Addiction can result in substantial costs to the individual and community, including job loss, crime, and violence. However, the financial costs cannot begin to approach the personal costs to the person and their family and friends.
Nurses are often the first healthcare providers that people with substance use disorders meet and are central to successful treatment. Discover more about addiction, the role substance use nurses play, and tips when a patient is experiencing addiction or a substance use disorder.
Substance Use and Addiction: An Overview
In 2019, the American Society of Addiction Medicine defined addiction as a “treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”
Substance abuse disorder is the diagnosis for those who struggle with the recurring use of substances. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for substance use disorder is not based solely on pharmaceutical dependence but rather on evidence of an individual’s behavior marked by social impairment, impaired control, and risky use of a substance.
Substance use nurses also participate in the treatment of addictive behavioral disorders. These share certain characteristics with a substance abuse disorder and often have similar environmental and biological etiologies.
An example of a behavioral addiction is a gambling disorder which falls under the non-substance-related disorders in the DSM-5.
Substance Use Disorder Prevalence and The Opioid Epidemic
According to the Centers for Disease Control and Prevention (CDC), drug overdose deaths increased roughly 30% from 2019 to 2020. Nearly 75% of the overdose deaths in 2020 involved opioids, including prescription opioids.
The Substance Abuse and Mental Health Services Administration also reports that in 2021, about 43 million people, or 16.5% of the population, met the DSM-5 criteria for having a substance use disorder. The population with the highest rate of substance abuse disorder were people aged 18-25, followed by youth and adults 26 and older.
The CDC noted the first wave of opioid overdose deaths occurred in the 1990s and involved prescription opioids — those numbers have only increased. After 2013, a significant number of overdose deaths included synthetic opioids, including Fentanyl, which is now found manufactured with counterfeit pills, heroin, and cocaine.
Joyce McMahon, RN, CARN, works in an outpatient substance use practice where she routinely helps manage withdrawal symptoms.
“In this practice, we see a lot of people who are trying to stop using opioids. When we check their urine toxicology, most of these patients will be fentanyl positive, which is sometimes a surprise to them! Maybe they think they are taking unprescribed Percocet, but their pills are really made of fentanyl. It’s a huge risk of fatal overdose,” she said.
The Role of Nurses in Caring for Patients Experiencing Addiction
Among the 46 million people with a diagnosable substance use disorder, only 6% received treatment. This means that nurses treating patients with substance use disorders are not limited to rehabilitation or treatment clinics.
It is vital nurses understand how to care for patients experiencing addictions in a variety of settings across specialties. For example, it would not be unusual for nurses practicing in orthopedics, cardiac care, or mother-baby specialties to encounter patients with substance use disorders that impact their health and the health of their families.
It is crucial that nurses treat addiction in the same way they would treat other diseases. The National Institute on Drug Abuse notes that addiction and other chronic diseases disrupt normal functioning, have serious long-term effects, and in many cases, are preventable and treatable.
Addictions nursing is a distinct specialty that incorporates therapeutic treatment and recovery services for individuals with substance use or behavioral addictions. Because nurses in a variety of settings encounter patients who have or are at risk of addictive disorders, the practice is defined as “knowledge specific” and not “settings specific.”
Nursing education must include standardized addiction content and help nurses reframe the adverse consequences within the context of an ever-growing public health crisis.
The origin of the opioid epidemic was fueled, in part, by generally ineffective pain management efforts. Nurses are often in key positions to help patients and their families understand the risks and benefits of chronic pain management.
The epidemic has highlighted the need for nurses across nearly all specialties to recognize the potential risks associated with opioid medications, understand alternative pain management strategies, identify potential substance use disorders, and support patient recovery.
Addiction Nursing Duties and Responsibilities
Many nursing programs have not kept pace with the advancing opioid crisis, so nurses wishing to specialize in addictions nursing must use other methods to improve their knowledge and clinical competencies about substance use and behavioral addictions.
In keeping with advances in the role, the Addiction Nursing Certification Board offers the certified addiction registered nurse (CARN) examination for registered nurses and advanced practice (AP) healthcare providers. During the last half of 2022, 88 RN candidates and 63 AP candidates took the exam.
“Getting a nationally recognized certification in your nursing specialty is a sign you really know your stuff, which is why I became a CARN,” McMahon said.
The duties and responsibilities of CARN nurse include:
- Conducting patient assessments and identifying care requirements
- Maintaining a knowledge base of new drugs
- Administering medications and treatments to relieve symptoms of withdrawal
- Educating patients and families on making healthy lifestyle choices
- Supporting patients coping with psychological and emotional issues associated with substance use disorders
- Recognizing the role trauma plays and assessing for the sequelae of traumatic experiences
- Educating communities and advocating for better healthcare practices
Tips for Nurses Providing Care to Patients Experiencing Addiction or Substance Use Disorder
Most nurses will provide care to patients with substance use disorder, even if they have not focused their professional career on treating patients with these conditions. These tips can help identify patients and improve patient outcomes.
1 | Keep an open mind toward how recovery is defined.
There are many challenges in recovering from addiction. It is a process of learning, growth, and healing that does not look the same from person to person. Beyond abstinence, people going through substance abuse recovery participate in activities that are healthy and meaningful, learn how to change their thought patterns, and develop new patterns of living that improve mental, emotional, and physical balance.
McMahon encourages nurses to see recovery as a process people must go through to live self-directed lives. She mentions that the National Institute on Drug Abuse’s definition of recovery doesn’t consider whether a person uses medication to support their recovery.
“There are certain traits I see in patients who are living in active recovery, regardless of which supports they use to get there, things like being able to enjoy life without drinking or using illicit substances, being the kind of person that people can count on, and being able to show up when they say they will. Even when they go through challenging experiences like losing a family member or having financial setbacks, if they remain stable in their recovery, that helps the whole situation,” she said.
2 | Educate patients on recovery programs and resources
Addiction nurses help educate people to make better lifestyle choices and enjoy their recovery. This includes providing patients with access to programs and resources that can structure the process for a greater potential for success.
McMahon assesses her patient needs, educates them on the available choices, and provides them with resources in the local area. She points out that a variety of community situations can cause programs to change drastically or close, which she found after the COVID-19 shutdown.
In response, she created a new resource referral list for patient use. Those resources included mental health providers and therapists, crisis hotlines, pain management practices, and inpatient substance abuse treatment options.
“Other nurses I work with serve on hospital-wide committees, provide Narcan training talks to new hospital staff, help train new staff, and act as a team resource. Basically, we notice things that need doing and do them in an effort to improve overall patient wellness,” she said.
3 | Address the unique needs of patients from special populations or with co-occurring mental illness experiencing addiction
Substance use nurses face unique situations in which they must use different approaches to care for special populations. For example, pregnant people, adolescents, and older adults dealing with addiction are considered special populations based on their special medical and nursing needs.
McMahon’s practice only sees adults but has treated pregnant people with substance use disorders. The practice helps them safely withdraw from alcohol and drugs, such as benzodiazepines and un-prescribed opioids. She works hard to move these patients to a maintenance medication like methadone or buprenorphine, which have been approved for use during pregnancy.
“We see a lot of successful pregnancies and moms who take great care of themselves and their babies on either methadone or buprenorphine. We support and educate the patient to make their own best choices. In addition, we have a protocol of additional appointments to see the woman throughout her pregnancy and for six months beyond,” she said.
4 | Recognize the signs of withdrawal
People with unidentified substance use disorders can be admitted to hospitals across multiple specialties. It is crucial that nurses learn how to recognize the signs of withdrawal and manage the symptoms with proper medical and psychological care.
Some people use recreational drugs but are not physically or psychologically dependent, so they will not experience symptoms of withdrawal. The symptoms depend on the type of drug, length of use, the person’s underlying medical conditions and age. Withdrawal symptoms can include:
- Irritability and changing moods
- Exhaustion or fatigue
- Nausea, vomiting, and diarrhea
- Sweating and shaking
- Runny nose
While withdrawal management is an important first step, it is unrealistic to think that management within an inpatient acute care hospital setting will lead to abstinence. In many instances, patients require long periods of psychological care and rehabilitation treatment on maintenance doses of methadone to achieve active recovery.
5 | Practice kindness and adopt a non-judgemental attitude to build trust
People with substance use disorders experience judgment throughout society and the healthcare community. Practicing kindness and a non-judgmental attitude is a good practice that helps patients open up and talk about their challenges.
Intentional kindness increases trust within relationships and can lead to greater cooperation and progress within treatment modalities. Communication strategies that help build trust and rapport with patients include:
- Active listening
- Minimal use of jargon
- Looking patients in the eye
- Mirroring behavior
- Communicating often
- Expressing empathy
- Showing respect and support
- Keeping your word
McMahon stresses the need for kindness and a non-judgmental attitude in addictions nursing.
“Kindness makes it possible for people to tell you about their substance use. Kindness makes them believe they can change. Being non-judgmental helps both nurse and patient to look in the direction of harm reduction, and to move towards it,” she said.
Working as a CARN Nurse
CARN is a nationally recognized certification offered by the Addictions Nursing Certification Board. McMahon stresses the importance of certification:
“One of the really cool things I’ve been able to do as an offshoot of my job is to serve on the board of an organization, the National Association of Chemical Dependency Nurses,” she said.
Certification offers nurses the opportunity to pursue higher salaries and legitimize their practice. CARN requirements include a current and unrestricted RN license, 2,000 hours of addiction nursing experience, and 30 hours of continuing education related to addictions nursing within three years of application.
CARN addiction nurses may work in clinical, administrative, teaching, and private practice situations. Others choose consulting or research roles that are related to addiction. McMahon notes just some of the things she does on a typical day:
“As a nurse, I assess patients, educate them on their choices, including medications, and provide resources. I present the patient to the provider for medication orders, describing the patient’s urine toxicology, prescribed medications, substances used, frequency and route of use, last use, withdrawal symptoms (using the COWS or CIWA scales), history of treatment, and their plan for aftercare if we are seeing them for withdrawal management,” she said.
Most nurses who encounter patients with substance use disorders or behavioral addictions must know how to identify withdrawal symptoms. They must also practice relevant skills that encourage patients to share their challenges, including kindness and non-judgmental attitudes.
No matter what specialty you choose, it’s highly likely you’ll care for patients who have substance use disorders. You may not always know the right thing to say, but you can offer support and help to patients with psychological and physical addictions that are negatively impacting their lives.
Meet Our Contributor
Joyce McMahon, BSN, RN, CARN
Joyce came to nursing as a second career, earning her second BSN in a 16-month bachelor’s program. She stayed in her first nursing job for seven years, working bedside on a busy telemetry floor. She left to be an at-home parent for five years, then had to take a nurse refresher program to return to the field. She’s glad she did. She has worked in community mental health with adults with significant mental health conditions, in an outpatient hospital psych program for adolescents, and as a withdrawal management nurse. She currently works in an outpatient substance use practice. She enjoys spending her free time with her family and trying to get people to compete in Wordle with her.
Page last reviewed June 16, 2023