Substance Use Disorders and Nursing Interventions

Substance Use Disorder (SUD)

• SUD is a cluster of cognitive, behavioral, and physiological symptoms.
• SUD includes significant substance-related problems, even when substance use disrupts responsibilities at work, school, or home.
• Individuals with SUD may want to reduce or control substance use, but their efforts often fail, leading to increased usage.

The Outlines

• Definition of substance use disorders (SUD).
• Difference between substance addiction and withdrawal.
• Types of addiction.
• Predisposing factors to SUD.
• General signs and symptoms of SUD.
• Complications of SUD.
• Nursing diagnosis, expected outcomes, and nursing interventions for SUD.
• Summary of SUD.

Substance Addiction

• Addiction is a chronic, relapsing disorder.
• It is characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.
• Individuals with addiction have an intense focus on using a substance (e.g., alcohol or drugs) to the point that it dominates their lives.

Age Group and Gender Ratios

• Substance abuse is most prevalent among individuals aged 18 to 24.
• Substance-related disorders are diagnosed more commonly in men than women.
• Gender ratios vary with the type of substance.

Substance Withdrawal

• Withdrawal occurs when a person who has developed a dependence on a substance reduces or stops using it.
• Withdrawal can cause a range of physical and psychological symptoms.
• Physical symptoms include sweating, shaking, nausea, vomiting, headaches, muscle pain, and seizures (severe cases).
• Psychological symptoms include anxiety, depression, irritability, mood swings, and cravings for the substance.
• Severity of symptoms can vary depending on the substance, duration of use, and amount consumed.

Ranking of Most Addictive Substances

• Heroin is extremely addictive with severe withdrawal symptoms.
• Cocaine is a potent stimulant leading to quick addiction.
• Nicotine is highly addictive due to frequent use and dependence.
• Alcohol is addictive with significant mental and physical health risks.
• Prescription opioids are quickly addictive when misused for pain relief.
• Cannabis is less addictive but can cause psychological dependence.
• Hallucinogens (e.g., LSD) are rarely addictive but may affect mental health.
• Inhalants are less addictive but highly harmful to physical health.

Smoking Rate in Jordan (2020)

• The smoking rate in Jordan for individuals aged 15 and over was approximately 34.8%.
• This equates to roughly 2 million smokers in this age group.
• Drug-related issues, including use, possession, and trafficking, have increased in Jordan, highlighting growing concern over substance abuse.

Signs and Symptoms of SUD (Physical)

• Sudden weight loss or gain. Changes in appetite and sleep patterns.
• Bloodshot eyes, slurred speech, impaired coordination or tremors.
• Runny nose.

Signs and Symptoms of SUD (Psychological)

• Feeling paranoid, anxious, or fearful.
• Unexplained changes in personality.
• Feeling "spaced out", intense cravings for the substance.
• Difficulty controlling substance use.
• Continued use despite knowing the harm.

Signs and Symptoms of SUD (Behavioral)

• Neglecting responsibilities at work, school, or home.
• Using substances in dangerous situations.
• Legal problems related to substance use.
• Relationship issues due to substance use.
• Spending significant time obtaining, using, or recovering from the substance.

Main Complications of SUD (Physical)

• Chronic diseases (e.g., liver disease, lung disease, cardiovascular diseases).
• Neurological issues (e.g., cognitive impairments, memory problems, brain structural changes).
• Infections (e.g., HIV, hepatitis).
• Overdoses (life-threatening, especially with opioids and other potent substances).

Main Complications of SUD (Mental)

• Depression and anxiety (high prevalence among those with SUD).
• Psychosis (experiencing hallucinations and delusions, particularly with hallucinogens).
• Impaired judgment (poor decision-making and risky behaviors).

Nursing Diagnosis, Expected Outcomes, and Interventions for SUD

• Risk for injury related to internal or external environmental conditions. Short-term goal: Client's condition will stabilize within 72 hours; long-term goal: Client will not experience physical injury. Nurse Interventions: Assess client's level of disorientation, obtain drug history, keep environment quiet, observe behaviors, provide transportation, and ensure client's access to potentially harmful items is limited.
• Ineffective denial related to weak, underdeveloped ego. Short-term goal: Client will divert attention from external issues to behavioral outcomes associated with substance use. Long-term goal: Client will verbalize acceptance of responsibility for their behavior and acknowledge the association between substance use and personal problems. Nurse Interventions: Develop trusting relationship, convey acceptance, correct misconceptions about substance abuse, identify maladaptive behaviors, and do not accept rationalization or projection.
• Ineffective coping related to inadequate coping skills and weak ego. Short-term goal: Client will express true feelings about using substances. Long-term goal: Client will use adaptive coping mechanisms instead of substance abuse. Nurse Interventions: Spend time and build trusting relationship, set limits, encourage verbalization, explain effects of substance use, provide positive reinforcement, and support independent decision-making.
• Dysfunctional family processes related to presence of a family member with a physical or mental illness. Short-term goal: Family members will participate in family programs, identify ineffective coping patterns, and plan for lifestyle changes. Long-term goal: Family members will change self-destructive behaviors and alter behaviors associated with the client's addiction. Nurse Interventions: Assess family history, understand family coping mechanisms, educate the family about substance abuse, involve them in treatment plans, and help family adjust to new behaviors.
• Altered nutrition related to use of substance instead of eating. Short-term goal: Restore nutritional balance, address dehydration, and reduce substance-related symptoms. Long-term goal: Achieve optimal nutritional status and support recovery from substance abuse. Nurse Interventions: Consult dietitian, determine calorie needs, encourage cessation of smoking, provide nutritious meals with supplements, and monitor weight.