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Pharmacology · chapter 15 · Substance Use Disorder Treatment Drugs

Introduction to Substance Use Disorders

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Most people with SUD get no treatment

    Unfortunately, it has been estimated that 94% of individuals with SUDs felt they did not need treatment and therefore did not receive any (Substance Abuse and Mental Health Services Administration, 2023a).

  2. The nurse may be first to notice

    This is why it is so critical for the nurse to be vigilant for SUDs in clients, as they may be the first health care provider to assess and identify an SUD.

  3. Dopamine and euphoria

    Substances of abuse all increase the release of the neurotransmitter dopamine in the brain, which causes more pleasure and euphoria than other naturally rewarding activities.

  4. Why “addiction” is no longer recommended

    Addiction is a historical term that has been replaced by the term “substance use disorder” but can technically refer to behaviors outside of substance use such as gambling, internet use, and shopping. The term “addiction” has a negative stigma and is no longer recommended.

  5. Stigma keeps clients away from care

    Negative experiences lead clients with SUDs to avoid health care encounters, to discharge themselves from the health care environment, and to be less likely to call emergency services due to perceived ridicule and maltreatment from health care providers.

  6. Contaminated substances make effects unpredictable

    However, the effects may be unpredictable if the client is unable or unwilling to tell health care providers what they used or if the substance was contaminated with an entirely different agent (e.g., the opioid fentanyl is found in many other substances of abuse, such as cocaine).

  7. What determines the level of intoxication

    The level of intoxication that someone will experience is extremely variable and is determined by the substance used along with the dose, frequency, and route of administration.

  8. Dependence happens in routine medical care

    Health care professionals should not confuse physical drug dependence with substance use disorders, because physical dependence can occur during routine medical care and is not always indicative of an SUD.

  9. Signs of psychological dependence

    The effects of psychological dependence can include cravings to use the substance in question as well as effects that occur if the client is attempting to, or being made to, stop using the substance, including anxiety, depression, sleep disturbances, and irritability.

  10. Tolerance alone does not prove SUD

    Like physical dependence, tolerance can occur with a variety of different substances during their normal course of use and should not be seen as a definitive sign of an SUD (e.g., a client with a terminal illness needing escalating doses of opioids for their chronic pain).

  11. Withdrawal is usually the opposite effect

    Alcohol use can cause CNS depression, whereas alcohol withdrawal can manifest as severe anxiety, hallucinations, and seizures.

  12. Assess withdrawal risk promptly

    Due to the potential for morbidity and mortality, the risk for withdrawal must be assessed in the client and prompt treatment administered if warranted.

  13. Withdrawal drives relapse

    Withdrawal can often be a major reason that clients will either be unable to stop use of their substance of choice or relapse during periods of sobriety.

  14. What medications for SUD do

    Finally, medications can be utilized to help individuals with SUDs achieve long-term success by helping reduce cravings, minimize withdrawal effects, or otherwise make using a substance of choice less appealing than simple abstention from use.

Terms to know

neuroadaptation
This change, referred to as neuroadaptation, causes the transition from being able to control the use of the substance to chronic misuse that can be difficult to control.
Intoxication
Intoxication refers to the substance-specific physiologic effects that occur after exposure to a psychoactive substance (American Psychological Association, 2023).
Physical dependence
Physical dependence refers to the homeostatic adaptation that occurs when the body is exposed to certain substances over a prolonged period (American Psychological Association, 2023).
abstinence syndrome
This adaptation means that the body becomes used to having the effect of the drug, and when that drug is removed, the body will develop a withdrawal reaction, known as abstinence syndrome.
Tolerance
Tolerance refers to the decrease in response to a drug after continuous use.
Withdrawal
Withdrawal refers to physiologic and psychological consequences of discontinuation or reversal of a substance that the client has been using for a sufficient period.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. During a shift report, a colleague refers to a client as "the addict in room 4." Which response by the nurse best reflects the section's guidance?

    1. Use the term only in the written chart.
    2. Accept the term because it is accurate clinical language.
    3. Ask the client whether they prefer to be called an addict.
    4. Refer to the client as a person with a substance use disorder, because stigmatizing labels keep clients from seeking care.

    Answer: Refer to the client as a person with a substance use disorder, because stigmatizing labels keep clients from seeking care.

    Stigmatizing language such as "addict" makes clients avoid care, leave against advice and hesitate to call for help; the accepted term is substance use disorder. Using the label in the chart or asking the client to accept it still stigmatizes.

  2. A client with terminal cancer has needed gradually higher opioid doses for pain over several months. How should the nurse interpret this?

    1. It means the opioid should be stopped immediately.
    2. It is a definitive sign of a substance use disorder.
    3. It reflects tolerance, which is not by itself a definitive sign of an SUD.
    4. It shows the client is in withdrawal.

    Answer: It reflects tolerance, which is not by itself a definitive sign of an SUD.

    Tolerance can develop during normal use and should not be taken as a definitive sign of an SUD; the book gives this exact example of a terminally ill client. Needing higher doses is not withdrawal and is not a reason to stop abruptly.

  3. A client is trying to stop using a substance. Which findings suggest psychological dependence? Select all that apply.

    1. Cravings for the substance
    2. Improved memory
    3. Sleep disturbances
    4. Inability to concentrate
    5. Irritability

    Answer: Cravings for the substance, Sleep disturbances, Inability to concentrate, Irritability

    Psychological dependence includes cravings, anxiety, depression, sleep disturbances and irritability, plus cognitive effects such as poor concentration and impaired memory. Improved memory is the opposite of what is described.

  4. A client admitted after heavy daily alcohol use has not had a drink for a day. Which findings should the nurse anticipate if withdrawal develops?

    1. Deep sedation and slowed breathing
    2. Increased appetite and weight gain only
    3. Constipation and pinpoint pupils
    4. Severe anxiety, hallucinations and seizures

    Answer: Severe anxiety, hallucinations and seizures

    Withdrawal usually shows the opposite of the drug's effect; alcohol causes CNS depression, so withdrawal can bring severe anxiety, hallucinations and seizures. Sedation and slowed breathing are effects of alcohol itself, not its withdrawal.

  5. Which factors determine how severe a client's withdrawal symptoms will be? Select all that apply.

    1. The dose
    2. The substance used
    3. The last time of exposure to the substance
    4. The client's eye color
    5. The duration of use

    Answer: The dose, The substance used, The last time of exposure to the substance, The duration of use

    The severity of withdrawal is determined by the substance, the dose, how long it was used and when it was last used. Eye color has no bearing on withdrawal.

  6. A client on long-term corticosteroids asks whether needing to taper the drug means they have a substance use disorder. What is the nurse's best response?

    1. Physical dependence can occur during routine medical care and does not by itself mean a substance use disorder.
    2. Physical dependence happens only with alcohol.
    3. Only illegal drugs cause physical dependence.
    4. Yes, any physical dependence means a substance use disorder.

    Answer: Physical dependence can occur during routine medical care and does not by itself mean a substance use disorder.

    Physical dependence can develop with prescribed agents such as corticosteroids and is not always a sign of an SUD. It is not limited to illegal drugs or alcohol.

Where every quote comes from

Section 15.1 Introduction to Substance Use Disorders of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.