Substance Use Disorder Nursing Care Plans

Substance use disorder turns up on every unit, not just psych. You will care for these patients during withdrawal, after trauma, postop, and in medical beds where the substance use is the thing nobody charted. Your job is safety first, then helping the patient face reality and build a way to live without the drug. This guide covers assessment, diagnosis, goals, and interventions.

What is Substance Use Disorder?

Substance use disorder is excessive use of nicotine, alcohol, or illicit substances that wrecks social, academic, and occupational functioning. The substances you will see most often are cannabis, sedatives, hypnotics, anxiolytics, inhalants, opioids, hallucinogens, and stimulants. The disorder runs through abuse, intoxication, and physical or psychological dependence.

Drug abuse and drug dependence sit at opposite ends of the same disease. Abuse is the intense drive to use more and more of a substance at the expense of everything else. Dependence is the body's physical need for the agent, which is the same thing as addiction. Over time that dependence produces physical harm, behavior problems, and a social world built around using. Stopping triggers a substance-specific withdrawal syndrome.

The DSM-5 diagnoses substance use disorder when a patient meets at least 2 of 11 criteria within a 12-month period for that substance:

• Uses more of the substance, and for longer, than intended.
• Wants to cut down and has tried and failed.
• Spends excessive time getting, using, or recovering from the substance.
• Craves the substance.
• Fails to meet major responsibilities because of use.
• Keeps using despite social and occupational damage.
• Gives up other activities to use.
• Uses in physically hazardous situations, such as while driving.
• Keeps using despite knowing the physical and psychological harm.
• Develops tolerance, needing more for the same effect.
• Has withdrawal symptoms that ease when the substance is taken again.

Number of criteria sets severity: 2 to 3 is mild, 4 to 5 is moderate, 6 or more is severe.

Nursing Care Plans and Management

Care centers on supporting the decision to stop, building coping skills, teaching new ways to manage anxiety, pulling the family into rehabilitation, and giving honest information about prognosis and treatment.

Nursing Problem Priorities

1. Ensure safety and monitor for withdrawal.
2. Educate on substance use and its effects.
3. Build coping skills and relapse-prevention strategies.
4. Connect the patient to treatment programs and resources.
5. Support physical and emotional wellbeing.
6. Address co-occurring mental health conditions.
7. Encourage support groups and counseling.

Nursing Assessment

Assess for the following:

• Physical signs: dilated or constricted pupils, bloodshot eyes, slurred speech, unsteady gait.
• Behavioral changes: mood swings, irritability, altered sleep, dropping motivation or productivity.
• Social and occupational decline: poor work or school performance, strained relationships, isolation.
• Intoxication or withdrawal signs: tremors, sweating, restlessness, agitation.
• Neglected hygiene and grooming.
• Damaged relationships tied to use.
• Elevated liver enzymes or positive drug screens.
• Reports from family, friends, or caregivers about the patient's use.

Nursing Diagnosis

Formulate the diagnosis from your assessment and clinical judgment, matched to the patient's condition. Diagnostic labels are a framework, not the point. On the floor your judgment shapes the plan around what this patient actually needs.

Nursing Goals

The patient will:

• Connect their substance use to the current situation.
• Accept responsibility for their own behavior.
• Identify ineffective coping behaviors, including using to cope.
• Admit loss of control over the drug and accept powerlessness over the addiction.
• Accept the need for treatment and that willpower alone will not hold abstinence.
• Participate actively in the program.
• Reach and hold a healthy, drug-free state.
• Gain weight toward goal with normalizing labs and no signs of malnutrition.
• Understand how substance use and poor intake affect nutrition.
• Adopt behaviors and lifestyle changes to reach and hold a healthy weight.
• Identify the feelings driving a negative self-image.
• Accept themselves and build self-worth.
• Set goals and plan realistic lifestyle changes for living without drugs.
• Take action to change self-destructive behaviors and behaviors that feed a partner's addiction.
• Acknowledge how drug use affects sexual function and reproduction.

Nursing Interventions and Actions

1. Helping the Patient Accept Reality

Recovery starts when the patient stops denying what the drug is doing to their body, mind, relationships, and life, and accepts that change is possible with support.

Ask what name the patient wants to be called. It signals respect and gives the patient a sense of control and identity beyond the diagnosis, which builds rapport.

Find out why the patient is choosing abstinence and treatment now. This tells you whether they are committed to long-term change and whether they believe they can change. Denial is the strongest, most stubborn symptom of this disease, and you cannot plan a future the patient will not admit to.

Review what dependence means and the categories of symptoms: patterns of use, impairment, tolerance. This helps the patient make decisions about accepting the problem and choosing treatment.

Answer questions honestly and keep your word. Trust is the foundation of the therapeutic relationship. Be straight about what treatment involves and update the patient on their progress.

Accept the person while rejecting the behavior. Separating the two protects dignity and self-worth. These patients carry stigma, shame, and guilt, and acceptance lowers those barriers and builds trust.

Explain addictive use versus experimental or occasional use, and the biochemical and genetic basis of addiction. Use moves along a continuum from experimental to addictive, and understanding that progression cuts through denial and guilt. Dependence is both psychological and physical, driven partly by the brain's attempt to regain homeostasis.

Discuss the patient's current life and how use has affected it. Seeing the link between use and personal problems is the first crack in denial. Letting the patient tell it in their own words starts the recovery.

Confront denial and rationalization in peer groups, and confront with caring. Peer confrontation helps the patient accept the real consequences of their behavior. A caring tone preserves self-concept and lowers defensiveness, so use concrete examples rather than judgment.

Explain how addiction affects mood and personality. Patients often mistake drug effects for their own traits and use that to justify using. Effects range from energy and euphoria to deep sedation, and early use is reinforced by that sense of wellbeing.

Stay nonjudgmental and watch for restlessness or rising tension. Confrontation can escalate agitation and threaten safety. A nonjudgmental first interview focused on recovery and goals sets the tone for the whole relationship.

Give positive feedback when the patient recognizes denial in self and others. It builds self-esteem and reinforces insight, and it shows the patient that recovery is within reach.

Hold firm that the patient attends recovery support and therapy groups regularly. Attendance reflects admitting the need for help and is tied to staying drug-free long term. Accepting the problem leads to taking treatment seriously.

Push the patient to own their recovery, including building alternatives to drug urges. Denial gives way to action when the patient accepts responsibility. Patients with solid support cope better with life demands and shift toward healthier behavior.

Tell families to get help whether or not the user does. Recovery is rarely solo. It usually comes through some mix of family, friends, mutual-help programs, treatment, supportive employers, and policy.

Offer denial-management counseling. Its practical exercises lower self-deception and impression management and help patients recognize and own their problems.

Encourage telemedicine and online digital recovery support. Online recovery meetings, discussion boards, chat rooms, and recovery social networks reach patients who cannot get to inperson services.

Refer to peer recovery support services and recovery coaching. Peers in stable recovery are experientially qualified to mentor and support. Peer support is linked to reduced use and relapse, better relationships with providers, higher treatment retention, and greater satisfaction.

2. Promoting Effective Coping

Effective coping means managing stress, cravings, and triggers without the substance through exercise, therapy, mindfulness, and a strong support network. For families it means support, education, and encouragement paired with boundaries and self-care.

Review program rules and philosophy. Knowing the expectations lets the patient cooperate and function in the milieu. Substance use disorder is lifelong and controllable, not curable, and detox starts by managing withdrawal that can range from cravings to seizures.

Assess how the patient has coped with problems before. This reveals the degree of denial, willingness to take responsibility, and any coping skills worth reusing now.

Identify outside stressors and other causes. This pinpoints specific needs and starts problem-solving. Personality traits play a real role in who develops the disorder.

Set limits and confront attempts to win special privileges, dodge agreed behaviors, or keep using. These patients have learned manipulation to get needs met and need a new way. Following through on consequences is what changes the behavior, and clear limits give needed structure.

Know your own attitudes and enabling behaviors as staff. Judgmental or enabling staff produce bad data and nontherapeutic care, and enabling stalls recovery and breeds codependency.

Encourage the patient to verbalize feelings, fears, and anxiety. Talking surfaces long-unresolved issues, builds self-awareness, releases emotion, and improves outcomes.

Institute suicide precautions per hospital policy. Co-occurring alcohol and substance use sharply raises risk of suicidal ideation, attempts, and death, and that risk stays elevated even after remission.

Explore alternative coping strategies. Many patients have no adaptive way to handle stress and need options for managing time, feelings, and relationships without drugs, including problem-focused coping and seeking support.

Teach and reinforce relaxation, guided imagery, and visualization. Slow deep breathing, progressive muscle relaxation, and picturing a calm scene lower anxiety and give the patient new tools for stress.

Build diversional activities tied to recovery, such as social activity within a support group. Finding other ways to handle drug hunger reminds the patient that addiction is lifelong and that change is possible, while connecting them to others in recovery.

Use peer support to work through drug hunger. Selfhelp groups promote abstinence through understanding, support, and peer pressure, and they respect the many pathways to recovery.

Encourage therapeutic writing, journaling, or an autobiography. Writing boosts engagement, releases grief and anger, helps monitor safety, tracks progress, and helps the patient see the chain of events behind the current situation.

Discuss the patient's plan for living without drugs. This builds and refines a relapse-prevention strategy for the maintenance phase, such as the Community Reinforcement Approach, which makes abstinence more rewarding than use through CBT, new activities, employment help, couples work, and monitored disulfiram.

Administer disulfiram, acamprosate, methadone, naltrexone, and nalmefene as indicated. See Pharmacologic Management.

Encourage involvement with Alcoholics Anonymous and Narcotics Anonymous. These put the patient in direct contact with the support system that maintains sobriety. After detox, counseling continues inpatient, outpatient, and through intensive outpatient programs that add coping skills and psychosocial support without admission.

Keep the environment quiet and safe during withdrawal. Excessive noise agitates the patient. Stopping high-dose CNS depressants can drive CNS stimulation to grand mal seizures, with agitation, restlessness, and insomnia more common.

Remove harmful objects from the room. Intoxication blunts the fear of death and can push a patient toward suicide, and chronic opioid use can deepen the negative states behind it.

Use restraints only if the patient may harm self or others. Restraints are a last resort, must be ordered by the provider, and must be documented strictly. Patients with alcohol misuse who present with suicidal plans or intent warrant inpatient care, preferably in a dual-diagnosis facility.

Provide a safe, nonthreatening environment. Free of judgment, criticism, or punishment, it lowers the stress that triggers use and lets the patient talk openly, reducing relapse risk.

Refer to psychotherapeutic interventions as indicated. CBT targets the distorted beliefs feeding depressed mood, suicidality, and alcohol misuse. Contingency management and supportive psychiatry add value alongside pharmacotherapy for opioid use disorder.

Review family history and explore family roles, the circumstances of use, strengths, and growth areas. This locates the focus and the potential for change. Family climate, parental support, parental drug use, and parental incarceration all shape a young person's risk.

Explore how the family member has coped, including denial, repression, rationalization, hurt, loneliness, and projection. The enabler suffers the same feelings as the patient and uses the same ineffective tactics, so they need new coping skills too. Family is the immediate social environment of the user, and family acceptance and problem-solving strengthen the patient's own.

Assess each family member's current functioning. A relative's substance use raises psychological and physical morbidity in the family, with depression, suicide, insomnia, shame, blame, and loss all common.

Determine the extent of enabling and explore it with each person. Enabling is doing for the patient what they need to do for themselves. People do not want to feel powerless, so they cover up, ignore red flags, and make excuses, which keeps the addiction going.

Note how the partner relates to the treatment team. It reveals their enabling style, which mirrors how they relate to the user. Forced treatment rarely works; the patient has to see the problem themselves.

Explore the enabling partner's conflicting feelings, including anger, guilt, fear, exhaustion, embarrassment, loneliness, distrust, grief, and relief. This establishes their own need for therapy. Their identity may be lost in the relationship, and family members often suffer in silence with little support.

Teach enabling behavior and the traits of addictive disease for both users and nonusers. Naming the behaviors, such as shielding, taking over responsibilities, and rationalizing, opens the door to change.

Identify and discuss family sabotage behaviors. A family member may say they want recovery but unconsciously resist it because the patient's recovery would change their own role or remove a source of sympathy and attention, a secondary gain from the problem continuing.

Encourage therapeutic writing for family members. Journaling releases anger, grief, and stress and moves them forward. Family is the most important source of support through a lifelong process.

Give the patient and family the facts on how addiction affects the family and what to expect after discharge. Many do not understand addiction, and a patient using legally obtained drugs may not see it as abuse. Affected family members face higher rates of depression, substance use disorders, and trauma than families dealing with diabetes or asthma.

Have family members check their own motives. Ask them whether they are being conned or acting out of fear, shame, guilt, anger, or a need to control. When they see how they perpetuate the problem and change themselves, the patient can finally face the consequences of their own actions.

Support the enabling partner and encourage group work. Families need support to change as much as the patient does. Services should adopt a family-first framework built on input from family members, not bolted onto existing treatment models.

Help the partner see that the patient's use and abstinence are not the partner's responsibility. Habits may or may not change regardless of the partner's involvement. The partner can encourage help and look for treatment together, but addiction is a disease, not the partner's fault.

Help a recovering partner separate destructive enabling from genuine help. Enabling can be a survival tactic. Saying no to a request that feeds the addiction is acceptable, and the partner has to address their own needs and mental health before they can help.

Involve the family in discharge referral plans. Addiction is a family illness, and family members need help adjusting to sobriety. Recovery rates nearly double when the family is treated alongside the patient.

Watch for enabling behaviors and feelings among staff. Not understanding enabling leads to nontherapeutic care. Family members take on roles around the user, and the enabler role is one of the most damaging.

Encourage Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, Alateen, and professional family therapy. These connect patient and family to the support systems that sustain sobriety and solve problems.

Refer the family to familial interventions as indicated. These help parents build positive communication, reduce conflict, and adopt a parenting style based on active listening, affection, and rules.

Account for the patient's and family's culture. Culture, race, gender, community context, and socioeconomic status can either block or support family functioning, so build the plan around the family's structure and strengths.

Promote good communication between patient and family. Openness builds social and emotional skills and lowers risky behavior, and parental drug-talk, especially in early adolescence, is a key prevention tool.

3. Promoting Support and Self-Esteem

Note behaviors that signal powerlessness or hopelessness. Statements like "they don't care" or "it won't make any difference" show the patient does not believe they can manage change. Lack of family support, unemployment, and homelessness are common in both substance use disorder and suicidality.

Determine the patient's degree of life mastery and locus of control. Both predict how well the patient adjusts to the disease. A patient with an external locus of control benefits from positive affirmation.

Use crisis intervention techniques to start behavior change. The patient is more open to treatment during a crisis. The ABC model, Achieve contact, Boil down the problem, Cope with the problem, and Determine the meaning of the event, helps bring the crisis under control.

Help the patient admit a problem exists, discussing in a caring, nonjudgmental way how the drug has interfered with life. In the precontemplation stage the patient has not yet named use as a problem. Acceptance is required before they can plan a future, and it comes from working through denial.

Involve the patient in building the treatment plan, identifying their own goals and agreeing to outcomes. In the contemplation stage the patient is weighing change, and they commit harder to solutions they helped create.

Discuss alternative solutions. Brainstorming opens possibilities and restores a sense of control during the preparation stage as the patient organizes resources for change.

Help select the most appropriate alternative. As options are weighed the best solution becomes clear. Behavioral activation, which increases participation in enjoyable activities, shows early promise here.

Support the decision and its implementation. This helps the patient persevere through the action stage, where sustained effort and supports maintain sobriety. Strong family ties, positive peers, and good role models protect against use.

Explore peer-group support and encourage sharing about drug hunger and triggers. The patient may need help admitting powerlessness and asking for help. Peer recovery support pairs someone in stable recovery with a patient seeking to establish or maintain their own.

Teach the patient to structure healthy diversions: balanced diet, adequate rest, exercise such as walking or running, plus acupuncture, biofeedback, and meditation. These restore biochemical balance, aid detox, and manage stress and free time, building confidence and self-esteem. Exercise releases endorphins and a sense of wellbeing.

Teach the basics of human behavior and interaction, such as transactional analysis. Understanding these patterns helps the patient address past losses and stop repeating ineffective coping. Present it in a motivational style and let the patient draw their own conclusions by asking, "What do you make of this?"

Help the patient examine spirituality and faith. Not required for recovery, but surrender to and faith in a higher power helps many and can ease the sense of powerlessness. In one study 84% of patients in addiction counseling wanted more emphasis on spirituality in treatment.

Teach and role-play assertive communication. Assertiveness, especially the skill of saying no, helps the patient refuse use, cut contact with users and dealers, build healthy relationships, and regain control.

Provide treatment information on an ongoing basis. Knowing what to expect lets the patient participate and make informed choices, so explore their treatment expectations and lay out the benefits and options.

Encourage family and friends to support the patient. Close relationships make treatment more effective, and supportive significant others help shift the patient from extrinsic to intrinsic motivation.

Give positive feedback and affirmation. Affirming the patient supports self-efficacy and tells them they are seen and that what they say matters, which builds confidence to act.

Assess mental status and screen for co-occurring psychiatric disorders. Many patients use to relieve depression or anxiety that may predate or result from use. Roughly 60% of substance-dependent patients have underlying psychological problems, and both must be treated to reach and hold abstinence.

Observe family and significant-other dynamics and level of support. Substance use is a family disease, and how members react shapes its course and the patient's self-image. Many unconsciously enable, and early child neglect is a significant risk factor for later use.

Encourage the patient to talk through their individual situation. Patients struggle to admit how large a role the substance has taken. Use open questions that invite reflection rather than closed ones.

Spend time and listen reflectively, discussing use without judgment. Your presence conveys that the patient is worthwhile, and reflective listening builds the safe, collaborative space where the patient names their own reasons for change.

Reinforce and affirm positive actions and help the patient accept the input. Failure and low self-esteem are longstanding problems, so the patient needs to learn to see themselves as a person with positive attributes.

Encourage expression of guilt, shame, and anger. The patient often feels hopeless and has lost self-respect. Voicing these feelings is the start of taking responsibility, since shame is tightly linked to substance use, stigma, depression, and anxiety.

Help the patient name substance use as the problem and confront denial, projection, and rationalization. Once the drug can no longer be blamed, the patient can deal with the real problems. Deliver confrontation inside a trusting, respectful relationship that still offers hope.

Have the patient list and review past accomplishments. Everyone has successes, but low self-esteem makes them hard to recall. Building on strengths parallels motivational counseling, which affirms autonomy and reinforces that change is possible.

Use role rehearsal. Practicing coping and refusal skills, then reversing roles, lets the patient build the skills of a person who no longer needs drugs to handle life.

Involve the patient in group therapy. Members at different stages of abstinence address each other's denial. The group offers new skills, hope, community, and a place to build social supports.

Build a plan to treat co-occurring mental illness. Patients who self-medicate other conditions will keep using after discharge, so treat both together. Keep the plan realistic, and rework it with shared decision-making when it is too ambitious or not ambitious enough.

Administer antipsychotic medications as needed. Prolonged psychosis after LSD or PCP use can be treated with these drugs since it likely reflects an emerging underlying psychosis. Avoid phenothiazines, which lower the seizure threshold and cause hypotension with LSD or PCP. A 2018 systematic review found clozapine superior to risperidone and equal to olanzapine or ziprasidone in polysubstance and cannabis users.

Negotiate a behavioral contract. A written or oral contract helps the patient start working their change plan. Have the patient compose and sign it themselves, since that act of going public strengthens commitment and self-esteem.

Encourage social support from family and friends. Positive support for behavior change helps the patient start and sustain it, especially friends who share interests outside of using.

Help the patient build self-efficacy. Identify strengths, review past successes, and express confidence in their ability to change. Self-efficacy is a strong predictor of addiction treatment outcomes, so build on how the patient has coped with problems before.

4. Promoting Nutrition

Chronic substance use damages nutritional status through decreased intake, poor absorption, altered metabolism, chaotic eating, and disrupted satiety hormones.

Monitor nutritional intake. Use compromises diet, and money often goes to drugs rather than food, leading to undernutrition. Type, frequency, and duration of use plus any infections all affect status.

Assess height, weight, age, body build, strength, activity, and rest. These set caloric needs and the dietary plan, and the condition of mucous membranes and teeth affects what the patient can eat. Patients who use drugs generally have a lower BMI than nonusers, and cocaine suppresses appetite and lowers body weight.

Take anthropometric measurements such as triceps skinfold when available. These estimate subcutaneous fat and muscle mass for dietary planning. In one study 24% of patients who use drugs showed mild to moderate malnutrition shortly after admission for detox.

Track total daily calories and keep a diary of intake, timing, and patterns. This identifies needs and deficiencies. Cocaine users often eat one late-night meal high in refined carbohydrates and fat, and opioid users replace protein and fat with sugar and alcohol.

Evaluate energy expenditure and set an individualized exercise program. Activity level drives nutritional needs, and exercise builds muscle tone and may stimulate appetite. It also reduces stress, anxiety, depression, and use during recovery.

Recommend weekly weights. This shows whether the dietary plan is working. Opioid substitution or methadone treatment raises BMI and weight, most in patients with higher education and income.

Review labs as indicated: glucose, serum albumin, prealbumin, electrolytes. These flag anemias, electrolyte imbalances, and other abnormalities needing treatment. Hemoglobin and hematocrit run lower in users, lowest in multiple-drug users, and morphine can blunt the epinephrine response and cause hypoglycemia.

Note the condition of the oral cavity. Poor hygiene, altered salivary pH, and cariogenic diets drive progressive caries and maxillofacial infections, and heavy alcohol use raises oral cancer risk, so examine soft tissue often.

Let the patient choose foods and snacks within the plan. Choice boosts participation and a sense of control and helps you gauge how well dietary teaching landed.

Consult a dietitian. Registered dietitian nutritionists are essential team members, qualified to provide nutrition education and counseling that improve treatment outcomes.

Refer for dental consultation as needed. Teeth are essential to nutrition and care is often neglected. Drugs and alcohol drive xerostomia, caries, periodontal disease, bruxism, and oral cancer.

Encourage good oral hygiene. Push fluoride, prescription toothpaste, and chlorhexidine, and use sugarless xylitol gum or candy to regulate salivary pH. Advise 8 to 10 glasses of water daily and avoiding caffeine, tobacco, and alcohol.

Provide a diet rich in macro- and micronutrients. Empty calories track with drug use. Micronutrients are cofactors for serotonin, dopamine, and catecholamine synthesis, and deficiencies in copper, selenium, manganese, magnesium, folate, and B-complex vitamins are linked to depression, so consider supplementation.

Promote foods rich in fatty acids. Fatty acids help regulate aggression, mood, sleep, and appetite. Supplementing omega-3 docosahexaenoic and eicosapentaenoic acids lowers anger and anxiety scores during detox.

5. Improving Sexual Functioning

Substance use disrupts sexual function through erectile dysfunction, lowered libido, and impaired performance, driven by physiology, hormones, psychological factors, and relationship strain.

Find out the patient's beliefs and expectations and have them describe the problem in their own words. This surfaces misperceptions and learning needs. Some patients use alcohol, opioids, or cannabis expecting better sexual function from the disinhibiting effects, especially early and in low doses.

Assess the drinking and drug history. A thorough history screening for psychiatric symptoms helps diagnose and rule out disorders. Knowing which substances were used and the time of last use guides treatment, since withdrawal can be fatal.

Review the sonogram if the patient is pregnant. It assesses fetal growth and the possibility of fetal alcohol syndrome. Alcohol in pregnancy causes miscarriage, stillbirth, and fetal alcohol spectrum disorders, and opioids are linked to poor growth, preterm birth, stillbirth, birth defects, and neonatal abstinence syndrome.

Screen for substance use, especially in pregnant patients. The USPSTF recommends screening all adults 18 years and older, including pregnant and postpartum patients, and adolescents 12 to 17 years in primary care.

Assess past sexual history. First sexual contact, knowledge of sexual function, any history of sexual abuse, and high-risk behavior all inform the management plan.

Rule out other causes of sexual dysfunction. Do a full physical and systemic exam and consider labs including a hormonal profile alongside hemogram, blood glucose, liver and thyroid function, and lipid profile.

Accept the patient's expressions of concern. Most people find this hard to raise directly. Stigma toward addiction is more severe than toward other mental illnesses, and it comes from health professionals as well as the public.

Provide education on how drugs affect sexual function. Good information reduces denial and hesitancy to seek treatment. Explain the link between use and dysfunction and, using a motivational approach, the sexual benefits of stopping.

Provide information about the patient's specific condition. Dysfunction may stem from the drug itself or from stress and depression, and understanding it helps the patient identify what to do, since psychosocial, cultural, comorbid, and treatment-related factors all contribute.

Discuss the prognosis for dysfunction such as impotence and low desire. With abstinence, impotence reverses in about 50% of cases, return to normal is delayed in 25%, and roughly 25% remain impotent. Heavy alcohol use lowers arousal and erection in men and causes decreased lubrication, dyspareunia, and difficulty reaching orgasm in women.

Refer for sexual counseling if indicated. Couples may need help with severe problems, and the patient may struggle if the drug had improved their sexual experience or driven a partner away.

Provide information about effects on the reproductive system and fetus, including premature birth, brain damage, and malformation. Awareness can motivate stopping, and identifying problems early helps plan for fetal needs. Marijuana in pregnancy is linked to low birth weight and possible attention and learning problems.

Refer the patient or couple for sex therapy as indicated. Beyond Masters and Johnson techniques, CBT, emotion-based therapy, and couples communication are treatment mainstays.

Have the couple consider each other's perspective. Dysfunction in one partner makes sex stressful for both. Among women with pain during intercourse, those with overly solicitous partners report worse pain and satisfaction than those whose partners help them adapt.

Improve communication between partners. Dysfunction in one partner often drives problems for the other, so therapy works on communication, awareness, and sensate focus. It is a couple's issue, not just an individual one.

Administer pharmacologic therapy as prescribed. In men, phosphodiesterase-5 inhibitors help erectile dysfunction as needed, and SSRIs such as fluoxetine and paroxetine help premature ejaculation. In women, systemic testosterone may be considered for low desire, with side effects including hirsutism, hoarseness, alopecia, and increased cardiovascular risk.

6. Patient Education and Health Teaching

Teaching covers the risks and consequences of use, relapse prevention, managing cravings and triggers, and accessing services and support groups.

Assess the patient's knowledge of their own disease, complications, and needed lifestyle changes. This drives the long-range plan for sobriety. Patients may have street knowledge of the drug but not the medical facts, and not all use progresses in severity.

Review condition, prognosis, and future expectations. This gives the patient a base for informed choices. Withdrawal severe enough to restart the cycle, degree of dependence, motivation, treatment time frame, genetics, craving severity, and stress coping all shape the outcome.

Assess readiness for change. Patients move at their own pace, cycle through stages, and some need time to resolve ambivalence while others are ready to act. Knowing where they are lets you pace the work.

Address the anxiety and ambivalence of patient and family. Anxiety blocks learning. Ambivalence, feeling two ways about a major change, is normal and is a roadblock to change rather than a lack of knowledge.

Give the patient and family an active role through discussion, group participation, and role-play. Active involvement and offering choices strengthen the alliance, lower dropout, and improve outcomes.

Provide written and verbal information, including relevant articles and books. Bibliotherapy adds to other approaches. Use handouts and visual aids showing screening scores, normative data, and risks, and provide materials in the patient's first language.

Pace teaching to the patient's needs. Information lands better when timing, understanding, urgency, and culture are considered. A directive style conveys importance in some cultures and reads as rude in others.

Discuss how use relates to the current admission. Patients often deny the real reason for a medical or psychiatric admission. Help them see the gap between their goals and current behavior, since that discrepancy drives change.

Educate on the effects of the specific drugs used. PCP is stored in body fat and can cause flashbacks long after abstinence, alcohol can cause mental deterioration and liver damage, and cocaine damages vessels and promotes thrombosis and infarction. Use hits the neurologic, endocrine, psychiatric, cardiopulmonary, hepatic, hematologic, and immunologic systems.

Warn about re-emergence of withdrawal symptoms in stimulant use, as early as 3 months or as late as 9 to 12 months after stopping. Even after intoxication passes, the patient may have flare-ups with anxiety, depression, irritability, sleep disturbance, and compulsiveness around sugar. Relapse after withdrawal management is common, so treat it as a first step before psychosocial treatment, not a cure.

Teach the disulfiram-alcohol interaction and the need to avoid all alcohol-containing products, including cough syrups, candy, mouthwash, aftershave, and cologne. The interaction causes nausea and hypotension that can produce fatal shock. Sensitivity varies and is dose-related. Never give it if alcohol use is suspected or without the patient's informed consent.

Review aftercare needs. PCP users should drink cranberry juice and continue ascorbic acid to speed PCP clearance, and patients with liver damage should avoid drugs, anesthetics, and cleaning products that are detoxified in the liver. Disulfiram clears slowly, so reactions can occur up to 14 days after stopping, and it interacts with amitriptyline, imipramine, phenytoin, chlordiazepoxide, diazepam, omeprazole, and acetaminophen.

Discuss organizations and programs for ongoing support. Long-term support maintains recovery. The NIH, the National Institute on Drug Abuse, and SAMHSA research, treat, and support people affected by addiction.

Encourage the patient to ask questions. Check for trouble with forms or questions and invite questions throughout, offering information in a neutral, respectful, culturally appropriate way.

Give advice that promotes positive change. Advice delivered in a motivational style changes drinking, drug, and tobacco use. Suggestions work better than directives, and educational advice should rest on credible evidence.

7. Pharmacologic Management

Medications depend on the substance. They are used as part of comprehensive treatment alongside counseling, behavioral therapy, and social support.

Alcohol use disorder

Disulfiram maintains abstinence while other therapy proceeds. By blocking alcohol oxidation it lets acetaldehyde build up, producing a highly unpleasant reaction, including headache, nausea, vomiting, flushing, dizziness, and weakness, if alcohol is consumed.

Acamprosate prevents relapse by lowering glutamate receptors. It does not make the patient sick if they drink, has no sedative, antianxiety, muscle-relaxant, or antidepressant effect, and causes no withdrawal. Add vitamin B1 and vitamin B9 with a multivitamin to address deficiencies.

Naltrexone and nalmefene suppress opioid craving and may prevent relapse in alcohol use disorder by interfering with the alcohol-induced release of endorphins.

Opioid use disorder

Methadone blunts craving and the effects of opioids and is used for withdrawal and long-term maintenance, letting the patient function and eventually withdraw. It can be dispensed only by designated Opioid Treatment Programs.

Buprenorphine is a partial opioid agonist that reduces withdrawal and craving and is used in medication-assisted treatment.

Naltrexone blocks opioid effects and reduces craving by binding opioid receptors.

Nicotine dependence

Nicotine replacement therapy (gum, patches, lozenges, inhalers, nasal sprays) delivers controlled nicotine to reduce withdrawal and wean the patient off tobacco.

Bupropion is an antidepressant that reduces nicotine craving and withdrawal.

Varenicline reduces nicotine craving and withdrawal by blocking nicotine receptors in the brain.