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Substance Dependence/Abuse Rehabilitation Nursing Care Plan (NCP)

Many drugs and volatile substances are subject to abuse (as noted in previous plans of care). This disorder is a continuum of phases incorporating a cluster of cognitive, behavioral, and physiological symptoms that include loss of control over use of the substance and a continued use of the substance despite adverse consequences. A number of factors have been implicated in the predisposition to abuse a substance (e.g., biological, biochemical, psychological [including developmental], personality, sociocultural and conditioning, and cultural and ethnic influences). However, no single theory adequately explains the etiology of this problem.

This plan of care addresses issues of dependence and is to be used in conjunction with plans of care relative to acute intoxification/withdrawal from specific substance(s).

DSM-IV
ALCOHOL USE DISORDERS
303.90 Alcohol dependence
305.00 Alcohol abuse

AMPHETAMINE (OR AMPHETAMINE-LIKE) USE DISORDERS
304.40 Amphetamine dependence
305.70 Amphetamine abuse

CANNABIS USE DISORDERS
304.30 Cannabis dependence
305.20 Cannabis abuse

COCAINE USE DISORDERS
304.20 Cocaine dependence
305.60 Cocaine abuse

HALLUCINOGEN USE DISORDERS
304.60 Hallucinogen dependence
305.30 Hallucinogen abuse

INHALANT USE DISORDERS
304.60 Inhalant dependence
305.90 Inhalant abuse

NICOTINE USE DISORDERS
305.10 Nicotine dependence

OPIOID USE DISORDERS
304.00 Opioid dependence
305.50 Opioid abuse

PHENCYCLIDINE USE DISORDERS
304.90 Phencyclidine dependence
305.90 Phencyclidine abuse

SEDATIVE, HYPNOTIC, OR ANXIOLYTIC SUBSTANCE USE DISORDERS
304.10 Sedative, hypnotic, or anxiolytic dependence
305.40 Sedative, hypnotic, or anxiolytic abuse

POLYSUBSTANCE USE DISORDER
304.80 Polysubstance dependence
(For other listings, consult DSM-IV manual.)

NURSING PRIORITIES
1. Provide support for decision to stop substance use.
2. Strengthen individual coping skills.
3. Facilitate learning of new ways to reduce anxiety.
4. Promote family involvement in rehabilitation program.
5. Facilitate family growth/development.
6. Provide information about condition, prognosis, and treatment needs.

DISCHARGE GOALS
1. Responsibility for own life and behavior assumed.
2. Plan to maintain substance-free life formulated.
3. Family relationships/enabling issues being addressed.
4. Treatment program successfully begun.
5. Condition, prognosis, and therapeutic regimen understood.

Nursing diagnosis for Substance Dependence/Abuse Rehabilitation: Denial may be related to Personal vulnerability; fear; difficulty handling new situation; and Learned response patterns; cultural factors, personal/family value systems possibly evidenced by Delay in seeking, or refusal of, healthcare attention to the detriment of health/life; Does not perceive personal relevance of symptoms or danger, or admit impact of condition on life pattern; projection of blame/responsibility for problems; and Use of manipulation to avoid responsibility for self.

Desired Outcomes
1. Verbalize awareness of relationship of substance abuse to current situation.
2. Engage in therapeutic program.
3. Verbalize acceptance of responsibility for own behavior.

Nursing intervention with rationale:
1. Ascertain by what name client would like to be addressed.
Rationale: Shows courtesy and respect, giving the client a sense of orientation and control.

2. Convey attitude of acceptance of client, separating individual from unacceptable behavior.
Rationale: Promotes feelings of dignity and self-worth.

3. Ascertain reason for beginning abstinence, involvement in therapy.
Rationale: Provides insight into client’s willingness to commit to long-term behavioral change and whether client even believes that he or she can change. Note: If treatment is court-ordered, client may just be “doing time” until case is resolved and therefore may not be fully committed to the program. (Denial is one of the strongest and most resistant symptoms of substance abuse.)

4. Answer questions honestly and provide factual information. Keep all promises.
Rationale: Creates trust, which is the basis of the therapeutic relationship.

5. Provide information about addictive use versus experimental, occasional use; biochemical/genetic disorder theory (genetic predisposition); use activated by environment; pharmacology of stimulant; compulsive desire as a lifelong occurrence.
Rationale: Progression of use continuum in the addict is from experimental/recreational to addictive use. Comprehending this process is important in combating denial. Education may relieve client of guilt and blame and may help awareness of recurring addictive characteristics.

6. Discuss current life situation and impact of substance use.
Rationale: First step in decreasing use of denial is for client to see the relationship between substance use and peer group. Use confrontation with caring. personal problems.

7. Confront and examine denial/rationalization in peer group. Use confrontation with caring.
Rationale: Because denial is the major defense mechanism in addictive disease, confrontation by peers can help the client accept the reality of adverse consequences of behaviors and that drug use is a major problem. Caring attitude preserves self-concept and helps decrease defensive response.

8. Confront use of anger, rationalization, or projection.
Rationale: Anger is often a response of defensiveness, and pointing this out to the client can help him or her to accept feelings underlying anger. These defense mechanisms prolong the stage of denial that problems exist in client’s life because of substance use.

9. Remain nonjudgmental. Be alert to changes in behavior (e.g., restlessness, increased tension).
Rationale: Confrontation can lead to increased agitation, which may compromise safety of client/staff.

10. Encourage and support client’s taking responsibility for own recovery (e.g., development of alternative behaviors to drug urge/use). Assist client to learn own responsibility for recovering.
Rationale: Denial can be replaced with responsible action when client accepts the reality of own responsibility.
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