8 Substance Abuse Nursing Care Plans

Ineffective Denial

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

Desired Outcomes

• 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).