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Chapter: Medical Surgical Nursing: Individual and Family Considerations Related to Illness

Substance Abuse

Some people use mood-altering substances in an attempt to cope with life’s challenges.

Substance Abuse


Some people use mood-altering substances in an attempt to cope with life’s challenges. A person who abuses substances has an inability to make healthy decisions and to solve problems ef-fectively. Typically, people who abuse substances are unable to identify and implement adaptive behaviors and use illegally ob-tained drugs, prescribed or over-the-counter medications, and alcohol alone or in combination with other drugs in an inef-fective attempt to cope with the pressures, strains, and burdens of life. Over time, physiologic, emotional, cognitive, and be-havioral problems develop as a result of continuous substance use. These problems cause distress for the individual, the family, and the community. Some people may respond to personal ill-ness or the illness of a loved one by using substances to decrease emotional pain


Substance abuse is encountered in all clinical settings. Intoxica-tion and withdrawal are two common substance abuse problems. Often, the nurse sees patients who have experienced trauma as a result of inebriation. Other patients who are active substance abusers enter the primary care setting with a diagnosis other than that of substance abuse. Many do not disclose the extent of their substance use. The patient’s use of denial or lack of knowledge about the devastating effects of psychoactive substances can be detected by the nurse who performs a substance use assessment (Chart 7-12). In addition, the nurse can incorporate tools into the assessment that enable drug use to be detected. Examples of such instruments are the CAGE Questionnaire (Ewing, 1984), the Michigan Alcohol Screening Test (Selzer, 1971), and the Addic-tion Severity Index (McLellan, Kushner, Metzger, & Peters, 1992).


Health professionals are in pivotal positions for identifying a substance abuse problem, instituting treatment protocols, and making follow-up referrals. Because substance abuse severely af-fects the family, the nurse helps the family members confront the situation, decrease their enabling behaviors, and motivate the per-son to obtain treatment.

Caring for codependent family members is another nursing priority. A codependent person tends to manifest unhealthy patterns in relationships with others. Codependents struggle with a need to be needed, an urge to control others, and a will-ingness to remain involved and suffer with a person who has a drug problem.


The family may approach the health care team to help set lim-its on the dysfunctional behavior of a person who abuses sub-stances. At these times, a therapeutic intervention is organized for the purpose of confronting the patient about substance use and the need to obtain drug or alcohol treatment. The nurse or other knowledgeable addiction counselor helps the family present the addicted person with a realistic perspective about the problem, their concerns about and caring for the person, and a specific plan for treatment. This therapeutic intervention works on the premise that honest and caring confrontation can break through the person’s denial of the addiction. If the person refuses to par-ticipate in the designed plan, the family members define the con-sequences and state their commitment to follow through with them. This intervention is empowering to the family and usually provides the structure needed to secure treatment.


Even with treatment, however, patients may experience re-lapse. Nurses work with patients and their families to prevent re-lapse and to be prepared if relapse occurs. Relapse is considered a part of the illness process and therefore must be viewed and ad-dressed in the same way that chronic illness is treated.


The nurse who is working with a patient and family struggling with an addiction must dispel the myth that addiction is a defect in character or a moral fault. Views on substance abuse vary within our society. A person’s background may help determine whether he or she uses drugs, what drugs are used, and when they are used (Copel, 2000). The combination of variables, such as values and beliefs, family and personal norms, spiritual convictions, and con-ditions of the current social environment, predisposes a person to the possibility of drug use, motivation for treatment, and contin-ual recovery (Copel, 2000). It has also been said that a person’s at-titude, especially toward alcohol, reflects the overall beliefs and attitudes of that individual’s culture (Giger & Davidhizer, 1999).


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