Use this nursing care plan and management guide to help care for patients with substance abuse. Learn about the nursing assessment, nursing interventions, goals and nursing diagnosis for substance abuse in this guide.
Substance use disorders involve excessive use of nicotine, alcohol, and other illicit substances that leads to social, academic, and occupational impairment. The most common illicit substances seen include cannabis, sedatives, hypnotics, anxiolytics, inhalants, opioids, hallucinogens, and stimulants. The specific factors of substance use disorder consist of abuse, intoxication, and physical/psychological dependence (Jahan & Burgess, 2022).
Drug abuse and drug dependence represent different ends of the same disease process.
Drug abuse is an intense desire to use increasing amounts of a particular substance or substances to the exclusion of other activities.
Drug dependence is the body’s physical need, or addiction, to a specific agent. There is, therefore, virtually no difference between dependency and addiction. Over the long term, this dependence results in physical harm, behavior problems, and association with people who also abuse drugs. Stopping the use of the drug can result in a specific withdrawal syndrome.
For establishing a diagnosis based on substance use, the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5), the client must meet at least two criteria out of 11 criteria, over a 12-month period, to have substance use disorder established for that substance. The 11 criteria are:
The number of criteria the client meets determines the severity level of the disorder; two to three sets the severity level as mild, four to five sets the severity level as moderate, and six or more sets the severity level as severe (Jahan & Burgess, 2022).
Nursing care plans and management for clients who abuse substances include providing support for the decision to stop substance use, strengthening individual coping skills, facilitating learning of new ways to reduce anxiety, promoting family involvement in a rehabilitation program, facilitating family growth and development, and provide information about the prognosis and treatment needs.
The following are the nursing priorities for patients with substance abuse:
Assess for the following subjective and objective data:
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with substance abuse based on the nurse’s clinical judgment and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
Goals and expected outcomes may include:
Therapeutic interventions and nursing actions for patients with substance abuse may include:
Accepting reality is a vital step for patients with substance abuse as it involves acknowledging the impact of the addiction and recognizing the need for change. It requires facing the consequences of substance abuse, understanding the harmful effects on their physical and mental health, relationships, and well-being, and embracing the reality that recovery is possible with the right support and treatment.
Ascertain by what name the client would like to be addressed.
This shows courtesy and respect, giving the client a sense of orientation and control. By using their preferred name, the nurse shows acknowledgment of their individuality and identity beyond their diagnosis. Additionally, using a client’s preferred name can help establish trust and rapport, which is crucial in the therapeutic relationship.
Ascertain the reason for beginning abstinence and involvement in therapy.
This provides insight into the client’s willingness to commit to long-term behavioral change, and whether the client even believes that he or she can change. (Denial is one of the strongest and most resistant symptoms of substance abuse.) Acceptance is essential to face and deal with reality; it is almost impossible to plan the future without accepting the present circumstances (Zafar & Farhan, 2020).
Review the definition of drug dependence and categories of symptoms (patterns of use, impairment caused by use, tolerance to substance).
This information helps clients make decisions regarding acceptance of problems and treatment choices. Effective education on the treatment of substance use disorders among the healthcare team can help to improve outcomes. Identifying high-risk client populations and reducing care barriers can help limit the negative impact of substance use disorders (Jahan & Burgess, 2022).
Answer questions honestly and provide factual information. Keep your word when agreements are made.
This creates trust, which is the basis of the therapeutic relationship. Honesty and transparency are crucial in building trust. The nurse should be honest about what the treatment process entails and what the client can expect. Providing feedback and updates must also be done regularly to keep the client informed about their progress.
Convey an attitude of acceptance, separating an individual from unacceptable behavior.
This promotes feelings of dignity and self-worth. Clients with substance abuse disorder may experience stigma, shame, and guilt. An attitude of acceptance helps reduce these negative feelings and promotes a more positive treatment experience. Acceptance also helps build trust between the client and the healthcare team.
Provide information about addictive use versus experimental, occasional use; biochemical or genetic disorder theory (genetic predisposition; use activated by the environment; compulsive desire.)
The progression of the use continuum is from experimental or recreational to addictive use. Comprehending this process is important in combating denial. Education may relieve the client’s guilt and blame and may help awareness of recurring addictive characteristics. Substance abuse disorders (SUD) involve both psychological and physical dependence on the substance of use. SUD and addiction stem in part from adaptive changes in the brain as it seeks to regain homeostasis (Jahan & Burgess, 2022).
Discuss the client’s current life situation and the impact of substance use.
The first step in decreasing the use of denial is for the client to see the relationship between substance use and personal problems. Based on a thorough literature review, it is reasoned that socially desirable response bias is generally driven by the desire to evade humiliation and consequences from revealing delicate information. Allowing the client to voice out their concerns can be the beginning of recovery from denial (Zafar & Farhan, 2020).
Confront and examine denial and rationalization in the peer groups. Use confrontation with caring.
Because denial is the major defense mechanism in addictive disease, confrontation by peers can help the client accept the reality of adverse consequences of behaviors and that drug use is a major problem. A caring attitude preserves self-concept and helps decrease defensive responses. The nurse may approach the client with empathy and use specific examples to illustrate the negative impact of substance abuse.
Provide information regarding the effects of addiction on mood and personality.
Individuals often mistake the effects of addiction and use this to justify or excuse drug use. Effects of different substances vary depending on the substance and can produce everything from increased energy and euphoria to profound sedation. In general, while the effects vary significantly, the initial stages of substance use disorders are characterized by positive reinforcement, where individuals experience a sense of well-being or euphoria with use (Jahan & Burgess, 2022).
Remain nonjudgmental. Be alert to changes in behavior, (restlessness, increased tension).
Confrontation can lead to increased agitation, which may compromise the safety of clients and staff. Evaluation of the client initially involves approaching the client in a non-judgemental manner. The diction should concentrate on recovery and goal setting. How well the first interview is conducted sets the tone for establishing a good rapport between the nurse and the client (Jahan & Burgess, 2022).
Provide positive feedback for expressing awareness of denial in self and others.
This may be necessary to enhance self-esteem and to reinforce insight into behavior. It can help them recognize the negative impact their substance abuse is having on their life and the lives of those around them. Positive feedback can also motivate the client and help them understand that change is possible and that recovery is within reach.
Maintain firm expectations that clients attend recovery support and therapy groups regularly.
Attendance is related to admitting the need for help, working with denial, and for maintenance of a long-term drug-free existence. The acceptance of substance abuse as a problematic factor would lead to taking treatment more seriously and looking for possible solutions in their treatment. This would increase their involvement in treatment and efforts to remain sober in the future (Zafar & Farhan, 2020).
Encourage and support clients in taking responsibility for their own recovery (development of alternative behaviors to drug urges and use). Assist the client to learn own responsibility for recovering.
Denial can be replaced with positive action when the client accepts the reality of their own responsibility. Clients who acquire adequate support throughout the disorder may be expected to enhance general strategies to cope with life demands and enhance psychological well-being and, at the same time, exposure to a recovery social norm may help shift attitudes in the direction of greater health behavior change (Bergman & Kelly, 2020).
Encourage family members to seek help whether or not the abuser seeks it.
This helps assist the client deal appropriately with the situation. There are examples of redemption in which individuals seem to have achieved it ‘on their own’. However, in most cases, there has been some combination of family members or friends, mutual help programs, treatment interventions, socially conscious employers, and national policies that have helped to facilitate recovery (McKay, 2016).
Provide additional information about denial management.
Denial management counseling is based on practical exercises for motivating the substance abuser to recover. Studies show that this method results in a significant decrease in self-deception enhancement and impression management. Denial management counseling plays a prominent role in lessening the level of denial in individuals with substance abuse, and they were able to recognize and relate to their problems (Zafar & Farhan, 2020).
Encourage the client to utilize telemedicine for recovery support services.
Telemedicine and online digital recovery support services (D-RSS) have taken center stage as potential solutions for individuals who are increasingly unable to access SUD treatment and recovery support services in person. Free, socially-based, online D-RSS including online video recovery support meetings, discussion boards and chat rooms, and social network sites may be critical resources in helping to address the unintended consequences of the pandemic and inaccessibility of health services (Bergman & Kelly, 2020).
Refer the client to peer recovery support services (PRSS) and recovery coaching.
PRSS is peer-driven mentoring, education, and support ministrations delivered by individuals who, because of their own experience with SUD and SUD recovery, are experientially qualified to support peers currently experiencing SUD and associated problems. Findings of the potential of peer support are evidenced by positive findings on measures including reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction (Eddie et al., 2019).
Effective coping strategies for patients with substance abuse involve developing healthy ways to manage stress, cravings, and triggers without relying on substances. This may include engaging in activities such as exercise, therapy, and mindfulness techniques, and seeking support from a strong social network. Effective family coping involves providing support, education, and encouragement to the patient while setting boundaries, practicing self-care, and seeking their own support to navigate the challenges of living with a loved one’s substance abuse.
Review program rules, and philosophy expectations.
Having information provides an opportunity for clients to cooperate and function as a member of the group or milieu, enhancing a sense of control and sense of success. Substance abuse is a life-long disease that can only be controlled, not cured. In a detoxification center, treatment initially consists of managing the varied symptoms of withdrawal, which can range from a longing to reuse to hallucinations and seizures (Krause & Brenner, 2021).
Observe understanding of current situation, previous, and other methods of coping with life’s problems.
This provides information about the degree of denial, acceptance of personal responsibility, and commitment to change. This also identifies coping skills that may be used in the present situation. These strategies are considered an important influence in the development, course, and treatment outcome of diverse mental disorders such as substance use disorder (SUD) (Adan et al., 2017).
Determine outside stressors and other causes of SUD.
This helps identify specific needs, provides an opportunity to offer information and support, and begins problem-solving. A cause of substance use disorder is the personality factor, with various personality traits making individuals inclined towards substance abuse. Therefore, personality factors play an important determining role in SUD (Ismail et al., 2021).
Set limits and confront efforts to get the caregiver to grant special privileges, making excuses for not following through on behaviors agreed on, and attempting to continue drug use.
The client has learned manipulative behavior throughout life and needs to learn a new way of getting their needs met. Following through on the consequences of failure to maintain limits can help the patient to change ineffective behaviors. Setting limits helps establish clear boundaries between acceptable and unacceptable behavior. It provides structure and helps the client understand what is expected of them.
Be aware of staff attitudes, feelings, and enabling behaviors.
Lack of understanding and judgmental or enabling behaviors can result in inaccurate data collection and non-therapeutic approaches. By perpetuating problems, impeding recovery, increasing risk, damaging relationships, and creating co-dependency, enabling can prevent clients from getting the help they need to overcome their substance abuse disorder.
Encourage verbalization of feelings, fears, and anxiety.
This may help the client begin to come to terms with long-unresolved issues. Verbalization of feelings can be an effective tool in the treatment of clients with SUD. It can encourage self-awareness, facilitate communication, provide emotional release, promote problem-solving, and enhance empathy. Clients can develop a deeper understanding of themselves and their disease, which can lead to more successful treatment outcomes.
Based on standard hospital policy, institute appropriate measures.
This is to avoid suicide attempts. Comorbidity with alcohol and substance use disorders vastly increases vulnerability to suicide ideation, attempts, and death. Additionally, suicidal ideation and behavior are significant clinical concerns among those seeking treatment for substance abuse disorder, and the risk for highly lethal suicide attempts remains to be elevated even after remission from SUD (Rizk et al., 2021).
Explore alternative coping strategies.
The client may have little or no knowledge of adaptive responses to stress and needs to learn other options for managing time, feelings, and relationships without drugs. There are three aspects to coping strategies: problem focus as a way to focus on solving the problem such as seeking relaxing diversions, referring to other examples of individuals seeking help from others about their problems, and non-productive coping, namely individuals taking unproductive action in relation to life problems (Ismail et al., 2021).
Assist the client to learn and encourage the use of relaxation skills, guided imagery, and visualizations.
These help clients relax and develop new ways to deal with stress and problem-solving. Encourage the client to take deep, slow breaths, focusing on the sensation of the air moving in and out of their body. Progressive muscle relaxation is a technique that involves tensing and then releasing different muscle groups in the body, one at a time. It helps the client release tension. Guided imagery involves visualizing a peaceful, calming scene or experience, reducing the client’s anxiety and improving their mood.
Structure diversional activity that relates to recovery (social activity within support group), wherein issues of being chemically free are examined.
The discovery of alternative methods of coping with drug hunger can remind clients that addiction is a lifelong process and opportunity for changing patterns is available. Dibversional activities can help the client take their mind off cravings for drugs and alcohol. It can also improve the client’s mood and reduce symptoms of depression and anxiety. Diversional activities provide opportunities for clients to connect with others who share similar interests, bringing in a sense of community and social support, which is important in the recovery process.
Use peer support to examine ways of coping with drug hunger.
Self-help groups are valuable for learning and promoting abstinence in each member, using understanding and support as well as peer pressure. Peer support services emphasize respect for the diverse pathways and styles of recovery, and stress the need for long-term continuity of recovery support through mobilization of personal, familial, and community help. They can be delivered through a variety of organizational venues and a variety of service roles including paid and volunteer recovery support specialists (Eddie et al., 2019).
Encourage involvement in therapeutic writing. Have the client begin journaling or writing an autobiography.
Therapeutic writing or journaling can enhance participation in treatment; serves as a release for grief, anger, and stress; provides a useful tool for monitoring a client’s safety; and can be used to evaluate a client’s progress. The autobiographical activity provides an opportunity for the client to remember and identify the sequence of events in his or her life that relate to the current situation.
Discuss the client’s plans for living without drugs.
This provides opportunities to develop and refine plans. Devising a comprehensive strategy for avoiding relapses helps clients in the maintenance phase of behavioral change. The Community Reinforcement Approach (CRA) was designed to make abstinence more rewarding than continued use. CRA consists of CBT-based intervention components, counseling focused on developing new recreational activities and healthy social networks, employment counseling and assistance with practical needs, couples counseling for those in a romantic relationship, and monitored disulfiram for those with alcohol problems (McKay, 2016).
Administer medications such as disulfiram, acamprosate, methadone, naltrexone, and nalmefene as indicated.
See Pharmacologic Management
Encourage involvement with self-help associations (Alcoholics, Narcotics Anonymous).
These put the client in direct contact with the support system necessary for managing sobriety and drug-free life. Once physical withdrawal is complete after detoxification, group, and individual counseling begins and continues on an inpatient, outpatient, and group support basis (Krause & Brenner, 2021). These intensive outpatient programs (IOP) do not require the client to be admitted. IOPs are composed of psychosocial support, developing coping skills, and any other needed services individually (Jahan & Burgess, 2022).
Maintain a quiet, safe environment during withdrawal from any drug.
Excessive noise may agitate the client. Discontinuing prolonged use or abuse of high doses of CNS depressants can lead to serious withdrawal symptoms. This can result in CNS stimulation to the point of grand mal seizures. Milder symptoms such as agitation, restlessness, and insomnia are more common (Krause & Brenner, 2021).
Remove harmful objects from the client’s room.
This is to prevent the client from harm. Intoxication promotes behavioral disinhibition and affective numbing, potentially lessening the fear of death that might otherwise act as a psychological barrier to suicide. Additionally, suicide may be an extreme expression of the negative affective states that result from the neurobiological changes associated with chronic opioid use (Rizk et al., 2021).
Use restraints ONLY if you think the client may harm himself or herself and others.
This is to promote safety, but this intervention must be approved by the provider and documented strictly by the nurse. Clinical recommendations suggest inpatient care for individuals with alcohol misuse who present with suicidal plans or intent, preferably in a dual-diagnosis facility (Rizk et al., 2021). Restraints must be the last resort for a violent or hostile client.
Provide a safe, non-threatening environment.
This encourages the client to talk freely without fear of judgment. A safe, non-threatening environment can reduce stress for clients, which can be a powerful trigger for substance use. By creating an environment that is free from judgment, criticism, or punishment, clients can feel more comfortable and relaxed, which can reduce their risk of relapse.
13. Refer the client to psychotherapeutic interventions, as indicated.
Cognitive behavioral therapy (CBT) focuses on dysfunctional, distorted, or self-deprecating schemas or beliefs that may be contributing, joint or severally, to depressed mood, suicidality, and alcohol misuse. Contingency management, as well as supportive psychiatry, has shown some evidence to support the incremental utility of psychosocial interventions in combination with pharmacotherap[y for opioid use disorder (Rizk et al., 2021).
Review family history; explore roles of family members, circumstances involving drug use, strengths, and areas for growth.
This determines areas for focus and potential for change. Several studies emphasized the impotence of family relationships and family climate- considering parenteral support and communication, parental drug abuse, and parental incarceration- on illicit and at-risk behaviors, such as crime and substance abuse of youth (Saladino et al., 2021).
Explore how the family member has coped with the client’s habit, (denial, repression, rationalization, hurt, loneliness, projection).
The person who enables also suffers from the same feelings as the client and uses ineffective methods for dealing with the situation, necessitating help in learning new and effective coping skills. A study states that the social problem-solving skills of individuals are closely related to the family; social environment and family are the natural and immediate social environments of substance abusers; thus, acceptance of the addiction and search for a solution in the family improve the social problem-solving skills of the substance abuser (Saladino et al., 2021).
Determine understanding of the current situation and previous methods of coping with life’s problems.
This provides information on which to base the present plan of care. Clients whose parents are involved in illegal activities and are often absent from home are more likely to experience a lack of family cohesion and support and are at more risk of developing binge drinking and smoking marijuana habits. On the contrary, the presence of parents increments the perceived support of the clients and decreases risky conduct (Saladino et al., 2021).
Assess the current level of functioning of family members.
This affects an individual’s ability to cope with the situation. The stresses that families experience as a consequence of the relative’s substance abuse have been associated with increased psychological and physical morbidity. Depression, suicide, insomnia, and emotional distress including feelings of shame, humiliation, blame, and loss are common experiences for affected family members (Groenewald & Bhana, 2018).
Determine the extent of enabling behaviors evidenced by family members; explore with each individual and client.
Enabling is doing for the client what he or she needs to do for self (rescuing). People want to be helpful and do not want to feel powerless to help their loved one stop substance use and change the behavior that is so destructive. However, the substance abuser often relies on others to cover up their own inability to cope with daily responsibilities. Enablers commonly live in a “fantasy world” where their loved one is not being harmed by addiction. The enabler ignores obvious red flags and makes excuses for the client (Northstar Transitions, 2020).
Note how the partner relates to the treatment team and staff.
This determines enabling style. A parallel exists between how the partner relates to the user and to staff, based on the partner’s feelings about self and situation. When an enabler comes along and takes away the consequences of addiction in the client’s life, this will only fuel their train of thought regarding their denial and allow them to continue their substance abuse. Forced treatment is almost never a good idea. The substance abuser must realize there is a problem and realize getting treatment is better than continuing down the path of addiction (Northstar Transitions, 2020).
Explore conflicting feelings the enabling partner may have about treatment including feelings similar to those of the abuser (a blend of anger, guilt, fear, exhaustion, embarrassment, loneliness, distrust, grief, and possibly relief).
This is useful in establishing the need for therapy for the partner. This individual’s own identity may have been lost, she or he may fear self-disclosure to staff and may have difficulty giving up the dependent relationship. Despite the stress associated with a family member’s substance abuse being profound and complex, family members of substance abusers often suffer in silence with little support (Groenewald & Bhana, 2018).
Provide information about enabling behavior, and addictive disease characteristics for both users and non-users.
Awareness and knowledge of behaviors (avoiding and shielding, taking over responsibilities, rationalizing, and subserving) provide opportunities for individuals to begin the process of change. Behaviors of the enabler may include living in denial, projecting blame onto others, covering for the substance abuser, avoidance, absence of boundary limits, and completing their loved ones’ responsibilities (Northstar Transitions, 2020).
Identify and discuss sabotage behaviors of family members.
Even though family member(s) may verbalize a desire for the individual to become substance-free, the reality of interactive dynamics is that they may unconsciously not want the individual to recover because this would affect the family member(s)’ own role in the relationship. Additionally, they may receive sympathy and attention from others (secondary gain). A secondary gain is when one benefits from a problem. It’s when a family member receives advantages from unwanted conditions, circumstances, or limitations. In other words, they benefit from not overcoming problems (Ritter, 2022).
Encourage participation in therapeutic writing such as journaling (narrative), guided or focused.
This serves as a release for feelings (anger, grief, stress); helps move individuals forward in the treatment process. The fight against alcohol and substance addiction is a life-long process, and it is necessary to give psychological support to family members since family is the most important source of support for substance abusers during this process (Ulas & Eksi, 2019).
Provide factual information to the client and family about the effects of addictive behaviors on the family and what to expect after discharge.
Many clients and family members are not aware of the nature of addiction. If the client is using legally obtained drugs, he or she may believe this does not constitute abuse. The effects of substance abuse extend beyond the individual user and profoundly affect the health, emotional, and economic well-being of the family. Affected family members have an increased likelihood to be diagnosed with severe mental health problems including depression, substance use disorders, and trauma when compared to family members of individuals who are suffering from diabetes or asthma (Groenewald & Bhana, 2018).
Encourage family members to be aware of their own feelings, and look at the situation with perspective and objectivity. They can ask themselves: “Am I being conned? Am I acting out of fear, shame, guilt, or anger? Do I have a need to control?”
When the enabling family members become aware of their own actions that perpetuate the addict’s problems, they need to decide to change themselves. If they change, the client can then face the consequences of his or her own actions and may choose to get well. To stop enabling a loved one, family members should work on bringing more attention to their addiction. This can be done in a nice way, but the issue must be brought to light and addressed by the family member, letting the client know that it is not okay (Northstar Transitions, 2020).
Provide support for enabling partner(s). Encourage group work.
Families and SOs need support to produce change as much as the person who is addicted. Policies to support affected family members need to adopt a “family first” framework that prioritizes the support needs of the family unit and its individual members. Support priorities for the family should not be simply fitted into existing treatment models haphazardly. Rather, evidence-based policy and service development are required through the input of family members and other family experts in order to adequately address the needs of the family (Groenewald & Bhana, 2018).
Assist the client’s partner to become aware that the client’s abstinence and drug use are not the partner’s responsibility.
Partners need to learn that users’ habits may or may not change despite the partner’s involvement in treatment. The partner may encourage the client to get help and talk about how they can help in looking for recovery addiction centers together. Instead of projecting blame onto others, the partner should understand that addiction is a disease and choices can lead to it, but it is its own monster (Northstar Transitions, 2020).
Help the recovering (former user) partner who is enabling to distinguish between destructive aspects of behavior and has a genuine motivation to aid the user.
Enabling behavior can be a partner’s attempts at personal survival. Let the partner know that saying no to the client is okay when they come asking for help. If what they are asking for will enable their addiction, it is okay to say no. boundaries should be kept and upheld, and addressing the partner’s own needs and mental health is necessary before they can help the client recover from addiction (Northstar Transitions, 2020).
Involve family in discharge referral plans.
Drug abuse is a family illness. Because the family has been so involved in dealing with substance abuse behavior, family members need help adjusting to the new behavior of sobriety and abstinence. The incidence of recovery is almost doubled when the family is treated along with the client. Early intervention approaches related to families and affected persons include identifying at-risk families and communities, enabling affected persons to identify warning signs of substance abuse, informing families and communities about the resources and support systems available to them, involving and promoting the participation of children, youth, parents, and families in identifying and seeking solutions to their problems, economic empowerment, and skills development (Groenewald & Bhana, 2018t.
Be aware of staff’s enabling behaviors and feelings about clients and enabling partners.
A lack of understanding of enabling can result in non-therapeutic approaches to clients and their families. Addiction is a disease that impacts each member of a family unit in a different way. Family members often take on different roles in their relation to the substance abuser once substance abuse becomes known. One of these unhealthy roles is of the enabler. The role of the enabler is one of the most damaging roles to be in (Northstar Transitions, 2020).
Encourage involvement with self-help associations, Alcoholics and Narcotics Anonymous, Al-Anon, Alateen, and professional family therapy.
This puts the client and family in direct contact with support systems necessary for continued sobriety and to assist with problem resolution. Policies and strategies that have been adopted in the UK, such as the Drugs: protecting families and communities strategy (which has a strong focus on children affected by parental substance abuse), the carers and families of substance misusers: A framework for the provision of support and involvement policy (which has a strong focus on affected family members), and the Think family: improving the life chances of families at risk strategy. These policies and strategic documents prioritize the involvement of families in the development and support services for affected family members (Groenewald & Bhana, 2018).
Provide additional information and refer the family to familial interventions as indicated.
Familial interventions can help parents to establish positive communication, reduce conflicts within the family, promote a parenting style based on active listening, affection, and rules, and lead parents to understand the effects of neglection, physical and psychological violence, and systematic exposure to a criminogenic context on the client’s development (Saladino et al., 2021).
Consider the client’s and family’s culture and diversity carefully.
The diverse background characteristics that are embedded in families as a function of culture, race, gender, socio-community context, and socioeconomic status may hinder or promote family functioning. The White paper on families in South Africa was designed to promote family functioning and resilience and to define the diverse family structures. This paper documents various support services for families and their members and provides capacity building and empowerment of parents and families to deal with and handle the challenging child and youth behaviors (Groenewald & Bhana, 2018).
Promote good communication between the client and their family.
Good family communication and disclosure are important in preventing risky behaviors among youth. A strong sense of openness within the family context increases social and emotional skills among teens and decreases risky behavior. Positive communication with parents is an anti-drug socialization agent. Parent drug-talk styles, especially in early adolescence, assume a key role in preventing substance abuse (Saladino et al., 2021).
Note behaviors indicative of powerlessness or hopelessness.
These behaviors indicate the client’s ability to manage life changes. Statements of despair such as “They don’t care” or “It won’t make any difference” are examples of powerlessness. Social and environmental disadvantages, such as lack of family support, unemployment, and homelessness are highly prevalent among persons with substance use disorder, as well as suicidal individuals (Rizk et al., 2021).
Determine the degree of life mastery and locus control.
Life mastery helps determine success in adjusting to the health condition. The locus of control relates to the ability to manage outcomes related to the disease process. An external locus of control would benefit from positive affirmation.
Use crisis intervention techniques to initiate behavior changes.
The client is more amenable to acceptance of the need for treatment at this time. Several crisis intervention techniques are commonly used to help bring crises under control. The method used may depend on the individual responder’s strengths and the situation faced at the moment. People may be responding to a person in the depths of substance abuse or a mental health crisis. The ABC model of crisis intervention is designed to help alleviate immediate crisis challenges. ABC stands for Achieve contact, Boil down the problem, Cope with the problem, and Determine the meaning of the event (Thankachen, 2023).
Assist the client to recognize a problem exists. Discuss in a caring, nonjudgmental manner how the drug has interfered with life.
In the pre-contemplation phase, the client has not yet identified that drug use is problematic. While the client is hurting, it is easier to admit substance use has created negative consequences. Acceptance is essential to face and deal with reality, it is almost impossible to plan the future without accepting the present circumstances. Acceptance can be brought by managing the denial that the individual has regarding their substance abuse (Zafar & Farhan, 2020).
Involve the client in the development of a treatment plan, using the problem-solving process in which the client identifies goals for change and agrees to desired outcomes.
During the contemplation phase, the client realizes a problem exists and is thinking about a change of behavior. The client is committed to the outcomes when the decision-making process involves solutions that are promulgated by the individual. A study found that coping strategies such as focusing on solving the problem and referring to others (seeking social or spiritual support) affected minimizing drug abuse behavior (Ismail et al., 2021).
Discuss alternative solutions.
Brainstorming helps creatively identify possibilities and provides a sense of control. During the preparation phase, minor action may be taken as an individual organizes resources for definitive change. If clients felt that their treatment sessions were focused more directly on positive, reinforcing activities and experiences in daily life and they experienced a clear increase in their frequency, they would be more likely to remain in treatment and reduce their use of alcohol and drugs (McKay, 2016).
Assist in selecting the most appropriate alternative.
As possibilities are discussed, the most useful solution becomes clear. Behavioral activation, a treatment developed for depression that is focused on increasing participation in enjoyable activities, has shown initial promise in the treatment of substance use disorder (McKay, 2016).
Support decision and implementation of selected alternative(s).
This helps the client persevere in the process of change. During the action phase, the client engages in a sustained effort to maintain sobriety, and mechanisms are put in place to support abstinence. A study reports that adolescents need a social supporting environment, such as strong family relationships, positive peer influence, and good role models. All those components can provide them with protective factors to prevent them from becoming involved in risky behavior such as substance use (Ismail et al., 2021).
Explore support in peer groups. Encourage sharing about drug hunger, situations that increase the desire to indulge, and ways that substance has influenced life.
The client may need assistance in expressing self, speaking about powerlessness, and admitting the need for help in order to face up to the problem and begin resolution. The Substance Abuse and Mental Health Services Administration (SAMHSA) has previously defined peer recovery support services as a peer-helping-peer service alliance in which a peer leader in stable recovery provides social support services to a peer who is seeking help in establishing or maintaining their recovery (Eddie et al., 2019).
Assist client to learn ways to enhance health and structure healthy diversion from drug use (maintaining a balanced diet, getting adequate rest, exercise [walking, slow or long-distance running]; and acupuncture, biofeedback, deep meditative techniques).
Learning to empower self in constructive areas can strengthen the ability to continue recovery. These activities help restore natural biochemical balance, aid detoxification and manage stress, anxiety, and use of free time. These diversions can increase self-confidence, thereby improving self-esteem. Note: Exercise promotes the release of endorphins, creating a feeling of well-being.
Provide information regarding the understanding of human behavior and interactions with others (transactional analysis).
Understanding these concepts can help the client to begin to deal with past problems or losses and prevent repeating ineffective coping behaviors and self-fulfilling prophecies. Use a motivational style to present the information. Do not pressure the client to accept a diagnosis or offer unsolicited opinions about the meaning of results. Let the client form their own conclusions, but help them by asking, “What do you make of this?” (The Substance Abuse and Mental Health Services Administration, 2019).
Assist the client in self-examination of spirituality, and faith.
Although not mandatory for recovery, surrendering to and faith in a power greater than oneself has been found to be effective for many individuals in substance recovery; may decrease the sense of powerlessness. 84% of the clients in addiction counseling expressed a desire for a greater emphasis on spirituality in treatment. Another study found that spiritual support and religious involvement can be an integral part of dealing with substance abuse, pertaining to both prevention and recovery (Grim & Grim, 2019).
Instruct in and role-play assertive communication skills.
These are effective in helping refrain from use, stop contact with users and dealers, build healthy relationships, and regain control of own life. Assertiveness training to strengthen the “saying no” skill is a systematic interventional method in which the client is taught the proper social behaviors to express themselves, express feelings, attitudes, wishes, points of view, and interests so that they can express their ideas, beliefs, feelings, and emotions easily and without fear and worry (Ganji et al., 2022).
Provide treatment information on an ongoing basis.
This helps clients know what to expect and creates opportunities for clients to be a part of what is happening and make informed choices about participation and outcomes. In working toward a decision, the nurse must understand what change means for the client and what their expectations of treatment are. By exploring treatment expectations with clients, the nurse introduces information about the benefits of treatment and can begin a discussion about available options (The Substance Abuse and Mental Health Services Administration, 2019).
Encourage family and friends to provide support for the client.
Including people with whom the client has a close relationship can make treatment more effective. Many people who misuse substances or those who have SUDs respond to motivation from spouses and significant others to enter treatment. Supportive SOs can help the client become intrinsically rather than just extrinsically motivated for behavior change (The Substance Abuse and Mental Health Services Administration, 2019).
Provide positive feedback or affirmation.
Affirming is a way to express genuine appreciation and positive regard for the client. Affirming clients supports and promotes self-efficacy. By affirming the nurse is saying, “I see you, what you say matters, and I want to understand what you think and feel”. Affirming can boost the client’s confidence about taking action (The Substance Abuse and Mental Health Services Administration, 2019).
Assess mental status. Note the presence of other psychiatric disorders (dual diagnosis).
Many clients use substances in an attempt to obtain relief from depression or anxiety, which may predate use and be the result of substance use. Approximately 60% of substance-dependent clients have underlying psychological problems, and treatment for both is imperative to achieve and maintain abstinence. Self-concept vulnerability pathways to drug use have been explained via self-medication theories, purporting that substances are used in order to cope with emotional pain and negative affect associated with early adverse experiences such as child neglect (Oshri et al., 2017).
Observe family interactions and SO dynamics and level of support.
Substance abuse is a family disease, and how the members act and react to the client’s behavior affects the course of the disease and how the client sees themself. Many unconsciously become “enablers,” helping the individual to cover up the consequences of the abuse. (Refer to ND: Family Processes, altered: alcoholism, following.) Additionally, child neglect is a significant risk factor for the development of drug use and abuse behaviors in adolescence and young adulthood (Oshri et al., 2017).
Provide opportunities for and encourage verbalization and discussion of individual situations.
The client often has difficulty expressing, and even more, difficulty accepting the degree of importance substance has assumed in life and its relationship to the present situation. Use open questions to invite the client to tell their story rather than closed questions, which merely elicit brief information. Open questions are questions that invite the client to reflect before answering and encourage them to elaborate (The Substance Abuse and Mental Health Services Administration, 2019).
Spend time with the client and listen reflectively. Discuss the client’s behavior and use of substances in a nonjudgmental way.
The nurse’s presence conveys acceptance of the individual as a worthwhile person. The discussion provides an opportunity for insight into the problems abuse has created for the client. Reflective listening is the key component of expressing empathy. It encourages a nonjudgemental, collaborative relationship. Reflective listening builds collaboration and a safe and open environment that is conducive to examining issues and eliciting the client’s reasons for change (The Substance Abuse and Mental Health Services Administration, 2019).
Provide reinforcement and affirmation for positive actions and encourage the client to accept this input.
Failure and lack of self-esteem have been problems for this client, who needs to learn to accept self as an individual with positive attributes. Affirming is a way to express genuine appreciation and positive regard for the client. Affirming clients supports and promotes self-efficacy. By affirming, the nurse is saying, “I see you, what you say matters, and I want you to understand what you think and feel”. Affirming can boost the client’s confidence about taking action (The Substance Abuse and Mental Health Services Administration, 2019).
Encourage the expression of feelings of guilt, shame, and anger.
The client often has lost respect for themself and believes that the situation is hopeless. Expression of these feelings helps the client begin to accept responsibility for themself and take steps to make changes. Belonging to a stigmatized group can lead to affective, physiological, cognitive, and behavioral stress reactions. Shame has been associated with substance abuse, the stigma linked to it, as well as depression and anxiety (Birtel et al., 2017).
Help the client acknowledge that substance use is the problem and that problems can be dealt with without the use of drugs. Confront the use of defenses (denial, projection, rationalization).
When drugs can no longer be blamed for the problems that exist, the client can begin to deal with the problems and live without substance use. Confrontation helps the client accept the reality of the problems as they exist. A constructive kind of confrontation must be done within the context of a trusting and respectful relationship and is delivered in a supportive way that also elicits hope for change (The Substance Abuse and Mental Health Services Administration, 2019).
Ask the client to list and review past accomplishments and positive happenings.
There are things in everyone’s life that have been successful. Often when self-esteem is low, it is difficult to remember these successes or to view them as successes. Today, greater emphasis is placed on identifying, enhancing, and using clients’ strengths, abilities, and competencies. This trend parallels the principles of motivational counseling, which affirms clients, emphasizes personal autonomy, supports and strengthens self-efficacy, and reinforces that change is possible (The Substance Abuse and Mental Health Services Administration, 2019).
Use techniques of role rehearsal.
This assists clients to practice developing skills to cope with a new role as a person who no longer uses or needs drugs to handle life’s problems. Use role-plays to practice coping or refusal skills, then reverse roles so that another member can experience and empathize with the group member’s situation while learning recovery skills (Substance Abuse and Mental Health Services Administration, 2020).
Involve the client in group therapy.
Group sharing helps encourage verbalization because other members of the group are in various stages of abstinence from drugs and can address the client’s concerns and denial. The client can gain new skills, hope, and a sense of family and community from group participation. Group therapy is also a therapy modality wherein clients learn and practice recovery strategies, build interpersonal skills, and reinforce and develop social support networks (Substance Abuse and Mental Health Services Administration, 2020).
Formulate a plan to treat other mental illness problems.
Clients who seek relief for other mental health problems through drugs will continue to do so once discharged. Both substance use and mental health problems need to be treated together to maximize abstinence potential. One of the most important tasks is to ensure that the plan is realistic and can be carried out. When the client offers a plan that seems unrealistic, too ambitious, or not ambitious enough, use shared decision-making to rework the plan. Work with the client to develop a change plan by eliciting their own ideas about what will work for them (The Substance Abuse and Mental Health Services Administration, 2019).
Administer antipsychotic medications as necessary.
Prolonged and profound psychosis following LSD or PCP use can be treated with these drugs because it is probably the result of an underlying functional psychosis that has now emerged. Note: Avoid the use of phenothiazines because they may decrease the seizure threshold and cause hypotension in the presence of LSD or PCP use. A systematic review published in 2018 found that clozapine was superior to risperidone but equal to olanzapine or ziprasidone in polysubstance and cannabis users. Since substance use disorders decrease medication adherence in clients, it is crucial to consider the association between antipsychotics and substance abuse treatments that might act synergistically in clients with dual diagnoses (Dervaux, 2020).
Negotiate a behavioral contract with the client.
Develop a written or oral contract to help the client start working on their change plans. The nurse should explain that others have found contracts useful and invite the client to try writing one. Avoid writing contracts for clients. Composing and signing it is a small but important ritual of “going public” that can enhance commitment and self-esteem (The Substance Abuse and Mental Health Services Administration, 2019).
Encourage social support from family and friends.
Positive social support for substance use behavior change is an important factor in the client’s initiating and sustaining behavior change. Social support often entails participating in non-substance use activities, so close friends with whom the client has a history of shared interests other than substance use are good candidates for this helpful role (The Substance Abuse and Mental Health Services Administration, 2019).
Assist the client in building self-efficacy.
Help the client build self-efficacy by being supportive, identifying their strengths, reviewing past successes, and expressing optimism and confidence in their ability to change. To succeed in changing, the client must believe that they can undertake specific tasks in a specific situation. Considerable evidence points to self-efficacy as an important factor in addiction treatment outcomes. Ask the client to identify how they have successfully coped with problems in the past. Once strengths are identified, the nurse can help the client build on past successes (The Substance Abuse and Mental Health Services Administration, 2019).
Chronic substance use affects a person’s nutritional status and body composition through decreased intake, nutrient absorption, altered metabolism, unhealthy eating habits, and dysregulation of hormones that alter the mechanisms of satiety and food intake (Mahboub et al., 2020).
Monitor the client’s nutritional intake.
This is to promote adequate nutrition. Substance use can compromise the user’s nutrition and greatly affects their dietary habits. In general, this population has a disrupted and chaotic lifestyle, and money is usually spent on drugs rather than on food. This severely affects the user’s food intake, which eventually leads to undernutrition. Other factors affecting the nutritional status of drug users include the type, frequency, and duration of the drug used and the presence of infectious diseases (Mahboub et al., 2020).
Assess height and weight, age, body build, strength, activity, and rest level.
This provides information about individuals on which to base caloric needs and dietary plans. The type of diet or foods may be affected by the condition of mucous membranes and teeth. In general, the BMI of people who use drugs (PWUD) is lower than that of non-users. HIV-positive persons who use cocaine have the lowest BMI, as compared with users of other drugs or with non-users. It is believed that cocaine suppresses appetite and decreases food intake, and subsequently body weight, by inhibiting dopamine transporters, decreasing the reuptake of serotonin, upregulating glucocorticoid production, and increasing the cocaine- and amphetamine-regulated transcripted expression (Mahboub et al., 2020).
Take anthropometric measurements (triceps skinfold, when available).
This calculates subcutaneous fat and muscle mass to aid in determining dietary needs. Women who are heavy drug users have less body fat and lower BMI as compared to PWUD moderately or infrequently and non-users. This difference among different levels of drug use is not present in men. A study showed that 24% of PWUD, within a short period of admission for detoxification, exhibited mild to moderate malnutrition, based on the Subjective Global Assessment (Mahboub et al., 2020).
Note total daily calorie intake; maintain a diary of intake, as well as times and patterns of eating.
Information will help identify nutritional needs and deficiencies. Cocaine drug users have irregular eating patterns and rely mainly on one meal taken late at night. Typically, this meal is high in refined carbohydrates and fat and low in fruits and vegetables. Substantial evidence supports the increased preference for sweet taste among PWUD. people addicted to opiates replace protein and fats with meals high in sugar and alcohol, which are low in essential nutrients and are empty sources of calories (Mahboub et al., 2020).
Evaluate energy expenditure (pacing or sedentary), and establish an individualized exercise program.
Activity level affects nutritional needs. Exercise enhances muscle tone, and may stimulate appetite. Personal and environmental factors like decreased physical activity and the purchase of high-fat, less-expensive foods play a role in weight gain seen among clients in recovery from drug use, thereby highlighting the need to incorporate exercise and nutrition information as part of the treatment. Exercise reduces stress, anxiety, depression, and drug use in individuals recovering from substance use (Mahboub et al., 2020).
Recommend monitoring weight weekly.
This provides information regarding the effectiveness of the dietary plan. OST or methadone treatment can improve the nutritional status of PWUD, whereby the BMI and weight of users starting treatment significantly increase. The increased weight and BMI are mostly seen in clients with higher education and income, suggesting a positive role of social factors on the nutritional status of PWUD (Mahboub et al., 2020).
Review laboratory studies as indicated, (glucose, serum albumin, prealbumin, electrolytes).
This identifies anemias, electrolyte imbalances, and other abnormalities that may be present, requiring specific therapy. Hemoglobin and hematocrit levels are lower in PWUD than in non-users, with the lowest levels seen among multiple-drug users and those with a longer duration of addiction. Another study showed that morphine can induce a reduction in the plasma counterregulatory epinephrine response, thus causing hypoglycemia symptoms in healthy individuals without diabetes (Mahboub et al., 2020).
Note the condition of the oral cavity.
Oral conditions in clients with SUDs such as poor oral hygiene, changes in salivary pH, and cariogenic diets can lead to progressive caries and maxillofacial infections. Soft tissue examination should be performed frequently due to the increased risk of oral cancer in clients who consume alcohol in large amounts. Poor oral hygiene and a sugar-based diet are likely to present in the majority of clients who consequently develop extensive caries (Cuberos et al., 2020).
Provide an opportunity to choose foods and snacks to meet the dietary plan.
This enhances participation or a sense of control, may promote the resolution of nutritional deficiencies, and helps evaluate clients’ understanding of dietary teaching. Nutrition knowledge seems to affect dietary choices in this population. For instance, when nutrition knowledge was offered as part of an OST program, sugary food craving was still observed but healthier foods and more meals were consumed by the participants (Mahboub et al., 2020).
Consult with a dietitian.
This is useful in establishing individual dietary needs and plans and provides an additional resource for learning. Registered dietitian nutritionists (RDNs) were described as essential members of the treatment team and urged to take “aggressive action to ensure involvement in treatment and recovery programs”. RDNs are qualified to provide nutrition education and counseling in SUD treatment facilities. Treatment outcomes may benefit from adding nutrition services to it (Wiss et al., 2018).
Refer for dental consultation as necessary.
Teeth are essential to good nutritional intake and dental hygiene and care is often neglected area in this population. Drugs and alcohol negatively impact oral health by inducing a myriad of orofacial conditions including xerostomia, dental caries, periodontal disease, bruxism, pre-cancer, and cancer. The importance of oral hygiene needs to be emphasized and basic oral hygiene steps should be regularly reviewed with the client (Cuberos et al., 2020).
Encourage the client to practice good oral hygiene.
Preventive measures including fluoride supplementation, prescription toothpaste, and chlorhexidine use should be encouraged. Sugarless products like xylitol-containing gum or candies have shown good results in the prevention of caries helping regulate saliva pH. The client is advised to drink eight to ten glasses of water each day and avoid the consumption of caffeine, tobacco, and alcoholic beverages (Cuberos et al., 2020).
Provide a diet rich in essential macro- and micronutrients.
The nutritional imbalance (a higher ratio of macronutrients to micronutrients) indicating higher intakes of empty calories is strongly associated with drug use. During MMT or detoxification, an increase in the overall intake of energy, proteins, and carbohydrates occurs with both modalities after the initiation of the treatment. The provision of micronutrients is required as a cofactor for the synthesis of serotonin, dopamine, and catecholamines. Deficiencies of copper, selenium, manganese, magnesium, folate, and B-complex vitamins are linked to depression, which might hinder the treatment process of drug users. Vitamin and mineral supplementation should be considered (Mahboub et al., 2020).
Promote the intake of foods rich in fatty acids.
Fatty acids are also involved in regulating behaviors such as violence, aggression, mood, sleep, and appetite. Elevated levels of corticotropin-releasing hormone, which is associated with defensive and violent behaviors, decrease with supplementation of a combination of omega-3 fatty acids docosahexaenoic and eicosapentaenoic acids. Clients undergoing detoxification from drug use have a decrease in anger score upon supplementation with docosahexaenoic acid, whereas lower anxiety scores are associated with supplementation with eicosapentaenoic acid (Mahboub et al., 2020).
Substance abuse can significantly impact sexual functioning in individuals, leading to various difficulties such as erectile dysfunction, decreased libido, and impaired sexual performance. These challenges may arise due to the physiological effects of substance use, hormonal imbalances, psychological factors, and relationship issues, highlighting the need for comprehensive assessment, support, and specialized interventions to address the complex interplay between substance abuse and sexual health.
Ascertain the client’s beliefs and expectations. Have the client describe the problem in their own words.
This determines the level of knowledge and identifies misperceptions and specific learning needs. Some clients often use substances such as alcohol, opioids, and cannabis with the expectancy of enhancing sexual functioning as a result of the depressant, anti-anxiety, and disinhibitory effects of some of these substances, especially during early use and in lower quantities (Ghadigaonkar & Murthy, 2019).
Assess the drinking and drug history of the client.
In addition to the physical exam, assessment of substance use should include a thorough history that screens several psychiatric symptoms to diagnose and rule out disorders. Certain substances can sauce more negative effects than others, so it is important to determine which ones were used, which may help in the recovery process. Additionally, the negative consequences of withdrawal symptoms may be fatal, therefore, if the provider is notified of the last use, then appropriate treatment can be administered on time (Jahan & Burgess, 2022).
Review the results of the sonogram if pregnant.
This assesses fetal growth and development to identify the possibility of fetal alcohol syndrome and future needs. Alcohol use during pregnancy can cause miscarriage, stillbirth, and a range of lifelong birth defects and developmental disabilities. These disabilities are known as fetal alcohol spectrum disorders (FASDs). Opioid use during pregnancy has also been linked to poor fetal growth, preterm birth, stillbirth, specific birth defects, and neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (Centers for Disease Control and Prevention, 2023).
Perform substance abuse screening for clients, especially pregnant women.
The US Preventive Services Task Force (USPSTF) recommends screening by asking questions about unhealthy drug and alcohol use in adults aged 18 years or older. This applies to all adults 18 years and older, including people who are pregnant or postpartum, and adolescents aged 12 to 17 years in primary care settings. These recommendations are based on the evidence of both the benefits and harms of the service (Centers for Disease Control and Prevention, 2023).
Assess the client’s past sexual history.
Past sexual history including first sexual contact, knowledge about sexual functioning as well as the history of sexual abuse will add important information to the assessment and management plan. A history of high-risk sexual behavior is also an inevitable part of sexual history (Ghadigaonkar & Murthy, 2019).
Determine if other causes of sexual dysfunction are present.
It is important to look for any organic causes of sexual dysfunction during assessment. This would include a thorough general physical and systemic examination. The laboratory investigations including hormonal profile can be considered in addition to the routine investigations (hemogram, blood glucose levels, liver function tests, lipid profile, thyroid function tests) (Ghadigaonkar & Murthy, 2019).
Encourage and accept individual expressions of concern.
Most people find it difficult to talk about this sensitive subject and may not ask directly for information. Public stigma towards drug addiction is more severe compared to stigma towards other mental illnesses such as depression. In the US, individuals with substance abuse disorder are judged as violent and dangerous. Furthermore, a systematic review indicated that it is not only the public who holds negative attitudes toward these individuals but also health professionals (Birtel et al., 2017).
Provide education opportunities (pamphlets, consultation with appropriate persons) for clients to learn the effects of drugs on sexual functioning.
Much of the denial and hesitancy to seek treatment may be reduced as a result of sufficient and appropriate information. The first step in the management of sexual dysfunction is a personalized explanation of the relationship between the use of substances and consequent sexual dysfunction. It is also useful to explain to the client, in a motivational interviewing approach, the benefits of substance use cessation on sexual functioning, and the further complications of continuing substance use (Ghadigaonkar & Murthy, 2019).
Provide information about the individual’s condition.
Sexual functioning may have been affected by the drug (alcohol) itself or psychological factors (such as stress or depression). Information can assist clients to understand their own situation and identify actions to be taken. Sexual dysfunction in the context of substance use is not only caused by the direct effects of the substances but is also influenced by psychosocial and cultural contexts, comorbid psychiatric and medical illnesses, as well as treatment-emergent side effects (Ghadigaonkar & Murthy, 2019).
Discuss the prognosis for sexual dysfunction (impotence, low sexual desire).
In about 50% of cases, impotence is reversed with abstinence from drug(s); in 25% the return to normal functioning is delayed; and approximately 25% remain impotent. Alcohol, when taken in large amounts among men, can cause a decrease in sexual arousal, impairment in erection, and a decrease in the client’s ability to ejaculate. Chronic use of alcohol in women can result in decreased vaginal lubrication, dyspareunia, and difficulty achieving orgasm (Ghadigaonkar & Murthy, 2019).
Refer for sexual counseling, if indicated.
Couples may need additional assistance to resolve more severe problems and situations. Clients may have difficulty adjusting if the drug has improved sexual experience (heroin decreases dyspareunia in women, and premature ejaculation in men). Furthermore, the client may have engaged enjoyably in bizarre, erotic sexual behavior under the influence of the stimulant drug; the client may have found no substitute for the drug, may have driven a partner away, and may have no motivation to adjust to sexual experience without drugs.
Provide information about the effects of substance abuse on the reproductive system and fetus ( increased risk of premature birth, brain damage, and fetal malformation).
Awareness of the negative effects of alcohol and other drugs on reproduction may motivate the client to stop using drug(s). When the client is pregnant, identification of potential problems aids in planning for future fetal needs and concerns. Some research shows that marijuana use during pregnancy is linked to low birth weight. It may also increase the chances of developmental problems for a child, such as problems with attention and learning (Centers for Disease Control and Prevention, 2023).
Refer the client or couple for sexual therapy as indicated.
Sex therapists use a variety of approaches to treat sexual dysfunction. In addition to the techniques outlined by Masters and Johnson, tools such as cognitive-behavioral therapy (CBT), emotion-based therapy, and couples communication techniques have been the treatment mainstays for sexual problems (Weir, 2019).
Encourage the couple to consider each other’s perspectives.
When one partner has sexual dysfunction, it can make sex more stressful and less pleasurable for the partner. For example, among heterosexual women who experience pain during intercourse, sympathetic partners might be inclined to stop a sexual encounter that becomes painful. Yet research shows that women with these sympathetic or “solicitous” partners have greater pain intensity and poorer sexual satisfaction compared to women with partners who encourage them to adapt and find ways to create sexual intimacy without engaging in an activity that is painful (Weir, 2019).
Encourage couples to improve their communication with each other.
Studies show consistently that dysfunction in one partner often contributes to problems in sexual satisfaction as well as sexual functioning for the other partner. Therapy, therefore, includes improving communication patterns between couples, improving awareness, and sensate focus therapy. Sexual dysfunction is often seen as an individual problem when it actually is often a couple’s issue (Weir, 2019). Open communication between the client and their partner can help in determining problems within the sexual relationship and identify steps on how they could minimize these concerns.
Administer pharmacologic therapy as prescribed.
In men, phosphodiesterase-5 inhibitors are found to be beneficial for erectile dysfunction and can be used on an as-needed basis without serious long-term side effects. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine are beneficial for premature ejaculation. In women, systemic testosterone can be considered for hypoactive sexual desire. However, it is associated with side effects such as hirsutism, hoarseness of voice, alopecia, and a potential increase in cardiovascular diseases (Ghadigaonkar & Murthy, 2019).
Health teachings for patients with substance abuse focus on providing education and support to promote physical and mental well-being. This may include information about the risks and consequences of substance abuse, strategies for relapse prevention, coping skills for managing cravings and triggers, and guidance on accessing appropriate healthcare services and support groups to aid in their road to recovery.
Assess the client’s knowledge of their own situation (disease, complications, and needed changes in lifestyle).
This assists in planning for long-range changes necessary for maintaining sobriety and drug-free status. Clients may have street knowledge of the drug but be ignorant of medical facts. Today, the addiction treatment field recognizes that substance misuse exists along a continuum from misuse to a SUD. Not all SUDs increase in severity. Many individuals never progress beyond substance use that poses a health risk, and others cycle back and forth through periods of abstinence, substance misuse, and meeting the criteria for SUD (The Substance Abuse and Mental Health Services Administration, 2019).
Review condition and prognosis and future expectations.
This provides a knowledge base from which clients can make informed choices. Clients who abuse substances for a chronic period develop extreme dependence on them. If the client attempts to stop using it, their withdrawal symptoms become severe enough for the client to restart the abuse cycle. Predicting factors that influence the outcome for the client include the degree of dependence and withdrawal, the motivation to be committed to abstinence, treatment time frame, genetics, the severity of cravings, and how the individual copes during stressful situations (Jahan & Burgess, 2022).
Assess the client’s readiness for change.
Every client moves at their own pace. Some will cycle back and forth numerous times between stages. Others need time to resolve their ambivalence about current substance use before making a change. A few are ready to get started and take action immediately. Knowing where the client has been and is now helps facilitate the change process at the right pace (Substance Abuse and Mental Health Services Administration, 2020).
Be aware of and deal with the anxiety and ambivalence of the client and family members.
Anxiety can interfere with the ability to hear and assimilate information. Ambivalence is a common concept in substance abuse recovery. It is normal for the client to feel two ways about making an important change in their lives. Client ambivalence is a roadblock to change, not a lack of knowledge or skills about how to change. Individuals with /SUD are often aware of the risks associated with their substance use but continue to use substances anyway. They may need to stop using substances, but they continue to use them. The tension between these feelings is ambivalence (The Substance Abuse and Mental Health Services Administration, 2019).
Provide an active role for the client and family members in the learning process (discussions, group participation, role-playing).
Learning is enhanced when people are actively involved. Offer choices to facilitate treatment initiation and engagement. These choices have been shown to enhance the therapeutic alliance, decrease dropout rates, and improve outcomes. Clients are more likely to adhere to a specific change strategy if they can choose from a menu of options (Substance Abuse and Mental Health Services Administration, 2020).
Provide written and verbal information as indicated. Include a list of articles and books related to client and family needs and encourage reading and discussing what they learn.
This helps the client and family members make informed choices about the future. Bibliotherapy can be a useful addition to other therapeutic approaches. Provide a handout or use visual aids that show the client’s scores on screening instruments, normative data, and risks and consequences of their level of substance use. Written materials should be provided in the client’s first language (Substance Abuse and Mental Health Services Administration, 2020).
Pace learning activities to individual needs.
This facilitates learning because the information is more readily assimilated when the timing is considered. Offer simple suggestions that match the client’s level of understanding and readiness, the urgency of the situation, and their culture. In some cultures, a directive approach is required to convey the importance of advice or situations; in others, a directive style is considered rude and intrusive (Substance Abuse and Mental Health Services Administration, 2020).
Discuss the relationship of drug use to the current situation.
Often the client has a misperception (denial) of the real reason for admission to the medical (psychiatric) setting. Help the client recognize any discrepancy or gap between their future goals and their current behavior. When the client sees that present actions conflict with important personal goals, such as good health, job success, or close personal relationships, change is more likely to occur (Substance Abuse and Mental Health Services Administration, 2020).
Educate about the effects of a specific drug(s) used].
Information will help the client understand the possible long-term effects of drug use. For example, PCP is deposited in body fat and may reactivate (flashbacks) even after a long interval of abstinence. Alcohol use may result in mental deterioration, and liver involvement/damage. Cocaine can damage postcapillary vessels and increase platelet aggregation, promoting thromboses and infarction of skin and internal organs, causing localized atrophy blanche, or sclerodermatous lesions. Substance use will impact multiple systems of the body, including but not limited to neurologic, endocrine, psychiatric, cardiopulmonary, hepatic, hematologic, and immunologic (Jahan & Burgess, 2022).
Discuss the potential for re-emergence of withdrawal symptoms in stimulant abuse as early as three months or as late as 9 to 12 months after discontinuing use.
Even though intoxication may have passed, the client may manifest denial, drug hunger, and periods of “flare-up,” wherein there is a delayed recurrence of withdrawal symptoms (anxiety; depression; irritability; sleep disturbance; compulsiveness with food, especially sugars). It is very common for people who complete withdrawal management to relapse into drug use. It is unrealistic to think that withdrawal management will lead to sustained abstinence. Rather, withdrawal management is an important first step before a client commences psychosocial treatment (World Health Organization, 2009).
Inform the client of the effects of disulfiram in combination with alcohol intake and the importance of avoiding the use of alcohol-containing products (cough syrups, foods, candy, mouthwash, aftershave, cologne).
Interaction of alcohol and disulfiram results in nausea and hypotension, which may produce fatal shock. Individuals on disulfiram are sensitive to alcohol on a continuum, with some being able to drink while taking the drug and others having a reaction with only slight exposure. Reactions also appear to be dose-related. Never administer to a client if alcohol use is suspected or without the client’s consent and understanding of disulfiram-alcohol interaction. Disulfiram-alcohol reactions have also been reported in clients exposed to environmental chemical compounds containing alcohol (Stokes & Abdijadid, 2022).
Review specific aftercare needs (PCP users should drink cranberry juice and continue the use of ascorbic acid; alcohol abusers with liver damage should refrain from drugs and anesthetics or use of household cleaning products that are detoxified in the liver).
This promotes individualized care related to a specific situation. Cranberry juice and ascorbic acid enhance the clearance of PCP from the system. Substances that have the potential for liver damage are more dangerous in the presence of an already damaged liver. Slow elimination of disulfiram may give rise to the disulfiram-alcohol reaction up to fourteen days after discontinuation. Drug interactions occur with compounds utilizing the cytochrome P450 enzyme system for oxidative metabolism in clients taking disulfiram. This interaction can occur with amitriptyline, imipramine, phenytoin, chlordiazepoxide, diazepam, omeprazole, and acetaminophen (Stokes & Abdijadid, 2022).
Discuss a variety of helpful organizations and programs that are available for assistance and referral.
Long-term support is necessary to maintain optimal recovery. Psychosocial needs and other issues may need to be addressed. There are a variety of organizations, nonprofits, and educational institutions dedicated to researching, educating, treating, and supporting the science of addiction and those it affects. The National Institutes of Health (NIH) provides leadership and direction to programs that aim to improve the health of Americans. The National Institute on Drug Abuse (NIDA) supports scientific research on drug use and its consequences. The Substance Abuse and Mental Health Services Administration (SAMHSA) focuses on public health efforts to advance behavioral health and help clients with mental and substance use disorders and their families (Curtis, 2023).
Encourage the client to ask questions and ask if they had encountered any difficulties.
Ask the client whether they had any difficulties with answering questions or filling out forms. Explore specific questions that might need clarification. Encourage them to ask questions, “I’ll be giving you lots of information. Please stop me if you have a question or don’t understand something.” offer information in a neutral, nonjudgemental, and respectful way using easy-to-understand and culturally appropriate language (The Substance Abuse and Mental Health Services Administration, 2019).
Provide advice that can promote positive behavioral change.
Behavioral intervention that includes advice delivered in the motivational enhancement therapy style can be effective in changing substance use behaviors such as drinking, drug use, and tobacco use. It is better not to tell the client what to do; suggestions yield better results. A motivational approach to offering advice may either be directive (making a suggestion) or educational (providing information). Educational advice should be based on credible scientific evidence (Substance Abuse and Mental Health Services Administration, 2020).
Medications used in substance abuse treatment vary depending on the substance of abuse. They can include medications such as disulfiram, acamprosate, and naltrexone for alcohol use disorder, methadone, buprenorphine, and naltrexone for opioid use disorder, and nicotine replacement therapy, bupropion, and varenicline for nicotine dependence, among others. These medications are often used as part of a comprehensive treatment approach that includes counseling, behavioral therapies, and social support to help in recovery.
Disulfiram
This drug can be helpful in maintaining abstinence from alcohol while another therapy is undertaken. By inhibiting alcohol oxidation, the drug leads to an accumulation of acetaldehyde with a highly unpleasant reaction if alcohol is consumed. These unpleasant reactions include headache, nausea, vomiting, flushing, dizziness, and weakness (Jahan & Burgess, 2022).
Acamprosate
This helps prevent relapses in alcoholism by lowering receptors for the excitatory neurotransmitter glutamate. This agent may become the drug of choice because it does not make the user sick if alcohol is consumed; it has no sedative, antianxiety, muscle relaxant, or antidepressant properties, and produces no withdrawal symptoms. It is important to include vitamin B1 and vitamin B9, along with multivitamins, to address any nutritional deficiencies (Jahan & Burgess, 2022).
Naltrexone and nalmefene
These are used to suppress craving for opioids and may help prevent relapse in the client abusing alcohol. Current research suggests that naltrexone suppresses the urge to continue drinking by interfering with the alcohol-induced release of endorphins (Jahan & Burgess, 2022).
Methadone
This drug is thought to blunt the craving or diminish the effects of opioids and is used to assist in withdrawal and long-term maintenance programs. It can allow the individual to maintain daily activities and ultimately withdraw from drug use. Methadone can only be used to treat opioid use disorder by specific treatment facilities designated as Opioid Treatment Programs (OTPs) (Jahan & Burgess, 2022).
Buprenorphine
A partial opioid agonist that can reduce withdrawal symptoms and cravings, also used in MAT programs.
Naltrexone
Blocks the effects of opioids and reduces cravings by binding to opioid receptors.
Nicotine Replacement Therapy (NRT) (nicotine gum, patches, lozenges, inhalers, and nasal sprays)
These can deliver controlled amounts of nicotine to help reduce withdrawal symptoms and gradually wean off tobacco.
Bupropion
An antidepressant that can reduce nicotine cravings and withdrawal symptoms.
Varenicline
Helps reduce nicotine cravings and withdrawal symptoms by blocking nicotine receptors in the brain.
Recommended nursing diagnosis and nursing care plan books and resources.
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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
Other care plans for mental health and psychiatric nursing:
The following are the references and recommended sources for substance abuse nursing care plans including interesting resources to further your reading about the topic:
Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.
