Substance Use Disorder and Treatment Options

About this course

Substance use disorder (SUD) is an intricate condition that is characterized by an unrestrained use of a substance despite harmful consequences. Until the last few decades, it was assumed that those who struggled with compulsive substance use suffered from nothing more than a lack of willpower. Thus, these individuals were often stigmatized as "addicts" and viewed as having a moral deficiency or character flaw. However, advances in neuroscience have changed this perception. This course discusses substance use disorder, covering the Controlled Substance Act, drug classifications, and types of substances used. It also examines the symptoms of drug overdose, treatment options for opioid use disorder, and essential nursing considerations.

Learning objectives

• Define substance use disorder (SUD) and Schedule I-V drugs as described by the Controlled Substance Act (CSA).
• Review the diagnostic criteria for substance use disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
• Review commonly abused drugs and the National Survey on Drug Use and Health (NSDUH) statistical data associated with each drug.
• Recognize signs and symptoms of overdose in commonly abused drugs.
• Identify treatment and recovery options for substance use disorder and overdose.

Course outline

26 sections · finish in any order across devices

1. 1

   Introduction

   Substance use disorder (SUD) is an intricate condition that is characterized by an unrestrained use of a substance despite harmful consequences.1 Until the last few decades, it was assumed that those who struggled with compulsive substance use suffered from nothing more than a lack of willpower. Thu

   4 min

2. 2

   Controlled Substance Act

   The Controlled Substance Act (CSA) stands as the center of the United States drug policy. Enacted in 1970 by President Richard Nixon, its primary purpose is to regulate the manufacturing, importing, possession, distribution, and use of certain substances.7 By creating a framework for drugs that have

   4 min

3. 3

   Substance Use Disorder Definition

   According to DSM-5, SUD encompasses 10 separate classes of drugs that, when taken in surplus, directly activate the brain’s reward system – a pathway involved in behavior reinforcement and memory production.9 These drugs are:

   4 min

4. 4

   Diagnostic Criteria

   According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), substance use disorders are diagnosed through a set of eleven cognitive, behavioral, and physiological symptoms that reveal ongoing substance use despite substantial substance-related issues.9 The criteria are organized

   4 min

5. 5

   Behavioral and Physical Signs

   Behavioral signs of SUD often manifest as significant changes in an individual's daily habits and interactions.1 The signs may include neglecting responsibilities at work, school, or home, and withdrawing from previously enjoyed social activities. It may also involve exhibiting secretive or suspicio

   4 min

6. 6

   Alcohol

   According to the 2022 National Survey on Drug Use and Health (NSDUH), an estimated 60% of SUD cases (29 million) among people aged 12 and older were related to alcohol use, making alcohol the most abused substance in the United States.10 The high prevalence is attributed to alcohol’s widespread soci

   4 min

7. 7

   Tobacco

   Tobacco use, whether through smoking cigarettes or vaping e-cigarettes, is driven by the addictive nature of nicotine. This chemical stimulates the release of dopamine, creating feelings of pleasure and relaxation.12 Despite widespread awareness of its severe health risks, including lung cancer, hea

   4 min

8. 8

   Cannabis

   Cannabis, or marijuana, is known for its psychoactive effects, primarily driven by the compound tetrahydrocannabinol (THC).14 Users often seek its euphoric and relaxing effects, which help lessen stress, anxiety, and pain. With increasing legalization and social acceptance, cannabis use has become m

   4 min

9. 9

   Opioids

   Opioids, such as heroin, and prescription opioids (narcotics), such as hydrocodone (Vicodin), oxycodone (OxyContin), and morphine, are highly addictive due to their potent pain-relieving and euphoric effects.15 They work by binding to opioid receptors in the brain, reducing the perception of pain an

   4 min

10. 10

    Benzodiazepines

    Benzodiazepines, such as Valium and Xanax, are sedatives that elevate gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits neural activity, resulting in a calming effect.16 Generally prescribed for anxiety and insomnia, benzodiazepines are potent and therefore highly addictive. In cases

    4 min

11. 11

    Methamphetamines

    Methamphetamines, commonly known as meth, is a highly addictive stimulant that significantly increases the release of dopamine, resulting in intense euphoria, increased energy, and heightened focus.17 The addictive properties and intense highs make it difficult for users to stop using methamphetamin

    4 min

12. 12

    Prescription Stimulants

    Prescription stimulants elevate dopamine and norepinephrine levels in the brain. Thus, they are utilized to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy.18 This in turn enhances focus, attention, and energy levels. They are particularly favored by students and professionals s

    4 min

13. 13

    Cocaine

    Cocaine is a powerful stimulant drug derived from the leaves of the coca plant.19 Cocaine heightens dopamine in the brain, creating feelings of intensified energy, alertness, and euphoria. However, these effects are short-lived, leading users to frequently take more to maintain the high. Given these

    4 min

14. 14

    Illegally Made Fentanyl

    Illegally made fentanyl (IMF) has become a significant concern due to its role in the increasing number of fatal opioid overdoses. Fentanyl is an extremely intoxicating synthetic opioid, shown to be 50 – 100 times stronger than morphine.20 Fentanyl’s high potency drastically elevates the risk of add

    4 min

15. 15

    Gamma Hydroxybutyrate (GHB)

    Gamma hydroxybutyrate (GHB), also known as "Liquid G," is a central nervous system depressant that induces hallucinations, euphoria, drowsiness, and decreased anxiety.21 Paradoxically, it may also induce excited and aggressive behavior. As regular use of GHB can quickly lead to addiction and severe

    4 min

16. 16

    Non-prescription Cough and Cold Medicines

    Non-prescription cough and cold medicines, particularly those containing dextromethorphan (DXM), have seen a surge in misuse.22 Dextromethorphan, a common cough suppressant, is available over the counter and is generally safe when used as directed. However, when taken in large doses, it can produce

    4 min

17. 17

    Signs and Symptoms of Overdose

    An overdose is a toxicological condition that occurs when an individual ingests or administers a dose of a substance that exceeds the therapeutic or lethal threshold, overwhelming the body's homeostatic mechanisms.24 This results in elevated blood concentration of the substance, disrupting normal ph

    4 min

18. 18

    Alcohol Poisoning

    Alcohol poisoning, also known as acute alcohol intoxication, presents a spectrum of symptoms, reflecting alcohol's depressant effects on the central nervous system.25 Initially, individuals may exhibit confusion, impaired coordination, and slurred speech as blood alcohol concentration rises. As into

    4 min

19. 19

    Opioid Overdose

    Opioid overdose presents distinct signs and symptoms as the drug influences the central nervous and respiratory systems.26 A hallmark symptom is miosis. Also known as pinpoint pupils, miosis is characterized by significant narrowing of the pupils. Opioids stimulate the muscarinic receptors on the sp

    4 min

20. 20

    Benzodiazepine Overdose

    Symptoms of benzodiazepine overdose reflect its depressant effects on the central nervous system. Early signs include pronounced dizziness, severe drowsiness, and confusion as the drug inhibits cognitive and motor functions.27 Individuals may also exhibit impaired coordination and ataxia, leading to

    4 min

21. 21

    Stimulant Overdose

    Signs of stimulant overdose, which involves substances such as cocaine, methamphetamine, and prescription amphetamines, are a product of heightened CNS and cardiovascular activity.28 The overstimulation of the brain's neurotransmitter systems leads to severe agitation, anxiety, and paranoia. This is

    4 min

22. 22

    Treatment Options for Opioid Use Disorder

    There are several treatment options available for opioid use disorder (OUD). The treatment options involve the use of medications combined with behavioral therapy. Currently, three medications are approved for OUD: 29

    4 min

23. 23

    Recovery Options

    Recovery options for SUD include inpatient programs, outpatient plans, and behavioral health interventions. Inpatient treatment programs provide intensive, round-the-clock care in a structured environment.34 These programs are for those who need a higher level of supervision, support, and medical at

    4 min

24. 24

    What to Do When an Overdose Occurs

    In the event of an overdose, swift and decisive action is crucial to saving lives. Promptly assess the patient's vital signs and level of consciousness, ensuring an open airway and initiating basic life support measures, as necessary. Administer antidotes specific to the substance if available and i

    4 min

25. 25

    Nursing Considerations

    Nurses are pivotal in the comprehensive management of substance use disorders through their multifaceted roles in patient care.35 Central to their responsibilities is the administration of pharmacological interventions and clinical monitoring. When administering pharmacological treatments, nurses sh

    4 min

26. 26

    Conclusion

    Substance use disorders (SUD) are multifaceted conditions that are now recognized as progressive yet treatable. The prevalence of widely abused substances such as alcohol, tobacco, cannabis, opioids, benzodiazepines, methamphetamines, and prescription stimulants highlight the diverse array contribut

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Volkow, N. D., & Blanco, C. (2023). Substance use disorders: A comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention. World Psychiatry, 22(2), 203–229. https://doi.org/10.1002/wps.21073
• 2022 NSDUH Annual National Report | CBHSQ Data. (2022). Samhsa.gov. https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report
• Spencer, M. R., Garnett, M. F., & Miniño, A. M. (2024, March 19). Products - Data Briefs - Number 491 - March 2024. Www.cdc.gov. https://www.cdc.gov/nchs/products/databriefs/db491.htm
• Government of Canada. (2024, March 27). Opioid- and stimulant-related harms in Canada. Health Infobase. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/
• Office for National Statistics. (2022). Deaths related to drug poisoning in England and Wales. Www.ons.gov.uk. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2021registrations
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• United States Drug Enforcement Administration. (2018). The Controlled Substances Act. Www.dea.gov. https://www.dea.gov/drug-information/csa
• United States Drug Enforcement Administration . (2018). Drug scheduling. Www.dea.gov; United States Drug Enforcement Administration. https://www.dea.gov/drug-information/drug-scheduling
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Psychiatry.org; American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm
• 2022 NSDUH Annual National Report | CBHSQ Data. (2022). Samhsa.gov. https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report
• Medline Plus. (2010). Alcohol. Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/alcohol.html
• Nicotine and tobacco: MedlinePlus Medical Encyclopedia. (2016). Medlineplus.gov. https://medlineplus.gov/ency/article/000953.htm
• National Institute on Drug Abuse. (2022, May). What is the scope of tobacco, nicotine, and e-cigarette use in the United States? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/what-scope-tobacco-use-its-cost-to-society
• Medline Plus. (2013). Marijuana. Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/marijuana.html
• Pain medications - narcotics: MedlinePlus Medical Encyclopedia. (2016). Medlineplus.gov. https://medlineplus.gov/ency/article/007489.htm
• National Institute on Drug Abuse. (2022, November 7). Benzodiazepines and Opioids. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids
• Methamphetamine. (2018). Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/methamphetamine.html
• Abuse, N. I. on D. (2020, June). What classes of prescription drugs are commonly misused? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/what-classes-prescription-drugs-are-commonly-misused
• Cocaine. (2019). Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/cocaine.html
• CDC. (2024, May 7). Fentanyl. Overdose Prevention. https://www.cdc.gov/overdose-prevention/about/fentanyl.html
• Palamar, J. J. (2022). Prevalence and Correlates of GHB Use among Adults in the United States. Journal of Psychoactive Drugs, 1–6. https://doi.org/10.1080/02791072.2022.2081948
• MedlinePlus. (2019). Dextromethorphan: MedlinePlus Drug Information. Medlineplus.gov. https://medlineplus.gov/druginfo/meds/a682492.html
• MedlinePlus. (2018). Diphenhydramine: MedlinePlus Drug Information. Medlineplus.gov. https://medlineplus.gov/druginfo/meds/a682539.html
• Azekour, K., Belamalem, S., Soulaymani, A., El Houate, B., & El Bouhali, B. (2019). Epidemiological Profile of Drug Overdose Reported in South-East Morocco from 2004 to 2016. Drugs - Real World Outcomes, 6(1), 11–17. https://doi.org/10.1007/s40801-019-0148-2
• NIAAA. (2017). Understanding the Dangers of Alcohol Overdose | National Institute on Alcohol Abuse and Alcoholism (NIAAA). Nih.gov. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-dangers-of-alcohol-overdose
• Substance Abuse and Mental Health Services Administration. (2023, March 21). Opioid Overdose. Www.samhsa.gov. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/opioid-overdose
• Benzodiazepine Toxicity: Practice Essentials, Background, Pathophysiology. (2023). EMedicine. https://emedicine.medscape.com/article/813255-overview?form=fpf
• CDC. (2024, May 8). Stimulant Overdose. Overdose Prevention. https://www.cdc.gov/overdose-prevention/about/stimulant-overdose.html
• SAMHSA. (2023, September 18). Methadone. Www.samhsa.gov. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/methadone
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