Nursing Care for Substance-Related Disorders

A substance use disorder, also sometimes referred to as a substance-related disorder, is when a patient is unable to control their use of a legal or illegal substance which interferes with the activities of their daily life.

Commonly abused substances include CNS depressants, like alcohol and opioids; CNS stimulants, like cocaine; and combined CNS depressants and stimulants, like tobacco.

Now, there isn’t a single cause of substance use disorders, but rather it’s a multifactorial condition, meaning that there’s a combination of genetic and environmental risk factors and triggers.

These include a family history of a substance use disorder or having a mental health disorder like depression or anxiety.

Certain experiences also put a patient at risk for developing a substance use disorder like using the substance at an early age, or experiencing physical, sexual, or emotional abuse.

Okay, so, in general, clinical manifestations of a substance use disorder occur when long-term use of a substance leads to severe physical, psychological, or social impairment.

This can include behavioral changes, like needing the substance daily, intense urges to use the substance, and using the substance despite disruption of the person’s life.

Other clinical manifestations depend on the type of substance used. For example, CNS depressants, like alcohol, can cause neurological symptoms like slurred speech, weakness, and impaired mobility; and opioids can cause sleepiness and decreased respiratory rate.

On the other hand, CNS stimulants, like cocaine, cause hyperactivity, tremors, and elevated heart rate; and combination CNS depressants and stimulants, like tobacco, initially cause stimulatory effects like sweating, tachycardia, and elevated blood pressure, followed by depressor effects like difficulty breathing, slurred speech, and muscle weakness.

Diagnosis of a substance use disorder begins with the patient’s history and physical examination. The diagnosis is confirmed if the patient meets certain criteria, that can include tolerance, which is an increased amount of the substance needed to achieve the same effect; dependence, or when the person physically or psychologically requires the substance to function; and withdrawal, which occurs when lack of using the substance causes severe physical, mental, and behavioral changes.

Laboratory tests, like alcohol levels and toxicology screens, can also aid in diagnosis. Treatment for substance use disorders may include a combination of therapies such as detoxification, psychotherapy, and pharmacotherapy.

Detoxification involves withdrawing the patient from the substance under medical supervision, usually on an inpatient hospital unit.

Psychotherapy can include various modalities like cognitive behavioral therapy, or CBT; group therapy, like Alcoholics or Narcotics Anonymous; and family therapy.

Pharmacotherapy can be prescribed for certain types of substance use, like disulfiram for alcohol use; methadone for certain opioids like heroin; or nicotine replacement for tobacco use.

Alright let’s look at the nursing care you’ll provide for your patient with a substance use disorder. First, collect information on your patient’s physical and psychosocial status.

Then, collaborate with the registered nurse, or RN, to develop the plan of care. Also be sure to establish a trusting therapeutic relationship by using active listening and reinforcing positive behaviors.

Keep in mind that every patient is unique and different approaches may be needed to establish trust and cooperation. If your patient is prescribed a pharmacologic regimen to help reduce cravings and prevent relapse, monitor them for a therapeutic response, as well as any adverse effects.

Reinforce education about strategies to help prevent a relapse and encourage them to be involved in group counseling and to identify a support person to help facilitate a full recovery.

Alright, as a quick recap...A substance use disorder is when a patient is unable to control their use of a legal or illegal substance that interferes with the activities of their daily life.

Causes are multifactorial and include genetic and environmental factors. Clinical manifestations include behavioral changes, like needing the substance daily, intense urges to use the substance, and using the substance despite it disrupting the person’s life; as well as physical effects due to CNS depression or stimulation.

Diagnosis is based on history and physical examination, as well as meeting certain criteria. Treatment can include a combination of therapies such as detoxification, psychotherapy, and pharmacotherapy.

Nursing considerations are focused on providing a supportive environment and