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SUBSTANCE DEPENDENCE/ABUSE REHABILITATION Many drugs and volatile substances are subject to abuse. This disorder is a continuum of phases incorporating a cluster of cognitive, behavioral, and physiological symptoms that include loss of control over use of the substance and a continued use of the substance despite adverse consequences. A number of factors have been implicated in the predisposition to abuse a substance: biological, biochemical, psychological (including developmental), personality, sociocultural and conditioning, and cultural and ethnic influences. However, no single theory adequately explains the etiology of this problem. CARE SETTING Inpatient stay on behavioral unit or outpatient care in a day program or community agency. RELATED CONCERNS Alcohol: acute withdrawal Psychosocial aspects of care Patient Assessment Database Depends on substances involved, duration of use, organs affected. TEACHING/LEARNING Discharge plan DRG projected mean length of stay depends on individual program, general health considerations: status May need assistance with long-range plan for recovery Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Drug screen: Identifies drug(s) being used. Addiction Severity Index (ASI) assessment tool: Produces a “problem severity profile” of the patient, including chemical, medical, psychological, legal, family/social and employment/support aspects, indicating areas of treatment needs. Other screening studies (e.g., hepatitis, HIV, TB): Depends on general condition, individual risk factors, and care setting. NURSING PRIORITIES 1. Provide support for decision to stop substance use. 2. Strengthen individual coping skills. 3. Facilitate learning of new ways to reduce anxiety. 4. Promote family involvement in rehabilitation program. 5. Facilitate family growth/development. 6. Provide information about condition, prognosis, and treatment needs. DISCHARGE GOALS 1. Responsibility for own life and behavior assumed. 2. Plan to maintain substance-free life formulated. 3. Family relationships/enabling issues being addressed. 4. Treatment program successfully begun. 5. Condition, prognosis, and therapeutic regimen understood. 6. Plan in place to meet needs after discharge.
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NURSING DIAGNOSIS: Denial May be related to Personal vulnerability; difficulty handling new situations Previous ineffective/inadequate coping skills with substitution of drug(s) Learned response patterns; cultural factors, personal/family value systems Possibly evidenced by Delay in seeking, or refusal of healthcare attention to the detriment of health/life Does not perceive personal relevance of symptoms or danger, or admit impact of condition on life pattern; projection of blame/responsibility for problems Use of manipulation to avoid responsibility for self DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Acceptance: Health Status (NOC) Verbalize awareness of relationship of substance abuse to current situation.
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