Substance Use Nursing Interventions
Introduction
Substance use disorders (SUDs) are complex conditions involving compulsive
use of substances despite harmful consequences, impacting physical,
psychological, and social wellbeing. Psychiatric nurses play a key role in
assessment, intervention, and recovery support for individuals with SUDs
across various care settings.
Common Substances of Abuse
Alcohol
Opioids (heroin, prescription painkillers)
Stimulants (cocaine, methamphetamine)
Cannabis
Sedative-hypnotics (benzodiazepines)
Hallucinogens
Assessment in Substance Use Disorders
1. Comprehensive History
Substance type, amount, frequency, route, and duration.
Last use and withdrawal history.
Impact on functioning, relationships, employment, and legal issues.
2. Screening Tools
CAGE Questionnaire: Alcohol use screening.
AUDIT (Alcohol Use Disorders Identification Test).
DAST (Drug Abuse Screening Test).
3. Physical and Psychiatric Assessment
Evaluate for signs of intoxication or withdrawal.
Identify co-occurring mental health disorders (e.g. depression, anxiety,
PTSD).
4. Risk Assessment
Assess for overdose risk, suicidality, or self-neglect.
Nursing Interventions
1. Withdrawal Management
a. Alcohol Withdrawal
Monitor using CIWA-Ar (Clinical Institute Withdrawal Assessment for
Alcohol).
Administer benzodiazepines (e.g. diazepam, lorazepam) as prescribed
to prevent seizures or delirium tremens.
Monitor vitals, hydration, and electrolyte balance.
b. Opioid Withdrawal
Manage symptoms with medications such as methadone or
buprenorphine.
Provide comfort measures for muscle aches, diarrhea, and anxiety.
c. Stimulant Withdrawal
Monitor for depression, fatigue, and suicidal ideation.
Provide supportive care; no specific pharmacological detoxification.
2. Motivational Interviewing
A client-centered, directive method to enhance motivation for change.
Techniques include:
o Expressing empathy.
o Developing discrepancy between goals and current behavior.
o Rolling with resistance.
o Supporting self-efficacy.
3. Psychoeducation
Effects of substances on health and functioning.
Relapse prevention strategies and coping skills.
Medication education for pharmacotherapy treatments (e.g.
naltrexone, acamprosate for alcohol dependence).
4. Relapse Prevention
Identify triggers, high-risk situations, and early warning signs.
Teach refusal skills and cognitive-behavioral strategies to manage
cravings.
5. Support for Co-Occurring Disorders
Integrated treatment approaches addressing both substance use and
mental health disorders simultaneously.
6. Referral and Collaboration
Link clients with addiction services, outpatient programs, or inpatient
rehabilitation as appropriate.
Facilitate connection with peer support groups (e.g. AA, NA, SMART
Recovery).
7. Harm Reduction Strategies
For clients not ready for abstinence, provide safer use education,
needle exchange program referrals, and overdose prevention (e.g.
naloxone training for opioid users).
Role of Psychiatric Nurses in Substance Use Care
Conduct thorough assessments to inform treatment planning.
Provide nonjudgmental, empathetic care to reduce stigma and
encourage engagement.
Monitor for medication side effects and withdrawal complications.
Advocate for clients’ access to comprehensive addiction and mental
health services.
Challenges in Nursing Care
Managing personal biases and stigma toward individuals with SUDs.
High rates of relapse leading to frustration among staff.
Complex social determinants affecting recovery, such as housing
instability or lack of support networks.
Strategies to Enhance Effectiveness
Engage in continuing education on addiction science and interventions.
Practice cultural humility, recognizing diverse experiences and barriers
to care.
Use trauma-informed approaches, understanding high rates of trauma
histories in this population.
Conclusion
Substance use nursing interventions require comprehensive assessment,
compassionate care, and evidence-based strategies to support recovery. By
combining pharmacological management, motivational interviewing,
psychoeducation, and harm reduction approaches, psychiatric nurses
empower individuals to achieve healthier, more fulfilling lives.
References
Townsend, M. C., & Morgan, K. I. (2018). Psychiatric Mental Health
Nursing: Concepts of Care in Evidence-Based Practice (9th ed.). F.A.
Davis.
Videbeck, S. L. (2020). Psychiatric-Mental Health Nursing (8th ed.).
Wolters Kluwer.
Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping
People Change (3rd ed.). Guilford Press.
