Behavior

Behavior

• Refers to the observable actions, reactions, and responses of an individual to internal and external stimuli.

• A form of communication that may reflect emotional distress, altered mental status, substance use, unmet physical needs, or a medical emergency.

• Nurses should avoid labeling patients as difficult, manipulative, or noncompliant. Instead, assess underlying causes, immediate safety concerns, and provide compassionate, evidence-based, nonjudgmental care.

Normal Behavior Versus Behavioral Disorders

• Normal responses are usually temporary and do not significantly interfere with daily functioning, such as sadness after disappointment, nervousness before an exam, occasional frustration, or temporary social withdrawal.

• Potential behavioral disorders involve persistent, severe, or harmful changes in mood, anxiety, impulse control, substance use, thinking, sleep, or social functioning. Warning signs include hallucinations, delusions, compulsive substance use, and escalating aggression.

• Nurses cannot diagnose a psychiatric disorder based on one behavior alone. Assessment must consider duration, severity, changes from baseline, impact on daily functioning, medical conditions, substance use, and cultural factors.

Behavior: The Nurse's Assessment Framework

• When a patient displays unusual or concerning behavior, first assess for a medical emergency or immediate safety risk, including potential harm to themselves or others. Prioritize safety and intervene as needed.

• Determine whether the behavior is a sudden change from baseline and assess for underlying causes such as hypoxia, hypoglycemia, stroke, infection, delirium, head injury, medication toxicity, intoxication, or withdrawal.

• Consider environmental and psychological triggers and choose interventions that maintain safety while preserving dignity and autonomy. Never automatically assume acute confusion or agitation is psychiatric in origin.

How Do Behavioral Disorders Develop?

• There is usually no single cause. Development often results from a combination of genetic susceptibility, brain development, and changes in brain chemistry or neurological functioning.

• Chronic stress, childhood adversity, trauma, and exposure to violence can increase the risk by affecting emotional regulation and coping abilities.

• Other contributing factors include medical conditions, substance use, social isolation, limited support systems, environmental instability, and coexisting psychiatric conditions.

Substance Use

• Refers to consuming alcohol, medications, tobacco, or other substances. Using a substance does not automatically mean a person has an addiction or substance use disorder.

Substance Misuse

• Occurs when a substance is used inappropriately or in a way that increases the risk of harm, such as taking more medication than prescribed or combining alcohol with sedatives.

• Misuse can lead to health complications, injuries, dependence, and an increased risk of developing a substance use disorder.

Substance Use Disorder (SUD)

• A clinically significant pattern of substance use that causes impaired control, continued use despite harmful consequences, and problems with health, relationships, work, or daily responsibilities.

• Under DSM-5-TR criteria, severity is based on the number of symptoms within a 12-month period: Mild (2–3 symptoms), moderate (4–5 symptoms), and severe (6 or more symptoms).

• Symptoms include using more than intended, unsuccessful attempts to cut down, cravings, spending excessive time obtaining or using substances, neglecting responsibilities, relationship problems, giving up activities, risky use, continued use despite harm, tolerance, and withdrawal. Tolerance and withdrawal are not required for diagnosis.

Addiction

• A severe, compulsive pattern of substance use that continues despite harmful consequences to health, relationships, and daily functioning.

• Not simply a lack of willpower. Repeated substance exposure can alter brain systems responsible for reward, motivation, learning, stress, and impulse control, making it difficult to stop using.

• Nurses should use person-first, nonjudgmental language to promote trust and therapeutic communication. Say “person with substance use disorder” instead of “addict,” “person who uses substances” instead of “drug abuser,” and “positive or negative toxicology result” instead of “dirty or clean urine.”

Addiction and Substance Use Disorders: Prevalence

• According to the 2024 National Survey on Drug Use and Health (SAMHSA), approximately 48.4 million Americans aged 12 and older (16.8%) experienced a substance use disorder within the past year.

• About 27.9 million people had an alcohol use disorder, while 28.2 million had a drug use disorder. Some individuals experienced both.

• Only about 1 in 5 people who needed substance use treatment received it, highlighting the importance of early screening, treatment referrals, and ongoing recovery support.

Addiction and Substance Use Disorders: Factors That Increase Risk

• Biological factors include genetic susceptibility, family history of addiction, chronic pain, exposure to certain medications, and coexisting mental health conditions.

• Psychological factors include depression, anxiety, trauma, difficulty regulating emotions, and using substances to cope with emotional distress.

• Social and environmental factors include peer pressure, easy access to substances, housing instability, family conflict, social isolation, barriers to health care, and exposure to violence.

Addiction and Substance Use Disorders: Protective Factors

• Supportive relationships, stable housing, and strong community connections help reduce the risk of substance misuse by providing emotional support and stability.

• Healthy coping skills, education about substance-related risks, and early identification of problems help individuals manage stress and prevent substance use from becoming harmful.

• Access to primary care, behavioral health services, and evidence-based addiction treatment supports early intervention, long-term recovery, and prevention of relapse.

Pathophysiology of Addiction: Stage 1 – Initial Substance Exposure

• Substance use may begin through experimentation, curiosity, peer pressure, prescribed medical treatment, or an attempt to escape emotional distress.

Pathophysiology of Addiction: Stage 2 – Reinforcement

• The brain begins to associate substance use with pleasure, reward, or relief from unpleasant feelings, increasing the desire to use the substance again.

Pathophysiology of Addiction: Stage 3 – Neuroadaptation

• Repeated substance exposure causes the brain to adapt, altering dopamine signaling, stress responses, emotional regulation, and impulse control.

• These changes can lead to increased cravings, reduced responsiveness to pleasurable effects, and difficulty controlling substance-seeking behavior.

Pathophysiology of Addiction: Stage 4 – Tolerance

• The body becomes less responsive to the same amount of a substance, requiring larger doses to achieve the previous effect.

Pathophysiology of Addiction: Stage 5 – Physical Dependence

• The body adapts to repeated substance exposure and begins to rely on its presence to function normally.

• When the substance is suddenly reduced or stopped, withdrawal symptoms may develop. Physical dependence does not automatically mean addiction.

Pathophysiology of Addiction: Stage 6 – Withdrawal and Craving

• Reducing or stopping a substance can cause physical and psychological withdrawal symptoms, including anxiety, irritability, tremors, nausea, vomiting, pain, increased heart rate, and elevated blood pressure.

• Severe withdrawal may cause seizures, hallucinations, or delirium, depending on the substance. Cravings can increase the risk of returning to substance use.

• Alcohol and benzodiazepine withdrawal can be life-threatening. Opioid withdrawal is usually not life-threatening but can be extremely uncomfortable, while opioid overdose can cause fatal respiratory depression.

Substance Effects: Alcohol

• Acute effects: A CNS depressant that causes impaired judgment, coordination, reaction time, and behavior, with increasing sedation as intoxication progresses.

• Intoxication/toxicity: Severe intoxication can cause respiratory depression, aspiration, hypoglycemia, injuries, and decreased consciousness. Chronic use can lead to liver cirrhosis, pancreatitis, heart disease, and thiamine deficiency.

• Withdrawal: Causes tremors, anxiety, sweating, tachycardia, hypertension, and agitation. Severe withdrawal may cause seizures and delirium tremens, which can be life-threatening.

Substance Effects: Opioids

• Acute effects: Act on opioid receptors in the CNS, causing pain relief (analgesia), sedation, euphoria, and drowsiness.

• Intoxication/toxicity: Can cause pinpoint pupils, decreased level of consciousness, and respiratory depression, potentially leading to death. Naloxone reverses opioid-induced respiratory depression.

• Withdrawal: Causes muscle aches, anxiety, nausea, vomiting, diarrhea, sweating, and cravings. Withdrawal is extremely uncomfortable but usually not life-threatening.

Substance Effects: Benzodiazepines

• Acute effects: Depress CNS activity, producing sedation, reduced anxiety, relaxation, and impaired coordination.

• Intoxication/toxicity: May cause excessive sedation, confusion, slurred speech, and respiratory compromise, especially when combined with alcohol or opioids.

• Withdrawal: Causes anxiety, insomnia, tremors, agitation, seizures, and delirium. Abrupt discontinuation can be life-threatening.

Substance Effects: Stimulants (Cocaine and Methamphetamine)

• Acute effects: Increase CNS activity and neurotransmitters such as dopamine and norepinephrine, producing increased energy, alertness, euphoria, and decreased appetite.

• Intoxication/toxicity: Can cause severe hypertension, tachycardia, chest pain, dysrhythmias, hyperthermia, agitation, and seizures, increasing the risk of heart attack or stroke.

• Withdrawal: Often produces a crash involving extreme fatigue, depression, increased sleep, increased appetite, and strong cravings.

Substance Effects: Cannabis

• Acute effects: Causes euphoria, altered perception, impaired memory, coordination, and judgment, and sometimes increased appetite.

• Intoxication/toxicity: May cause anxiety, panic, paranoia, tachycardia, and, in severe cases, psychotic symptoms.

• Withdrawal: Causes irritability, anxiety, insomnia, decreased appetite, restlessness, and cravings. Symptoms usually begin within several days and may last a few weeks.

Substance Effects: Hallucinogens

• Acute effects: Alter perception, sensory experiences, mood, and awareness, potentially causing hallucinations and distorted reality.

• Intoxication/toxicity: May cause severe panic, paranoia, impaired judgment, dangerous behavior, and cardiovascular changes. Some substances can cause hyperthermia or seizures.

• Withdrawal: Varies by substance, but classic hallucinogens generally do not produce a significant physical withdrawal syndrome.

Substance Effects: Inhalants

• Acute effects: Rapidly affect the CNS, causing brief euphoria, dizziness, lightheadedness, slurred speech, and altered consciousness.

• Intoxication/toxicity: Can cause life-threatening dysrhythmias, hypoxia, seizures, and neurologic damage, including sudden death after a single exposure.

• Withdrawal: Usually mild or absent, but some patients may experience irritability, nausea, sleep disturbances, and cravings. Treatment is primarily supportive.

Alcohol Use Disorder (AUD)

• A chronic pattern of problematic alcohol use involving impaired control, continued drinking despite harmful consequences, and difficulty fulfilling daily responsibilities.

• Alcohol affects the CNS, altering judgment, impulse control, mood, behavior, coordination, and respiratory and cardiac function.

• Chronic use can cause hypertension, atrial fibrillation, stroke, cirrhosis, hepatitis, pancreatitis, GI bleeding, anemia, malnutrition, thiamine deficiency, dementia, and increased cancer risk.

Binge Drinking

• Defined as consuming 5 or more drinks for males or 4 or more drinks for females on one occasion, typically within about 2 hours.

• Increases the risk of alcohol poisoning, impaired judgment, injuries, motor vehicle accidents, risky behaviors, and cardiovascular complications.

• Repeated binge drinking increases the risk of developing alcohol use disorder, but binge drinking alone does not automatically mean someone has AUD.

Alcohol Withdrawal Syndrome (AWS)

• Occurs when a person with physical dependence on alcohol suddenly reduces or stops drinking. Symptoms can begin within 6–24 hours, often peaking around 24–48 hours.

• Early symptoms include anxiety, agitation, tremors, sweating, nausea, insomnia, tachycardia, and hypertension. Severe withdrawal can cause seizures and delirium tremens (confusion, hallucinations, and autonomic instability), which may be life-threatening.

• Nurses assess withdrawal severity using the CIWA-Ar scale, monitor vital signs, and implement seizure precautions. Treatment commonly includes benzodiazepines, thiamine, fluids, and electrolyte replacement.

Alcohol Toxicity

• Occurs when excessive alcohol intake causes severe CNS depression, potentially leading to respiratory depression, hypotension, unconsciousness, coma, and death.

• Complications include hypoglycemia, hypokalemia, hypomagnesemia, aspiration, and injuries. Combining alcohol with opioids or benzodiazepines increases the risk of fatal respiratory depression.

• No specific antidote exists. Nursing priorities are maintaining airway, breathing, and circulation (ABCs), monitoring vital signs and consciousness, providing IV fluids and glucose when indicated, and administering thiamine before or alongside glucose when feasible without delaying treatment of hypoglycemia.

Alcohol Withdrawal: Clinical Institute Withdrawal Assessment (CIWA-Ar)

• The CIWA-Ar scale assesses the severity of alcohol withdrawal and helps guide treatment. Higher scores indicate more severe withdrawal symptoms.

• Assesses 10 symptoms: agitation, anxiety, auditory disturbances, headache, orientation/clouding of sensorium, sweating, tactile disturbances, tremors, visual disturbances, and nausea/vomiting.

• Nine categories are scored 0–7, while orientation/clouding of sensorium is scored 0–4, for a maximum total of 67 points. Scores are commonly interpreted as mild (under 10), moderate (10–18), and severe (19 or higher), although facility protocols may vary.

Opioid Overdose: Recognition and Nursing Interventions

• Signs of overdose include decreased level of consciousness, slow or absent breathing, low oxygen saturation, pinpoint pupils (not always present), cyanosis, and poor responsiveness.

• Priority interventions: Activate emergency response, assess ABCs, support airway, breathing, and oxygenation, and administer naloxone as prescribed or per protocol. Begin CPR and use an AED when indicated.

• Continue respiratory support and monitoring, repeating naloxone if needed. Respiratory depression may return because naloxone can wear off before the opioid. Emergency evaluation is necessary even if the patient improves.

Behavior: Aggression

• Refers to behavior that threatens or causes harm to another person or property, including verbal threats, intimidation, or physical actions.

• Not every angry patient is aggressive or dangerous. Nurses should assess behavior and immediate safety risks rather than make assumptions based on emotions or diagnoses.

Behavior: Assaultive Behavior

• Involves threats, attempted physical harm, or physical actions that create a safety risk for others.

• Nurses should recognize warning signs, maintain a safe distance, and use de-escalation techniques to prevent injury. The legal definition of assault varies by jurisdiction.

Behavior: Violence

• Involves the use or threat of physical force or power that may result in injury, death, psychological harm, or deprivation.

• Nurses should prioritize safety, recognize escalating behaviors, and intervene early while maintaining the patient's dignity.

• A psychiatric diagnosis alone does not predict violence. Risk assessment should focus on the patient's current behavior, circumstances, and warning signs.

Potential Contributing Factors to Aggression and Violence

• Physical and medical factors include pain, unmet physical needs, intoxication, withdrawal, delirium, dementia, head injuries, and neurological conditions.

• Psychological factors include severe fear, perceived threats, acute psychosis, mood disturbances, trauma, previous experiences of violence, and feelings of frustration or loss of control.

• Environmental and interpersonal factors include overstimulation, communication difficulties, and feeling ignored, threatened, or disrespected. These factors can increase agitation and the risk of aggressive behavior.

Recognizing Escalation

• Verbal warning signs include increasing hostility, threatening statements, agitation, and sudden changes in behavior or consciousness.

• Physical warning signs include pacing, clenched fists, invading personal space, throwing objects, and attempting to strike, kick, or physically restrain others.

• No single sign reliably predicts violence. Nurses should assess the pattern of behavior, specific threats, immediate environment, access to weapons, and the patient's current mental and physical condition to identify safety risks.

De-escalation and Management of Assaultive Behavior

• The goal is to prevent violence, maintain safety, and reduce agitation while preserving the patient's dignity, autonomy, and sense of control.

• Nurses should recognize warning signs, assess underlying causes, maintain a safe environment, use therapeutic communication, and offer appropriate choices to reduce escalation.

• Medications, restraints, or seclusion may be necessary when safety is at risk, but less restrictive interventions are preferred. Always reassess, document, and update the care plan.

De-escalation: Step 1 – Recognize and Assess

• Assess the patient's behavior and immediate risk of harm to themselves, staff, or others.

• Identify potential medical causes, including hypoxia, hypoglycemia, stroke, head injury, infection, delirium, intoxication, withdrawal, medication toxicity, severe pain, or acute psychiatric symptoms.

• When safe, obtain vital signs, oxygen saturation, and blood glucose without increasing agitation.

De-escalation: Step 2 – Maintain Safety

• Call for assistance early, follow emergency protocols, maintain a safe distance and clear exit, and never attempt to manage a dangerous patient alone.

• Reduce environmental stimulation, avoid crowding, and remove bystanders when appropriate.

• If a weapon or immediate threat is present, follow facility security and emergency procedures rather than attempting to disarm the patient.

De-escalation: Step 3 – Use Therapeutic Communication

• Speak in a calm voice, use simple language, maintain nonthreatening body language, and acknowledge the patient's feelings without judgment.

• Use statements such as "I want to understand what is happening" or "I want to help, and we need to keep everyone safe."

• Avoid arguing, shouting, threatening, humiliating, unexpected touching, multiple commands, or making promises you cannot keep.

De-escalation: Step 4 – Offer Choices and Reduce Triggers

• Offer simple, realistic choices that help the patient maintain a sense of control and autonomy.

• Examples include choosing a quieter area, speaking with a preferred staff member, or receiving an explanation before a procedure.

• Identify and reduce environmental or emotional triggers whenever possible to prevent further escalation.

De-escalation: Step 5 – Administer Medication When Indicated

• Medication may be necessary when severe agitation creates immediate danger or prevents essential medical treatment.

• Medication selection depends on the underlying cause, medical condition, medications already received, and facility protocols.

• Medications should never replace proper assessment or be used for punishment, staff convenience, or simply silencing the patient.

De-escalation: Step 6 – Restraints or Seclusion Only When Necessary

• Restraints and seclusion are last-resort interventions used only when legally and clinically permitted and less restrictive measures have failed or are not feasible during an immediate emergency.

• Follow facility policies for authorization, continuous safety observation as required, monitoring, reassessment, documentation, and prompt discontinuation.

• Never use restraints or seclusion for punishment, retaliation, or staff convenience. Discontinue as soon as safely possible.

De-escalation: Step 7 – Reassess and Debrief

• After the situation is controlled, assess for injuries, reassess vital signs and mental status, and monitor medication effects or adverse reactions.

• Identify triggers, effective interventions, and opportunities to prevent future escalation.

• Document objective findings and interventions, participate in staff debriefing, and revise the care plan to reduce recurrence.

Addiction and Substance Use Disorders: Screening and Diagnostic Tests

• Diagnostic testing depends on the substance used, presenting symptoms, and suspected complications. Common tests include blood alcohol level, urine drug screen, and toxicology testing to identify possible substance exposure.

• Blood glucose checks for hypoglycemia, CBC evaluates infection or anemia, and blood gas analysis assesses oxygenation, ventilation, and acid-base imbalances.

• ECG and troponin evaluate cardiac complications, while pregnancy testing and suicide screening help identify additional risks and guide safe treatment.

Medications Used to Treat Opioid Use Disorder: Methadone

• A long-acting opioid agonist that reduces withdrawal symptoms, cravings, and illicit opioid use by activating opioid receptors.

• Used for long-term maintenance treatment of opioid use disorder and helps reduce the risk of overdose and death.

• Monitor for sedation, respiratory depression, medication interactions, and QT prolongation, which can increase the risk of dangerous cardiac dysrhythmias.

Medications Used to Treat Opioid Use Disorder: Buprenorphine

• A partial opioid agonist that reduces withdrawal symptoms and cravings while helping prevent continued opioid use.

• Has a ceiling effect on respiratory depression, making it generally safer than full opioid agonists, although overdose remains possible, especially with other sedatives.

• Timing of initiation is important because starting too soon after full opioid use can cause precipitated withdrawal. Monitor for sedation, respiratory depression, and medication interactions.

Medications Used to Treat Opioid Use Disorder: Naltrexone

• An opioid antagonist that blocks opioid receptors, preventing the euphoric and rewarding effects of opioids and supporting relapse prevention.

• Patients must be opioid-free before starting treatment, typically 7–10 days or longer depending on the opioid, to avoid severe precipitated withdrawal.

• Assess liver function and current opioid use. Patients may have an increased overdose risk after discontinuation because opioid tolerance decreases.

Medications Used to Treat Alcohol Use Disorder: Naltrexone

• An opioid antagonist that reduces the rewarding effects of alcohol, cravings, and heavy drinking, helping patients reduce or stop alcohol consumption.

• Used for long-term alcohol use disorder treatment, not for managing acute alcohol withdrawal.

• Assess for current opioid use, opioid dependence, and liver disease, because it can precipitate opioid withdrawal and requires caution with significant liver problems.

Medications Used to Treat Alcohol Use Disorder: Acamprosate

• Helps maintain alcohol abstinence by supporting the balance of neurotransmitter activity disrupted by chronic alcohol exposure.

• Used for long-term recovery after alcohol cessation, but does not treat acute alcohol withdrawal.

• Assess kidney function, as the medication is eliminated through the kidneys and is contraindicated in severe renal impairment.

Medications Used to Treat Alcohol Use Disorder: Disulfiram

• Blocks alcohol metabolism, causing an unpleasant reaction when alcohol is consumed to discourage drinking.

• Combining alcohol with disulfiram can cause flushing, severe nausea, vomiting, headache, palpitations, and hypotension, potentially becoming dangerous.

• Teach patients to avoid alcohol in beverages, medications, mouthwash, and other products containing alcohol. Monitor liver function and assess readiness for treatment.

Medications Used to Treat Alcohol Withdrawal: Benzodiazepines

• Commonly used as first-line medications for acute alcohol withdrawal to reduce anxiety, agitation, tremors, seizures, and the risk of delirium tremens.

• Examples include lorazepam, diazepam, and chlordiazepoxide, which enhance the calming effects of GABA in the CNS.

• Monitor sedation, respiratory status, vital signs, fall risk, and withdrawal severity using CIWA-Ar when appropriate. These medications treat acute withdrawal, not long-term alcohol use disorder.

Medications Used to Treat Alcohol Withdrawal: Thiamine (Vitamin B1)

• Replaces vitamin B1 deficiency, which is common in patients with chronic alcohol use due to poor nutrition and impaired absorption.

• Helps prevent Wernicke encephalopathy, a serious neurologic condition involving confusion, impaired coordination, and abnormal eye movements that can progress to Wernicke-Korsakoff syndrome.

• Assess nutritional status and administer thiamine before or alongside glucose when feasible, without delaying emergency treatment of hypoglycemia.

Medications Used to Treat Tobacco Use Disorder: Nicotine Replacement Therapy (NRT)

• Provides controlled amounts of nicotine without tobacco smoke, helping reduce withdrawal symptoms and cravings during smoking cessation.

• Available as patches, gum, lozenges, inhalers, and nasal sprays. Combining a nicotine patch with a short-acting form can improve quit rates.

• Monitor for nicotine-related adverse effects, such as nausea, palpitations, and sleep disturbances, and teach correct use of each product.

Medications Used to Treat Tobacco Use Disorder: Bupropion

• An atypical antidepressant that increases dopamine and norepinephrine activity, helping reduce nicotine cravings and withdrawal symptoms.

• Used for smoking cessation, including in patients without depression. Common side effects include insomnia, dry mouth, and anxiety.

• Lowers the seizure threshold and is contraindicated in patients with seizure disorders, eating disorders, or abrupt alcohol/sedative withdrawal.

Medications Used to Treat Tobacco Use Disorder: Varenicline

• A partial nicotine receptor agonist that reduces nicotine cravings and withdrawal symptoms while blocking some of nicotine's rewarding effects.

• Helps patients quit smoking by reducing the pleasure associated with continued tobacco use.

• Common adverse effects include nausea, insomnia, and vivid dreams. Monitor for mood or behavioral changes and adjust dosing in significant renal impairment.

Medications Used to Treat Stimulant Use Disorder

• There is currently no FDA-approved medication specifically established for routine treatment of cocaine or methamphetamine use disorder.

• Treatment focuses on behavioral interventions, particularly contingency management, cognitive behavioral therapy (CBT), and treatment of coexisting psychiatric conditions.

• Selected medications may be considered by qualified clinicians in specific situations, but behavioral treatment remains the primary evidence-based approach.

Medications Used to Treat Cannabis Use Disorder

• There is currently no FDA-approved medication specifically established for routine treatment of cannabis use disorder.

• Treatment focuses on motivational enhancement therapy, cognitive behavioral therapy (CBT), and other behavioral interventions.

• Nurses provide supportive care for withdrawal symptoms, including irritability, anxiety, insomnia, and decreased appetite, while addressing coexisting conditions.

Addiction and Substance Use Disorders: Primary Prevention

• Focuses on preventing substance misuse and addiction before they develop through education, prevention programs, and supportive relationships.

• Promote healthy coping skills, problem-solving, adequate sleep, regular exercise, and early help-seeking behaviors.

• Teach safe medication storage and disposal and assess risk factors to help reduce substance exposure and misuse.

Addiction and Substance Use Disorders: Secondary Prevention

• Focuses on early detection and intervention to identify substance misuse before it progresses or causes serious complications.

• Perform routine substance use screenings, identify prescription medication misuse, and assess for depression, anxiety, and suicide risk.

• Provide early interventions, education, and referrals for patients showing signs of problematic substance use.

Addiction and Substance Use Disorders: Tertiary Prevention

• Focuses on reducing complications, preventing recurrence, and supporting long-term recovery in patients with an established substance use disorder.

• Provide evidence-based treatment, individualized care planning, patient education, and access to recovery support services.

• Encourage ongoing follow-up care, relapse prevention strategies, and continued support after discharge to promote recovery and prevent complications.

Addiction and Substance Use Disorders: Harm Reduction

• Focuses on reducing the health risks and harmful consequences of substance use, even when a patient is not ready or willing to stop using substances. Abstinence is not required to receive care.

• Interventions include providing naloxone and overdose education, discouraging opioid use alone, warning against mixing opioids with alcohol or sedatives, and promoting access to sterile injection equipment.

• Nurses should encourage infection screening and treatment, access to medications for substance use disorders, and nonjudgmental, stigma-free care to improve safety and encourage patients to seek treatment.

Documentation After an Aggressive Incident

• Document events leading up to the incident, observable behaviors, relevant patient statements, safety concerns, and any injuries. Use objective, factual language without speculation or blame.

• Record de-escalation attempts, emergency responses, notifications, medications, restraints or seclusion used, and the patient's response to each intervention.

• Include ongoing monitoring, reassessment, and follow-up safety measures. Follow facility incident-reporting procedures, remembering that an incident report does not replace documentation in the medical record.

Addiction and Substance Use Disorders: Assessing Readiness to Quit

• Nurses use open-ended, nonjudgmental questions to assess a patient's motivation, readiness to change, and personal goals related to substance use.

• Ask questions such as “How would you like things to change?”, “What don't you like about the effects of drinking or drug use?”, and “How do you want your life to be different a year from now?”

• Use motivational interviewing to explore the patient's concerns, hopes, relationships, and desired outcomes, helping them identify their own reasons for change without pressure or judgment.

Addiction and Substance Use Disorders: Assessing Ability to Quit

• Nurses use open-ended, nonjudgmental questions to assess a patient's confidence, perceived ability to change, and available strategies for reducing or stopping substance use.

• Ask questions such as “If you decided to quit drinking, how could you do it?”, “What do you think you might be able to change?”, and “How confident are you that you could quit?”

• Use motivational interviewing to identify the patient's strengths, available resources, barriers, and realistic options, helping build self-efficacy (confidence in their ability to change).

Addiction and Substance Use Disorders: Assessing Reasons to Quit

• Nurses use open-ended, nonjudgmental questions to explore a patient's personal reasons, motivations, and perceived benefits of reducing or stopping substance use.

• Ask questions such as “What are some reasons you have for making this change?”, “What's the downside of the way things are now?”, and “What might be the good things about quitting?”

• Use motivational interviewing to help patients identify their own reasons for change, expected benefits, and personal values, strengthening their motivation without pressure or judgment.