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14.9 Applying the Nursing Process to Substance Use Disorders

Assessment (Recognizing Cues)

Mental Status Examination

See Table 14.9a for common findings when assessing a client with a substance use disorder. (See expected findings for these components of a mental status examination in the “Assessment” section in Chapter 4.) Critical findings that require immediate notification of the provider are bolded with an asterisk. This table helps identify clinical features that may present during intoxication, withdrawal, or long-term substance use and supports a comprehensive nursing assessment.

Table 14.9a Common Findings During Mental Status Examinations for Clients With Substance Use Disorders[1]

Mental Status Examination Component Common Findings in Substance Use Disorders

(*Indicates immediately notify provider)
Signs of Distress May present with anxiety, agitation, physical discomfort, or withdrawal symptoms (e.g., tremors, sweating, nausea). May appear drowsy, euphoric, or dysregulated depending on the substance used and timing.
Level of Consciousness and Orientation Varies with substance type and use pattern. May be fully alert or display fluctuating levels of  consciousness, confusion, or disorientation—especially during withdrawal or overdose of alcohol, opioids, and benzodiazepines.
Appearance and General Behavior May appear disheveled or neglected, especially with chronic use of a substance. Signs of intoxication or withdrawal may include dilated or constricted pupils, slurred speech, or slowed/increased movements. Behavior may be guarded, restless, or impulsive. Track marks may be present for those using IV substances.
Speech Speech may be slurred, rapid, pressured, or incoherent, depending on substance being used.
Motor Activity May display tremors, psychomotor agitation (e.g., pacing, jitteriness), retardation (e.g., sedation), or repetitive movements. Falls, unsteadiness, or hyperactivity may also occur.
Mood and Affect Mood may fluctuate based on substance used and timing. Mood may be euphoric, irritable, anxious, depressed, or flat. Clients may appear emotionally labile or detached. Intoxication may mask the client’s true emotional state and withdrawal may increase distress.
Thought and Perception Thought content may include denial, guilt, paranoia, or preoccupation with obtaining substances. In severe intoxication or withdrawal, hallucinations, delusions, or psychosis may occur (e.g., alcohol-induced hallucinosis).
Attitude and Insight Insight is often impaired—clients may minimize or deny the extent of use or its consequences. Attitude may range from cooperative to guarded, defensive, or evasive depending on trust and withdrawal status.
Cognitive Abilities and Level of Judgment Impaired attention, memory deficits, or poor concentration are common. Long-term use may cause cognitive slowing (e.g., in alcohol or benzodiazepine use). Executive function and judgment may be compromised.

Psychosocial Assessment

A comprehensive psychosocial assessment includes the following components:

  • Reason for seeking health care (i.e., “chief complaint”)
  • Thoughts of suicide or self injury
  • Cultural assessment
  • Spiritual assessment
  • Family dynamics
  • Current and past medical history
  • Current medications
  • History of previously diagnosed mental health disorders
  • Previous hospitalizations
  • Educational background
  • Occupational background
  • History of exposure to psychological trauma, violence, and domestic abuse
  • Substance use (tobacco, alcohol, recreational drugs, misused prescription drugs)
  • Family history of mental illness
  • Coping mechanisms
  • Functional ability/Activities of daily living

After identifying the reason the client is seeking health care, additional focused questions are used to obtain detailed information. The mnemonic PQRSTU can be used to ask questions in an organized fashion. See Table 14.9b for a sample PQRST assessment for a client experiencing an alcohol use disorder.

Table 14.9b Sample PQRSTU Questions for Assessing Alcohol Use Disorder

PQRSTU Sample Questions Sample Client Response
Provocation/Palliation

 

 “What usually leads you to drink?”
“What helps you cut back or stop, even temporarily?”		 “I usually drink when I feel stressed overwhelmed. It helps me feel calmer and numb to things. I’ve tried to stop a few times, but then the anxiety gets worse and I go back to it.”
Quality “How would you describe your drinking experience—what does it do for you?” “When I’m drinking, I feel relaxed and have more fun with my friends.”
Region “Do you notice any physical effects when you drink or stop drinking?” “I noticed if I stop drinking alcohol every day, I get shaky and can’t sleep.”
Severity “How much has drinking affected your health, work, or relationships?” “I broke up with my partner because they said they’re tired of me drinking too much. I lost my last job because I missed too many days of work from being hungover.”
Timing/Treatment

 

 “When did you start drinking regularly?”
“How has your drinking changed over time?”		 “I started drinking in high school with my friends and drank every weekend in college. After my breakup it got even worse. Now I have to have some drinks every night, and sometimes in the morning to steady myself.”
Understanding “Why do you think this problem developed?”

“What do you believe needs to happen to stop this problem?”

 “I started drinking to have fun then drank more to make myself feel numb. I’ve tried to stop drinking in the past, but if I have one or two drinks with my friends, it starts all over again.”

Suicide and Self Injury Screening

Clients being evaluated or treated for substance use disorders may have suicidal ideation. It is important for the nurse to introduce suicide screening in a way that helps the client understand its purpose and normalize questions that might otherwise seem intrusive. The Patient Safety Screener (PSS-3) is an example of a brief screening tool to detect suicide risk in all client presenting to acute care settings.[2]

Non-suicidal self-injury (NSSI) refers to intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned. Common forms of NSSI include behaviors such as cutting, burning, scratching, and self-hitting. It is considered a maladaptive coping strategy without the desire to die. NSSI is a common finding among adolescents and young adults in psychiatric inpatient settings.[3]

Review information about suicide screening, the Patient Safety Screener, and screening for non-suicidal self-injury (NSSI) in the “Assessment” section of the Applying the Nursing Process to Mental Health Care” chapter.

Cultural Assessment

Cultural Formulation Interview (CFI) questions help nurses understand a client’s cultural background and how it influences their experience of substance use disorder.[4] Sample CFI questions focused specifically on understanding alcohol use disorder within a cultural context include the following:

  • Cultural Definition of the Problem
    • “How would you describe your drinking problem to someone close to you?”
    • “What terms or labels are used in by your friends or family to talk about heavy drinking?”
    • “Do people around you see your drinking as a problem?”
  • Cultural Perceptions of Cause, Context, and Support
    • “Why do you think drinking became an issue for you?”
    • “How is alcohol used in your family or community? Is it used in celebrations, rituals, or as a coping tool?”
    • “Do you feel pressure—positive or negative—from your family or friends related to your drinking?
  • Cultural Factors Affecting Coping and Help-Seeking
    • “Have you tried anything on your own to manage your drinking? What helped and what didn’t?”
    • “Are there any traditional practices, herbs, or dietary supplements you have tried to use to manage it?”
    • “Do people in your community seek help for alcohol-related issues? If so, from whom (e.g., religious leaders, clinics, family)?”
    • “What kinds of treatment or help do you think would be most useful or acceptable to you?”
  • Cultural Features of the Nurse–Client Relationship
    • “Are there any concerns you have about talking to a mental health professional?”
    • “Would you feel more comfortable speaking with someone of a similar gender, cultural, or religious background?”
    • “What would help you feel more supported or understood during treatment?”
    • “Have you had past experiences with healthcare or addiction treatment that were helpful or unhelpful?”

Findings from the cultural formulation interview are used to individualize a client’s plan of care to their preferences, values, beliefs, and goals.

Spiritual Assessment

The FICA Spiritual History Tool is a widely used assessment model for evaluating a client’s spiritual beliefs and how they may influence health, illness, and coping. It’s especially helpful in understanding how clients with substance use disorders draw on spirituality or religion for support—or how spiritual distress may be contributing to feelings of anxiety. Addressing a client’s spirituality and advocating spiritual care have been shown to improve clients’ health and quality of life.[5],[6]

The FICA Spiritual History Tool© is a common tool used to gather information about a client’s spiritual history and preferences. FICA© is a mnemonic for the domains of Faith, Importance, Community, and Address in Care.[7] Table 14.9C summarizes a sample FICA Spiritual Assessment for a client with a substance use disorder.

Table 14.9C Sample FICA Spiritual Assessment Questions For Clients With A Substance Use Disorder

Domain Sample Assessment Question Sample Client Response
Faith “Do you have spiritual beliefs or religious faith that help you cope with challenges or give your life meaning?” “Yes, I believe in God and used to go to church, especially when I was trying to get sober. But I’ve drifted away because I feel ashamed about using.”
Importance “What importance does your faith or belief have in your life? Has it influenced how you cope with stress or your anxiety?” “They’re still important to me, but I don’t feel like I’m living life the way I should be. God will probably punish me for all I’ve done.”
Community “Are you part of a spiritual or religious community? Does participation in this community provide support when you’re feeling anxious or stressed?” “I haven’t gone back to church since I relapsed. I don’t want to be judged.”
Address in Care “How would you like me (or the health care team) to address spiritual issues during your care? Would you like to speak with a chaplain?” “Yes I would be interested in speaking to someone who will listen and not judge me.”

Nurses may recognize cues of spiritual distress or beliefs in divine punishment that may exacerbate feelings of anxiety. Nurses can offer to connect the client with a chaplain or spiritual care services. Spiritual goals may be included in the nursing care plan if the client finds them valuable.

History

The following client history should be obtained from a client diagnosed with a substance use disorder[8]:

  • History of substance use: Include names of the substances used, the time of last use, the duration of use, the quantity and frequency of use, and the method of use (e.g., oral, intravenous, inhaled, intranasal). A detailed substance use history helps determine the expected time frame for emergence of withdrawal symptoms and the potential for severe withdrawal syndromes. Family history of substance use.
  • Detailed history of previous withdrawal treatments & treatment history: For clients who have previously undergone withdrawal management, a history of these treatments should be obtained. The history of any previous treatment programs should be obtained. History should include previous treatments (such as inpatient or outpatient programs, 12-step programs such as Alcoholics Anonymous, or medications such as naltrexone or acamprosate), as well as what treatments have been helpful or not helpful.
  • Mental health history: Concurrent mental health illness can impact the client’s withdrawal symptoms. Clients should receive integrated post-withdrawal treatments for multiple diagnoses of mental health and substance use disorders.
  • Social history: Identification of social supports (such as a supportive family member who can encourage abstinence and potentially dispense withdrawal medication), as well as barriers (such as poor transportation), can also help determine the most appropriate post-withdrawal treatment plan (e.g., residential, outpatient, and recovery programs).
  • Medical history and recent physical symptoms: Medical problems can contribute to the client’s symptoms and/or worsen withdrawal symptoms.

The client should receive a comprehensive physical examination to evaluate signs related to current withdrawal symptoms, as well as symptoms of concurrent medical and mental health diagnoses. If the client has been diagnosed with alcohol use disorder, signs of complications such as liver or pancreatic disease should be assessed.[9]

Screening Scales

Screening scales may be administered such as CIWA-aR (for alcohol withdrawal symptoms) and COWS (for opioid withdrawal symptoms). Read more information about these scales in the “Withdrawal Management/Detoxification” section of this chapter.

Diagnostic and Lab Work

Laboratory testing for clients admitted for withdrawal treatment may include these items[10]:

    • Complete blood count
    • Serum electrolytes, including potassium, magnesium, and phosphate
    • Glucose
    • Creatinine
    • Liver function tests
    • Amylase and lipase
    • Blood alcohol level
    • Urine drug testing for benzodiazepines, cocaine, and opioids. (The opioid test may include testing for heroin, codeine, morphine, buprenorphine, oxycodone, methadone, and fentanyl.)
  • Urine human chorionic gonadotropin (HCG) test for premenopausal women to check for pregnancy
  • Electrocardiogram (ECG) for clients over 50 years of age or if there is a history of cardiac problems

Life Span Considerations

Children and Adults

In 2020, nearly 10 million U.S. adolescents met the diagnostic criteria for a substance use disorder, and the majority were untreated. In the United States, more than 90% of adults with SUDs began their substance use in adolescence. [11]Adolescents with SUDs  are at greater lifetime risk for sexually transmitted diseases, poor family planning, justice system involvement, school-related challenges, neurocognitive impairments, and increased risk of mental health disorders. Adolescent substance use is associated with the leading causes of death of unintentional injury, suicide, and violence. Onset of substance use disorders may begin during childhood, often with alcohol, cannabis, or vaping. Substance use is influenced by peer pressure, family dynamics, trauma, adverse childhood experiences, and emotional dysregulation. Early substance use increases risk for lifelong addiction due to ongoing brain development. Behavioral changes for children using substances may include irritability, truancy, declining grades, secretiveness, withdrawal from family. Risk-taking, mood swings, and impulsivity may be misattributed to “normal adolescence.” Coexisting disorders such as ADHD, anxiety, or depression should be considered. Adolescents need developmentally appropriate, preventive, and early intervention-focused strategies that engage their families and social systems.[12]

Older Adults

Onset of substance use disorder in older adults may occur due to late-life stressors such as grief, retirement, isolation, or chronic illness. Prescription drug misuse (e.g., opioids, benzodiazepines) is common. Substance use may present with falls, memory loss, confusion, sleep disturbances, or social withdrawal that may be mistaken for dementia symptoms. Older adults require holistic care that integrates mental health, physical health, and social support.[13]

Diagnosis (Analyzing Cues)

A nursing diagnosis related to the abrupt cessation of a psychoactive substance is Acute Substance Withdrawal Syndrome. As a syndrome diagnosis, defining characteristics are the related nursing diagnoses, including Acute Confusion, Anxiety, Disturbed Sleep Pattern, Nausea, Risk for Electrolyte Imbalance, and Risk for Injury.[14]

Review information about syndrome nursing diagnosis in the “Diagnosis” section of the “Nursing Process” chapter of Open RN Nursing Fundamentals.

Outcome Identification (Generate Solutions)

An example of a broad goal related to withdrawal treatment is the following:

  • The client will stabilize and remain free from injury.[15]

These are some sample SMART outcomes[16]:

  • The client’s vital signs will remain within normal ranges during treatment.
  • The client’s electrolyte levels will remain within normal ranges during treatment.
  • The client will participate in planning a post-withdrawal treatment program before discharge.

Planning (Generate Solutions)

Safety

Safety receives top priority when planning and implementing interventions for clients with substance use disorder who are at risk of suicide, and interventions are planned according to their level of risk. Review interventions for clients at risk of suicide in the “Application of the Nursing Process in Mental Health Care” chapter.

Implementation (Take Action)

Nursing Interventions for Substance Use Disorder Based on Categories of the APNA Implementation Standard

Nursing interventions for substance use disorders can be categorized based on the American Psychiatric Nurses Association (APNA) standard for Implementation that includes the Coordination of Care; Health Teaching and Health Promotion; Pharmacological, Biological, and Integrative Therapies; Milieu Therapy; and Therapeutic Relationship and Counseling. Read more about these subcategories in the “Application of the Nursing Process in Mental Health Care” chapter. See examples of interventions for each of these categories for clients with anxiety disorders in Table 14.9.

Table 14.9d Examples of Nursing Interventions for Substance Use Disorders by APNA Subcategories[17],[18]

Subcategory of the APNA Standard of Implementation The nurse will … Rationale
Coordination of Care -Collaborate with a multidisciplinary team (physician, addiction counselor, social worker, pharmacist) to ensure integrated care.
-Facilitate referrals to detoxification, rehabilitation, or community recovery programs.		 Effective treatment of SUDs requires a collaborative and coordinated approach that addresses medical, psychological, and social needs.
Health Teaching and Health Promotion -Educate the client on the effects of substance use, including its impact on physical health, mental health, and relationships.
-Use motivational interviewing to promote behavior change and harm reduction.		 Health education and motivational techniques improve insight, self-efficacy, and readiness for change while reducing relapse risk.
Pharmacological, Biological, and Integrative Therapies -Administer medications as prescribed (e.g., naltrexone, buprenorphine, acamprosate).
-Monitor for withdrawal symptoms, side effects, and adherence.
-Incorporate integrative methods such as mindfulness or guided imagery to manage cravings and anxiety.		 Medications can support recovery by reducing cravings, preventing relapse, and managing co-occurring conditions.
Monitoring ensures safety and promotes therapeutic response.
Milieu Therapy -Establish a safe, structured, and substance-free environment.
-Promote positive peer interaction through group therapy, relapse prevention groups, or 12-step meetings.
-Set clear expectations and boundaries.		 A therapeutic milieu reduces triggers and access to substances, supports accountability, and promotes recovery-focused behavior.
Therapeutic Relationship and Counseling -Build a nonjudgmental, empathetic relationship based on trust.
-Support client-led goals.
-Explore underlying emotional pain, trauma, or mental illness contributing to substance use.		 A strong therapeutic alliance improves treatment engagement, reduces shame, and facilitates the exploration of root causes and maladaptive coping.

Nursing Interventions for Physiological Signs of Substance Use Disorder

Nursing interventions also target common physiological signs of substance use disorder and associated self-care deficits. See common interventions for these conditions in Table 14.9e.

Table 14.9e Nursing Interventions Targeting Physiological Signs of Substance Use Disorder and Self-Care Deficit[19],[20]

Problem/Intervention Rationale
Withdrawal

  • Monitor for withdrawal symptoms using tools such as CIWA-Ar (for alcohol) or COWS (for opioids).
  • Administer medications (e.g., benzodiazepines, methadone, clonidine) as prescribed.
  • Provide quiet, low-stimulus environment.
 Withdrawal from substances like alcohol or opioids can lead to seizures, delirium, or autonomic instability. Early detection and medication management reduce complications and mortality.
Nutrition and Hydration

  • Monitor weight and BMI.
  • Assess fluid status (I&O, skin turgor, mucous membranes).
  • Monitor electrolytes and administer replacement therapy as prescribed (e.g., magnesium, potassium).
  • Encourage oral fluids unless contraindicated.
  • Provide nutrient-dense meals and snacks.
  • Administer vitamins (e.g., thiamine, folic acid, multivitamins) as prescribed.
  • Consult dietitian.
 Poor dietary intake, gastrointestinal issues, and neglect are common in SUD. Replenishing nutrition helps restore energy, immune function, and cognitive clarity. Many individuals with SUD experience dehydration and electrolyte imbalance, especially during detox. Rehydration prevents complications such as arrhythmias or Wernicke’s encephalopathy.
Sleep

  • Promote sleep hygiene: reduce noise, dim lights, avoid caffeine.
  • Assess for night sweats, nightmares, or insomnia.
  • Teach relaxation strategies (e.g., guided breathing, music therapy).
 Insomnia is common in withdrawal and early recovery phases, particularly in stimulant and alcohol users. Rest supports emotional regulation and healing.
Pain

  • Use non-opioid pain relief (e.g., acetaminophen, hot packs, distraction).
  • Assess for hyperalgesia in opioid users.
  • Collaborate on safe pain management strategies for clients with SUD and coexisting chronic pain.
 Clients with SUD may have altered pain sensitivity or fear of severe pain due to previous history of poor pain management. Addressing pain appropriately promotes trust and recovery adherence.
Elimination 

  • Monitor for nausea, vomiting, diarrhea, or constipation.
  • Provide antiemetics, fiber supplements, or stool softeners as needed.
  • Encourage small, frequent meals.
 GI symptoms are common during detox and in chronic use of alcohol or opioids. Symptom relief increases treatment tolerability and nutritional intake.
Respiratory Status

  • Assess for respiratory depression, especially with use of opioids or benzodiazepines.
  • Monitor oxygen saturation and respiratory rate.
  • Have naloxone available per protocol.
 Overdose and sedation are risks with for clients with a history of misusing central nervous system depressants. Vigilant respiratory monitoring is essential for preventing hypoxia or death.
Self-Care Deficits

  • Assess ability and motivation to perform hygiene, grooming, and ADLs.
  • Provide structured daily routines and support gradual reengagement with hygiene tasks.
  • Use positive reinforcement to promote independence.
 Individuals with SUD may neglect self-care due to depression, intoxication, or environmental instability. Supporting ADLs enhances self-worth, engagement in recovery, and reintegration into daily life.

Communication Tips for Clients With Substance Use Disorders

Communicating effectively with someone experiencing a substance use disorder must foster feelings of trust, safety, and therapeutic alliance. People in states of heightened anxiety may struggle to process information, express themselves clearly, or feel emotionally overwhelmed. The following box provides communication tips when speaking with clients with severe anxiety.

 Communication Tips for Clients With A Substance Use Disorder[21]

  • Use nonjudgmental, person-first language. For example, say “a person with a substance use disorder” instead of “addict” or “alcoholic.”
    • Rationale:  Person-first language reduces stigma and supports the client’s sense of identity beyond the diagnosis.
  • Tailor communication to the client’s stage in the readiness for change model.
    • Rationale: Assess where the client is in the Stages of Change Model (e.g., precontemplation, contemplation) and adjust your message accordingly.
  • Explore rather than confront denial. For example, instead of saying, “You’re in denial about drinking too much,” ask, “What do you think others are concerned about?” or “What might happen if you continued drinking at this level?”
    • Rationale:  Using exploratory language maintains rapport while encouraging insight into their behavior.
  • Avoid power struggles or ultimatums.
    • Rationale: Framing treatment as a collaborative process rather than a directive one encourages cooperation and empowerment, which improves treatment adherence.
  • Reflect on their strengths and past successes.  For example, highlight what the client has done well or survived in the past (e.g., “You’ve taken steps to come here— that takes courage”)..
    •  Rationale: Reflecting on strengths and past successes builds self-efficacy, resilience, and motivation.
  • Be consistent and set clear, compassionate boundaries.
    • Rationale: Setting clear expectations around behavior and attendance help the client feel secure and respected, especially in early recovery.
  • Normalize relapse as part of recovery, if it occurs. For example say “Relapse doesn’t mean failure. Let’s figure out what happened and move forward.”.
    • Rationale: Relapse is common but doesn’t necessarily mean treatment failure. Normalizing relapse reduces shame and hopelessness.

Withdrawal Treatment

Nursing interventions provide a supportive environment while the client undergoes withdrawal treatment. Vital signs are monitored closely because increases in temperature, pulse, and blood pressure are signs of withdrawal. After ensuring that an individual’s physiological needs of airway, breathing, and circulation are met, safety measures receive top priority. Safety measures during withdrawal treatment may include interventions such as fall precautions, seizure precautions, or implementing restraints as needed to maintain the safety of the individual or those around them. [22]

Review information on fall precautions in the “Preventing Falls” section of the “Safety” chapter in Open RN Nursing Fundamentals, 2e.

Seizures can occur in clients experiencing alcohol withdrawal. Seizure precautions include keeping the bed in the lowest position with side rails padded. Suction and oxygen equipment must be available at all times at the client’s bedside. Review ANA guidelines on using restraints in the “Client Rights” section of the “Legal and Ethical Considerations in Mental Health Care” chapter and information on safely implementing restraints in the “Workplace Violence” section of the “Trauma, Abuse, and Violence” chapter.

Medications are administered as prescribed to keep the client safe and comfortable, so they do not suffer.[23] Review medications used during withdrawal treatment in the “Withdrawal Management/Detoxification” section of this chapter.

Clients with substance use disorders may exhibit a poor nutritional status due to long-term use of substances taking precedence over food and fluid intake. Nurses provide hydration and gradually reintroduce healthy foods while also promoting rest. Clients with alcohol use disorder are specifically at risk for thiamine (B1) and magnesium deficiencies that can lead to cardiac arrest. Thiamine and other electrolyte replacement is typically included during withdrawal treatment.[24]

Developing a therapeutic nurse-client relationship can encourage the client to explore harmful feelings of anxiety, hopelessness, and spiritual distress. Encouraging self-care and hygiene helps improve clients’ self-esteem.

Nurses educate clients about healthy coping skills and evidence-based treatment and recovery services available in the community.[25] Client education includes understanding the neurobiology behind substance use disorders and the impact on behavior, avoiding triggers, managing cravings, and early warning signs and when to seek help. Family member education includes how to provide emotional support without enabling behavior, family therapy, the importance of boundaries and managing caregiver stress. Review evidence-based treatments and recovery services in the “Treatment of Substance Use Disorders” section of this chapter.

In addition to implementing the withdrawal treatment plan prescribed by the provider, the nurse collaboratively develops a post-withdrawal treatment plan with interprofessional health care team members. The plan should be client-centered and include their goals and readiness for change. Motivational interviewing is a helpful therapeutic technique when planning individualized treatment goals and programs.[26]

Evaluation (Evaluate Outcomes)

Evaluation occurs on several levels by assessing the individualized SMART outcomes related to the effectiveness of the withdrawal treatment plan, symptom management, and the client’s readiness and progress towards changes in their behavior.[27]

Examples of potential evaluation outcomes include:

  • Monitor reduction in substance use, improvement in physical and mental health
  • Increased engagement in therapy, improved social functioning, employment
  • Modify based on client’s progress, address new issues (e.g., relapse, co-occurring disorders)
  • Reinforce coping mechanisms, provide ongoing support
  1. Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
  2. Suicide Prevention Resource Center. (n.d.). The patient safety screener: A brief tool to detect suicide risk. https://sprc.org/micro-learning/patientsafetyscreener ↵
  3. Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematic review. Frontiers in Psychology, 8. https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01946/full ↵
  4. DeSilva, R., Aggarwall, N. K., & Lewis-Fernandez, R. (2015). The DSM-5 cultural formulation interview and the evolution of cultural assessment in psychiatry. Psychiatric Times, 32(6). https://www.psychiatrictimes.com/view/dsm-5-cultural-formulation-interview-and-evolution-cultural-assessment-psychiatry ↵
  5. Pilger, C., Molzahn, A. E., de Oliveira, M. P., & Kusumota, L. (2016). The relationship of the spiritual and religious dimensions with quality of life and health of patients with chronic kidney disease: An integrative literature review. Nephrology Nursing Journal: Journal of the American Nephrology Nurses’ Association, 43(5), 411–426. https://pubmed.ncbi.nlm.nih.gov/30550069/ ↵
  6. Puchalski, C., Jafari, N., Buller, H., Haythorn, T., Jacobs, C., & Ferrell, B. (2020). Interprofessional spiritual care education curriculum: A milestone toward the provision of spiritual care. Journal of Palliative Medicine, 23(6), 777–784. https://doi.org/10.1089/jpm.2019.0375 ↵
  7. GW School of Medicine & Health Sciences. (n.d.). Clinical FICA tool. https://smhs.gwu.edu/spirituality-health/program/transforming-practice-health-settings/clinical-fica-tool ↵
  8. Pace, C. (2022). Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis. UpToDate. Retrieved March 19, 2022, from www.uptodate.com ↵
  9. Pace, C. (2022). Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis. UpToDate. Retrieved March 19, 2022, from www.uptodate.com ↵
  10. Pace, C. (2022). Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis. UpToDate. Retrieved March 19, 2022, from www.uptodate.com ↵
  11. Simon, K. M., Levy, S. J., & Bukstein, O. G. (2022). Adolescent substance use disorders. NEJM evidence, 1(6), EVIDra2200051. https://doi.org/10.1056/EVIDra2200051 ↵
  12. Simon, K. M., Levy, S. J., & Bukstein, O. G. (2022). Adolescent substance use disorders. NEJM evidence, 1(6), EVIDra2200051. https://doi.org/10.1056/EVIDra2200051 ↵
  13. Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation for change in substance use disorder treatment. Treatment Improvement Protocol (TIP) Series, No. 35:. Chapter 3—Motivational Interviewing as a Counseling Style. https://www.ncbi.nlm.nih.gov/books/NBK571068/ ↵
  14. Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier ↵
  15. Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier ↵
  16. Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier ↵
  17. Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
  18. National Institute on Drug Abuse. (2023). Treatment. https://nida.nih.gov/research-topics/treatment ↵
  19. Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
  20. National Institute on Drug Abuse. (2023). Treatment. https://nida.nih.gov/research-topics/treatment ↵
  21. Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation for change in substance use disorder treatment. Treatment Improvement Protocol (TIP) Series, No. 35:. Chapter 3—Motivational Interviewing as a Counseling Style. https://www.ncbi.nlm.nih.gov/books/NBK571068/ ↵
  22. Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
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  26. Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵
  27. Halter, M. (2022). Varcarolis’ foundations of psychiatric-mental health nursing (9th ed.). Saunders. ↵

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