Substance use from the nursing side: screening, intoxication, harm reduction and recovery
- Safe practice
Screen everyone without judging, recognise intoxication and overdose, protect the airway, offer a brief intervention and link to treatment.
What it is
Substance use disorders behave like other chronic illnesses: they can be treated, remission is possible and relapse is part of the course, not a failure. The nurse screens for substance misuse in every setting, takes a detailed use history, recognises intoxication and overdose, delivers a brief non-judgemental intervention, refers to treatment when needed and supports recovery. Because detoxification lowers tolerance, the risk of overdose rises if the person uses again in the same amount; overdose prevention and naloxone education are part of discharge.
What it requires
- A non-judgemental, stigma-free approach and private interview.
- Validated screening tools and a referral route agreed by the institution.
- Knowledge of intoxication and overdose signs by substance group.
- Links with treatment, mutual-help groups and recovery services.
Components
- Screening and history.
- Recognising intoxication and overdose.
- Brief intervention, motivational interviewing and referral.
- Harm reduction, relapse prevention and recovery support.
How it is applied (and why)
- Ask every person about alcohol, tobacco and other drugs in private, with a validated tool — early detection allows early intervention.
- Record substances, time of last use, amount, frequency, duration and route — this predicts when withdrawal will appear and how severe it may be.
- Assess vital signs, consciousness, pupils and breathing — intoxication can depress breathing, above all when alcohol is mixed with opioids or sedatives.
- If the person is drowsy from alcohol or drugs, keep them on their side and stay with them — a depressed gag reflex can lead to aspiration.
- Give a brief intervention: share the result, ask about their reasons for change, respect ambivalence — a collaborative talk works better than confrontation.
- Refer to specialised treatment when the person meets criteria for a disorder or brief intervention has not worked — severe disorders need longer care.
- Teach the danger of mixing alcohol with opioids or sedatives and of lowered tolerance, and that witnesses can be trained to use naloxone — this saves lives.
- Plan discharge with the person: follow-up, treatment, family support and what to do after a relapse — a relapse means adjusting the plan, not giving up.
In nursing practice
- Many myths (addiction as a choice, «you can only help someone who wants help») block care; treatment need not be voluntary to work.
- Treat a co-occurring mental disorder together with the substance use disorder.
- In pregnancy, substance use can harm the baby; refer early and without blame.
- Medicines such as those for alcohol use disorder or smoking cessation may be part of the plan; the nurse teaches and watches for effects.
Common mistakes
- Asking about substances in front of relatives or in a hurry.
- Using labels such as «addict» or «drunk».
- Letting someone «sleep it off» unobserved.
- Discharging after detoxification without overdose education or follow-up.
Test yourself
Think of the answer, then tap the question to see it.
What are the three signs of the opioid overdose triad?
Pinpoint pupils, respiratory depression and decreased level of consciousness.
Why is overdose risk higher after detoxification?
Withdrawal management lowers tolerance; if the person uses their former amount again, they may overdose, especially with opioids.
What does SBIRT stand for?
Screening, Brief Intervention and Referral to Treatment: screen, give a short motivational talk and refer when a disorder is present or the intervention fails.
Elsewhere in DurgiPedia
- Screening and brief intervention (SBIRT) and harm reduction
- Motivational interviewing
- Addiction concepts: reward, tolerance, dependence and withdrawal
- Cues, craving and relapse
Connections
In Pharmacology2
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing: Mental Health and Community Concepts, 14.9: Treatment of substance use disorders (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Nursing: Mental Health and Community Concepts, 14.4: Substances: use, intoxication and overdose (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Nursing: Mental Health and Community Concepts, 14.11: Applying the nursing process to substance use disorders (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Opioid overdose (fact sheet) (World Health Organization (WHO), 2025).
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Representative model, for educational purposes only.