8 Substance Abuse Nursing Care Plans

Ineffective Denial

Ineffective Denial may occur for patients 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, patients may continue to rely on substance abuse as a coping mechanism rather than seeking alternative methods of addressing their challenges.

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 patient would like to be addressed.
Shows courtesy and respect, giving the patient a sense of orientation and control.

2. Ascertain the reason for beginning abstinence and involvement in therapy.
Provides insight into the patient’s willingness to commit to long-term behavioral change, and whether the patient even believes that he or she can change. (Denial is one of the strongest and most resistant symptoms of substance abuse.)

3. Review the definition of drug dependence and categories of symptoms (patterns of use, impairment caused by use, tolerance to substance).
This information helps patients make decisions regarding acceptance of problems and treatment choices.

Nursing Interventions and Rationales

1. Answer questions honestly and provide factual information. Keep your word when agreements are made.
Creates trust, which is the basis of the therapeutic relationship.

2. Convey an attitude of acceptance, separating an individual from unacceptable behavior.
Promotes feelings of dignity and self-worth.

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 patient’s guilt and blame and may help awareness of recurring addictive characteristics.

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 patient to see the relationship between substance use and personal problems.

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 patient 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.

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.

7. Remain nonjudgmental. Be alert to changes in behavior, (restlessness, increased tension).
Confrontation can lead to increased agitation, which may compromise the safety of patients and staff.

8. Provide positive feedback for expressing awareness of denial in self and others.
Necessary to enhance self-esteem and to reinforce insight into behavior.

9. Maintain firm expectations that patients 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.

10. Encourage and support patients in taking responsibility for their own recovery (development of alternative behaviors to drug urge and use). Assist patient to learn own responsibility for recovering.
Denial can be replaced with positive action when the patient accepts the reality of their own responsibility.

11. Encourage family members to seek help whether or not the abuser seeks it.
To assist the patient deal appropriately with the situation.