[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Mental health and psychiatric nursing](https://durgical.com/en/nursing/areas/mental-health/) › Substance use from the nursing side: screening, intoxication, harm reduction and recovery # 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. Updated Nov 13, 2026 ## Key points - Screen everyone with a validated tool, such as the WHO-based AUDIT for alcohol; people often under-report use. - History: substances, last use, amount, frequency, duration, route, past withdrawal and past treatment. - Screening, brief intervention and referral to treatment (SBIRT): short, respectful, focused on the person's own reasons for change. - Do not leave a person who has passed out from alcohol alone: side-lying position, watch the airway. - Opioid overdose triad: pinpoint pupils, slow breathing and reduced consciousness; naloxone can prevent death. - After detoxification, release from prison or a break in use, tolerance falls and overdose risk rises. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/nursing/substance-use-from-the-nursing-side-screening-intoxication-harm-reduction-and-re/) ## Elsewhere in DurgiPedia - [Screening and brief intervention (SBIRT) and harm reduction](https://durgical.com/en/behavioral-science/screening-and-brief-intervention-and-harm-reduction/) - [Motivational interviewing](https://durgical.com/en/behavioral-science/motivational-interviewing/) - [Addiction concepts: reward, tolerance, dependence and withdrawal](https://durgical.com/en/behavioral-science/addiction-concepts-reward-tolerance-dependence-and-withdrawal/) - [Cues, craving and relapse](https://durgical.com/en/behavioral-science/cues-craving-and-relapse/) ## Connections ## Related 2 - [Alcohol withdrawal: CIWA-Ar monitoring, seizure and delirium precautions and thiamine before glucose](https://durgical.com/en/nursing/alcohol-withdrawal-ciwa-ar-monitoring-seizure-and-delirium-precautions-and-thiam/) - [Opioid withdrawal and overdose risk: COWS monitoring, naloxone and safe discharge](https://durgical.com/en/nursing/opioid-withdrawal-and-overdose-risk-cows-monitoring-naloxone-and-safe-discharge/) ## Related conditions 5 - [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/) - [Stimulant use disorder (cocaine, amphetamines)](https://durgical.com/en/conditions/stimulant-use-disorder/) - [Cannabis use disorder](https://durgical.com/en/conditions/cannabis-use-disorder/) - [Tobacco use disorder](https://durgical.com/en/conditions/tobacco-use-disorder/) - [Sedative-hypnotic (benzodiazepine) use disorder and withdrawal](https://durgical.com/en/conditions/sedative-hypnotic-use-disorder-and-withdrawal/) ## In Pharmacology 2 - [Medicines for alcohol use disorder](https://durgical.com/en/pharmacology/classes/medicines-for-alcohol-use-disorder/) - [Smoking cessation medicines](https://durgical.com/en/pharmacology/classes/smoking-cessation-medicines/) [← All of nursing](https://durgical.com/en/nursing/) 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](https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/14%3A_Substance_Use_Disorders/14.09%3A_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](https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/14%3A_Substance_Use_Disorders/14.04%3A_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](https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/14%3A_Substance_Use_Disorders/14.11%3A_Applying_the_Nursing_Process_to_Substance_Use_Disorders) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); [Opioid overdose (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/opioid-overdose) (World Health Organization (WHO), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/substance-use-from-the-nursing-side-screening-intoxication-harm-reduction-and-re/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/substance-use-from-the-nursing-side-screening-intoxication-harm-reduction-and-re/