Data from a recent National Survey on Drug Use and Health (NSDUH) showed that approximately 48.5 million people aged 12 or older experienced substance use disorder (SUD) in the past year. It is likely that nurse practitioners across disciplines will encounter patients living with SUD, so it’s imperative to learn the nuances of this condition and the most effective treatment methods. Here, we break down your role as an NP in the support of patients struggling with SUD and co-morbid mental health conditions.
What are the most effective screening methods for SUD?
Substance abuse is a nuanced clinical issue that presents in a variety of ways. However, there are some tried and true tools for recognizing the signs and symptoms in your patients.
- The National Institute of Drug Abuse: This federal organization has compiled a list of comprehensive screening surveys that assess a patient’s dependency on a variety of substances, including alcohol, tobacco, cannabis, opioids and more.
- Screening, Brief Intervention and Referral to Treatment (SBIRT): This clinical tool focuses on the diagnosis, intervention, and referral protocols for a patient’s unique situation and addiction challenges.
- Drug Use Screening Tests: Clinicians can use laboratory testing to screen for substances currently present in a patient’s body. Tests can identify traces of cannabis, heroin, methamphetamine, cocaine, and other drugs in the body using urine, hair, or blood samples.
Related: Controlled Substance (Opioid)
Which patients are most at risk for SUD?
While addiction can affect people of all demographics, some co-morbid diseases can heighten the risk of substance abuse. These conditions are typically psychiatric, and include depression/anxiety, bipolar I/II, eating disorders, and personality disorders. Many people who develop substance use disorders are also diagnosed with other mental health disorders, and vice versa. According to the 2023 National Survey on Drug Use and Health, 35% of adults aged 18 and over in the U.S. who have another mental disorder also have a substance use disorder.
Individuals suffering from chronic pain disorders are also at risk for developing SUD, especially if they have been previously prescribed controlled substance to manage their symptoms. Additionally, people living with HIV, AIDS or viral hepatitis are at increased risk of SUD. Use of medications for SUD treatment typically involves HIV and hepatitis antibody testing at admission, or a referral for antibody testing.
How can I safely prescribe controlled substances to people living with SUD?
The National Library of Medicine outlines specific protocols for responsible prescribing of opioid medications to people with a history of opioid dependency. A study conducted by the NLM in 2023 states, “Responsible prescribing involves a thorough evaluation of the patient’s medical conditions and pain management needs, with the consideration of non-opioid alternatives before prescribing opioids.” Other recommendations include:
- Differentiating Schedule I, II, III, IV, and V substances based on their potential for abuse, accepted medical use, and regulatory controls as defined by the Controlled Substance Act.
- Implementing evidence-based strategies to minimize the risk of opioid misuse, including the use of prescription drug monitoring programs, informed consent, and treatment agreements.
- Applying appropriate dosage adjustments, alternative non-opioid therapies, or tapering plans when necessary to optimize pain management and minimize long-term opioid use.
- Collaborating with interdisciplinary teams, including pain specialists, addiction medicine specialists, mental health professionals, and pharmacists, to optimize patient care and coordinate comprehensive treatment approaches.
Related: Pain Management Boot Camp for the Primary Care Provider
SUD management protocols and best practices for treatment program referrals
According to the AANP, it is estimated that 7 in 10 adults with a past substance use problem consider themselves to be recovering or in recovery from their substance use and/or mental health problems. In an interview with AANP, Susanne Fogger, DNP, CRNP, PMHNP-BC, CARN-AP, FAANP, FAAN offers a candid look into what works and what doesn’t when supporting patients on the road to recovery:
“As you’re working with patients, it’s incredibly important to understand Prochaska and DiClemente’s transtheoretical model and its stages of change. It’s a model that’s helpful because it recognizes the fact that people don’t change in a linear manner. While not all people benefit from going to Alcoholics Anonymous (AA), it does work for some. One concept that can be useful in helping someone recover is an old AA saying, ‘Recovery requires you to change your playground, playmates and playthings.’ It’s really difficult to stay away from substances if you’re hanging out with old friends who are still using them.
But I think the thing that’s the most hopeful for people getting into recovery is that it isn’t one-size-fits-all. It’s individualized and it requires providers to recognize that the patient must find their own way. Recovery is more than just not using substances — it is about becoming a better and healthier human being.
People can be helped to reduce their substance use or change how they use. Working with people requires flexibility to meet them where they are, as some won’t even entertain the idea of recovery if total abstinence is the one and only goal. Recovery is a matter of improving a person’s health and helping them move toward self-fulfillment. The concept of total abstinence doesn’t necessarily apply to all people — and people can be in recovery even though they’re not totally abstinent from all substances.”
Featured course: Clinical Pharmacology for NPs and Advanced Practice Clinicians
