Summary

Chronic substance use disorders significantly impact individuals, families, communities, and society. Misuse of alcohol, drugs, and prescribed medications is estimated to cost the United States more than $400 billion in health-care expenses (SAMHSA & Office of the Surgeon General, 2016), law enforcement and criminal justice costs, lost workplace productivity, and losses from motor vehicle crashes.

Substance use disorders (SUD) occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home. People who have an SUD may also have a mental health disorder. Three regions of the brain are the key components in the development and persistence of substance use disorders: the basal ganglia, the extended amygdala, and the prefrontal cortex. Prolonged, repeated misuse of substances can produce changes to the brain that can lead to a substance use disorder. Substances that are abused can be both legal and illegal in nature (Substance Abuse and Mental Health Services Administration & Office of the Surgeon General, 2016).

Nurses also struggle with substance use disorders. Many state boards of nursing have programs designed to assist nurses with substance use disorders recover so that they can provide safe care to their clients.

Alcohol use disorder occurs in all ages, cultures, and socioeconomic groups. Risk factors for developing an alcohol use disorder include the age at which a person starts drinking, genetics, psychological factors, and environmental factors. There are several FDA-approved medications to help treat alcohol use disorders. In addition to medication, examples of behavioral treatments include CBT, DBT, motivational enhancement therapy (MET), and family therapy. Each of these treatments can work individually or in combination to help the client develop the skills they need to decrease/stop drinking, work on goal setting, and build a support system. Mutual support groups include Alcoholics Anonymous and Al-Anon. As part of the standard of care, nurses should assess all clients for alcohol use.

Stimulants include amphetamine-type substances, cocaine, and crack. Stimulants cause the release of dopamine in the brain and are highly addictive because the flood of dopamine in the brain’s reward circuit strongly reinforces drug-taking behaviors. Legal stimulants are most commonly prescribed to mitigate the symptoms of ADHD and include the medications Ritalin and Adderall, among others. Over-the-counter cold/allergy medications containing pseudoephedrine are easily accessible stimulants that are prone to misuse. Illegal stimulants, such as cocaine and methamphetamine, are highly addictive substances that cause a sense of euphoria and increased energy.

Stimulant intoxication causes problematic behavioral or psychological changes, such as euphoria or blunted affect; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; and impaired judgment. It is important for health-care systems to work together to assess and provide treatment to individuals who are experiencing all substance use disorders. Nurses and any health-care professionals who complete client screenings need extensive training.

Even though many opioids are legally prescribed by physicians to address pain, the use of these medications can lead to opioid use disorder. Opioid intoxication causes problematic behavioral or psychological changes, such as initial euphoria followed by apathy, dysphoria, psychomotor retardation or agitation, and impaired judgment. When misused, opioids cause a person to feel relaxed and euphoric or to overdose. Naloxone reverses the effects of an opioid overdose. Outpatient counseling, intensive outpatient treatment, short-term residential treatment, long-term therapeutic communities (sober living), and medication-assisted treatment (MAT) are all recovery methods for OUD. One main nursing goal with respect to detox is to minimize withdrawal symptoms to the point that the client can begin working on discharge planning.

The U.S. Department of Health and Human Services, Office of the Surgeon General (2016) suggests that screening for substance misuse begin in health-care organizations by training health-care teams, including nurses, to recognize the signs and symptoms of substance misuse, and then using therapeutic communication skills to engage the client in brief interventions for mild substance use problems or referral to more intense therapies and use of medications for more severe cases.

There are several medications that can be used to either block cravings or decrease withdrawal symptoms. MAT uses a holistic approach that has been shown to improve outcomes for people with SUD. Treatment settings include inpatient, outpatient, and self-help groups. Unfortunately, many individuals who receive withdrawal management do not become engaged in treatment. Studies have found that half to three-quarters of individuals with substance use disorders who receive withdrawal management services do not enter treatment.