SUBSTANCE DISORDER
Description
1. Maladaptive usage patterns of one or more mood-
altering substances or chemicals
2. Over 50% of individuals with a serious medical
or mental condition are addicted to an illicit drug.
3. Alcohol is the most common substance that
occurs in substance abuse.
Theories
1. Biological
a. Substance abuse problems tend to occur in
families.
b. Children of alcoholic parents have a greater
incidence of developing alcoholism than children of
nonalcoholic parents.
2. Psychological
a. There is no addictive personality, but certain
factors—such as an intolerance to frustration or
pain, failure to establish a meaningful or loving
relationship, low self-esteem, or a lack of success in
one’s life—may predispose a client to a substance
addiction.
3. Sociocultural
a. Certain cultures may have a higher incidence of
substance abuse.
b. Substance abuse tends to be more common in
certain socioeconomic cultures; individuals my
abuse substances in an attempt to develop an
identity and a sense of belonging.
c. Women tend to have a low rate of substance
abuse.
Terms
1. Substance abuse
a. Maladaptive usage pattern of a mood-altering
substance
b. Usage causes significant distress or impairment
in numerous areas within a period of time.
c. Unable to fulfill major responsibilities at home,
work, or school
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d. Persistent substance use in situations where it is
physically dangerous
e. Persistent legal problems related to use of a
mood-altering substance
f. Substance use continues, with ongoing disregard
of the social and interpersonal problems created or
made worse by the effects of the substance, such as
physical fights or loss of family relationships or job.
2. Substance intoxication
a. Syndrome that is specific to the abused substance
b. Caused by recent ingestion of a moodaltering
substance that has an effect on the central nervous
system (CNS)
c. Maladaptive psychological and behavioral
changes caused by moodaltering substances are
experienced, such as mood lability and
belligerence.
d. May develop shortly after the use of the
substance
3. Substance dependence
a. Maladaptive usage pattern of a mood-altering
substance, leading to significant distress or
impairment
b. Characterized by three or more of the following
within 12 months of time:
1) Tolerance to the substance is developed and
either increased or smaller amounts are needed to
achieve intoxication.
2) Withdrawal clinical manifestations occur on
discontinuation of usage of the substance.
3) Client requires the consumption of the same or a
similar substance to relieve or avoid withdrawal
clinical manifestations.
4) Larger amounts of the substance are consumed
over a longer period of time than was intended.
5) There is a desire to cut down or control the
substance intake, with or without successful efforts
to do so.
6) Large amounts of time are spent obtaining the
substance.
 SUBSTANCE DISORDER
7) Important occupational, social, or recreational
activities are unfulfilled due to substance use.
8) Substance use continues, with disregard of
knowledge of the physiological and psychological
problems caused by it.
4. Substance withdrawal
a. Substance-specific syndrome develops due to
decrease or cessation of heavy and prolonged
substance use.
b. Clinically significant impairment or distress in
occupational, social, or other significant areas of
functioning occurs.
c. Clinical manifestations are not caused by a
general medical condition or other mental disorder.
d. Withdrawal clinical manifestations vary
depending on:
1) Length of use
2) Dosage
3) Other mood-altering substances taken
simultaneously
4) Type of drug taken and half-life of the drug or
substance
Alcohol Abuse
Description: maladaptive pattern
of alcohol use, causing significant
impairment in numerous areas,
including the job, home life, or
school
Assessment
1. Job or school performance is negatively
impacted.
2. Legal difficulties occur due to the effects of
alcohol, such as an arrest due to driving while under
the influence.
3. Interpersonal and social issues arise due to
alcohol use, such as fights with significant
others or failure to attend scheduled social
activities.

Nursing Diagnoses Nursing Interventions

A. Hopelessness 1. Instruct the client to abstain from alcohol and

B. Ineffective Coping other mood-altering substances.
C. Chronic Low Self-Esteem 2. Instruct the client to attend Alcoholics
D. Social Isolation Anonymous.
E. Disturbed Sensory Perception 3. Instruct the client and the family about the
F. Disturbed Thought Processes medical consequences of long-term alcohol usage.
G. Ineffective Health Maintenance
H. Imbalanced Nutrition: Less Than Body Alcohol Intoxication
Requirements
I. Deficient Fluid Volume Description
J. Self-Care Deficit 1. An alcohol-specific syndrome caused by recent
K. Risk for Suicide ingestion of alcohol because of its effect on the
L. Anxiety CNS
M. Disturbed Sleep Pattern 2. Maladaptive psychological and behavioral
N. Interrupted Family Processes changes caused by alcohol are experienced, such as
Nursing Diagnoses: Definitions and Classification mood lability, belligerence, and impaired judgment.
2012–2014. Copyright © 2012, 1994–2012 by 3. Develops within 8–12 hours of last usage of
NANDA International. Used alcohol on up to 5 days
by arrangement with John Wiley & Sons Limited.
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 SUBSTANCE DISORDER
Assessment perspiration, dyspnea, and thirst.
1. Blood pressure decreased b. Alcohol must be abstained from for at least 12
2. Pulse increased hours before starting the Antabuse.
3. Respirations decreased c. The Antabuse reaction starts within minutes after
4. Temperature decreased the ingestion of alcohol and may last for hours.
5. Drowsiness d. The client should be informed of the Antabuse
6. Slurred speech reaction that results from the ingestion of alcohol.
7. Gastrointestinal (GI) tract slowed e. Inform the client of other sources of alcohol, such
8. Slowed thought processes as cough syrup and mouthwash.
9. Slowed reflexes f. Initial dose of Antabuse is 500 mg daily for 1 to 2
weeks followed by a maintenance dose of 250 mg
Nursing Interventions daily.
1. Promote safety, such as preventing falls and
managing blood pressure. Nursing Interventions
2. Assess neurological functioning.
3. Encourage rest. 1. Assess vital signs every 2–4 hours.
2. Encourage fluid intake such as water or juice.
Alcohol Withdrawal 3. Inform the client about the withdrawal process.
4. Assist with activities of daily living as needed.
Description: an alcohol-specific syndrome
developing within 8–12 hours after the decrease or Alcohol Dependence
cessation of heavy and prolonged use of alcohol
Description
Assessment 1. Development of tolerance to alcohol and
1. Blood pressure increase subsequent physiological withdrawal
2. Pulse increase clinical manifestations
3. Respiration increase
4. Temperature increase 2. Leads to significant distress or impairment on the
5. Anxiety, restlessness job and in social and interpersonal relationships
6. Gastrointestinal hyperactivity
7. Hyperactive thought process Assessment
8. Hyperreflexic 1. Assessment occurs through a variety of methods:
9. Insomnia a. Information received from the significant other,
10. Skin diaphoretic, pale family, coworkers, boss, or friends
b. Serum and urine drug screens
Medical Management c. Blood alcohol levels (BALs)
1. If withdrawal clinical manifestations are noted, d. Michigan Alcohol and Drug Screening Test
medicate the client with the same or a similar CNS e. CAGE questionnaire
depressant, such as a benzodiazepine f. Criteria met based on the Diagnostic and
chlordiazepoxide (Librium), clorazepate Statistical Manual of Mental Disorders, Fourth
(Tranxene), or diazepam (Valium). Edition, Text Revision (DSM-IV-TR)
2. Administer prescribed thiamine for clients in g. The following criteria occur at any time within a
alcohol withdrawal due to vitamin deficiency. 12-month period:
3. Administer prescribed disulfiram (Antabuse).
a. Antabuse produces an unpleasant reaction when 1) Tolerance to alcohol is developed and is either
taken with alcohol, including palpitations, vomiting, increased or smaller amounts are needed to achieve
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 SUBSTANCE DISORDER
intoxication.
2) Withdrawal clinical manifestations occur on
discontinuation of use of alcohol.
3) Client requires the consumption of alcohol or a
benzodiazepine to relieve or avoid withdrawal
clinical manifestations.
4) Larger amounts of alcohol are consumed or are
consumed over a
longer period of time than was intended.
5) There may be a desire to cut down or control the
alcohol intake with or without successful efforts
to do so.
6) Large amounts of time are spent obtaining
alcohol.
7) Use causes lack of fulfillment of important
occupational, social, or recreational activities.
Medical Complications
1. Brain atrophy
2. Wernicke-Korsakoff Syndrome
a. One of the most commonly found conditions in
the alcoholic
b. Caused primarily from deficiency in thiamine
(vitamin B1)
c. Clinical manifestations include marked
confusion, which occurs suddenly, unsteady gait,
double vision, and uncoordinated movement.
Medical management
a) Prompt treatment with large amounts of thiamine
is required within the first few hours to the first few
days of onset of clinical manifestations (if thiamine
is not given within this time period, death may
result or the client may develop marked impairment
of memory; disorientation to person, place, date,
and time; an inability to retain memory of ongoing
events; and short-term memory loss).
3. Chronic subdural hematoma
a. May develop due to frequent falls to which the
alcoholic individual is very prone
4. Gastritis
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a. Due to alcohol causing an increase in production
of stomach acid
b. Clinical manifestations include upper abdominal
pain, indigestion, nausea, and decreased appetite.
c. Infrequent vomiting of blood may result due to
the erosion of the stomach lining.
5. Pancreatitis
a. Inflammation of the pancreas with clinical
manifestations, including acute abdominal pain,
nausea, and vomiting
6. Diarrhea
a. Results as alcohol causes the retention of water
and salt in the intestine and encourages strong
movements within the intestine
7. Fatty liver
a. Fat accumulates on the liver because the fat is not
burned or metabolized due to the high levels of
alcohol consumed
8. Alcoholic hepatitis
a. Inflammation of the liver due to the toxic effects
of alcohol on the liver
b. Occurs between the development of a fatty liver
and liver cirrhosis
c. Flulike clinical manifestations develop.
9. Ascites
a. Fluid accumulation in the abdominal cavity
10. Alcoholic liver cirrhosis
a. Liver becomes inactive due to severe damage to
and scar development on it.
b. Liver will atrophy and may become rock hard or
nodular.
c. Clinical manifestations include jaundice (a
yellow coloring of the skin and eyes) or a palmar
erythema (a reddening of the palms of the hands).
11. Esophageal varices
a. Pockets of blood that accumulate in the varicose
veins in the esophagus
 SUBSTANCE DISORDER
12. Portal hypertension
a. Blood is blocked in the liver and cannot flow
freely through it, requiring finding another route to
the heart, causing undue pressure on the already
vulnerable vein systems such as the esophagus and
stomach.
b. Portal hypertension is not associated with high
blood pressure.
13. Cardiac arrhythmias
a. May result from consumption of small to
moderate amounts of alcohol
b. Drinking alcohol along with caffeinated
beverages will predispose an individual to
developing an arrhythmia.
14. Coronary artery disease
a. Narrowing of the blood vessels due to
accumulation of fatty substances
15. Alcoholic cardiomyopathy
a. Heart muscle damage
b. Clinical manifestations include shortness of
breath, peripheral edema, decreased tissue perfusion
to the nail beds, fatigue, and palpitations.
16. Peripheral neuropathy
a. Occurs due to a decrease of thiamine in the
nerves of the arms and legs of the individual
b. Clinical manifestations include prickling,
tingling, or a burning sensation in the fingers and
feet.
17. Diminished sexual desire
a. Initially increased in women and men, or at least
the perception of their performance is increased
b. Diminished sexual desire and potency is a
frequent complaint of chronic alcoholics.
18. Gynecomastia (enlargement of the breast area)
a. Can result in men due to the alcohol increasing
the amount of estrogen in the male
19. Atrophy of the testicles
20. Fetal alcohol syndrome
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a. Excessive maternal alcohol consumption during
pregnancy, which may cause one or more of the
following birth defects:
1) Small head, low weight, short body length, and
slow growth after birth
2) Narrowed eye slits
3) Underdeveloped facial structure
4) Flattened cheekbones
5) An abnormally thin upper lip
21. Sleep disturbances
a. During the sobering-up period, there is an
increase in rapid eye movements.
b. Restless sleep, along with vivid dreams or
nightmares, or both
c. Within weeks to months after cessation of the
alcohol, sleep may be restless, and there can be
frequent, yet unremembered, awakenings.
Nursing Interventions
1. Monitor the client every 2–4 hours to assess for
alcohol withdrawal.
2. If withdrawal clinical manifestations are
observed, instruct the client about the necessity for
detoxification.
3. Detoxify the client with a prescribed CNS
depressant.
4. Instruct the client regarding long-term effects of
alcohol usage.
5. Instruct the client about the consequences of
behavior, such as providing feedback regarding
liver function tests.
6. Provide intrapersonal skills training, such as
problem solving, coping skills, awareness and
management of negative self-talk, increasing
pleasant activities, and relaxation training.
7. Assist the client with interpersonal skills such as
starting conversations, assertiveness training,
nonverbal communication, how to refuse offers of
alcohol and drugs, and strengthening
social support networks.
Sedative-, Hypnotic-, or Anxiolytic-
Related Use Disorders
Sedative, Hypnotic, or Anxiolytic
 SUBSTANCE DISORDER
Abuse
Description: maladaptive pattern of sedative,
hypnotic, or anxiolytic use that causes significant
impairment in a number of areas, including job,
home life, and school
Assessment (See assessment section for alcohol
abuse)
Nursing interventions
a. Instruct the client regarding the necessity to
abstain from sedative-, hypnotic-, or anxiolytic-
induced disorders and other mood-altering
substances.
b. Encourage the client to attend Narcotics
Anonymous.
c. Inform the client and the family about the
medical consequences of long-term sedative,
hypnotic, or anxiolytic usage.
Sedative, Hypnotic, or Anxiolytic
Intoxication
Description
a. A sedative-, hypnotic-, or anxiolyticspecific
syndrome
b. Caused by recent ingestion of a sedative,
hypnotic, or anxiolytic because of its effect on the
CNS
c. Maladaptive psychological and behavioral
problems caused by the sedative, hypnotic, or
anxiolytic are experienced, such as mood lability,
belligerence, or impaired judgment.
d. Develops within the time period of the half-life
of the drug up to the halflife of the drug multiplied
by 5.
Assessment
a. One or more of the following clinical
manifestations occur shortly after
usage of the sedative, hypnotic, or
anxiolytic:
1) Nystagmus
2) Slurred speech
3) Impaired memory or attention
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4) Incoordination
5) Unsteady gait
6) Coma or stupor
3. Nursing interventions
a. Ensure safety of the client, such as
preventing falls.
b. Monitor the client’s vital signs.
c. Assess cardiac and respiratory status.
d. Assess neurological status by completing a
cranial nerve exam.
Sedative, Hypnotic, or Anxiolytic
Withdrawal
Description: a sedative-, hypnotic-, or
anxiolyticspecific syndrome with
clinical manifestations developing within several
hours to several days after prolonged usage
Assessment
a. Hyperactivity of the autonomic nervous system,
such as elevated pulse or diaphoresis
b. Nausea or vomiting
c. Anxiety
d. Psychomotor agitation
e. Increased hand tremors
f. Insomnia
g. Occasional auditory, visual, or tactile
hallucinations or illusions
3. Medical management
a. Administer a benzodiazepine, per detoxification
protocol, followed by tapered dosages.
b. Administer a barbiturate for detoxification if the
client is using and withdrawing from it.
Nursing interventions
a. Monitor vital signs every 4 hours.
b. Assess for clinical manifestations of
benzodiazepine or barbiturate withdrawal.
c. Provide comfort and management of the clinical
manifestations measures to reduce distress.
d. Encourage rest.
e. Provide adequate fluid and food intake.
 SUBSTANCE DISORDER
Sedative, Hypnotic, or Anxiolytic
Dependence
Description: development of tolerance and
physiological withdrawal clinical
manifestations due to maladaptive usage pattern
of sedative, hypnotic, or anxiolytic, leading to
significant distress or impairment on the job or in
social and interpersonal relationships
Assessment
a. Assessment occurs through a variety of methods:
1) Information received from the significant other,
family, coworkers, boss, or friends
b. Serum and urine drug screens
c. Criteria met based on the DSM-IV-TR
d. Presence of physiological dependence or
withdrawal clinical manifestations along with
increased or decreased tolerance for the substance
Medical management
a. Detoxify the client with a prescribed CNS
depressant in tapering dosages.
Nursing interventions
a. Monitor the client every 2–4 hours to assess for
sedative, hypnotic, or anxiolytic withdrawal.
b. If withdrawal clinical manifestations are
observed, instruct the client about the necessity for
detoxification.
c. Inform the client regarding the longterm effects
of sedative, hypnotic, or anxiolytic use.
d. Inform the client about the consequences of
chemical use, such as providing feedback about the
effect of chemical use on family relationships and
medical complications as a result of use.
e. Assist the client to develop interpersonal skills,
such as assertiveness training, skills in refusing
offers of chemicals, and strengthening social
support networks.
f. Inform the client regarding clinical manifestations
that could precipitate a relapse.
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Opioid (Narcotic) Use Disorders
OPIOID Abuse
Description
a. Maladaptive pattern of opioid use that causes
significant impairment in a number of areas,
including job, home life, or school
b. Includes drugs such as meperidine (Demerol),
morphine sulfate, hydromorphone (Dilaudid),
opium, and heroin
Assessment (See the assessment section for
alcohol abuse.)
3. Medical complications
a. Abscesses
b. Transmission of human immunodeficiency virus
(HIV) and hepatitis through the use of contaminated
needles by more than one person
c. Death from an overdose of an opiate or an opioid
is generally due to respiratory arrest from the
respiratory depressant effects of the drug.
Nursing interventions
a. Instruct the client to abstain from opioids and
other mood-altering substances.
b. Instruct the client regarding benefits of attending
Narcotics Anonymous meetings and participating in
recreational activities.
c. Instruct the client on socialization skills.
d. Instruct the client and family about the medical
consequences of long-term opioid use.
Opioid Intoxication
Description
a. An opioid-specific syndrome caused by recent
ingestion of an opioid
b. Maladaptive psychological and behavioral
problems caused by the opioid are experienced,
such as mood lability, belligerence, or impaired
judgment.
2. Assessment
a. Analgesia
b. Apathy
 SUBSTANCE DISORDER
c. Drooling 14) Rhinorrhea
d. Drowsiness 15) Sneezing
e. Euphoria 16) Vomiting
f. Flushing of skin 17) Yawning
g. Itching
h. Nodding Medical management
i. Peripheral vasodilation a. Administer clonidine (Catapres), an opioid
j. Slowed speech antagonist that assists in blocking the opioid
k. Spontaneous orgasm receptor sites to prevent or alleviate withdrawal
l. Respiratory depression clinical manifestations.
b. Administer a nonsteroidal anti-inflammatory
Nursing interventions medication p.r.n. to relieve discomfort or pain.
a. Promote a safe environment for the client. c. Administer antidiarrheal medication p.r.n.
b. Monitor vital signs.
c. Assess for respiratory depression. Nursing interventions
d. Administer naloxone (Narcan) as the antidote for a. The goal of opiate withdrawal treatment is to
an opioid overdose. focus on the alleviation of discomfort and to
e. Provide comfort measures based on clinical provide management of the clinical manifestations.
manifestations. b. Monitor vital signs.
c. Provide comfort measures.
d. Encourage warm whirlpool baths.
Opioid Withdrawal e. Provide the client with warm blankets to assist in
alleviating chills.
Description f. Provide reassurance to the client.
a. An opioid-specific syndrome that develops g. Promote adequate hydration.
within 24–62 hours after prolonged and heavy h. Provide interventions to alleviate nausea and
usage of an opioid vomiting.
b. Clinical manifestations generally subside after 5– i. Inform the client about the medical consequences
7 days. of opiate abuse.
2. Assessment
a. Three or more of the following clinical Opioid Dependence
manifestations develop within 24–72 hours after
prolonged and heavy use: Description
1) Abdominal spasms a. Maladaptive usage pattern of an opioid, leading
2) Anorexia, weight loss to significant distress or impairment
3) Chills b. Characterized by three or more of the following
4) Depression within 12 months of time:
5) Diarrhea 1) Tolerance to the opioid is developed or increased
6) Elevated temperature after smaller amounts are needed to achieve
7) Elevated pulse intoxication.
8) Flushing of the skin 2) Withdrawal clinical manifestations occur on
9) Gooseflesh discontinuation of usage of the opioid.
10) Irritability 3) Consumption of the same or a similar opioid is
11) Lacrimation necessary to relieve or avoid withdrawal
12) Lower back pain clinical manifestations.
13) Muscle cramps

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 SUBSTANCE DISORDER
4) Larger amounts of the opioid are consumed or 1) Use of amphetamines with needles
consumed over a longer period of time than was is associated with HIV, hepatitis, and
originally intended. the development of lung abscesses
5) There is a desire to cut down or control the and endocarditis (inflammation of
opioid intake with or without successful efforts to the lining of the heart).
do so. 2) Impotence and sexual
6) Large amounts of time are spent obtaining the dysfunctions can occur with
opioid. long-term use and high doses.
7) Opioid use causes an inability to fulfill important d. Medical complications due to
occupational, social, or recreational activities. cocaine abuse:
8) Opioid consumption continues, with disregard of 1) Acute dystonia, tics
knowledge of the physiological and psychological 2) Acquired immune deficiency
problems caused by the substance. syndrome (AIDS) from
IV cocaine use
Nursing interventions 3) Cardiac arrhythmias
a. Assess the client for opioid withdrawal. 4) Cerebral infarctions
b. Inform the client about opioid withdrawal. 5) Embolisms
c. Instruct the client about the importance of 6) Infection
attending Narcotics Anonymous. 7) Migrainelike headaches
d. Explore with the client alternatives to opioid use, 8) Myocardial infarctions
such as exercise. 9) Nasal congestion
e. Promote social support. 10) Transient ischemic attacks (TIAs)
f. Inform the client about medical complications 11) Respiratory depression
that may result from opioid use. 12) Seizures
g. Instruct the client regarding relapse prevention, 13) Ulceration of the nasal mucosa
such as behaviors and attitudes to be aware of that 2. Amphetamine and cocaine
may precipitate a relapse. intoxication
a. Description: amphetamine- and cocaine-specific
syndrome that occurs during, or shortly after, usage
Stimulant Use Disorders of amphetamine or cocaine

Assessment
Amphetamine and Cocaine Use 1) Increased sense of alertness
Disorders 2) Anxiety; psychomotor agitation or retardation
3) Blood pressure increase or decrease
1. Amphetamine and cocaine abuse 4) Cardiac arrhythmias
a. Description: maladaptive pattern of amphetamine 5) Chest pain
or cocaine use that causes significant impairment in 6) Chills or perspiration
a number of areas, including job, home life, or 7) Confusion
school 8) Diarrhea
9) Dyskinesias, dystonias, coma
10) Insomnia
Assessment (See the assessment 11) Muscular weakness
section for alcohol abuse.) 12) Nausea and vomiting
c. Medical complications due to 13) Panic attacks
amphetamine abuse: 14) Psychomotor agitation or Retardation

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 SUBSTANCE DISORDER
15) Pulse increase or decrease
16) Pupillary dilation
17) Respiratory depression
18) Decreased urine production
19) Weight loss
20) Clinical manifestations at toxic levels include
compulsive behaviors, hallucinations
(auditory, visual, tactile), hypertension, looseness of
associations, overly suspicious or paranoia,
preoccupation, and touching and picking of the
extremities and face.
c. Nursing interventions
1) Promote safety for the client.
2) Provide symptomatic comfort measures.
3) Manage clinical manifestations.
4) Instruct the client on sleep hygiene techniques.
5) Promote abstinence from amphetamines and
cocaine.
3. Amphetamine and cocaine withdrawal
a. Description: an amphetamine- and cocaine-
specific syndrome that develops during or shortly
after usage of either amphetamine or cocaine
b. Assessment
1) Depression
2) Drug craving
3) Fatigue
4) Increased appetite
5) Psychomotor agitation or retardation
6) Unpleasant, vivid dreams
c. Nursing interventions
1) Instruct the client on sleep hygiene measures.
2) Provide distraction technique to keep the client’s
mind off drug cravings.
3) Encourage a well-balanced diet.
4) Provide a quiet and nonstimulating environment
for the client.
4. Amphetamine and Cocaine Dependence
a. Description: maladaptive usage pattern of
amphetamine or cocaine, leading to significant
distress or impairment
b. Assessment
1) Characterized by three or more of the following
within 12 months of time:
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a) Tolerance to amphetamine or cocaine is
developed or increased and smaller amounts
are needed to achieve intoxication.
b) Withdrawal clinical manifestations occur on
discontinuation of usage of amphetamine or
cocaine.
c) Consumption of amphetamine or cocaine is
necessary to relieve or avoid withdrawal clinical
manifestations.
d) Larger amounts of amphetamine or cocaine are
consumed or consumed over a longer period
of time than was originally intended.
e) There may be a desire to cut down or control
amphetamine or cocaine intake with or without
successful efforts to do so.
f) Large amounts of time are spent obtaining
amphetamine or cocaine.
g) Amphetamine or cocaine use causes inability to
fulfil important occupational, social, or recreational
activities.
h) Amphetamine or cocaine consumption continues,
with disregard of knowledge of the physiological
and psychological problems caused by the
stimulant.
c. Nursing interventions
1) Assess the client for amphetamine or cocaine
intoxication and withdrawal.
2) Monitor vital signs.
3) Treat any respiratory or cardiac distress.
4) Perform a cranial nerve exam to assess
neurological functioning.
5) Orient the client, if needed, to surroundings.
6) Administer an antidiarrheal for diarrhea.
7) Provide comfort measures for nausea and
vomiting such as providing ice chips, cool cloth to
the back of the neck and forehead.
8) Provide adequate food and fluid intake.
9) Instruct the client regarding relapse prevention
and behaviors and attitudes that would indicate
a possible relapse.
10) Instruct the client about the medical
complications of amphetamine or cocaine
consumption and other negative consequences that
can result due to their use, such as impaired
social and interpersonal relationships.
 SUBSTANCE DISORDER
X. Caffeine Use Disorders a. Four or more of the following clinical
A. Caffeine Intoxication manifestations develop within 24 hours of nicotine
1. Description: caffeine-specific syndrome with use:
clinical manifestations developing after prolonged, 1) Agitation
heavy (in excess of 250 mg) consumption 2) Increased cravings for nicotine
of caffeine 3) Decreased concentration
4) Decreased judgment
2. Assessment 5) Decreased psychomotor performance
a. Clinical manifestations (five or more) that 6) Drowsiness
develop during or shortly after caffeine use:
1) Cardiac arrhythmias or tachycardia 7) GI disturbance
2) Diuresis 8) Increased appetite and weight gain
3) Endurance and energy 9) Labile emotions
4) Excitement 10) Mental dullness
5) Flushed face 11) Nervousness
6) Increased blood sugar 12) Sleep disturbance
7) Gastric reflux
8) Hand tremors 3. Medical management
9) Increased bowel motility a. Administer a nicotine patch or bupropion (Zyban)
10) Insomnia to manage withdrawal clinical manifestations.
11) Muscle twitching
12) Nervousness 4. Nursing interventions
13) Psychomotor agitation a. Instruct the client about the medical
14) Rambling of speech and thoughts complications of nicotine usage, such as bronchitis,
15) Ringing in the ears, flashes of light lung cancer, coronary disease, and obstructive
pulmonary disease.
3. Nursing interventions b. Instruct the client about the use of a nicotine
a. Instruct the client on the importance of patch or the use of bupropion (Zyban) for managing
abstinence or moderation of use of caffeine. withdrawal clinical manifestations.
b. If the client desires to cut down usage of caffeine, c. Assist the client in identifying triggers to nicotine
instruct the client to cut down gradually so as to use and explore alternative coping strategies.
decrease withdrawal clinical manifestations of d. Instruct the client on relaxation techniques such
fatigue, headaches, irritability, and tremulousness. as deep breathing and guided imagery.
c. Instruct the client on the medical complications
of prolonged excessive (more than 250 mg per day) B. Nicotine Dependence
usage of caffeine. 1. Description: tolerance to nicotine includes
d. Instruct the client to abstain from experiencing a greater effect of nicotine on
caffeine 12 hours prior to retiring to the first time it is used during the day and the
bed (caffeine has a 12-hour half-life). absence of nausea and dizziness after prolonged
usage.
XI. Nicotine Use Disorders 2. Assessment
a. Withdrawal clinical manifestations occur on
A. Nicotine Withdrawal discontinuation of usage of nicotine.
1. Description: clinical manifestations produced due b. Nicotine use is necessary to relieve or avoid
to the cessation of nicotine after its daily use withdrawal clinical manifestations.
2. Assessment

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 SUBSTANCE DISORDER
c. The supply of cigarettes is used up more quickly c. Inform the client and family about medical
than was intended. complications that can result from hallucinogen
d. Chain-smoking abuse.
e. Use of nicotine continues despite knowledge of
the physiological problems caused by the substance.
B. Hallucinogen Intoxication
3. Nursing interventions 1. Description
a. Inform the client on the medical complications of a. A hallucinogen-specific syndrome with
nicotine usage and the negative consequences of behavioral or psychological problems, or both, such
secondhand smoke to family members. as paranoia or impaired judgment, that results due
b. Inform the client of the benefits of smoking to recent hallucinogen use
cessation. b. Perceptual changes such as hallucinations and
c. Instruct the client on smoking cessation such as illusions occur shortly after hallucinogen use.
the use of a nicotine patch or bupropion (Zyban). 2. Assessment
d. Instruct the client on ways to distract self when a. Two or more of the following clinical
cravings for nicotine emerge, such as eating manifestations develop during or shortly after
sunflower seeds or carrot sticks and use of hallucinogen use:
relaxation techniques. 1) Labile affect
2) Anorexia
XII. Hallucinogen Use Disorders 3) Anxiety
4) Blurred vision
A. Hallucinogen Abuse 5) Body image changes
1. Description 6) Diaphoresis
a. Maladaptive pattern of hallucinogen use that 7) Dizziness
causes significant impairment in a number of areas, 8) Euphoria
including job, home life, or school 9) Floating feeling
b. Examples of hallucinogenics include lysergic 10) Hallucinations
acid diethylamide (LSD), psilocybine (from various 11) Hypertension
mushrooms), dimethyltryptamine (DMT), 12) Hyperthermia
mescaline, and peyote. 13) Incoordination
14) Nausea and vomiting
2. Assessment (See assessment 15) Palpitations
section for alcohol abuse.) 16) Paresthesia

3. Medical complications 17) Pupils, dilated

a. The effects are unique to each individual. 18) Suspiciousness
b. Mild or severe depression 19) Tachycardia
c. Flashbacks can occur at any time. 20) Tremors
d. Death can occur from toxic drug levels, suicide,
driving under the influence, and convulsions. 3. Nursing interventions
a. Educate the client on anxiety reduction.
4. Nursing interventions b. Talk calmly with the client.
a. Instruct the client to abstain from hallucinogen c. Reassure client safety.
use. d. Provide management of clinical manifestations.
b. Encourage the client to participate in a 12–step C. Hallucinogen-Persisting Perception Disorder
program. (Flashbacks)

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 SUBSTANCE DISORDER
1. Description: characterized by occasional
recurrence of perceptual disturbances
reminiscent of those experienced during one or
more previous hallucinogen intoxications
2. Assessment
a. Reexperiencing of one or more perceptual
disturbances experienced during previous
hallucinogen intoxications, such as trails of images
of moving objects, halos, and flashes of color
b. The clinical manifestations create significant
distress or impairment in relational, occupational,
social, and other areas of functioning.
3. Nursing interventions
a. Ensure safety of the client.
b. Provide reassurance to the client.
c. Assist the client with reducing anxiety, such as
through decreased lighting and environmental
stimuli and deep-breathing techniques.
XIII. Cannabis (Marijuana) Use Disorders
A. Cannabis Abuse
1. Description: maladaptive pattern of cannabis use
that causes significant impairment in a number of
areas, including job, home life, or school
2. Assessment (See assessment section for alcohol
abuse.)
3. Medical complications
a. Cerebral atrophy
b. Susceptibility to seizures
c. Birth defects
d. Chromosomal damage
e. Alterations in concentrations of testosterone
f. Disruption in the menstrual cycle
g. Impaired immune system
4. Nursing interventions
a. Instruct the client regarding the physical, social,
and legal effects of cannabis use.
b. Inform the client about the benefits of cessation.
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c. Encourage the client to attend 12–step group
meetings.
B. Cannabis Intoxication
1. Description: a cannabis-specific syndrome that
creates behavioral and psychological changes
caused by recent ingestion of cannabis
2. Assessment
a. Urine drug screens can be positive for cannabis
for 7–10 days after use.
b. Heavy use of cannabis can be detected in urine
for up to 2–4 weeks.
c. Anxiety
d. Conjunctival injection
e. Dry mouth
f. Euphoria
g. Impaired judgment
h. Impaired motor coordination
i. Increased appetite
j. Sensation of slowed time
k. Social withdrawal
l. Tachycardia
3. Nursing interventions
a. Promote environmental safety.
b. Provide adequate hydration and nutrition.
c. Encourage rest.
d. Encourage use of relaxation techniques, if
needed, such as deep breathing and listening to
soothing music.
C . Cannabis Dependence
1. Description: maladaptive psychological and
behavioural problems caused by cannabis
are experienced, such as euphoria, social
withdrawal, and impaired motor coordination.
2. Assessment
a. Compulsive use of cannabis
b. Decreasing or giving up important occupational,
recreational, or social activities in order to use
cannabis
c. Larger amounts of the drug are taken and for
longer amounts of time than was originally planned.
d. Large amounts of time spent using
and recovering from the effects of the substance
 SUBSTANCE DISORDER
e. Substance use continues despite knowledge of
physical and psychological problems that can result
from its use.
f. There may be a desire to cut down or control
cannabis intake with or without successful efforts to
do so.
3. Nursing interventions
a. Encourage participation in a 12–step
program.
b. Explore with the client relapse triggers and
coping strategies to manage those triggers.
c. Provide interpersonal skills training, such as
problem solving, coping skills, awareness and
management of negative self-talk, increasing
pleasant activities, and relaxation training.
d. Provide education on interpersonal skills, such as
starting conversations, assertiveness training,
nonverbal communication, refusing offers of
alcohol and drugs, and strengthening social support
networks.
e. Encourage the use of relaxation techniques such
as deep breathing and listening to soothing music.
originally planned.
e. Large amounts of time are spent using and
recovering from the effects of inhalant and
phencyclidine use.
f. Substance use continues despite knowledge of
physical and psychological problems that can
result from its use.
3. Medical complications
a. Death can occur from respiratory depression,
cardiac irregularity, asphyxiation, the aspiration of
vomitus, or accident or injury such as driving while
intoxicated.
b. Irreversible liver or kidney damage and
permanent muscle damage
c. Seizures
d. Coma
4. Nursing interventions
a. Encourage abstinence from inhalant use.
b. Inform the client about medical complications
that can result due to inhalant abuse.
c. Encourage participation in Narcotics Anonymous
12–step program.

XIV. Inhalant and Phencyclidine Use B. Inhalant Intoxication

Disorders 1. Description: an inhalant-specific syndrome with
A. Inhalant and Phencyclidine Abuse behavioral or psychological problems, or
1. Description both, such as assaultiveness, impaired judgment, or
a. Maladaptive pattern of inhalant and paranoia, that result due to recent inhalant use
phencyclidine use that causes significant 2. Assessment
impairment in a number of areas, including job, a. Two or more of the following clinical
home life, or school manifestations develop during or shortly after
b. Examples of inhalants include gasoline, glue, inhalant use:
adhesives, rubber cement, lighter fluid, paint 1) Blurred vision or diplopia
thinners, varnish, typewriter correction fluid, 2) Dizziness
and spray can propellants. 3) Euphoria
4) Incoordination
2. Assessment 5) Lethargy
a. Job or school performance is negatively 6) Muscle weakness, generalized
impacted. 7) Nystagmus
b. Interpersonal and social problems due to inhalant 8) Psychomotor retardation
abuse, such as fights with significant others 9) Reflexes, depressed
c. Decreasing or giving up important occupational, 10) Slurred speech
recreational, or social activities 11) Stupor or coma
d. Larger amounts of the inhalant and phencyclidine 12) Tremor
are taken and for longer amounts of time than was 13) Unsteady gait

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 SUBSTANCE DISORDER
3. Nursing interventions
a. Provide for environmental safety.
b. Perform a neurological assessment, including a
cranial nerve exam.
C. Phencyclidine Intoxication
1. Description: a phencyclidinespecific syndrome
with behavioral or psychological problems, or both,
such as assaultiveness, impaired judgment, or
paranoia, that results due to recent phencyclidine
use
2. Assessment
a. Within 1 hour or less if inhaled, two or more of
the following clinical manifestations develop:
1) Ataxia
2) Dysarthria
3) Horizontal or vertical nystagmus
4) Hypercusis
5) Hypertension
6) Muscle rigidity
7) Numbness or decreased pain response
8) Seizures or coma
9) Tachycardia
3. Nursing interventions (See nursing interventions
section for inhalant intoxication.)
D. Inhalant Dependence and Phencyclidine
Dependence
1. Description: maladaptive usage pattern of an
inhalant or phencyclidine that leads to
significant distress or impairment in the client’s
occupation, interpersonal, and social life
2. Assessment
a. Larger amounts of the inhalant or phencyclidine
are consumed or are consumed over a longer period
of time than was originally intended.
b. There may be a desire to cut down or control
inhalant or phencyclidine intake with or without
successful efforts to do so.
c. Large amounts of time are spent using the
substance along with experiencing the effects.
d. Inhalant and phencyclidine use causes an
inability to perform important occupational, social,
or recreational activities.
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e. Inhalant or phencyclidine consumption continues,
with disregard of knowledge of the physiological
and psychological problems caused by the
substance.
3. Nursing interventions
a. Assess the client for amphetamine intoxication.
b. Ensure the client’s safety such as preventing falls
due to incoordination, muscle weakness,
psychomotor retardation, and unsteady gait.
c. Instruct the client about negative consequences of
inhalant or phencyclidine consumption, such as
impaired social and interpersonal relationships and
physical and psychological problems.
d. Inform the client about methods of relapse
prevention.
XV. Impaired Nurses
A. Description
1. Licensed practical or registered nurses who abuse
drugs illegally obtained from the work environment
2. Results in suspension or revocation of nursing
license and may result in a jail term
3. Places clients at risk for unsafe care being
delivered
4. May be the result of increased stressors in the
nurse’s life and the easy access to a wide variety of
drugs
B. Assessment
1. Narcotic count being wrong when checked
2. Client fails to report a decrease in pain after
supposedly receiving pain medication.
3. Poor judgment
4. Inability to concentrate
5. Frequently reporting to work late or repeated
absences
6. Alcohol breath
C. Nursing Interventions
1. It is the responsibility of a coworker to report a
nurse who is suspected of stealing drugs from the
nursing unit.
2. Keep and check the narcotic count at the end of
every shift.
3. Document the impaired nurse’s behavior.
 SUBSTANCE DISORDER
4. Realize that the impaired nurse may deny being
impaired.
5. Offer support to the impaired Nurse

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