Substance-Related and Addictive Disorders

Chapter 23: Substance-Related and Addictive Disorders

K. McAllister MSN, RN, CHSE
NUR 332: Mental Health Nursing
Spring, 2026

Class Objectives

  • Describe the impact of substance-related and addiction disorders on a client’s overall health.

  • Explore epidemiological and etiological risk factors that contribute to clients experiencing substance-related and addiction disorders.

  • Differentiate the clinical presentation of clients experiencing substance-related and addiction disorders.

  • Explore the role of the nurse when caring for clients experiencing substance-related and addiction disorders.

  • Apply the nursing process through the use of clinical judgment functions while providing care to clients experiencing substance-related and addiction disorders.

Definition of Substance-Use Disorders

  • A cluster of cognitive, behavioral, and physiological manifestations indicating continued use of a substance despite clinical impairment from the substance with diagnosis based on pathological patterns.

  • Substance-related Disorders:

    • Defined as a pattern of use of any substance, legal or illegal, for mood- or behavior-altering purposes.

    • Substances can include alcohol, legal medications, and illegal drugs.

Statistics on Substance Use Disorders

  • Affects people from all walks of life.

  • In 2020, approximately 14.8 million people had a substance use disorder.

  • In 2019, percentages of students reporting having been drunk in the previous month were:

    • 7.9% of eighth graders

    • 18.4% of ninth graders

    • 29.3% of 12th graders

  • Deaths resulting from drug overdoses, especially opioids, have risen drastically over the last decade.

Definition of Addiction

  • A compulsion to use substances.

  • If the need is unfulfilled or unmanaged, there will be physical or psychological distress.

  • Addictions are considered brain disorders.

Severity Levels for Substance Use Disorder

  • Mild substance use disorder: The client has two or three manifestations.

  • Moderate substance use disorder: The client has four or five manifestations.

  • Severe substance use disorder: The client has six or more manifestations.

Manifestations of Substance Use Disorder (SUD)

  • Manifestations of SUD fall into one of these categories:

    • Impaired Control: Difficulty controlling substance use.

    • Social Problems: Issues arising in social contexts due to substance use.

    • Risky Use: Engaging in hazardous行为 while under the influence.

    • Physical Dependence: Experiencing withdrawal symptoms when not using the substance.

Common Reasons for Drug and Alcohol Use

  • Desire to feel relaxed.

  • To feel fewer physiological effects such as pain.

  • To perform better in tasks.

  • To fit in with peers.

  • Sheer curiosity.

Risk Factors for Developing Substance Use Disorders

  • Various factors contributing to development include:

    • Mental illness: Existing mental health issues.

    • Stress: Increases vulnerability.

    • Gender: Certain genders may be more susceptible.

    • Ethnicity: Cultural background may play a role.

    • Genetics: Family history may increase risk.

    • Peer pressure: Influence from social groups.

    • Emotional abuse and trauma: Previous experiences can lead to substance misuse.

    • Environmental factors: Surroundings and community influences.

Mental Illness & Drug Use

  • Substance-induced psychosis: A condition where substance use leads to psychosis.

  • Individuals in mental health treatment may face a high risk for addiction, particularly with anxiety medications such as benzodiazepines.

  • Users often self-medicate for mental health symptoms, leading to a dual diagnosis of mental illnesses, such as depression, alongside substance use disorder.

Common Substances Associated with Substance Use Disorders

  • Ethanol: Alcohol.

  • Benzodiazepines: Anti-anxiety medications.

  • Cocaine: Stimulant drug.

  • Gamma-hydroxybutyrate (GHB): A central nervous system depressant.

  • Hallucinogens: Include ketamine, LSD, mescaline, and peyote.

  • Heroin: An opioid.

  • Inhalants: Substances inhaled for psychoactive effects.

  • Cannabis (marijuana): Widely used psychoactive substance.

  • MDMA (Ecstasy/Molly): Synthetic hallucinogen and stimulant.

  • Methamphetamine: A highly addictive stimulant.

Presentation of Substance Use

  • Categories of substances include:

    • Alcohol

    • Hallucinogens

    • Opiates (natural)

    • Opioids (synthetic)

    • Stimulants

    • Sedatives

Comorbidities & Co-Occurring Disorders

  • Substance misuse frequently presents alongside other health issues, such as:

    • HIV/AIDS

    • Lung or heart disease

    • Stroke

    • Cancer

    • Mental health conditions

Wernicke-Korsakoff Syndrome

  • A neurological condition commonly associated with alcohol use disorder.

  • Wernicke's Encephalopathy:

    • Occurs first and is reversible with timely treatment and thiamine supplementation.

  • Korsakoff Syndrome:

    • Occurs second and involves irreversible damage, particularly to the mammillary bodies.

Nonsubstance Addictions (Process Addictions)

  • Similar to drug or alcohol addiction but involves compulsion toward behaviors.

  • Manifestations include:

    • Craving the activity for pleasure.

    • Engaging in compulsive behaviors and risky activity.

    • Inability to control or stop the activity.

    • Impaired judgment and consequences understanding.

    • Strained personal and work relationships.

Symptoms and Warning Signs of Substance Use Disorder

  • Mood changes: New or worsening depressive or anxious symptoms.

  • Decline in performance: Notable drops in school or work effectiveness.

  • Change in weight, eating, sleeping, overall health: Potential indicators of misuse.

  • Change in peer group: Shifts to social circles that enable or normalize substance use.

  • Inability to be present in personal interactions: Difficulty maintaining focus with others.

  • Loss of money and valuables: Frequent financial problems due to substance use.

Alcohol Withdrawal Stages

  • Stage 1: Begins 6 - 8 hours after the last drink.

  • Stage 2: Prolonged withdrawal symptoms lasting 1-3 days.

  • Stage 3: Severe withdrawal symptoms may persist for 1 week or more.

Diagnostic and Laboratory Testing

  • Various tests used to assess substance use include:

    • Blood alcohol levels

    • Saliva tests

    • Urine samples

    • Hair samples

Treatments for Alcohol Use Disorder

  • Withdrawal from alcohol typically treated with the following:

    • Benzodiazepines: To manage withdrawal symptoms.

    • Clients recommended to drink non-caffeinated fluids and take a daily multivitamin.

    • Thiamine: Administered to prevent Wernicke-Korsakoff syndrome.

    • Alcohol abstinence medications such as naltrexone and acamprosate may be used.

Nursing Process in Substance Use Disorders

  • The nursing process involves several steps:

    • Assessment: Recognize cues and gather signs and symptoms.

    • Diagnosis/Analysis: Formulate diagnosis and prioritize problems and interventions based on recognized cues.

    • Planning: Generate solutions and treatment strategies.

    • Implementation: Carry out the interventions decided upon in the planning phase.

    • Evaluation: Assess the effectiveness of interventions - determine if the actions taken were successful.

Pharmacology Related to Substance Use Disorders

  • Common substances that are to be monitored include:

    • Nicotine

    • Opioids

    • Sedatives

    • Alcohol

    • Amphetamines

    • Hallucinogens

    • TABLETS and INGestibles for treatment plans.