17 SUBSTANCEABUSE 423
wanted to and they continue to deny or minimize the
extent of the problem.
SENSORIUM AND
INTELLECTUAL PROCESSES
Clients generally are oriented and alert unless they
are experiencing lingering effects of withdrawal. In-
tellectual abilities are intact unless clients have expe-
rienced neurologic deficits from long-term alcohol use
or inhalant use.
JUDGMENT AND INSIGHT
Clients are likely to have exercised poor judgment es-
pecially while under the influence of the substance.
Judgment may still be affected: clients may behave
impulsively such as leaving treatment to obtain the
substance of choice. Insight usually is limited regard-
ing substance use. Clients may have difficulty ac-
knowledging their behavior while using or may not
see loss of jobs or relationships as connected to the
substance use. They may still believe that they can
control the substance use.
SELF-CONCEPT
Clients generally have low self-esteem, which they
may express directly or cover with grandiose behavior.
They do not feel adequate to cope with life and stress
without the substance and often are uncomfortable
around others when not using. They often have diffi-
culty identifying and expressing true feelings; in the
past they have preferred to escape feelings and to
avoid any personal pain or difficulty with the help of
the substance.
ROLES AND RELATIONSHIPS
Clients usually have experienced many difficulties
with social, family, and occupational roles. Absen-
teeism and poor work performance are common. Often
family members have told these clients that the sub-
stance use was a concern, and it may have been the
subject of family arguments. Relationships in the fam-
ily often are strained. Clients may be angry at family
members who were instrumental in bringing them to
treatment or who threatened loss of a significant rela-
tionship.
PHYSIOLOGIC CONSIDERATIONS
Many clients have a history of poor nutrition (using
rather than eating) and sleep disturbances that per-
sist beyond detoxification. They may have liver dam-
age from drinking alcohol, hepatitis or HIV infection
from intravenous drug use, or lung or neurologic dam-
age from using inhalants.Data Analysis
Each client has nursing diagnoses specific to his or
her physical health status. These may include the
following:- Imbalanced Nutrition: Less Than Body
Requirements - Risk for Infection
- Risk for Injury
- Diarrhea
- Excess Fluid Volume
- Activity Intolerance
- Self-Care Deficits
Nursing diagnoses commonly used when working
with clients with substance use include the following: - Ineffective Denial
- Ineffective Role Performance
- Dysfunctional Family Processes: Alcoholism
- Ineffective Coping
Outcome Identification
Treatment outcomes for clients with substance use
may include the following:- The client will abstain from alcohol and
drug use. - The client will express feelings openly and
directly. - The client will verbalize acceptance of
responsibility for his or her own behavior. - The client will practice nonchemical
alternatives to deal with stress or difficult
situations. - The client will establish an effective
aftercare plan.
Intervention
PROVIDING HEALTH TEACHING FOR CLIENT
AND FAMILY
Clients and family members need facts about the
substance, its effects, and recovery. The nurse must
dispel the following myths and misconceptions:- “It’s a matter of will power.”
- “I can’t be an alcoholic if I only drink beer or
on weekends.” - “I can learn to use drugs socially.”
- “I’m okay now; I could handle using once in a
while.”
Education about relapse is important. Family
members and friends should be aware that clients who
begin to revert to old behaviors, return to substance-