10 Substance Use and Addictive Disorders
Learn how substance use disorders are assessed and treated, how to recognize urgent risks, and how respectful, person-centered care can support safety and recovery.
Understanding substance use disorders
A is a pattern of substance use that causes clinically significant distress or impairment. It may involve alcohol, opioids, stimulants, cannabis, sedatives, nicotine, or other substances. It is a health condition—not a moral failing—and can occur alongside medical or mental health conditions.
Diagnosis is based on clinical assessment, not on a screening score or toxicology test alone. Assessment considers features such as impaired control, craving, risky use, continued use despite harm, and tolerance or . Within a twelve-month period, severity is classified as mild when two to three criteria are met, moderate when four to five are met, and severe when six or more are met.
A positive screen signals a need for further assessment; it does not establish a diagnosis. Ask routinely, respectfully, and in private. Explain why you are asking, use nonjudgmental language, and follow applicable confidentiality and consent requirements.
Takeaway: Screening can identify who may need more support, while diagnosis requires a broader clinical assessment.
Screening and assessment
Brief validated screening tools include the Tobacco, Alcohol, Prescription medication, and other Substance use Tool and the NIDA Quick Screen. links screening to a brief, motivational conversation and referral when more specialized care is indicated. Use screening tools as aids alongside clinical judgment.
A focused assessment explores:
The substances used, amount, frequency, route, and time of last use.
Prescribed medications and any history of or overdose.
Effects on health and daily life.
Immediate safety, including intoxication, , suicidal thoughts, pregnancy where relevant, and use of multiple substances—especially opioids with alcohol or sedatives.
A supportive response can invite shared planning: “Thank you for telling me. Can we talk about what you’ve noticed and what kind of help would feel useful?” The next step is assessment, not blame.
Recognizing and urgent risks
can occur when the body adapts to repeated substance exposure and use is reduced or stopped. Symptoms vary by substance and patient. Assess the time of last use, vital signs, hydration, sleep, mental status, pain, and risk of seizures or self-harm. Follow clinical protocols and use validated scales when appropriate—for example, CIWA-Ar for alcohol or COWS for opioid —as part of a broader assessment.
Alcohol can become life-threatening. Tremor, sweating, nausea, anxiety, and insomnia may progress to seizures or delirium tremens, which can involve severe confusion, agitation, or hallucinations. Suspected significant needs prompt medical assessment. Seizures, severe confusion, hallucinations, fever, or an irregular heartbeat require emergency care. Clinicians may use medication and close monitoring to prevent complications. management alone does not treat the underlying alcohol use disorder.
from benzodiazepines and other sedative-hypnotics can also be medically dangerous. Do not advise abrupt cessation after sustained use without clinical guidance. Opioid can cause substantial physical distress and warrants symptom management and treatment planning. After a period of reduced or no opioid use, tolerance may fall, increasing overdose risk if use resumes. Stimulant may include fatigue, sleep and mood changes, and depression; assess suicide risk and provide support.
Takeaway: Identify urgent symptoms early and follow clinical protocols; some forms of require emergency care.
Reducing harm and responding to overdose
means reducing preventable injury and illness while respecting a person's goals, including when they are not ready to stop using. Offer practical, nonjudgmental support and connect people with local services. Depending on need and availability, options include , drug-checking resources, sterile supplies and safe disposal, wound care, infectious-disease testing and vaccination, and referral to treatment. Syringe services programs can provide sterile equipment and link participants to health care and treatment.
For a suspected opioid overdose, activate emergency response, give if available, and follow the dispatcher’s instructions. can reverse opioid overdose, including overdose involving fentanyl. It is safe to use when an opioid overdose is suspected even if the cause is uncertain. Continue emergency care because does not replace medical evaluation.
Takeaway: Respond quickly to suspected overdose and offer practical safety resources without judgment.
Treatment, , and continuity of care
Treatment should be individualized, evidence-based, and matched to clinical risk and patient preference. Care settings may include outpatient counseling, intensive outpatient care, residential treatment, or hospital-level care. Behavioral approaches can include motivational interviewing, cognitive behavioral therapy, contingency management, family therapy, and peer or mutual-support groups. Address co-occurring mental and physical health conditions, and plan follow-up and transitions between care settings.
Medication is an important treatment option. For , FDA-approved medications include buprenorphine, methadone, and naltrexone. Detoxification without ongoing medication treatment is not recommended for because return to use can lead to overdose and death. For alcohol use disorder, approved medications include naltrexone, acamprosate, and disulfiram; the choice depends on a person’s health, goals, and other medications.
is a personal process that may include improved health, relationships, safety, and quality of life. It does not follow one path. A return to use can signal a need to reassess the plan, not a reason to withdraw care. Nurses support through respectful communication, shared decisions, education, coordination, and encouragement of realistic next steps.
Takeaway: Combine appropriate treatment and support with continuity, dignity, and hope.