Substance-Related Disorders

• Definition: ingesting in any manner a chemical that has an effect on the body.


• General assessment:
  • Behavioral changes exist while under the influence of substance.
  • Engages in regular use of substance.
    1. Substance abuse:
       • Pattern of pathological use (i.e., day-long intoxication; inability to stop use, even when contraindicated by serious physical disorder; overpowering need or desire to take the drug despite legal, social, or medical problems); daily need of substance for functioning; repeated medical complications from use.
       • Interference with social, occupational functioning.
       • Willingness to obtain substance by any means, including illegal.
       • Pathological use for more than 1 mo.
    2. Substance dependence:
       • More severe than substance abuse; body requires substance to continue functioning.
       • Physiological dependence (i.e., either develops a tolerance - must increase dose to obtain desired effect - or has physical withdrawal symptoms when substance intake is reduced or stopped).
       • Person feels it is impossible to get along without drug.
  • Effects of substance on central nervous system (CNS).


• General analysis: only in recent years has substance abuse been viewed as an illness rather than moral delinquency or criminal behavior. The disorders are very complex and little understood. There are physiological, psychological, and social aspects to their causality, dynamics, symptoms, and treatment, where personality disorder has a major part.
  • Physiological aspects - current unproven theories include “allergic” reaction to alcohol, disturbance in metabolism, genetic susceptibility to dependency, and hypofunction of adrenal cortex. There are organic effects of chronic excessive use.
  • Psychological aspects - disrupted parent-child relationship and family dynamics; deleterious effect on ego function.
  • Social and cultural aspects - local customs and attitudes vary about what is excessive.
  • Maladaptive behavior related to:
    1. Low self-esteem.
    2. Anger.
    3. Denial.
    4. Rationalization.
    5. Social isolation.
    6. A rigid pattern of coping.
    7. Poorly defined philosophy of life, values,
  • Nursing diagnosis in acute phase of abuse, intoxication:
    1. Risk for ineffective breathing patterns related to pneumonia caused by aspiration, malnutrition; depressed immune system.
    2. Risk for decreased cardiac output related to effect of substances on cardiac muscle; electrolyte imbalance.
    3. Risk for injury related to impaired coordination, disorientation, and altered judgment (worse at night).
    4. Risk for violence: self-directed or directed at others, related to misinterpretation of stimuli and feelings of suspicion or distrust of others.
    5. Sensory/perceptual alterations: visual, kinesthetic, tactile, related to intake of mind-altering substances.
    6. Altered nutrition, less than body requirements.
    7. Altered thought processes (delusions, incoherence) related to misinterpretation of stimuli due to severe panic and fear.
    8. Sleep pattern disturbance related to mindaltering substance.
    9. Ineffective individual coping related to inability to tolerate frustration and to meet basic needs or role expectations, resulting in unpredictable behaviors.
    10. Noncompliance with abstinence and supportive therapy, related to inability to stop using substance because of dependence and refusal to alter lifestyle.
    11. Impaired communication related to mental confusion or CNS depression related to substance use.
    12. Impaired health maintenance management related to failure to recognize that a problem exists and inability to take responsibility for health needs.