17 SUBSTANCEABUSE 421
dually focused, however, has been shown to have any
type of success (Drake et al., 2001; Magura, Laudet,
Mahmood, Rosenblum & Knight, 2002). Research and
funding are needed to develop more effective methods
of treatment.
APPLICATION OF THE
NURSING PROCESS
Identifying people with substance use problems can
be difficult. Substance use typically includes the use
of defense mechanisms especially denial.Clients
may deny directly having any problems or may mini-
mize the extent of problems or actual substance use.
In addition, the nurse may encounter clients with
substance problems in various settings unrelated to
mental health. A client may come to a clinic for treat-
ment of medical problems related to alcohol use, or a
client may develop withdrawal symptoms while in
the hospital for surgery or an unrelated condition.
The nurse must be alert to the possibility of substance
use in these situations and prepared to recognize
their existence and to make appropriate referrals.
The Alcohol Use Disorders Identification Test
(AUDIT) is a useful screening device to detect haz-
ardous drinking patterns that may be precursors to
full-blown substance use disorders (Bohn, Babor &
Kranzler, 1995). This tool (Box 17-5) promotes recog-
nition of problem drinking in the early stage, when
resolution without formal treatment is more likely
(Cloud & Granfield, 2001). Early detection and treat-
ment are associated with more positive outcomes.
Detoxification is the initial priority. A nursing
care plan for the client in alcohol withdrawal is in-
cluded at the end of this chapter. Priorities for indi-
vidual clients are based on their physical needs and
may include safety, nutrition, fluids, elimination,
and sleep. The remainder of this section will focus on
care of the client being treated for substance abuse
after detoxification.Assessment
HISTORY
Clients with a parent or other family members with
substance abuse problems may report a chaotic fam-Box 17-5
➤ ALCOHOLUSEDISORDERIDENTIFICATIONTEST(AUDIT)
The following questionnaire will give you an indication of the level of risk associated with your current drinking pat-
tern. To accurately assess your situation, you will need to be honest in your answers. This questionnaire was devel-
oped by the World Health Organization and is used in many countries to assist people to better understand their cur-
rent level of risk in relation to alcohol consumption.- How often do you have a drink containing alcohol? (0) Never, (1) Monthly or less, (2) 2 to 4 times a month,
(3) 2 to 3 times a week, (4) 4 or more times a week. - How many standard drinks do you have on a typical day when you are drinking? (0) 1 or 2, (1) 3 or 4, (2) 5 or
6, (3) 7 to 9, (4) 10 or more. - How often do you have six or more drinks on one occasion? (0) Never, (1) Less than monthly, (2) Monthly,
(3) Weekly, (4) Daily or almost daily. - How often during the last year have you found that you were not able to stop drinking once you had started?
(0) Never, (1) Less than monthly, (2) Monthly, (3) Weekly, (4) Daily or almost daily. - How often during the past year have you failed to do what was normally expected of you because of drink-
ing? (0) Never, (1) Less than monthly, (2) Monthly, (3) Weekly, (4) Daily or almost daily. - How often during the last year have you needed a drink in the morning to get yourself going after a heavy
drinking session? (0) Never, (1) Less than monthly, (2) Monthly, (3) Weekly, (4) Daily or almost daily. - How often during the last year have you had a feeling of guilt or remorse after drinking? (0) Never, (1) Less
than monthly, (2) Monthly, (3) Weekly, (4) Daily or almost daily. - How often during the last year have you been unable to remember what happened the night before because
you had been drinking? (0) Never, (1) Less than monthly, (2) Monthly, (3) Weekly, (4) Daily or almost daily. - Have you or someone else been injured as a result of your drinking? (0) Never, (1) Less than monthly,
(2) Monthly, (3) Weekly, (4) Daily or almost daily. - Has a relative, a doctor, or other health worker been concerned about your drinking or suggested that you cut
down? (0) No, (2) Yes, but not in the last year, (4) Yes, during the last year.
Adapted from Babor, T., de la Fuente, J. R., Saunders, J., Grant. (1992). Alcohol Use Disorders Identification Test (AUDIT): Guide-
lines for use in primary health care.World Health Organization, Geneva. Used with permission. Bohn, Babor & Kranzler (1995).