17 SUBSTANCEABUSE 427
➤ KEY POINTS
- Substance use and substance-related
disorders can involve alcohol, stimulants,
cannabis, opioids, hallucinogens, inhalants,
sedatives, hypnotics, anxiolytics, caffeine,
and nicotine. - Substance use and dependence include
major impairment in the user’s social and
occupational functioning and behavioral and
psychological changes. - Alcohol is the substance abused most often in
the United States; cannabis is second. - Intoxication is the use of a substance that
results in maladaptive behavior. - Withdrawal syndrome is defined as negative
psychological and physical reactions when
use of a substance ceases or dramatically
decreases. - Detoxification is the process of safely with-
drawing from a substance. Detoxification
from alcohol and barbiturates can be life-
threatening and requires medical supervision. - The most significant risk factors for alcoholism
are having an alcoholic parent, genetic vulner-
ability, and growing up in an alcoholic home. - Routine screening with tools such as the
AUDIT in a wide variety of settings (clinic,
physician’s office, emergency services) can be
used to detect substance use problems.- After detoxification, treatment of substance
use continues in various outpatient and
inpatient settings. Approaches often are
based on the 12-step philosophy of absti-
nence, altered lifestyles, and peer support. - Substance abuse is a family illness, meaning
that it affects all members in some way.
Family members and close friends need
education and support to cope with their
feelings toward the abuser. Many support
groups are available to family members and
close friends. - Clients who are dually diagnosed with sub-
stance use problems and major psychiatric
illness do poorly in traditional treatment
settings and need specialized attention. - Nursing interventions for clients being
treated for substance abuse include teaching
clients and families about substance abuse,
dealing with family issues, and helping
clients to learn more effective coping skills. - Health care professionals have increased
rates of substance use problems particularly
involving opioids, stimulants, and sedatives.
Reporting suspected substance abuse in
colleagues is an ethical (and sometimes
legal) responsibility of all health care
professionals.
For further learning, visit http://connection.lww.com.
- After detoxification, treatment of substance
NURSING CARE PLAN DUAL DIAGNOSIS
Nursing Diagnosis
➤Ineffective Coping
Inability to form a valid appraisal of the stressors, inadequate choices of practiced
responses, and/or inability to use available resources.ASSESSMENTDATA
- Poor impulse control
- Low self-esteem
- Lack of social skills
- Dissatisfaction with life circumstances
- Lack of purposeful daily activity
EXPECTEDOUTCOMES
Immediate
The client will- Take only prescribed medication
- Interact appropriately with staff and
other clients - Express feelings openly
- Develop plans to manage unstruc-
tured time
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