Strategies for Nurses Encountering Patients at Risk for Addiction or Substance Use Disorder

by Deborah A. Thomas, M.Ed., LPC, CADC, Chief Executive Officer The Walker Center, Gooding, Idaho Email:

Addiction is a chronic, progressive, primary disease that if left untreated will lead to an early death. According to the American Society of Addiction Medicine [ASAM] (2011, Definition of Addiction, para 1), addiction “is characterized by an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”

As the first step in helping a person at risk for an addiction or with a substance use disorder (SUD), the nurse must recognize that there is an addiction problem. When encountering these adolescents and/or adults, a nurse may feel manipulated and experience an active addict’s playing on the nurse’s emotions with lies, complaints, or even appealing to the nurse’s sympathies in order to continue to obtain the reward the addict may be actively seeking. Oftentimes a nurse will not know how to interact with these patients. Even worse is that those persons at risk for addiction or with a SUD will not know what to do with themselves. It’s a frustrating situation. It can seem hopeless at times for the patient, the patient’s family, and the nurse.

How Nurses Can Intervene

In interactions with persons at risk for addiction or SUD, nurses may not know the words that will help these individuals or their family. From a nurse’s perspective, it may be challenging to determine whether a patient at risk for addiction or with SUD needs inpatient or outpatient treatment. The expectation is not that the nurse would assess or treat these patients, but instead should make a referral to an addiction treatment center. Nurses should be aware however that this might lead to upset patients and/or family members. The person at risk for addiction or with SUD needs to hear that there is hope, that there is someone that can provide options, and that life can get better.

At the addiction treatment center, the addiction specialist will conduct a multidimensional assessment of the individual using the American Society of Addiction Medicine Criteria (see Figure 1). According to ASAM (2011. ASAM Criteria, para 1), these criteria are a “comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions.”

Nurses play a pivotal role in ensuring the patient receives the best treatment. By facilitating the referral, nurses plant the seed to initiate change, which may turn around the life of these individuals and assist them toward sobriety and ultimately to become a productive, motivated contributor to society. Residential facilities such as The Walker Center in Gooding, Idaho, can help treat adults over 18 who are at risk for addiction and/or who abuse drugs and alcohol. The underlying emotional or behavioral issues are addressed through gender-specific and gender-separate treatment such as cognitive behavioral group therapy.

If you are concerned about someone who has a substance abuse problem, facilitate the addiction specialist consult.