In this guide are eight (8) nursing diagnoses for substance abuse nursing care plans. Included in substance abuse are nursing interventions, assessments, goals, related factors, and rationale.
What is Substance Abuse?
Substance use disorders involve excessive use of nicotine, alcohol, and other illicit substances that leads to social, academic, and occupational impairment. The most common illicit substances seen include cannabis, sedatives, hypnotics, anxiolytics, inhalants, opioids, hallucinogens, and stimulants. The specific factors of substance use disorder consist of abuse, intoxication, and physical/psychological dependence (Jahan & Burgess, 2022).
Drug abuse and drug dependence represent different ends of the same disease process.
Drug abuse is an intense desire to use increasing amounts of a particular substance or substances to the exclusion of other activities.
Drug dependence is the body’s physical need, or addiction, to a specific agent. There is, therefore, virtually no difference between dependency and addiction. Over the long term, this dependence results in physical harm, behavior problems, and association with people who also abuse drugs. Stopping the use of the drug can result in a specific withdrawal syndrome.
For establishing a diagnosis based on substance use, the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5), the client must meet at least two criteria out of 11 criteria, over a 12-month period, to have substance use disorder established for that substance. The 11 criteria are:
- The substance use amount is taken more than what was intended and taken longer than what was intended.
- There is the intention and failed attempts to decrease use.
- Extra time and effort are used to obtain and use the substance or recover after taking them.
- Having a strong craving for the substance.
- The use of the substance leads to the individual being unable to fulfill his or her responsibility.
- Continued use of the substance despite having social and occupational impairment due to the substance use.
- Other activities are reduced or given up due to continued substance use.
- Using the substance in a high-risk setting, such as when operating a motor vehicle or operating heavy machinery.
- Continued use of the substance with the knowledge of the psychological and harmful effects caused by the substance.
- Tolerance development either from taking more amount of the substance to reach the same effect from the last time or from having decreased effect from using the same amount of the substance.
- Withdrawal symptoms are manifested after the substance use is discontinued, and the withdrawal symptoms are relieved with the continuation of substance use.
The number of criteria the client meets determines the severity level of the disorder; two to three sets the severity level as mild, four to five sets the severity level as moderate, and six or more sets the severity level as severe (Jahan & Burgess, 2022).
Nursing Care Plans
Nursing care plan goals for clients who abuse substances include providing support for the decision to stop substance use, strengthening individual coping skills, facilitating learning of new ways to reduce anxiety, promoting family involvement in a rehabilitation program, facilitating family growth and development, and provide information about the prognosis and treatment needs.
Below are eight (8) substance abuse nursing care plans and nursing diagnoses:
- Ineffective Denial
- Ineffective Individual Coping
- Imbalanced Nutrition: Less Than Body Requirements
- Chronic Low Self-Esteem
- Interrupted Family Process
- Sexual Dysfunction
- Deficient Knowledge
Ineffective denial may occur for clients with substance abuse related to personal vulnerability, ineffective coping skills with the substitution of drugs, and learned response patterns as a means of avoiding the discomfort of facing underlying issues and behaviors. By denying the existence of these factors, clients may continue to rely on substance abuse as a coping mechanism rather than seeking alternative methods of addressing their challenges. In denial, individuals do not only ignore the reality and problems but also minimize others’ concerns regarding their substance abuse, they also avoid taking responsibility for their actions and make others accountable for them (Zafar & Farhan, 2020).
May be related to
- Personal vulnerability; difficulty handling new situations
- Previous ineffective/inadequate coping skills with substitution of drug(s)
- Learned response patterns; cultural factors, personal/family value systems
Possibly evidenced by
- Delay in seeking, or refusal of healthcare attention to the detriment of health/life
- Does not perceive personal relevance of symptoms or danger, or admit the impact of the condition on life pattern; projection of blame/responsibility for problems
- Use of manipulation to avoid responsibility for self
- The client will verbalize awareness of the relationship between substance abuse and the current situation.
- The client will engage in a therapeutic program.
- The client will verbalize acceptance of responsibility for their own behavior.
Nursing Assessment and Rationales
1. Ascertain by what name the client would like to be addressed.
This shows courtesy and respect, giving the client a sense of orientation and control. By using their preferred name, the nurse shows acknowledgment of their individuality and identity beyond their diagnosis. Additionally, using a client’s preferred name can help establish trust and rapport, which is crucial in the therapeutic relationship.
2. Ascertain the reason for beginning abstinence and involvement in therapy.
This provides insight into the client’s willingness to commit to long-term behavioral change, and whether the client even believes that he or she can change. (Denial is one of the strongest and most resistant symptoms of substance abuse.) Acceptance is essential to face and deal with reality; it is almost impossible to plan the future without accepting the present circumstances (Zafar & Farhan, 2020).
3. Review the definition of drug dependence and categories of symptoms (patterns of use, impairment caused by use, tolerance to substance).
This information helps clients make decisions regarding acceptance of problems and treatment choices. Effective education on the treatment of substance use disorders among the healthcare team can help to improve outcomes. Identifying high-risk client populations and reducing care barriers can help limit the negative impact of substance use disorders (Jahan & Burgess, 2022).
Nursing Interventions and Rationales
1. Answer questions honestly and provide factual information. Keep your word when agreements are made.
This creates trust, which is the basis of the therapeutic relationship. Honesty and transparency are crucial in building trust. The nurse should be honest about what the treatment process entails and what the client can expect. Providing feedback and updates must also be done regularly to keep the client informed about their progress.
2. Convey an attitude of acceptance, separating an individual from unacceptable behavior.
This promotes feelings of dignity and self-worth. Clients with substance abuse disorder may experience stigma, shame, and guilt. An attitude of acceptance helps reduce these negative feelings and promotes a more positive treatment experience. Acceptance also helps build trust between the client and the healthcare team.
3. Provide information about addictive use versus experimental, occasional use; biochemical or genetic disorder theory (genetic predisposition; use activated by the environment; compulsive desire.)
The progression of the use continuum is from experimental or recreational to addictive use. Comprehending this process is important in combating denial. Education may relieve the client’s guilt and blame and may help awareness of recurring addictive characteristics. Substance abuse disorders (SUD) involve both psychological and physical dependence on the substance of use. SUD and addiction stem in part from adaptive changes in the brain as it seeks to regain homeostasis (Jahan & Burgess, 2022).
4. Discuss the client’s current life situation and the impact of substance use.
The first step in decreasing the use of denial is for the client to see the relationship between substance use and personal problems. Based on a thorough literature review, it is reasoned that socially desirable response bias is generally driven by the desire to evade humiliation and consequences from revealing delicate information. Allowing the client to voice out their concerns can be the beginning of recovery from denial (Zafar & Farhan, 2020).
5. Confront and examine denial and rationalization in the peer groups. Use confrontation with caring.
Because denial is the major defense mechanism in addictive disease, confrontation by peers can help the client accept the reality of adverse consequences of behaviors and that drug use is a major problem. A caring attitude preserves self-concept and helps decrease defensive responses. The nurse may approach the client with empathy and use specific examples to illustrate the negative impact of substance abuse.
6. Provide information regarding the effects of addiction on mood and personality.
Individuals often mistake the effects of addiction and use this to justify or excuse drug use. Effects of different substances vary depending on the substance and can produce everything from increased energy and euphoria to profound sedation. In general, while the effects vary significantly, the initial stages of substance use disorders are characterized by positive reinforcement, where individuals experience a sense of well-being or euphoria with use (Jahan & Burgess, 2022).
7. Remain nonjudgmental. Be alert to changes in behavior, (restlessness, increased tension).
Confrontation can lead to increased agitation, which may compromise the safety of clients and staff. Evaluation of the client initially involves approaching the client in a non-judgemental manner. The diction should concentrate on recovery and goal setting. How well the first interview is conducted sets the tone for establishing a good rapport between the nurse and the client (Jahan & Burgess, 2022).
8. Provide positive feedback for expressing awareness of denial in self and others.
This may be necessary to enhance self-esteem and to reinforce insight into behavior. It can help them recognize the negative impact their substance abuse is having on their life and the lives of those around them. Positive feedback can also motivate the client and help them understand that change is possible and that recovery is within reach.
9. Maintain firm expectations that clients attend recovery support and therapy groups regularly.
Attendance is related to admitting the need for help, working with denial, and for maintenance of a long-term drug-free existence. The acceptance of substance abuse as a problematic factor would lead to taking treatment more seriously and looking for possible solutions in their treatment. This would increase their involvement in treatment and efforts to remain sober in the future (Zafar & Farhan, 2020).
10. Encourage and support clients in taking responsibility for their own recovery (development of alternative behaviors to drug urges and use). Assist the client to learn own responsibility for recovering.
Denial can be replaced with positive action when the client accepts the reality of their own responsibility. Clients who acquire adequate support throughout the disorder may be expected to enhance general strategies to cope with life demands and enhance psychological well-being and, at the same time, exposure to a recovery social norm may help shift attitudes in the direction of greater health behavior change (Bergman & Kelly, 2020).
11. Encourage family members to seek help whether or not the abuser seeks it.
This helps assist the client deal appropriately with the situation. There are examples of redemption in which individuals seem to have achieved it ‘on their own’. However, in most cases, there has been some combination of family members or friends, mutual help programs, treatment interventions, socially conscious employers, and national policies that have helped to facilitate recovery (McKay, 2016).
12. Provide additional information about denial management.
Denial management counseling is based on practical exercises for motivating the substance abuser to recover. Studies show that this method results in a significant decrease in self-deception enhancement and impression management. Denial management counseling plays a prominent role in lessening the level of denial in individuals with substance abuse, and they were able to recognize and relate to their problems (Zafar & Farhan, 2020).
13. Encourage the client to utilize telemedicine for recovery support services.
Telemedicine and online digital recovery support services (D-RSS) have taken center stage as potential solutions for individuals who are increasingly unable to access SUD treatment and recovery support services in person. Free, socially-based, online D-RSS including online video recovery support meetings, discussion boards and chat rooms, and social network sites may be critical resources in helping to address the unintended consequences of the pandemic and inaccessibility of health services (Bergman & Kelly, 2020).
14. Refer the client to peer recovery support services (PRSS) and recovery coaching.
PRSS is peer-driven mentoring, education, and support ministrations delivered by individuals who, because of their own experience with SUD and SUD recovery, are experientially qualified to support peers currently experiencing SUD and associated problems. Findings of the potential of peer support are evidenced by positive findings on measures including reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction (Eddie et al., 2019).
Other Possible Nursing Care Plans
Nursing diagnoses you can use to make your own care plan for substance abuse:
- Therapeutic Regimen: Individual/Families, ineffective management—decisional conflicts, excessive demands made on individual or family, family conflict, perceived seriousness/benefits.
- Coping, Individual, ineffective—vulnerability, situational crises, multiple life changes, inadequate relaxation, inadequate/loss of support systems.
- Family Coping: potential for growth—needs sufficiently gratified and adaptive tasks effectively addressed to enable goals of self-actualization to surface.
- (Physical needs depend on substance effect on organ systems—refer to appropriate medical plans of care for additional considerations.)
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans for mental health and psychiatric nursing:
- Alcohol Withdrawal | 5 Care Plans
- Anxiety and Panic Disorders | 7 Care Plans
- Bipolar Disorders | 6 Care Plans
- Major Depression | 9 Care Plans UPDATED!
- Personality Disorders | 4 Care Plans
- Schizophrenia | 6 Care Plans UPDATED!
- Sexual Assault | 1 Care Plan
- Substance Dependence and Abuse | 8 Care Plans UPDATED!
- Suicide Behaviors | 3 Care Plans
References and Sources
The following are the references and recommended sources for substance abuse nursing care plans including interesting resources to further your reading about the topic:
- Adan, A., Antunez, J. M., & Navarro, J. F. (2017, May). Coping strategies related to treatment in substance use disorder patients with and without comorbid depression. Psychiatry Research, 251.
- Bergman, B. G., & Kelly, J. F. (2020). Online digital recovery support services: An overview of the science and their potential to help individuals with substance use disorder during COVID-19 and beyond. Journal of Substance Abuse Treatment.
- Birtel, M. D., Wood, L., & Kempa, N. J. (2017, June). Stigma and Social Support in Substance Abuse: Implications for Mental Health and Well-Being. Psychiatry Research, 257.
- Breslin, F. C., Zack, M., & McMain, S. (2002). An information-processing analysis of mindfulness: Implications for relapse prevention in the treatment of substance abuse. Clinical psychology: Science and practice, 9(3), 275.
- Centers for Disease Control and Prevention. (2023). Polysubstance Use During Pregnancy | CDC. Centers for Disease Control and Prevention.
- Cuberos, M., Chatah, E. M., Baquerizo, H. Z., & Weinstein, G. (2020). Dental management of patients with substance use disorder. Clinical Dentistry Reviewed, 4(1).
- Curtis, L. (2023, February 27). Addiction & Substance Use Organizations. American Addiction Centers.
- Dervaux, A. (2020, June). Antipsychotics for schizophrenia and substance misuse. The Lancet, 395(10241).
- Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., Weinstein, C., & Kelly, J. F. (2019). Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Frontiers in Psychology, 10.
- Ganji, F., Khani, F., Karimi, Z., & Rabiei, L. (2022, February). Effect of assertiveness program on the drug use tendency, mental health, and quality of life in clinical students of Shahrekord University of Medical Sciences. Journal of Education and Health Promotion, 11(48).
- Ghadigaonkar, D. S., & Murthy, P. (2019). Sexual Dysfunction in Persons With Substance Use Disorders. Journal of Psychosexual Health, 1(2).
- Grim, B. J., & Grim, M. E. (2019). Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse. Journal of Religion and Health, 58(5).
- Groenewald, C., & Bhana, A. (2018). Substance abuse and the family: An examination of the South African policy context. Drugs: Education, Prevention and Policy, 25(2).
- Ismail, W., Damayanti, E., Nurpahmi, S., & Hj Hamid, D. H. T. A. (2021). Coping strategy and substance use disorders: The mediating role of drug hazard knowledge. Psikohumaniora: Jurnal Penelitian Psikologi,, 6(2).
- Jahan, A. R., & Burgess, D. M. (2022). Substance Use Disorder – StatPearls. NCBI.
- Javed, S., Chughtai, K., & Kiani, S. (2020). Substance abuse: From abstinence to relapse. Life and Science, 1(2), 4-4.
- Krause, R. S., & Brenner, B. E. (2021, November 11). Alcohol and Substance Abuse Evaluation: Overview, Epidemiology, Clinical Presentation. Medscape Reference.
- Mahboub, N., Rizk, R., Karavetian, M., & de Vries, N. (2020, September 25). Nutritional status and eating habits of people who use drugs and/or are undergoing treatment for recovery: a narrative review. NCBI.
- McKay, J. R. (2016). Making the hard work of recovery more attractive for those with substance use disorders. Addiction, 112(5).
- Neville, K., & Roan, N. (2014). Challenges in nursing practice. The journal of nursing administration, 44(6), 339-346.
- Northstar Transitions. (2020, September 14). Family Members of Addicts: The Enabler. NorthStar Transitions.
- Oshri, A., Carlson, M. W., Kwon, J. A., Zeichner, A., & Wickrama, K. K. A. S. (2017). Developmental Growth Trajectories of Self-Esteem in Adolescence: Associations with Child Neglect and Drug Use and Abuse in Young Adulthood. Journal of Youth and Adolescence, 46.
- Ritter, C. (2022, December 16). Examples of Secondary Gains in Psychology. Cate Ritter Wellness.
- Rizk, M. M., Herzog, S., Dugad, S., & Stanley, B. (2021, March 14). Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. NCBI.
- Saladino, V., Mosca, O., Petruccelli, F., Hoelzlhammer, L., Lauriola, M., Verrastro, V., & Cabras, C. (2021). The Vicious Cycle: Problematic Family Relations, Substance Abuse, and Crime in Adolescence: A Narrative Review. Frontiers in Psychology, 12.
- Stokes, M., & Abdijadid, S. (2022). Disulfiram – StatPearls. NCBI.
- The Substance Abuse and Mental Health Services Administration. (2019). Enhancing Motivation for Change in Substance Use Disorder Treatment. Treatment Improvement Protocol 35.
- Substance Abuse and Mental Health Services Administration. (2020). GROUP THERAPY IN SUBSTANCE USE TREATMENT. SAMHSA Advisory.
- Thankachen, S. (2023). Crisis Intervention. Healthy Life Recovery.
- Topaz, M., Murga, L., Bar-Bachar, O., Cato, K., & Collins, S. (2019). Extracting alcohol and substance abuse status from clinical notes: The added value of nursing data. In MEDINFO 2019: Health and Wellbeing e-Networks for All (pp. 1056-1060). IOS Press.
- Ulas, E., & Eksi, H. (2019). Inclusion of Family Therapy in Rehabilitation Program of Substance Abuse and Its Efficacious Implementation. The Family Journal, 27(4).
- Weir, K. (2019, February 1). CE Corner: Sex therapy for the 21st century: Five emerging directions. American Psychological Association.
- Wiss, D. A., Schellenberger, M., & Prelip, M. L. (2018, December). Registered Dietitian Nutritionists in Substance Use Disorder Treatment Centers. Journal of the Academy of Nutrition and Dietetics, 118(12).
- World Health Organization. (2009). Withdrawal Management – Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. NCBI.
- Rowe, C. L., & Liddle, H. A. (2003). Substance abuse. Journal of Marital and Family Therapy, 29(1), 97-120.
- You, Y. H., Lu, S. F., Tsai, C. P., Chen, M. Y., Lin, C. Y., Chong, M. Y., … & Wang, L. J. (2020). Predictors of five-year relapse rates of youths with substance abuse who underwent a family-oriented therapy program. Annals of general psychiatry, 19(1), 1-8.
- Zafar, A., & Farhan, S. (2020, December). EFFECTIVENESS OF DENIAL MANAGEMENT COUNSELLING FOR INDIVIDUALS WITH SUBSTANCE ABUSE. Pakistan Journal of Psychology, 51(2).
1 thought on “8 Substance Abuse Nursing Care Plans”
thank you for this interesting information