Drug and alcohol use problem is a perennial issue that has plagued the US healthcare system for decades. Notable cultural phenomena such as perverse drinking that led to Prohibition in the 1920s and the Crack Epidemic in the 1980s are just some of the events that emphasize the drug and alcohol abuse problem in the US. According to the 2022 National Survey on Drug Use and Health (NSDUH), over 221 million people (or 84% of the population) in the US aged twelve years and older reported that they had used alcohol at some point in their lifetime (NIAAA, 2023). The Centers for Disease Control and Prevention (CDC) and National Center for Drug Abuse Statistics (NCDAS) (2024) estimate that about half of US residents aged twelve and older have used illicit drugs at least once in their lifetime, About one million deaths have been recorded since 2000, costing the federal government about $35 billion in control. America Addiction Centers (AAC) also notes that marijuana, cocaine, LSD, and alcohol are the most abused drugs and that 19.7 million (38% of adults) users of these substances are battling with substance use disorder. AAC also noted that 74% of users with substance use disorders are also struggling with alcohol addiction. These statistics affirm that the issue of drug and alcohol use is not new, is prevalent, and is a national health issue. The billions channeled at addressing the problem have been utilized by various drug and alcohol intervention programs to a considerable degree of success. This essay will review the current literature on co-occurring drug and alcohol use, evidence-based interventions that have been employed to address the problem, and Healthy People 2030 objectives on the issue while inspecting nursing care plans for intervention.
Scholarly interest in understanding the prevalence of alcohol and other drug use (AOD) disorders and devising treatment approaches have revealed various findings that confirm the necessity and effectiveness of interventions. AOD is prevalent among older people (Searby et al., 2016) and a problem among younger people (Patrick et al., 2017; Ansari & Salam, 2021). Cognitive behavioral therapy is highlighted as one of the effective evidence-based interventions for addressing the issue (Chiang et al., 2017; Mehta et al., 2021), while pharmacotherapy has been highlighted as a complementary approach to addressing it (Li, 2023).
AOD use is a problem among older people, which mandates prompt intervention. Searby et al. (2016) conducted a two-year study with 593 participants from 2012 to 2014 to determine this. The study found that dual diagnosis for AOD and mental health issues was common and presented a significant challenge in addressing either of the problems. The study further noted that patients with dual diagnosis were more likely to have substandard treatment outcomes and higher rates of psychiatric relapse. Treating mental health illness and drugs and substance abuse was also costly, and patients had poorer treatment engagement with their care providers. The study also highlighted inadequate screening procedures to assess the extent of AOD and mental health to form targeted and responsive interventions. This study’s findings affirm that AOD is a global health issue, and that is poorly understood, leading to weaker interventions to address it.
AOD use is a problem that also affects younger people. The study by Patrick et al. (2017), in a study funded by the NIAAA, examined the patterns of co-use (concurrent and simultaneous) of alcohol and marijuana among adolescents in the US. The scholars drew 12th-grade statistics and data from the Monitoring the Future study conducted between 1976 and 2016 to determine the prevalence of simultaneous alcohol and marijuana use (SAM). The study found that 56.4% of 12th-grade alcohol users were also likely to use marijuana. Similarly, SAM use was found to be associated with high levels of truancy, violence, evening outs, and the use of alcohol alongside other illicit drugs other than marijuana. Heavy SAM use was also found to be more likely to be associated with male students compared with their female counterparts. These observations are congruent with the statistics highlighted by the AAC (2024) and CDC (2023) that show that men are more likely to be heavy alcohol users compared to women. The findings by Patrick et al. recognize that AOD is a public health risk that affects not only older but also adolescents. The co-occurring use of alcohol and other substances has also been found by studies such as that of tobacco and alcohol, as confirmed by Ansari and Salam (2021), which focused on patterns of use in Finland universities. These studies emphasize the necessity to direct intervention measures towards adolescents and young adults who are potential high-risk lifetime users.
Cognitive behavioral interventions (CBT) have been highlighted as one of the most effective therapeutic interventions for treating AOD use. The use of cognitive behavioral therapy (CBT) has found great relevance in the treatment and management of AOD use. Various studies have been conducted on the therapeutic process and efficacy of the process in preventing relapse, with varying results. Chiang et al. (2017) and Mehta et al. (2021) elaborated that CBT works through psychoeducation, cognitive restructuring, and enhancement of coping skills. Psychoeducation is the critical first step in the treatment process. In psychoeducation, CBT helps individuals with AOD use to understand the nature of their problem and recognize their triggers. It also emphasizes the essence of adherence to the medication regimen and helps the patients recognize the early warning signs of mood variations (Li, 2023). This process is integral in functional analysis, the second step in the treatment process.
According to Ye et al. (2016), functional analysis in CBT helps clients understand the antecedents, behaviors, and consequences of substance use. This approach allows the patients to gain insight into the factors that contribute to their substance use and develop alternative, healthier behaviors. It manages moods by tracking fluctuations, observing sleep patterns, and vibrant life events. Functional analysis works simultaneously with cognitive restructuring, challenging one’s negative thought patterns that have been recognized to be associated with addiction (Chiang et al., 2017). Through techniques of cognitive dissonance, Chiang et al. (2017) state that patients can learn to recognize and reframe their attitudes toward drugs. CBT continues with learning new behavioral strategies for overcoming addiction. According to Li (2023), pharmacological options such as naltrexone, disulfiram, acamprosate, and combination treatment should be adopted to complement talk therapy. While CBT has been proven to be a suitable evidence-based intervention, Searby et al. (2016) and Chiang et al. (2017) affirm that high relapse rates characterize interventions for AOD use. Intervening therapists should, therefore, ensure that the structured care plan considers the patient’s specific drug problem and is also effective in addressing alcohol addiction.
Case scenario: Jane is a 32-year-old White Caucasian woman. On June 17, 2023, at about 1900, her sister, Daisy, brought Jane to the emergency department. Daisy reported that Jane has had a severe simultaneous use of marijuana and alcohol that started when she was on campus, slowed after her graduation, but became more pronounced a year ago. Daisy reported that Jane has also had significantly noticeable changes in her behavior. Jane is 5’8” and weighs 120 pounds. She confirms to have lost 20 pounds in the last three months. Her vital signs are: O2 is 98% on room air, BP is 120/82 mmHg, P is 92 bpm, RR is 18 bpm, and oral temperature is 99.0 degrees Fahrenheit. She states that her back pain is 3/10 due to a persistent headache. Her BMI is calculated at 18.2. When questioned about her daily activities, Jane says: “I have lost interest in almost everything I used to enjoy on campus with friends. Nowadays, I prefer to stay at home and get high and drunk and numb everything.” On her mental wellness, Jane admits that she experiences overwhelming sadness, anxiety, and, sometimes, a sense of hopelessness. She acknowledges that her substance and alcohol use made her lose her job, and she has not been able to work for the past ten months. She says that alcohol and marijuana help her cope. Daisy says that Jane has rejected all treatment attempts, but Jane says that now she is willing to give it a try. She says: “I know I need to cut down or stop, but every time I try, I feel even worse. What can I do to break free from this cycle? I want to find a way to feel better without relying on substances.”
| Subjective Data | Objective Data |
| The patient is malnourished and anxious. | The patient says: “I have lost interest in almost everything I used to enjoy.” |
| The patient is 32 years old, 5’8”, and only 120 pounds with a BMI of 18.2 (underweight) | Patient says that getting drunk and high numbs everything |
| Oxygen saturation at 98% on room air, respiration rate is 22 bpm | Patient says that only marijuana and alcohol can make her cope |
| Oral temperature is at 99.0 degrees Fahrenheit, and Blood pressure | She states back pain is 3/10 due to a persistent headache (mild pain) |
| 120/82 mmHg, P is 92 bpm. No prior diagnosis of AOD use disorder | The patient says: “I know I need to cut down or stop, but every time I try, I feel even worse. She admits helplessness in overcoming addiction. |
| Actual Nursing Diagnosis: Imbalanced body nutrition, which is less than the body requirements related to her depression, as evidenced by being underweight and comments such as “I have lost interest in everything.”
SMART Goal: By December 30, 2023, the client will demonstrate knowledge of high-calorie foods, be able to identify healthy nutritional meals, meet her dietary requirements, and gain ten pounds. Intervention#1: Obtain baseline laboratory tests, including serum albumin, transferrin, and a complete blood count, to identify malnourishment and establish a nutritional baseline. Rationale: Baseline data is essential to track the nutritional development of the patient. Serum albumin, if low, will confirm malnutrition. Blood count levels will reveal the number of hemoglobin and other abnormalities (Taylor et al., 2019). Intervention #2: Discuss food preferences, offer encouragement, and ensure visually appealing food presentation to stimulate demand for food. Rationale: Engaging the patient in food choices, providing positive reinforcement, and presenting visually appealing meals can stimulate appetite (Taylor et al., 2019). Intervention #3: Work with a registered dietitian within the health center to educate patients on the importance of nutritional requirements, then develop a meal plan based on their preferences and needs. Rationale: Involving a dietitian will lead to a tailored and efficient healthy plan to address the specific patient’s nutritional needs (Taylor et al., 2019). Evaluation: Goal Met. Jane engaged with the dietitian and identified high-calorie/nutritional meals. However, she gained eleven pounds, meeting and exceeding the set goal. |
| At-Risk Nursing Diagnosis: Jane is at risk of suicide-related to her absence of effective coping mechanisms, as evidenced by her intense simultaneous marijuana and alcohol use to escape reality.
SMART Goal: By December 30, 2023, the client will show evidence of recovery from depression, reduced marijuana and alcohol dependence, and healthy coping mechanisms. Intervention#1: The nurse will introduce the therapist, who will discuss with Jane the details of CBT and its benefits and risks Rationale: CBT is confirmed to be effective in addressing alcohol and substance addiction (Chiang et al., 2017). Intervention #2: The therapist will apply the steps of CBT to take Jane through the recovery process. Rationale: CBT must be administered in doses over time to allow patients to recover (Mehta et al., 2021). Intervention #3: The nurse will intervene so that the family can allow Jane to continue with the CBT sessions beyond her period at the hospital. Rationale: As stated, CBT is effective if applied in various sections. The continuous intervention will reduce the risks of relapse (Mehta et al., 2021). Evaluation: Goal Partially Met. Jane showed remarkable recovery. The therapist recounted a changed perspective, renewed vigor, and positive attitude toward life. However, the client still reported frequent signs of boredom and occasional craving for marijuana (Mehta et al., 2021). |
| Health Prevention-Promotion Nursing Diagnosis: Prepare Jane to be able to enhance her optimism related to her anxiety, as evidenced by her stating, “What can I do to help me feel better?”
SMART Goal: By December 30, 2023, the client can redefine her attitude towards life and set personal goals. Intervention#1: The therapist will assess the mental barriers that fuel Jane’s pessimism. Rationale: CBT is anchored on functional analysis and addressing co-occurring mental health issues (Mehta et al., 2021). Intervention #2: The therapist will guide Jane on setting realistic and achievable goals for herself on topics related to jobs and career Rationale: CBT helps individuals set realistic and achievable goals to help them abstain from substance use, improve relationships, or pursue personal and professional growth (Mehta et al., 2021). Intervention #3: Therapist will help Jane account for all progress made by the end of December Rationale: By achieving small successes in managing substance use, Jane can build confidence in her ability to make positive changes in her life (Mehta et al., 2021). Evaluation: Goal Partially Met. Jane made remarkable progress in setting goals for herself. Most of the goals were met, but she has yet to meet those related to her career. |
One of the objectives of Healthy People 2030 is to help over 20 million Americans who have an addiction overcome their addiction problem. This nursing care plan encompasses critical aspects of overcoming addiction, including establishing stable physical health, having a clear mindset, and setting goals for personal development. This plan meets the Healthy People 2030 requirements that a strategy for preventing addiction should focus on helping these people be active and part of the treatment process. The implication of this plan for nursing practice is that when formulating a treatment plan for people with AOD use, the focus must be on addressing both alcohol and drug problems while also focusing on the person’s mental and physical health. However, it must be noted that Jane’s case was not a severe one, and the success may have been due to the lack of a prior addiction diagnosis. However, the success paints an optimistic picture of progress.
This essay has reviewed the developing discourse on how to treat people with co-occurring drug and substance addiction, as well as the Healthy People 2030 objectives regarding overcoming addiction. There are millions of Americans and people the world over, particularly men, who are still slaves to addiction. While the case for Jane has shown some success, she needs ongoing support to assess her commitment to the plan. She, therefore, should be assisted to focus on restoring her health. Daisy and other family should engage a mental health professional to help her cope with her depression. This recommendation emphasizes the necessity of using all available support structures to help addicts and alcohol users navigate through their addiction and thrive.
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