nicotine replacement therapy (patches, gum)
Medications used to treat alcohol use disorder include:
- Acamprosate
- Naltrexone
- Disulfiram
The nurse should educate the patient that disulfiram causes unpleasant side effects when alcohol is consumed, such as headache, nausea, vomiting, and dizziness, to prevent alcohol intake. Patients who are receiving treatment for alcohol use disorder commonly experience B vitamin deficiencies and may require supplementation.
Medications used to treat opioid use disorder include:
- Methadone
- Naltrexone
- Buprenorphine
2. Prevent withdrawal symptoms in the inpatient setting.
To manage alcohol withdrawal, the nurse should implement the Clinical Institute Withdrawal Assessment (CIWA) scale to guide the treatment of withdrawal symptoms. Sudden cessation of alcohol or benzodiazepines can trigger seizures, so it is vital to administer medications to prevent this complication.
3. Administer antidotes for emergency toxicity.
Administer naloxone (Narcan) to patients with opioid toxicity. Administer flumazenil for suspected benzodiazepine toxicity.
4. Initiate detoxification.
Detoxification (known as “detox” or withdrawal therapy) helps the patient to stop using the addictive substance as soon as possible while maintaining their safety. This can occur in the inpatient or outpatient setting. Detox may involve gradually reducing the dose of a drug or taking alternative substances, like methadone, to reduce withdrawal symptoms and cravings and avoid relapse.
5. Initiate behavior therapy.
Behavior therapy is a type of psychotherapy provided by a mental health professional. The goal is to help the patient learn to cope with cravings, develop strategies to prevent relapse or what to do if relapse occurs, manage interpersonal relationships, and address any mental health conditions.
6. Encourage support groups.
Groups such as Alcoholics Anonymous or Narcotics Anonymous can reduce feelings of shame and isolation that may trigger a relapse in patients. These programs are effective because of the ongoing emotional support from former addicts.
7. Encourage treatment adherence.
Managing drug addiction requires a life-long commitment. Encourage the patient to attend regular group sessions, self-help programs, and follow-up visits with a counselor as often as needed. If there is a relapse, advise the patient to seek assistance immediately.
8 Include the family in the treatment plan.
Adolescents who participate in substance abuse can benefit from the involvement of family members through brief strategic family therapy (BSFT), which can address conduct disorders or behavioral issues that may contribute to drug use.
9. Recognize that the patient must choose sobriety.
The nurse must remain nonjudgmental in treating patients with substance abuse disorders. Patients with addiction may seek medical support over and over in relation to their substance use, and the nurse can continue to provide resources for recovery. The nurse can also educate the patient on the effects of their long-term drug use, which may include organ failure, HIV, sepsis, muscle weakness, memory loss, and death. For there to be any chance of recovery, the patient must recognize the negative effects of their drug use, be willing to change their behavior, and take responsibility and action to overcome their addiction.
Nursing Care Plans
Once the nurse identifies nursing diagnoses related to 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.
Acute Substance Withdrawal Syndrome
Acute substance withdrawal syndrome occurs when substance-dependent patients suddenly reduce or stop their intake of a substance, causing various physiological and behavioral changes.
Nursing Diagnosis: Acute Substance Withdrawal Syndrome
Related to:
- Dependence on an addictive substance
- Sudden cessation of an addictive substance
- Excessive use of an addictive substance over time
As evidenced by:
- Anxiety
- Acute confusion
- Nausea
- Disturbed sleep pattern
- Electrolyte imbalances
- Injuries
- Vital sign alterations
Expected outcomes:
- Patient will maintain vital signs within normal limits.
- Patient will remain oriented to person, place, and time with an alert level of consciousness.
Assessment:
1. Determine the substance abused, pattern/amount, and last use.
Withdrawal symptoms will depend on the substance, frequency, amount, and last use. Withdrawal symptoms from alcohol can begin as quickly as 6 to 8 hours after alcohol levels decrease, within 24 hours for heavy amphetamine use, and anywhere from 1-3 days for opioids or benzodiazepines.
2. Monitor withdrawal symptoms.
Symptoms are dependent on the substance used, but can include: anxiety, nausea, vomiting, tremors, headache, insomnia, hallucinations, diaphoresis, and alterations in heart rate and blood pressure.
3. Review lab values.
Closely monitor the results of alcohol concentration levels, complete blood counts, kidney and liver panels, electrolyte panels, and urine toxicology screenings.
Interventions:
1. Provide a calm environment with minimal stimuli.
Keeping the environment free from excessive noise and bright lighting can help reduce the agitation and irritability associated with withdrawal symptoms.
2. Implement appropriate withdrawal scales.
The Clinical Institute Withdrawal Assessment (CIWA) scale monitors the severity of alcohol withdrawal, while the Clinical Opiate Withdrawal Scale (COWS) evaluates opioid withdrawal severity to guide the nurse in implementing appropriate treatment.
3. Implement seizure precautions.
Patients withdrawing from alcohol or benzodiazepines are at a high risk for seizures. Implement seizure precautions to prevent injuries
4. De-escalate agitated behavior and ensure safety.
The nurse should be prepared to implement de-escalation techniques for patients experiencing agitation or delusions. Ensure the safety of the patient and staff by implementing 1:1 supervision as necessary.
5. Administer intravenous fluids and electrolytes as indicated.
Patients with heavy alcohol use are commonly deficient in B vitamins and other minerals. The nurse may administer IV fluids, commonly called a “banana bag” for its yellow color, that contains thiamine, folic acid, and electrolytes.
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:
- Patient will recognize instances that cause increased stress and a desire to use substances.
- 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.
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:
- Patient will report awareness of the substance abuse problem.
- Patient will verbalize acceptance of responsibility for their behavior.
- 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.
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:
- Patient will verbalize areas where they have control over their substance abuse.
- 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.
Risk for Suicide
Substance abuse can significantly increase the patient’s risk for suicide. Drug abuse can weaken the patient’s impulse control, interrupt neurotransmitter pathways, and impair judgment, leading to suicidal ideations and attempts.
Nursing Diagnosis: Risk for Suicide
Related to:
- Substance misuse
- Ineffective impulse control
- Self-injurious behavior
- Guilt
- Maladaptive coping behaviors
- Inadequate social support
- Easy access to a weapon
- Perceived failures
- Low self-esteem
- Chronic pain
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at prevention.
Expected outcomes:
- Patient will not harm self.
- Patient will disclose suicidal ideations.
- Patient will demonstrate effective and positive coping mechanisms in managing substance abuse and withdrawal symptoms.
Assessment:
1. Assess the type of substance used.
Alcohol and opioids are the two most common drugs that are associated with increased suicide risk. Alcohol and opioid use disorders significantly increase the risk for suicidal ideations and attempts.
2. Assess for pre-existing mental health conditions.
Substance abuse disorders commonly co-occur with mental illnesses or mood disorders, exacerbating the patient’s ability to cope effectively and increasing the risk for suicidal behaviors.
3. Identify patients at an increased risk.
Some populations and demographics who experience substance abuse are most at risk for suicide. These groups include those who are:
- Economically disadvantaged
- Socially isolated
- Of black or multi-racial ethnicity
- LGBTQ+
Interventions:
1. Determine the patient’s coping response and behaviors.
Impulsiveness, aggression, hopelessness, poor judgment or decision-making, and unstable emotional states increase the risk of suicide and are heightened by substance use.
2. Perform a suicide risk screening.
Research shows that nearly half of suicide victims saw a healthcare professional in the month before their suicide. All patients should be screened for suicide, regardless of the reason for their visit.
3. Expand access to mental health counseling and substance abuse treatment.
A major barrier for many patients who experience mental health issues and substance abuse is the lack of access to care. The nurse should provide resources or collaborate directly to connect patients with telehealth services, support groups, outpatient clinics, and more.
4. Promote a safe environment.
Patients experiencing substance abuse already have the means to carry out suicide if they have access to medications or illegal drugs. Substances alter the patient’s decision-making ability and may reduce their sense of fear, which can be extremely dangerous if they have access to weapons or potentially hazardous items.
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