This educational activity is credited for 2 contact hours at completion of the activity.
The goal of this course is to present a comprehensive overview of substance use disorder, including the Controlled Substances Act, drug classifications, commonly used substances, symptoms of overdose, treatment options for opioid use disorder, and key nursing considerations essential to patient care and recovery.
Substance use disorder (SUD) is a complex medical condition marked by the compulsive use of substances despite negative consequences. In previous decades, individuals with SUD were often viewed through a lens of moral failing or lack of willpower, frequently labeled as “addicts” and burdened with stigma. However, advances in neuroscience have reshaped this understanding, recognizing SUD as a chronic brain disorder. This course provides an overview of substance use disorder, including the Controlled Substances Act, classifications of drugs, and commonly misused substances. It also explores overdose symptoms, treatment approaches for opioid use disorder, and critical nursing considerations in managing and supporting individuals with SUD.
Upon completion of this course, the learner will be able to:
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| Addiction | A chronic brain disorder that involves compulsive seeking and using of substances or engaging in activities despite negative consequences. |
| Alcohol | A colorless volatile flammable liquid that is produced by the natural fermentation of sugars and is the intoxicating constituent of wine, beer, spirits, and other drinks. |
| Anxiolytic | Medications that prevent or treat anxiety symptoms or disorders. |
| Ataxia | Loss of coordination of voluntary muscle movements. |
| Attention Deficit Hyperactivity Disorder (ADHD) | A mental health condition that affects focus, impulsivity and behavior. |
| Benzodiazepines | Medications that slow down the nervous system and treat anxiety, insomnia, seizures and other conditions. |
| Buprenorphine | An opioid medication used to treat opioid use disorder (OUD), acute pain, and chronic pain. |
| Cannabis | A tall plant with a stiff upright stem, divided serrated leaves, and glandular hairs that is used to produce hemp fiber and as a drug. |
| Cardiopulmonary Resuscitation (CPR) | A medical procedure involving repeated compression of a patient’s chest, performed in an attempt to restore the blood circulation and breathing of a person who has suffered cardiac arrest. |
| Cocaine | A tropane alkaloid that acts as a central nervous system (CNS) stimulant. |
| Cocaine Use Disorder | A stimulant addiction where people continue to take cocaine despite its negative effects. |
| Controlled Substance | A drug regulated by the DEA for safety, medical use, and misuse prevention. |
| Controlled Substance Act (CSA) | The statute establishing federal US drug policy under which the manufacture, importation, possession, use, and distribution of certain substances is regulated. |
| Cyanosis | A bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood. |
| Dextromethorphan (DXM) | A cough suppressant that is an ingredient in over the counter (OTC) cold medications. |
| Diagnostic And Statistical Manual Of Mental Disorders (DSM-5) | A publication by the American Psychiatric Association (APA) for the classification of mental health disorders using a common language and standard criteria. |
| Diphenhydramine | An antihistamine used to relieve allergy, cold, and motion sickness symptoms. |
| Dopamine | A chemical messenger that helps regulate many functions in the body and brain. |
| Drug Enforcement Administration (DEA) | A federal agency that combats criminal drug networks and educates the public about the dangers of drugs. |
| Euphoria | Intense feeling of happiness and pleasure. |
| Fentanyl | A synthetic opioid that is up to 100 times more potent than morphine and 50 times more potent than heroin. |
| Flumazenil | An antidote that reverses the effects of benzodiazepine sedatives. |
| Gamma Hydroxybutyrate (GHB) | A naturally occurring neurotransmitter and a depressant drug. |
| Hallucinogen | A group of drugs that alter perception, thoughts and feelings. |
| Heroin | A highly addictive drug that comes from the opium poppy and can be smoked, snorted, or injected. |
| Homeostasis | The automatic process that keeps the body steady and balanced in response to changes in the environment. |
| Hypoxia | A below-normal level of oxygen in the blood, specifically in the arteries. |
| Illegally Made Fentanyl (IMF) | A highly potent synthetic opioid or an analog developed in clandestine laboratories. |
| Inhalants | Volatile substances that produce chemical vapors that can be inhaled to alter the mind. |
| Meth Mouth | A colloquial term used to describe severe tooth decay and tooth loss, as well as tooth fracture, acid erosion, and other oral problems that are often symptomatic to extended use of the drug methamphetamine. |
| Methamphetamine | A potent stimulant that can cause euphoria, increased activity, and weight loss. |
| Miosis | A condition where the pupil is smaller than normal, even in bright light. |
| Muscarinic Receptors | Acetylcholine receptors that form G protein-coupled receptor complexes in the cell membranes of certain neurons and other cells. |
| Naloxone | A medicine that can reverse an opioid overdose by blocking the effects of other opioids. |
| Narcolepsy | A sleep disorder that causes excessive daytime sleepiness, sudden loss of muscle tone, and other symptoms. |
| Nicotine | A highly addictive substance in tobacco and e-cigarette products that can affect the brain and body. |
| Opioids | A class of drugs that relieve pain, but can also cause side effects, dependence, and overdose. |
| Overdose | When a person consumes over the recommended or typical dose of a substance. |
| Phencyclidine (PCP) | A dissociative illicit drug that can cause hallucinations, delirium, and violence. |
| Premature Death | Death that occurs before the average age of death in a certain population. |
| Schedule I Drugs | Drugs with no currently accepted medical use and a high potential for abuse. |
| Schedule II Drugs | Drugs considered to have a high potential for misuse but with acknowledged medical uses under strict regulation. |
| Schedule III Drugs | Drugs that are considered to have a lower potential for abuse compared with Schedule 1 and 2 drugs and have accepted medical uses and a moderate to low potential for physical and psychological dependence. |
| Schedule IV Drugs | Substances with a lower potential for misuse compared to those in Schedules 1–3 and have currently accepted medical use and a lower risk of physical or psychological dependence than Schedule 3 drugs. |
| Schedule V Drugs | Substances with a lower potential for misuse compared with those in Schedules 1–4 and have a currently accepted medical use and contain limited quantities of certain narcotics. |
| Sedatives | Drugs that slow brain activity and can help with anxiety, insomnia, seizures, and more. |
| Stimulants | Medicines that speed up mental and physical processes, used for conditions such as ADHD, narcolepsy, and obesity. |
| Substance Use Disorder (SUD) | A mental health condition in which a person has a problematic pattern of substance use that causes distress and/or impairs their life. |
| Tetrahydrocannabinol (THC) | The chemical that is responsible for most of marijuana’s psychological effects. |
| Tobacco | The common name of several plants in the genus Nicotiana of the family Solanaceae and the general term for any product prepared from the cured leaves of these plants. |
| Tolerance | A person’s diminished response to a drug, which occurs when the drug is used repeatedly, and the body adapts to the continued presence of the drug. |
| Withdrawal | The combination of physical and mental symptoms a person experiences after they stop using or reduce their intake of a substance such as alcohol and prescription or recreational drugs. |
Substance use disorder (SUD) is a complex condition defined by the compulsive use of substances despite harmful outcomes.¹ Historically, individuals battling substance dependence were often perceived as lacking self-control and labeled as morally flawed or weak. However, developments in neuroscience have shifted this narrative, recognizing SUD as a progressive and treatable disorder rooted in significant changes in brain function.¹ Each year, around 48 million people in the U.S. aged 12 and older—approximately 17% of this population—are affected by SUD, signaling a critical public health concern.²
SUD is associated with numerous acute and chronic health issues, including infectious diseases, cardiovascular and respiratory conditions, metabolic imbalances, psychiatric disorders, and various forms of cancer.³ It is also a major contributor to early mortality, with overdose deaths—particularly from opioids, stimulants, and synthetic drugs like fentanyl—on the rise.⁵ Beyond its health implications, the societal burden of SUD is extensive. The annual cost of substance use disorder is estimated to exceed $700 billion due to lost productivity, healthcare demands, and criminal justice expenses, emphasizing the need for comprehensive intervention strategies.⁶
This course provides an overview of substance use disorder, including the Controlled Substances Act, drug classifications, commonly used substances, overdose symptoms, treatment approaches for opioid use disorder, and key nursing responsibilities.
The Controlled Substances Act (CSA), enacted in 1970 under President Richard Nixon, serves as the foundation of U.S. drug policy. Its main objective is to regulate the manufacture, importation, possession, distribution, and use of substances with the potential for abuse.⁷ Through this legislation, a comprehensive system was established to manage both legal and illegal drugs, ensuring their availability for legitimate medical and scientific use while minimizing misuse. Healthcare professionals are required to adhere strictly to CSA regulations to prescribe, dispense, or administer controlled substances legally. Noncompliance can lead to serious consequences, including fines, imprisonment, and the revocation of professional licenses. Additionally, any healthcare provider authorized to prescribe these substances must be registered with the Drug Enforcement Administration (DEA) and maintain detailed records of all transactions involving controlled drugs to ensure accountability.
Under the CSA, substances are classified into five Schedules (I–V), based on their abuse potential, recognized medical applications, and likelihood of causing dependence.⁸
Schedule I substances are deemed to have a high potential for abuse, no accepted medical use in the United States, and a lack of safety even under medical supervision. Examples include heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (MDMA or ecstasy), methaqualone, and peyote.⁸ Despite being legalized in some states, marijuana remains a Schedule I drug at the federal level due to its classification.
Schedule II substances also have a high potential for abuse and carry a significant risk of severe physical or psychological dependence. However, they do have accepted medical uses under strict regulation. Examples include hydrocodone combinations (Vicodin), methadone, hydromorphone (Dilaudid), oxycodone (OxyContin), meperidine (Demerol), fentanyl, cocaine, methamphetamine, Dexedrine, Adderall, and Ritalin. While primarily used for pain relief or treatment of attention-deficit/hyperactivity disorder (ADHD), these medications are heavily monitored due to their abuse potential.
Schedule III substances have a lower abuse potential than Schedules I and II and a moderate to low risk of dependence. They are accepted for medical use. Examples include products with less than 90 mg of codeine per dose (e.g., Tylenol with codeine), ketamine, anabolic steroids, and testosterone.⁸ Ketamine is used in surgical anesthesia but is also known for its hallucinogenic effects. Anabolic steroids and testosterone are prescribed for hormonal deficiencies but have a history of misuse in athletic performance enhancement.
Schedule IV substances are considered to have a lower abuse risk than Schedule III drugs and are widely accepted for medical use. The potential for dependence is also lower. Examples include alprazolam (Xanax), diazepam (Valium), and tramadol.⁸ These medications are often prescribed for anxiety, muscle spasms, or moderate pain management.
Schedule V substances present the least potential for abuse and dependence. They are typically used for medical purposes and have minimal restrictions. Examples include cough syrups with less than 200 mg of codeine per 100 ml or per 100 grams, and ezogabine.⁸ Because of their low risk, Schedule V drugs are subject to fewer regulatory controls compared to substances in the higher Schedules.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), substance use disorder (SUD) involves ten categories of substances that, when consumed in excess, strongly stimulate the brain’s reward system—a key network involved in reinforcing behavior and storing memories.⁹ These categories include:
Excessive use of these substances can overstimulate the reward system, to the point that normal responsibilities are neglected. While natural behaviors activate this system gradually, drugs directly target and intensify its response, often producing an immediate sense of pleasure or euphoria. Though each class works through different mechanisms, they all share this capacity to reinforce repeated use.
Diagnostic Criteria for SUD
The DSM-5 outlines eleven specific symptoms—cognitive, behavioral, and physiological—that indicate continued substance use despite significant problems.⁹ These criteria are grouped into four categories:
1. Impaired Control (Criteria 1–4)
2. Social Impairment (Criteria 5–7)
3. Risky Use (Criteria 8–9)
A key part of Criterion 9 is the inability to stop using the substance despite understanding the risks and consequences.
4. Pharmacological Criteria (Criteria 10–11)
Withdrawal symptoms vary by substance. They are commonly seen and clearly identifiable with alcohol, opioids, and sedatives, but may be less obvious for stimulants, tobacco, and cannabis. Substances like hallucinogens, inhalants, and phencyclidine generally do not cause withdrawal, so this criterion is not used in their assessment.
It is also important to note that tolerance or withdrawal arising from medically supervised use—such as opioid therapy for pain—without other signs of misuse does not qualify as substance use disorder.
Behavioral indicators of substance use disorder (SUD) often involve noticeable disruptions in a person’s daily routine and interpersonal relationships.¹ Common signs include neglecting responsibilities at work, school, or home, as well as withdrawing from hobbies or social activities that were once enjoyable. Individuals may also display secretive or deceptive behaviors aimed at concealing their substance use. Despite facing adverse consequences—such as damaged relationships, loss of employment, or legal problems—those with SUD typically continue using the substance. A marked decline in overall reliability and performance across various areas of life is also frequently observed.
Physical signs of SUD can differ significantly based on the type of substance used.¹ General indicators include distinct changes in physical appearance and health status, such as sudden weight loss or gain, impaired coordination, and red or glassy eyes. Additional signs may include unusual body odors suggestive of substance use, poor hygiene, and abrupt shifts in mood or demeanor—ranging from irritability and restlessness to euphoria followed by depressive episodes. Substance-specific signs may also appear, such as visible track marks from intravenous drug use, frequent nosebleeds from snorting substances, or burns on fingers or lips associated with smoking drugs.
In the United States, the most abused drugs are alcohol, tobacco, cannabis, benzodiazepines, methamphetamines, opioids, cocaine, and prescription stimulants. Other substances that have recently shown a notable increase in misuse and carry a high risk of addiction include illegally manufactured fentanyl, gamma-hydroxybutyrate (GHB), and non-prescription cold and cough medications.
Alcohol
As reported by the 2022 National Survey on Drug Use and Health (NSDUH), around 60% of substance use disorder (SUD) cases—approximately 29 million individuals aged 12 and older—were associated with alcohol use, making it the most commonly misused substance nationwide. The widespread prevalence of alcohol misuse is largely influenced by its legal status, ease of access, and societal normalization. Alcohol, a central nervous system depressant, produces calming and pleasurable sensations, which makes it attractive for recreational and stress-related use. Nonetheless, prolonged consumption can result in dependency and severe health complications such as liver damage, cardiovascular disease, and neurological issues. Contributing factors often include peer pressure, inherited predispositions, and its use as a coping mechanism for emotional distress.
Tobacco
Tobacco consumption—either by traditional smoking or using electronic nicotine devices—is primarily driven by nicotine’s addictive influence on the brain’s dopamine system. This leads to feelings of reward and stress relief. Despite public awareness of its dangerous health outcomes like cancer, heart disease, and lung disorders, tobacco use remains widespread. Among individuals aged 12 and above, roughly 8% meet the criteria for nicotine addiction. Many users begin tobacco use at a young age due to social influences, peer pressure, or stress, and over time develop a strong habit that is difficult to break due to physical and psychological dependence.
Cannabis
Cannabis contains the psychoactive component tetrahydrocannabinol (THC), which creates a feeling of euphoria and calm. Its increasing legalization and social acceptance have contributed to its widespread use. Although often perceived as safer than other illicit substances, cannabis can lead to dependency and negative outcomes such as memory issues, impaired cognitive function, anxiety, and depression. According to 2022 NSDUH data, more than 61 million individuals aged 12 and older used cannabis, and approximately 30% of these users met the criteria for cannabis use disorder. People often misuse cannabis for recreation, pain management, mental health relief, or due to social and environmental influences.
Opioids
Opioid misuse, including both illicit drugs like heroin and prescription narcotics such as oxycodone, hydrocodone, and morphine, is a significant public health issue. These drugs are highly addictive because they bind to opioid receptors in the brain, reducing pain and producing euphoria. Many cases of misuse begin with valid medical use but evolve into dependency due to tolerance and withdrawal symptoms. In 2022, about 8 million people aged 12 and older reported opioid misuse, with more than 95% involving prescription drugs and fewer than 5% involving heroin. Misuse is frequently fueled by emotional distress, pain management needs, and drug accessibility.
Benzodiazepines
Benzodiazepines, such as alprazolam and diazepam, are sedatives that enhance the effects of gamma-aminobutyric acid (GABA), leading to reduced brain activity and a calming effect. They are typically prescribed for anxiety and sleep disorders but can be habit-forming. Misuse includes taking higher-than-prescribed doses or using the medication without a prescription. In 2022, approximately 3 million people misused prescription benzodiazepines, and 64% developed a sedative use disorder. Motivations for misuse include fast-acting relief of anxiety, self-treatment of mental health conditions, and desire for relaxation. Long-term misuse can lead to tolerance, dependence, and severe withdrawal symptoms.
Methamphetamines
Methamphetamine is a potent stimulant that drastically increases dopamine levels, resulting in intense pleasure, energy, and focus. Its strong addictive properties make it difficult for users to stop, leading to widespread misuse and dependency. In 2022, 2 million people aged 12 and older reported methamphetamine use, and around 66% met the criteria for methamphetamine use disorder. Prolonged use is associated with serious health issues such as dental damage, skin lesions, paranoia, and aggressive behavior. Users are often drawn to meth for its energizing effects, potential for weight loss, or to improve attention and performance. Though methamphetamine can be prescribed in rare cases (e.g., Desoxyn), most of the supply in the U.S. is illicit.
Prescription Stimulants
Prescription stimulants, including those used for attention deficit hyperactivity disorder (ADHD) and narcolepsy, increase dopamine and norepinephrine activity, thereby improving focus and alertness. Misuse is common among students and professionals who seek cognitive or physical enhancement. In 2022, about 4 million individuals aged 12 or older reported non-medical use, and 1 million had stimulant use disorder. Common reasons for misuse include academic pressure, work demands, and recreational purposes. Since these medications are available through legal prescriptions, accessibility can contribute to their overuse and potential addiction.
Cocaine
Cocaine is an illegal stimulant derived from coca plant leaves that boosts dopamine levels, creating brief but intense feelings of pleasure and alertness. Because its effects are short-lived, users often take repeated doses, heightening the risk of addiction. In 2022, 1.9 million individuals aged 12 and older reported using cocaine, and as many as 74% developed cocaine use disorder. Reasons for misuse include its stimulating effects, social use, and the belief that it can improve confidence or performance. Chronic use can lead to life-threatening cardiovascular issues, respiratory problems, neurological impairments, and psychological dependence.
Illegally Made Fentanyl
Illegally made fentanyl (IMF) poses a serious public health threat due to its extreme potency—50 to 100 times more powerful than morphine. Even small amounts can cause overdose or death, especially in individuals unfamiliar with opioids. IMF is often found mixed into other drugs or counterfeit pills, leading many users to unknowingly ingest it. In 2022, an estimated 991,000 individuals aged 12 and older reported fentanyl misuse. Motivations include its intense euphoric effects and accidental exposure through contaminated drug supplies.
Gamma Hydroxybutyrate (GHB)
Gamma hydroxybutyrate (GHB), often called “Liquid G,” is a depressant that induces hallucinations, euphoria, and drowsiness, but can also cause agitation and aggression. Regular use can quickly result in dependency and serious withdrawal symptoms. Illegally manufactured GHB is classified as a Schedule I controlled substance. In 2022, around 211,000 individuals reported using GHB. It is often misused for its mind-altering effects and is commonly associated with party or club environments.
Non-prescription Cough and Cold Medicines
Over-the-counter medications containing dextromethorphan (DXM) have seen rising misuse. DXM, typically used to suppress cough, can cause dissociation and hallucinations when taken in large doses. Other active ingredients, like diphenhydramine, may also induce drowsiness or mild psychoactive effects. In 2022, 2.2 million individuals aged 12 and over misused non-prescription cough or cold medications. Misuse is often driven by the ease of access, false perceptions of safety, and the search for psychoactive effects.
An overdose is a toxic condition that arises when a person consumes or administers a substance in an amount that surpasses the body’s capacity to metabolize or eliminate it, thereby disrupting the body’s internal balance.⁴² This leads to abnormally high concentrations of the substance in the bloodstream, impairing normal biological functions. The physiological response to an overdose varies by substance but may include central nervous system suppression, respiratory compromise, unstable cardiovascular activity, or metabolic imbalance. Clinicians evaluate the severity of overdose by observing vital signs, neurologic function, and laboratory test results. Prompt and effective intervention is essential to avoid life-threatening consequences and to help the body restore equilibrium.
Alcohol Poisoning
Alcohol poisoning, also referred to as acute intoxication, occurs when the depressant effects of alcohol overwhelm the brain and body.⁴³ Initial symptoms often include mental confusion, lack of coordination, and slurred speech as blood alcohol levels climb. Vomiting is also common in this stage, increasing the risk of dehydration and disturbances in electrolyte balance. As poisoning becomes more severe, breathing may slow or become irregular—a warning sign of respiratory suppression. Alcohol’s influence on body temperature regulation can result in hypothermia. In critical cases, the individual may suffer seizures or lose consciousness. These symptoms are medical emergencies. Treatment generally involves securing the airway, administering intravenous fluids to maintain hydration and electrolyte stability, and monitoring for complications such as low blood sugar or aspiration into the lungs.
Opioid Overdose
An overdose from opioids leads to distinct clinical signs due to their action on the central and respiratory systems.⁴⁴ One of the hallmark symptoms is pinpoint pupils, known as miosis, caused by stimulation of the iris sphincter muscle. Additional signs include profound sedation or unconsciousness and dangerously slowed or shallow breathing. As oxygen in the blood diminishes, cyanosis may develop, evidenced by a bluish hue around the lips and fingertips. Individuals may appear cold, unresponsive, or have a weak pulse. Without timely treatment, respiratory arrest and death can quickly follow. The first-line treatment is naloxone, a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression. Immediate care is essential to prevent lasting neurological impairment or fatality.
Benzodiazepine Overdose
Overdose involving benzodiazepines manifests primarily through suppression of central nervous system activity.⁴⁵ Common early signs include heavy sedation, confusion, dizziness, and impaired motor coordination. Individuals may also have slurred speech, difficulty with movement, and signs of low blood pressure and slow heart rate. If the dose is large enough, respiratory depression can occur, raising the risk for hypoxia and subsequent organ damage. In extreme cases, coma may result. Emergency treatment focuses on maintaining airway patency, supporting cardiovascular function, and in select cases, using flumazenil—a benzodiazepine-specific antagonist. Supportive measures such as oxygen therapy, intravenous fluids, and cardiac monitoring may be required to stabilize the patient and minimize complications.
Stimulant Overdose
Overdose from stimulants—including drugs like cocaine, methamphetamine, or prescription amphetamines—results in exaggerated activity of the central nervous and cardiovascular systems.⁴⁶ Users may become extremely agitated, paranoid, or experience visual and auditory hallucinations. This heightened stimulation also affects the heart and blood vessels, leading to symptoms like elevated heart rate, high blood pressure, and chest discomfort, all of which increase the risk of heart attack, stroke, or arrhythmias. An abnormally high body temperature (hyperthermia) is frequently observed and must be addressed quickly. Other symptoms may include muscle tremors, convulsions, and extreme physical restlessness. Immediate treatment includes administering sedatives to reduce agitation, intravenous fluids for hydration and electrolyte management, and close monitoring of cardiac function to identify and address potentially life-threatening irregularities.
Several treatment options are available for opioid use disorder (OUD), involving a combination of medication and behavioral therapy. Three primary medications currently approved for OUD include:²⁹
Methadone is a full opioid agonist that activates the same brain receptors as opioids like heroin or prescription narcotics but without producing the intense euphoria. This helps reduce cravings and withdrawal symptoms. With a duration of action lasting 24–36 hours, methadone allows patients to maintain daily functioning without experiencing cycles of intoxication and withdrawal. As a Schedule II drug, methadone is only dispensed through specialized clinics under strict regulation. Treatment typically begins with a single daily dose ranging from 10–20 mg, with higher initial doses possible for individuals with greater opioid tolerance.³⁰ If withdrawal symptoms persist 2–3 hours after dosing, an additional 5–10 mg may be administered.
If sedation occurs, the following day’s dose should be decreased. Methadone is available as an oral tablet, suspension, or liquid.³¹ Once stabilization is achieved, the goal is to find the lowest effective dose. Common side effects include constipation, sweating, and drowsiness, while more serious risks include respiratory depression, particularly when combined with other sedatives. Close monitoring is essential, especially in the early treatment phase, to reduce the risk of overdose and ensure safe titration.
Buprenorphine is a partial opioid agonist that provides relief from withdrawal symptoms while presenting a lower risk of misuse. It features a ceiling effect, which limits the extent of respiratory depression and euphoria at higher doses. Because it does not fully mimic other opioids, buprenorphine is primarily used for maintenance therapy. It is administered sublingually, buccally, or as a subdermal implant, with a duration of 24–60 hours.³¹ Dosing typically escalates over the first few days to 8–12 mg daily, then is tapered by 2–4 mg per day as treatment progresses.³² Common side effects include headaches, nausea, and constipation. Close patient monitoring is essential during initiation and dose adjustment to ensure therapeutic effectiveness and manage any adverse effects.
Naltrexone is an opioid antagonist that blocks the euphoric effects of opioids, making it effective in preventing relapse. It is available in oral form (lasting 24–48 hours) and as a long-acting intramuscular injection (effective for one month). Treatment may begin with 25 mg orally, followed by daily doses of 50 mg, or alternate-day regimens such as 100 mg every other day, 150 mg every third day, or 380 mg via monthly injection.³² Naltrexone must not be used while opioids are still present in the system, as it may displace them from receptors and cause precipitated withdrawal, which is often severe and can lead to treatment abandonment. Therefore, a period of complete opioid abstinence is required before initiating therapy. Common side effects include injection site reactions, elevated liver enzymes, and gastrointestinal discomfort. Liver function should be routinely monitored, and GI symptoms are often manageable with OTC medications.
Behavioral therapy is a critical element in treating OUD.³³ It addresses the psychological and behavioral roots of addiction that medications alone may not resolve. Therapy focuses on reshaping thoughts and behaviors, helping individuals develop skills for stress management, problem-solving, and relapse prevention. These interventions are especially beneficial for managing co-occurring mental health disorders, such as anxiety and depression, which, if untreated, can heighten the risk of relapse.
Recovery options for substance use disorder (SUD) include inpatient programs, outpatient treatment plans, and behavioral health interventions. Inpatient programs offer intensive, 24-hour care in a controlled and structured environment.³⁴ These programs are suited for individuals with severe addiction or co-occurring mental health conditions who require close supervision and medical oversight. Services typically include detoxification, medical stabilization, individual and group therapy, educational sessions, and alternative therapies such as art or music therapy. The controlled setting of inpatient care helps remove external triggers and access to substances, allowing individuals to focus entirely on recovery. Medical staff can also closely monitor and manage withdrawal symptoms and other complications during the detox phase. Despite these benefits, inpatient programs involve restricted personal freedom and a disruption of daily life, which can be challenging. The time commitment—ranging from several weeks to months—and higher cost may also limit accessibility for some individuals due to work, family, or financial constraints.
Outpatient treatment plans consist of scheduled visits to a treatment facility for therapy, counseling, and medication management under clinical supervision.³⁴ Since individuals remain in their home environment, they can continue with work, school, and family responsibilities. Outpatient care is more affordable than inpatient treatment and generally more accessible. A key advantage of outpatient care is that patients can apply therapeutic strategies to real-world situations as they progress through treatment. However, outpatient settings may expose individuals to more environmental triggers and temptations. This increased exposure requires patients to demonstrate strong personal commitment and discipline. The level of medical and psychological supervision is also lower than in inpatient programs, making a supportive home and community environment critical for success.
Behavioral health interventions are essential tools in promoting long-term recovery and involve a variety of therapeutic methods designed to change behaviors related to substance use.³³ Common approaches include:
These therapies help patients understand the root causes of their substance use, identify triggers, develop healthier coping strategies, and reshape harmful behaviors. Behavioral interventions alone may be sufficient for individuals with mild or early-stage substance use disorders, particularly when supported by a strong personal motivation and stable environment. For more severe or chronic cases, behavioral therapy alone is often inadequate. Because addiction is influenced by a mix of biological, psychological, and social factors, pharmacologic treatments may be necessary to control cravings and ease withdrawal symptoms. Combining behavioral and medication-assisted treatments generally produces the most effective outcomes for moderate to severe substance use disorders.
In the event of an overdose, immediate and effective intervention is essential to preserving life. Begin by assessing the patient’s airway, breathing, circulation, and level of consciousness, and initiate basic life support if required. Administer specific antidotes based on the suspected substance, such as naloxone for opioid overdose.²⁶ After administering naloxone, continuous monitoring is vital, as its effects may wear off before the opioid is fully cleared from the body, leading to a recurrence of symptoms.
Following stabilization, sustained observation is necessary to identify and respond to complications. Monitor for changes in consciousness, respiratory function, and cardiovascular stability to detect early signs of deterioration. Diagnostic tests, including toxicology screens, help determine the type and amount of substance involved and inform ongoing medical management.
Long-term care should include evaluating the underlying causes and contributing factors of the overdose. This may involve a comprehensive assessment for substance use disorder and co-occurring psychiatric conditions.²⁶ A collaborative, multidisciplinary approach that includes addiction specialists, mental health professionals, and social workers is crucial in developing a treatment plan focused on recovery and preventing future overdoses.
Nurses are integral to the effective management of substance use disorders (SUD) through their diverse responsibilities in patient care.³⁵ A core aspect of their role includes administering pharmacologic treatments and performing vigilant clinical monitoring. Nurses must follow exact protocols when dispensing medications—ensuring correct dosage calculations, adhering to safety standards, and complying with established treatment guidelines to reduce risk and enhance outcomes. Continuous monitoring for withdrawal symptoms, overdose indicators, or adverse medication reactions is essential. Based on these evaluations, nurses collaborate with interdisciplinary teams to revise treatment plans, ensuring optimal patient care.³⁶ Nurses also serve as patient advocates, helping to tailor and implement personalized care plans. Their proactive engagement significantly supports treatment effectiveness and enhances recovery outcomes.
During overdose events, nurses must respond swiftly and decisively. They begin by assessing the patient’s vital signs and visible symptoms, ensuring airway patency, and administering emergency interventions like oxygen therapy or cardiopulmonary resuscitation (CPR) as needed. In cases involving opioids, nurses should promptly administer naloxone (Narcan) to counteract life-threatening respiratory depression.
In addition to clinical responsibilities, nurses provide critical patient education and emotional support.³⁷ They educate patients and their families on the nature of SUD, treatment strategies, and relapse prevention. By enhancing understanding of substance use effects and the value of adherence to treatment, nurses empower patients to take ownership of their recovery. Establishing trust and offering compassionate support fosters a therapeutic relationship that encourages patient engagement in the recovery process.
Nurses are also bound by ethical obligations that uphold patient dignity, autonomy, and justice.³⁸ This includes maintaining professional competence, treating all patients equitably, and acting in accordance with legal and institutional standards. Nurses must maintain confidentiality by safeguarding patient information, only disclosing it with consent or when legally required in emergencies. Respect for patient autonomy means supporting informed decision-making and encouraging active participation in care planning. Nurses ensure patients are aware of their rights and understand their options within ethical boundaries.
Accurate and timely documentation is another essential nursing duty. It supports continuity of care, upholds safety, and ensures compliance with legal standards. Nurses should record all patient assessments, interventions, and responses objectively and thoroughly, following institutional protocols and legal guidelines. This includes reporting adverse events, incidents, or suspected abuse as required. Documentation should be clear, confidential, and consistent with professional and regulatory expectations.
To remain effective, nurses must stay informed about emerging substances and drug trends, as these developments impact clinical care. Recognizing new signs and symptoms, understanding pharmacological profiles, and adapting interventions to address new substances like synthetic opioids (e.g., fentanyl) is vital. Ongoing education and awareness ensure nurses can effectively manage withdrawal, prevent overdose, and deliver high-quality care in a constantly evolving substance use landscape.
Substance use disorders (SUD) are complex, chronic conditions that, while progressive, are treatable. The wide-ranging substances involved—such as alcohol, tobacco, cannabis, opioids, benzodiazepines, methamphetamines, and prescription stimulants—illustrate the varying pathways and risk factors contributing to misuse. Factors such as social acceptance, accessibility, and pharmacological potency influence both the appeal and the danger of these substances. The rise in misuse of illicitly manufactured fentanyl and over-the-counter medications further complicates SUD treatment and public health efforts, introducing heightened risks and new challenges.
Managing overdoses effectively requires rapid, structured intervention to prevent fatal outcomes and restore physiological stability. Regardless of the substance, the immediate goal is to stabilize the patient, support vital functions, and prevent long-term complications. Comprehensive treatment of SUD includes accurate diagnosis, behavioral therapies, and when appropriate, medication-assisted treatment. Recovery can be facilitated through inpatient or outpatient programs that integrate individualized care plans with evidence-based strategies.
Nurses are essential to this multidisciplinary approach. Their responsibilities encompass administering medications safely, monitoring patient responses, providing education, and advocating for personalized, holistic care. Through their clinical expertise and empathetic support, nurses help patients navigate the recovery process, reduce the risk of relapse, and improve overall treatment outcomes. Coordinated healthcare efforts that blend medical care with psychological and social support are critical to managing overdoses, supporting sustained recovery, and reducing the broader impact of substance use disorders.
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