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 bodys 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.
Symptoms of Alcoholism
The term alcoholic refers to a person who suffers from alcoholism. Alcoholism is the
chronic, severe illness characterized by four key symptoms:
* Craving strong need to have alcohol
* Loss of control an inability to cease drinking, no control of the situation
* Physical dependence withdrawal symptoms when alcohol is not drunk which
includes nausea and vomiting
* Tolerance more alcohol required to meet cravings and to get drunk

TYPES of ALCOHOLISM:
Each of the alcoholic subtypes determined by the NIAA research has its own distinct
characteristics, drinking behaviours and risk factors. The five subtypes of alcoholics that
the NIAAA study found are:
* The young adult subtype largest group and yet the least likely to seek help for their
problems with alcohol
* The young antisocial subtype tend to be in their mid-twenties and can be
categorized by early onset of drinking and alcohol related problems, often have
depression or other mental health issues.
* Functional subtype Usually middle aged, educated and employed
* Intermediate familial subtype Typically middle aged and come from families with
mult-generational alcoholism
* Chronic severe subtype Smallest subtype and can be defined as those who have

multi-generational alcoholism in their family, have high rates of personality disorders

and other mental health issues plus significant substance abuse issues
REFERENCE: http://alcoholrehab.com/alcoholism/five-types-of-alcoholics/

Diagnostic Studies

Blood alcohol/drug levels: Alcohol level may/may not be severely elevated,

depending on amount consumed, time between consumption and testing, and the
degree of tolerance, which varies widely. In the absence of elevated alcohol
tolerance, blood levels in excess of 100 mg/dL are associated with ataxia; at 200
mg/dL the patient is drowsy and confused; respiratory depression occurs with blood
levels of 400 mg/dL and death is possible. In addition to alcohol, numerous
controlled substances may be identified in a poly-drug screen, e.g., amphetamine,
cocaine, morphine, Percodan, Quaalude.

CBC: Decreased Hb/Hct may reflect such problems as iron-deficiency anemia or

acute/chronic GI bleeding. WBC count may be increased with infection or
decreased if immunosuppressed.

Glucose/Ketones: Hyperglycemia/hypoglycemia may be present, related to

pancreatitis, malnutrition, or depletion of liver glycogen stores. Ketoacidosis may be
present with/without metabolic acidosis.

Electrolytes: Hypokalemia and hypomagnesemia are common.

Liver function tests: LDH, AST, ALT, and amylase may be elevated, reflecting
liver or pancreatic damage.

Nutritional tests: Albumin is low and total protein may be decreased. Vitamin
deficiencies are usually present, reflecting malnutrition/malabsorption.

Other screening studies (e.g., hepatitis, HIV, TB): Depend on general

condition, individual risk factors, and care setting.

Urinalysis: Infection may be identified; ketones may be present, related to

breakdown of fatty acids in malnutrition (pseudodiabetic condition).

Chest x-ray: May reveal right lower lobe pneumonia (malnutrition, depressed
immune system, aspiration) or chronic lung disorders associated with tobacco use.

ECG: Dysrhythmias, cardiomyopathies, and/or ischemia may be present

because of direct effect of alcohol on the cardiac muscle and/or conduction system,
as well as effects of electrolyte imbalance.

Addiction Severity Index (ASI): An assessment tool that produces a problem

severity profile of the patient, including chemical, medical, psychological, legal,
family/social, and employment/support aspects, indicating areas of treatment
needs.

Ref: http://nurseslabs.com/5-alcohol-withdrawal-nursing-care-plans/

Medical Management for alcoholism

Treatment for alcoholism can begin only when the alcoholic accepts that the problem
exists and agrees to stop drinking. He or she must understand that alcoholism is
curable and must be motivated to change. Treatment has three stages:
1.

Detoxification (detox): This may be needed immediately after discontinuing

alcohol use and can be a medical emergency, as detox can result in withdrawal
seizures, hallucinations, delirium tremens (DT), and in some cases may result in death.

2.

Rehabilitation: This involves counseling and medications to give the recovering

alcoholic the skills needed for maintaining sobriety. This step in treatment can be done
inpatient or outpatient. Both are equally effective.

3.

Maintenance of sobriety: This step's success requires an alcoholic to be selfdriven. The key to maintenance is support, which often includes regular Alcoholics
Anonymous (AA) meetings and getting a sponsor.
There are several medicines used to help people in recovery from alcoholism
maintain abstinence and sobriety.

One drug, disulfiram may be used once the detox phase is complete and the
person is abstinent. It interferes with alcohol metabolism so that drinking a small
amount will cause nausea, vomiting, blurred vision, confusion, and breathing
difficulty. This medication is most appropriate for alcoholics who are highly motivated
to stop drinking or whose medication use is supervised, because the drug does not
affect the motivation to drink.
Another medicine, naltrexone, reduces the craving for alcohol. Naltrexone can be
given even if the individual is still drinking; however, as with all medications used to
treat alcoholism, it is recommended as part of a comprehensive program that
teaches patients new coping skills. It is now available as a long-acting injection that
can be given on a monthly basis.
Acamprosate is another medicine that has been FDA-approved to reduce alcohol
craving.
Finally, research suggests that the anti-seizure medicines topiramate and
gabapentin may be of value in reducing craving or anxiety during recovery from
drinking, although neither of these drugs is FDA-approved for the treatment of
alcoholism.
Antidepressants may be used to control any underlying or resulting anxiety or
depression, but because those symptoms may disappear with abstinence, the
medications are usually not started until after detox is complete and there has been
some period of abstinence.
Campral taken by mouth three times daily, acts on chemical messenger systems in
the brain. It appears to reduce the symptoms that alcoholics may experience when
they abstain from booze over long periods. These symptoms can
include insomnia, anxiety, restlessness, and unpleasant changes in mood that could
lead to relapse. In European clinical trials and in pooled data from several studies,
Campral increased the proportion of alcoholics who were able to refrain from
drinking for several weeks or months.
According to Weiss, at least three forms of psychosocial therapy have been shown to
be effective at treating alcoholism, with roughly similar success rates. These include:

Cognitive behavioral therapy, a form of psychotherapy focusing on identifying

and modifying negative thoughts and thought patterns.

12-step facilitation, in which patients are encouraged to enter 12-step programs

such Alcoholics Anonymous.

Motivational enhancement therapy, a patient-centered approach in which
counselors try to get patients to think about and express their motivations for change
and to develop a personal plan that can help them make the necessary changes.
Retrieved from: Understanding Alcohol Abuse Treatment(2015).
http://www.webmd.com/mental-health/addiction/understanding-alcohol-abusetreatment?page=2

Nursing management
1. Denial
Nursing Diagnosis

Denial

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 impact of

condition on life pattern; projection of blame/responsibility for problems

Use of manipulation to avoid responsibility for self

Desired Outcomes

Verbalize awareness of relationship of substance abuse to current situation.

Engage in therapeutic program.

Verbalize acceptance of responsibility for own behavior.

Nursing Interventions

Rationale

Ascertain by what name patient would like to be

Shows courtesy and respect, giving patient a

addressed.

sense of orientation and control.

Convey attitude of acceptance, separating

Promotes feelings of dignity and self-worth.

individual from unacceptable behavior.

Ascertain reason for beginning abstinence,

Provides insight into patients willingness to

involvement in therapy.

commit to long-term behavioral change, and

whether patient even believes that he or she can
change. (Denial is one of the strongest and most
resistant symptoms of substance abuse.)

Nursing Interventions

Rationale

Review definition of drug dependence and

This information helps patient make decisions

categories of symptoms (patterns of use,

regarding acceptance of problem and treatment

impairment caused by use, tolerance to

choices.

substance).

Answer questions honestly and provide factual

Creates trust, which is the basis of the therapeutic

information. Keep your word when agreements

relationship.

are made.

Provide information about addictive use versus

Progression of use continuum is from

experimental, occasional use; biochemical or

experimental or recreational to addictive use.

genetic disorder theory (genetic predisposition;

Comprehending this process is important in

use activated by environment; compulsive desire.)

combating denial. Education may relieve patients

guilt and blame and may help awareness of
recurring addictive characteristics.

Discuss current life situation and impact of

First step in decreasing use of denial is for patient

substance use.

to see the relationship between substance use

and personal problems.

Confront and examine denial and rationalization

Because denial is the major defense mechanism

in peer group. Use confrontation with caring.

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. Caring attitude preserves selfconcept and helps decrease defensive response.

Provide information regarding effects of addiction

Individuals often mistake effects of addiction and

Nursing Interventions

Rationale

on mood and personality.

use this to justify or excuse drug use.

Remain nonjudgmental. Be alert to changes in

Confrontation can lead to increased agitation,

behavior, (restlessness, increased tension).

which may compromise safety of patient and staff.

Provide positive feedback for expressing

Necessary to enhance self-esteem and to

awareness of denial in self and others.

reinforce insight into behavior.

Maintain firm expectation that patient attend

Attendance is related to admitting need for help,

recovery support and therapy groups regularly.

to working with denial, and for maintenance of a

long-term drug-free existence.

Encourage and support patients taking

Denial can be replaced with positive action when

responsibility for own recovery (development of

patient accepts the reality of own responsibility.

alternative behaviors to drug urge and use).

Assist patient to learn own responsibility for
recovering.

Encourage family members to seek help whether

To assist the patient deal appropriately with the

or not the abuser seeks it.

situation.

2. Ineffective Individual Coping

Nursing Diagnosis

Ineffective Individual Coping

May be related to

Personal vulnerability

Negative role modeling; inadequate support systems

Previous ineffective/inadequate coping skills with substitution of drug(s)

Possibly evidenced by

Impaired adaptive behavior and problem-solving skills

Decreased ability to handle stress of illness/hospitalization

Financial affairs in disarray, employment difficulties (e.g., losing time on job/not

maintaining steady employment; poor work performances, on-the-job injuries)

Verbalization of inability to cope/ask for help

Desired Outcomes

Identify ineffective coping behaviors/consequences, including use of substances

as a method of coping.

Use effective coping skills/problem solving.

Initiate necessary lifestyle changes.

Nursing Interventions

Rationale

Review program rules, philosophy expectations.

Having information provides opportunity for

patient to cooperate and function as a member of
the group or milieu, enhancing sense of control
and sense of success.

Determine understanding of current situation,

Provides information about degree of denial,

previous, and other methods of coping with lifes

acceptance of personal responsibility and

problems.

commitment to change; identifies coping skills

Nursing Interventions

Rationale
that may be used in present situation.

Set limits and confront efforts to get caregiver to

Patient has learned manipulative behavior

grant special privileges, making excuses for not

throughout life and needs to learn a new way of

following through on behaviors agreed on, and

getting needs met. Following through on

attempting to continue drug use.

consequences of failure to maintain limits can

help the patient to change ineffective behaviors.

Be aware of staff attitudes, feelings, and enabling

Lack of understanding, judgmental or enabling

behaviors.

behaviors can result in inaccurate data collection

and non-therapeutic approaches.

Encourage verbalization of feelings, fears, and

May help patient begin to come to terms with

anxiety.

long-unresolved issues.

Based on standard hospital policy, institute

To avoid suicide attempts

appropriate measures.

Explore alternative coping strategies.

Patient may have little or no knowledge of

adaptive responses to stress and needs to learn
other options for managing time, feelings, and
relationships without drugs.

Assist patient to learn and encourage use of

Helps patient relax, develop new ways to deal

relaxation skills, guided imagery, visualizations.

with stress, problem-solve.

Structure diversional activity that relates to

Discovery of alternative methods of coping with

recovery (social activity within support group),

drug hunger can remind patient that addiction is a

Nursing Interventions

Rationale

wherein issues of being chemically free are

lifelong process and opportunity for changing

examined.

patterns is available.

Use peer support to examine ways of coping with

Self-help groups are valuable for learning and

drug hunger.

promoting abstinence in each member, using

understanding and support as well as peer
pressure.

Use peer support to examine ways of coping with

Self-help groups are valuable for learning and

drug binges.

promoting abstinence in each member, using

understanding, support, and peer pressure.

Encourage involvement in therapeutic writing.

Therapeutic writing or journaling can enhance

Have patient begin journaling or writing

participation in treatment; serves as a release for

autobiography.

grief, anger, and stress; provides a useful tool for

monitoring patients safety; and can be used to
evaluate patients progress. Autobiographical
activity provides an opportunity for patient to
remember and identify sequence of events in his
or her life that relate to current situation.

Discuss patients plans for living without drugs

Provide opportunity to develop and refine plans.

Devising a comprehensive strategy for avoiding
relapses helps patient into maintenance phase of
behavioral change.

Administer medications as indicated:

Nursing Interventions

Rationale

Disulfiram (Antabuse);

This drug can be helpful in maintaining

abstinence from alcohol while other therapy is
undertaken. By inhibiting alcohol oxidation, the
drug leads to an accumulation of acetaldehyde
with a highly unpleasant reaction if alcohol is
consumed.

Acamprosate;

Helps prevent relapses in alcoholism by lowering

receptors for the excitatory neurotransmitter
glutamate. This agent may become drug of choice
because it does not make the user sick if alcohol
is consumed; it has no sedative, antianxiety,
muscle relaxant, or antidepressant properties and
produces no withdrawal symptoms.

Methadone (Dolophine);

This drug is thought to blunt the craving

or diminish the effects of opioids and is used to
assist in withdrawal and long-term maintenance
programs. It can allow the individual to maintain
daily activities and ultimately withdraw from drug
use.

Naltrexone (Trexan), nalmefine (Revex).

Used to suppress craving for opioids and may

help prevent relapse in the patient abusing
alcohol. Current research suggests that
naltrexone suppresses urge to continue drinking
by interfering with alcohol-induced release of
endorphins.

Nursing Interventions

Rationale

Encourage involvement with self-help

Puts patient in direct contact with support system

associations ( Alcoholics, Narcotics Anonymous).

necessary for managing sobriety and drug-free

life.

Maintain a quiet, safe environment during

Excessive noise may agitate the patient.

withdrawal from any drug.

Remove harmful objects from the patients room.

To prevent the patient from harm

Use restraints ONLY if you think the patient may

To promote safety

harm himself or herself and others.

Provide safe, non threatening environment.

Encourages patient to talk freely without fear of

judgment.

3. Powerlessness

Powerlessness

May be related to

Substance addiction with/without periods of abstinence

Episodic compulsive indulgence; attempts at recovery

Lifestyle of helplessness

Possibly evidenced by

Ineffective recovery attempts; statements of inability to stop behavior/requests for

help

Continuous/constant thinking about drug and/or obtaining drug

Alteration in personal, occupational, and social life

Desired Outcomes

Admit inability to control drug habit, surrender to powerlessness over addiction.

Verbalize acceptance of need for treatment and awareness that willpower alone
cannot control abstinence.

Engage in peer support.

Demonstrate active participation in program.

Regain and maintain healthy state with a drug-free lifestyle.

Nursing Interventions

Rationale

Use crisis intervention techniques to initiate

Patient is more amenable to acceptance of need

behavior changes:

for treatment at this time.

Assist patient to recognize problem exists.

In the precontemplation phase, the patient has

Discuss in a caring, nonjudgmental manner how

not yet identified that drug use is problematic.

drug has interfered with life;

While patient is hurting, it is easier to admit

substance use has created negative
consequences.

Involve patient in development of treatment plan,

During the contemplation phase, the patient

using problem-solving process in which patient

realizes a problem exists and is thinking about a

identifies goals for change and agrees to desired

change of behavior. The patient is committed to

outcomes;

the outcomes when the decision-making process

involves solutions that are promulgated by the
individual.

Discuss alternative solutions;

Brainstorming helps creatively identify possibilities

Nursing Interventions

Rationale
and provides sense of control. During the
preparation phase, minor action may be taken as
individual organizes resources for definitive
change.

Assist in selecting most appropriate alternative;

As possibilities are discussed, the most useful

solution becomes clear.

Support decision and implementation of selected

Helps the patient persevere in process of change.

alternative(s).

During the action phase, the patient engages in a

sustained effort to maintain sobriety, and
mechanisms are put in place to support
abstinence.

Explore support in peer group. Encourage sharing

Patient may need assistance in expressing self,

about drug hunger, situations that increase the

speaking about powerlessness, admitting need

desire to indulge, ways that substance has

for help in order to face up to problem and begin

influenced life.

resolution.

Assist patient to learn ways to enhance health

Learning to empower self in constructive areas

and structure healthy diversion from drug use

can strengthen ability to continue recovery. These

(maintaining a balanced diet, getting adequate

activities help restore natural biochemical

rest, exercise [walking, slow or long distance

balance, aid detoxification, and manage stress,

running]; and acupuncture, biofeedback, deep

anxiety, use of free time. These diversions can

meditative techniques).

increase self-confidence, thereby improving selfesteem.Note: Exercise promotes release of

endorphins, creating a feeling of well-being.

Nursing Interventions

Rationale

Provide information regarding understanding of

Understanding these concepts can help the

human behavior and interactions with others

patient to begin to deal with past problems or

(transactional analysis).

losses and prevent repeating ineffective coping

behaviors and self-fulfilling prophecies.

Assist patient in self-examination of spirituality,

Although not mandatory for recovery,

faith.

surrendering to and faith in a power greater than

oneself has been found to be effective for many
individuals in substance recovery; may decrease
sense of powerlessness.

Instruct in and role-play assertive communication

Effective in helping refrain from use, to stop

skills.

contact with users and dealers, to build healthy

relationships, regain control of own life.

Provide treatment information on an ongoing

Helps patient know what to expect, and creates

basis.

opportunity for patient to be a part of what is

happening and make informed choices about
participation and outcomes.

4. Altered Nutrition
Nursing Diagnosis

Nutrition: altered, less than body requirements

May be related to

Insufficient dietary intake to meet metabolic needs for psychological,

physiological, or economic reasons

Possibly evidenced by

Weight loss; weight below norm for height/body build; decreased subcutaneous
fat/muscle mass

Reported altered taste sensation; lack of interest in food

Poor muscle tone

Sore, inflamed buccal cavity

Laboratory evidence of protein/vitamin deficiencies

Desired Outcomes

Demonstrate progressive weight gain toward goal with normalization of

laboratory values and absence of signs of malnutrition.

Verbalize understanding of effects of substance abuse, reduced dietary intake on

nutritional status.

Demonstrate behaviors, lifestyle changes to regain and maintain appropriate

weight.

Nursing Interventions

Rationale

Monitor the patients nutritional intake.

To promote adequate nutrition

Assess height and weight, age, body build,

Provides information about individual on which to

strength, activity and rest level. Note condition of

base caloric needs and dietary plan. Type of diet

oral cavity.

or foods may be affected by condition of mucous

membranes and teeth.

Take anthropometric measurements (triceps

Calculates subcutaneous fat and muscle mass to

skinfold, when available).

aid in determining dietary needs.

Note total daily calorie intake; maintain a diary of

Information will help identify nutritional needs and

Nursing Interventions

Rationale

intake, as well as times and patterns of eating.

deficiencies.

Evaluate energy expenditure (pacing or

Activity level affects nutritional needs. Exercise

sedentary), and establish an individualized

enhances muscle tone, may stimulate appetite.

exercise program.

Provide opportunity to choose foods and snacks

Enhances participation or sense of control, may

to meet dietary plan.

promote resolution of nutritional deficiencies, and

helps evaluate patients understanding of dietary
teaching.

Recommend monitoring weight weekly.

Provides information regarding effectiveness of

dietary plan.

Consult with dietitian.

Useful in establishing individual dietary needs and

plan and provides additional resource for learning.

Review laboratory studies as indicated, (glucose,

Identifies anemias, electrolyte imbalances, and

serum albumin and prealbumin, electrolytes).

other abnormalities that may be present, requiring

specific therapy.

Refer for dental consultation as necessary.

Teeth are essential to good nutritional intake and

dental hygiene and care is often a neglected area
in this population.

5. Low Self-Esteem
Nursing Diagnosis

Low Self-Esteem

May be related to

Social stigma attached to substance abuse, expectation that one controls

behavior

Negative role models; abuse/neglect, dysfunctional family system

Life choices perpetuating failure; situational crisis with loss of control over life
events

Biochemical body change (e.g., withdrawal from alcohol/other drugs)

Possibly evidenced by

Self-negating verbalization, expressions of shame/guilt

Evaluation of self as unable to deal with events, confusion about self, purpose or
direction in life

Rationalizing away/rejecting positive feedback about self

Desired Outcomes

Identify feelings and underlying dynamics for negative perception of self.

Verbalize acceptance of self as is and an increased sense of self-worth.

Set goals and participate in realistic planning for lifestyle changes necessary to
live without drugs.

Nursing Interventions

Rationale

Provide opportunity for and encourage

Patient often has difficulty expressing self, even

verbalization and discussion of individual

more difficulty accepting the degree of importance

situation.

substance has assumed in life and its relationship

Nursing Interventions

Rationale

to present situation.

Assess mental status. Note presence of other

Many patients use substances in an attempt to

psychiatric disorders (dual diagnosis).

obtain relief from depression or anxiety, which

may predate use and be the result of substance
use. Approximately 60% of substance-dependent
patients have underlying psychological problems,
and treatment for both is imperative to achieve
and maintain abstinence.

Spend time with patient. Discuss patients

The nurses presence conveys acceptance of the

behavior and use of substance in a

individual as a worthwhile person. Discussion

nonjudgmental way.

provides opportunity for insight into the problems

abuse has created for the patient.

Provide reinforcement for positive actions and

Failure and lack of self-esteem have been

encourage patient to accept this input.

problems for this patient, who needs to learn to

accept self as an individual with positive
attributes.

Observe family interactions and SO dynamics and

Substance abuse is a family disease, and how the

level of support.

members act and react to the patients behavior

affects the course of the disease and how patient
sees self. Many unconsciously become
enablers, helping the individual to cover up the
consequences of the abuse. (Refer to ND: Family
Processes, altered: alcoholism, following.)

Nursing Interventions

Rationale

Encourage expression of feelings of guilt, shame,

The patient often has lost respect for self and

and anger.

believes that the situation is hopeless. Expression

of these feelings helps the patient begin to accept
responsibility for self and take steps to make
changes.

Help the patient acknowledge that substance use

When drugs can no longer be blamed for the

is the problem and that problems can be dealt

problems that exist, the patient can begin to deal

with without the use of drugs. Confront the use of

with the problems and live without substance use.

defenses (denial, projection, rationalization).

Confrontation helps the patient accept the reality

of the problems as they exist.

Ask the patient to list and review past

There are things in everyones life that have been

accomplishments and positive happenings.

successful. Often when self-esteem is low, it is

difficult to remember these successes or to view
them as successes.

Use techniques of role rehearsal.

Assists patient to practice developing skills to

cope with new role as a person who no longer
uses or needs drugs to handle lifes problems.

Involve patient in group therapy.

Group sharing helps encourage verbalization

because other members of group are in various
stages of abstinence from drugs and can address
the patients concerns and denial. The patient can
gain new skills, hope, and a sense of family and
community from group participation.

Nursing Interventions

Rationale

Formulate plan to treat other mental illness

Patients who seek relief for other mental health

problems.

problems through drugs will continue to do so

once discharged. Both the substance use and the
mental health problems need to be treated
together to maximize abstinence potential.

Administer antipsychotic medications as

Prolonged and profound psychosis following LSD

necessary.

or PCP use can be treated with these drugs

because it is probably the result of an underlying
functional psychosis that has now
emerged. Note: Avoid the use of phenothiazines
because they may decrease seizure threshold
and cause hypotension in the presence of LSD or
PCP use.

6. Altered Family Process

Nursing Diagnosis

Family Processes, altered: alcoholism [substance abuse]

May be related to

Abuse of substance(s); resistance to treatment

Family history of substance abuse

Addictive personality

Inadequate coping skills, lack of problem-solving skills

Possibly evidenced by

Anxiety; anger/suppressed rage; shame and embarrassment

Emotional isolation/loneliness; vulnerability; repressed emotions

Disturbed family dynamics; closed communication systems, ineffective spousal

communication and marital problems

Altered role function/disruption of family roles

Manipulation; dependency; criticizing; rationalization/denial of problems

Enabling to maintain drinking (substance abuse); refusal to get help/inability to

accept and receive help appropriately

Desired Outcomes

Verbalize understanding of dynamics of enabling behaviors.

Participate in individual family programs.

Identify ineffective coping behaviors and consequences.

Initiate and plan for necessary lifestyle changes.

Take action to change self-destructive behaviors/alter behaviors that contribute to

partners/SOs addiction.

Nursing Interventions

Rationale

Review family history; explore roles of family

Determines areas for focus, potential for change.

members, circumstances involving drug use,

strengths, areas for growth.

Explore how the SO has coped with the patients

The person who enables also suffers from the

habit, (denial, repression, rationalization, hurt,

same feelings as the patient and uses ineffective

loneliness, projection).

methods for dealing with the situation,

necessitating help in learning new and effective
coping skills.

Determine understanding of current situation and

Provides information on which to base present

Nursing Interventions

Rationale

previous methods of coping with lifes problems.

plan of care.

Assess current level of functioning of family

Affects individuals ability to cope with situation.

members.

Determine extent of enabling behaviors being

Enabling is doing for the patient what he or she

evidenced by family members; explore with each

needs to do for self (rescuing). People want to be

individual and patient.

helpful and do not want to feel powerless to help

their loved one stop substance use and change
the behavior that is so destructive. However, the
substance abuser often relies on others to cover
up own inability to cope with daily responsibilities.

Provide information about enabling behavior,

Awareness and knowledge of behaviors (avoiding

addictive disease characteristics for both user and

and shielding, taking over responsibilities,

nonuser.

rationalizing, and subserving) provide opportunity

for individuals to begin the process of change.

Identify and discuss sabotage behaviors of family

Even though family member(s) may verbalize a

members.

desire for the individual to become substancefree, the reality of interactive dynamics is that they
may unconsciously not want the individual to
recover because this would affect the family
member(s) own role in the relationship.
Additionally, they may receive sympathy and
attention from others (secondary gain).

Encourage participation in therapeutic

Serves as a release for feelings (anger, grief,

Nursing Interventions

Rationale

writing such as journaling (narrative), guided or

stress); helps move individuals forward in

focused.

treatment process.

Provide factual information to patient and family

Many patients and SOs are not aware of the

about the effects of addictive behaviors on the

nature of addiction. If patient is using legally

family and what to expect after discharge.

obtained drugs, he or she may believe this does

not constitute abuse.

Encourage family members to be aware of their

When the enabling family members become

own feelings, look at the situation with perspective

aware of their own actions that perpetuate the

and objectivity. They can ask themselves: Am I

addicts problems, they need to decide to change

being conned? Am I acting out of fear, shame,

themselves. If they change, the patient can then

guilt, or anger? Do I have a need to control?

face the consequences of his or her own actions

and may choose to get well.

Provide support for enabling partner(s).

Families and SOs need support to produce

Encourage group work.

change as much as the person who is addicted.

Assist the patients partner to become aware that

Partners need to learn that users habit may or

patients abstinence and drug use are not the

may not change despite partners involvement in

partners responsibility.

treatment.

Help the recovering (former user) partner who is

Enabling behavior can be partners attempts at

enabling to distinguish between destructive

personal survival.

aspects of behavior and genuine motivation to aid

the user.

Note how partner relates to the treatment team

Determines enabling style. A parallel exists

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and staff.

between how partner relates to user and to staff,

based on partners feelings about self and
situation.

Explore conflicting feelings the enabling partner

Useful in establishing the need for therapy for the

may have about treatment including the feelings

partner. This individuals own identity may have

similar to those of abuser (blend of anger, guilt,

been lost, she or he may fear self-disclosure to

fear, exhaustion, embarrassment, loneliness,

staff, and may have difficulty giving up the

distrust, grief, and possibly relief).

dependent relationship.

Involve family in discharge referral plans.

Drug abuse is a family illness. Because the family

has been so involved in dealing with the
substance abuse behavior, family members need
help adjusting to the new behavior of sobriety and
abstinence. Incidence of recovery is almost
doubled when the family is treated along with the
patient.

Be aware of staffs enabling behaviors and

Lack of understanding of enabling can result in

feelings about patient and enabling partners.

non-therapeutic approaches to patients and their

families.

Encourage involvement with self-help

Puts patient and family in direct contact with

associations, Alcoholics and Narcotics

support systems necessary for continued sobriety

Anonymous, Al-Anon, Alateen, and professional

and to assist with problem resolution.

family therapy.

7. Sexual Dysfunction
Nursing Diagnosis

Sexual Dysfunction

May be related to

Altered body function: Neurological damage and debilitating effects of drug use
(particularly alcohol and opiates)

Possibly evidenced by

Progressive interference with sexual functioning

In men: a significant degree of testicular atrophy is noted (testes are smaller and
softer than normal); gynecomastia (breast enlargement); impotence/decreased
sperm counts

In women: loss of body hair, thin soft skin, and spider angioma (elevated
estrogen); amenorrhea/increase in miscarriages

Desired Outcomes

Verbally acknowledge effects of drug use on sexual functioning/reproduction.

Identify interventions to correct/overcome individual situation.

Nursing Interventions

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Ascertain patients beliefs and expectations. Have

Determines level of knowledge, identifies

patient describe problem in own words.

misperceptions and specific learning needs.

Encourage and accept individual expressions of

Most people find it difficult to talk about this

concern.

sensitive subject and may not ask directly for

information.

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Provide education opportunity (pamphlets,

Much of denial and hesitancy to seek treatment

consultation with appropriate persons) for patient

may be reduced as a result of sufficient and

to learn effects of drug on sexual functioning.

appropriate information.

Provide information about individuals condition.

Sexual functioning may have been affected by

drug (alcohol) itself or psychological factors (such
as stress or depression). Information can assist
patient to understand own situation and identify
actions to be taken.

Assess drinking and drug history of pregnant

Awareness of the negative effects of alcohol and

patient. Provide information about effects of

other drugs on reproduction may motivate patient

substance abuse on the reproductive system and

to stop using drug(s). When patient is pregnant,

fetus ( increased risk of premature birth, brain

identification of potential problems aids in

damage, and fetal malformation).

planning for future fetal needs and concerns.

Discuss prognosis for sexual

In about 50% of cases, impotence is reversed

dysfunction (impotence, low sexual desire).

with abstinence from drug(s); in 25% the return to

normal functioning is delayed; and approximately
25% remain impotent.

Refer for sexual counseling, if indicated.

Couple may need additional assistance to resolve

more severe problems and situations. Patient
may have difficulty adjusting if drug has improved
sexual experience (heroin decreases dyspareunia
in women, premature ejaculation in men).
Furthermore, the patient may have engaged
enjoyably in bizarre, erotic sexual behavior under

Nursing Interventions

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influence of the stimulant drug; patient may have
found no substitute for the drug, may have driven
a partner away, and may have no motivation to
adjust to sexual experience without drugs.

Review results of sonogram if pregnant.

Assesses fetal growth and development to

identify possibility of fetal alcohol syndrome and
future needs.

8. Deficient Knowledge
Nursing Diagnosis

Deficient Knowledge

May be related to

Lack of information; information misinterpretation

Cognitive limitations/interference with learning (other mental illness

problems/organic brain syndrome); lack of recall

Possibly evidenced by

Statements of concern; questions/misconceptions

Inaccurate follow-through of instructions/development of preventable

complications

Continued use in spite of complications/adverse consequences

Desired Outcomes

Verbalize understanding of own condition/disease process, prognosis, and

potential complications.

Verbalize understanding of therapeutic needs.

Identify/initiate necessary lifestyle changes to remain drug-free.

Participate in treatment program including plan for follow-up/long-term care.

Nursing Interventions

Rationale

Be aware of and deal with anxiety of patient and

Anxiety can interfere with ability to hear and

family members.

assimilate information.

Provide an active role for the patient and SO in

Learning is enhanced when persons are actively

the learning process (discussions, group

involved.

participation, role playing).

Provide written and verbal information as

Helps patient and SO make informed choices

indicated. Include list of articles and books related

about future. Bibliotherapy can be a useful

to patient and family needs and encourage

addition to other therapeutic approaches.

reading and discussing what they learn.

Assess patients knowledge of own situation

Assists in planning for long-range changes

(disease, complications, and needed changes in

necessary for maintaining sobriety and drug-free

lifestyle).

status. Patient may have street knowledge of the

drug but be ignorant of medical facts.

Pace learning activities to individual needs.

Facilitates learning because information is more

readily assimilated when timing is considered.

Nursing Interventions

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Review condition and prognosis and future

Provides knowledge base from which patient can

expectations.

make informed choices.

Discuss relationship of drug use to current

Often patient has misperception (denial) of real

situation.

reason for admission to the medical (psychiatric)

setting.

Educate about effects of specific drug(s) used

Information will help patient understand possible

[PCP is deposited in body fat and may reactivate

long-term effects of drug use.

(flashbacks) even after long interval of

abstinence; alcohol use may result in mental
deterioration, liver involvement/damage; cocaine
can damage postcapillary vessels and increase
platelet aggregation, promoting thromboses and
infarction of skin and internal organs, causing
localized atrophie blanche or sclerodermatous
lesions].

Discuss potential for re-emergence of withdrawal

Even though intoxication may have passed,

symptoms in stimulant abuse as early as 3 mo or

patient may manifest denial, drug hunger, and

as late as 912 mo after discontinuing use.

periods of flare-up, wherein there is a delayed

recurrence of withdrawal symptoms (anxiety;
depression; irritability; sleep disturbance;
compulsiveness with food, especially sugars).

Inform patient of effects of disulfiram (Antabuse)

Interaction of alcohol and Antabuse results in

in combination with alcohol intake and importance

nausea and hypotension, which may produce

of avoiding use of alcohol-containing products

fatal shock. Individuals on Antabuse are sensitive

Nursing Interventions

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(cough syrups, foods and candy, mouthwash,

to alcohol on a continuum, with some being able

aftershave, cologne).

to drink while taking the drug and others having a

reaction with only slight exposure. Reactions also
appear to be dose-related.

Review specific aftercare needs (PCP user

Promotes individualized care related to specific

should drink cranberry juice and continue use of

situation. Cranberry juice and ascorbic acid

ascorbic acid; alcohol abuser with liver damage

enhance clearance of PCP from the system.

should refrain from drugs and anesthetics or use

Substances that have the potential for liver

of household cleaning products that are detoxified

damage are more dangerous in the presence of

in the liver).

an already damaged liver.

Discuss variety of helpful organizations and

Long-term support is necessary to maintain

programs that are available for assistance and

optimal recovery. Psychosocial needs and other

referral.

issues may need to be addressed.