NCLIP

Dealing with Addiction

3 min read

Dealing with Addiction

Key Points

  • Effective addiction care uses a continuum from early intervention to treatment and long-term recovery support.
  • Medication-assisted treatment combines pharmacotherapy with behavioral care and improves retention and outcomes.
  • Withdrawal stabilization is medically important but is not a complete treatment for substance use disorder.
  • Collaborative, nonjudgmental care lowers relapse and overdose risk after detox.

Pathophysiology

Addiction reflects chronic neurobehavioral dysregulation affecting reward, stress response, and executive control. Acute withdrawal destabilizes multiple physiologic systems and can become life-threatening in alcohol or benzodiazepine dependence.

Post-detox periods are high risk because tolerance decreases. If a person returns to previous doses, overdose risk rises substantially, especially with opioids.

Classification

  • Early intervention stage: Screening, brief intervention, guided self-change.
  • Active treatment stage: Detox/stabilization, medication, psychotherapy, structured programming.
  • Recovery support stage: Peer/community supports, relapse prevention, long-term follow-up.

Nursing Assessment

NCLEX Focus

Determine whether the client needs emergency overdose care, acute withdrawal stabilization, or step-down recovery support.

  • Assess substance history, current symptoms, and immediate medical risk.
  • Assess overdose signs by substance type (opioid, stimulant, alcohol, medication ingestion).
  • Assess withdrawal trajectory, severity, and complication risk (seizure, delirium, autonomic instability).
  • Assess stage of readiness for change (precontemplation to maintenance).
  • Assess support network, housing, insurance access, and treatment continuity barriers.

Nursing Interventions

  • Deliver rapid overdose response: emergency activation, airway support, and opioid reversal when indicated.
  • Use validated withdrawal protocols and frequent reassessment for symptom-guided treatment.
  • Provide education on relapse risk after detox and individualized safety planning.
  • Coordinate discharge across inpatient, residential, community, IOP, and peer-support options.
  • Use culturally responsive, trauma-informed, stigma-free communication in all encounters.

Detox Alone Is Insufficient

Withdrawal management without follow-up treatment has high relapse and overdose risk.

Pharmacology

MAT medications include methadone, buprenorphine, and naltrexone for opioid-related disorders. Symptom-based detox medications may include agents for pain, nausea, rhinorrhea, diarrhea, anxiety, and autonomic symptoms.

Alcohol withdrawal often uses benzodiazepines and may require thiamine/electrolyte correction; severe cases can require ICU-level care. Nurses monitor blood pressure, sedation level, respiratory status, renal risk, and medication response.

Clinical Judgment Application

Clinical Scenario

A client completes inpatient detox and reports strong cravings, low confidence, and uncertain follow-up plans.

Recognize Cues: Reduced tolerance, high craving, and weak post-discharge supports. Analyze Cues: Immediate relapse and overdose risk is high without continuity planning. Prioritize Hypotheses: Priority is safe transition with treatment engagement. Generate Solutions: Arrange MAT follow-up, counseling, peer support, and crisis contacts. Take Action: Finalize coordinated discharge plan with family/team education. Evaluate Outcomes: Verify appointments, support activation, and client understanding of relapse response.

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