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Optimising Care for a Patient With Chronic Substance Use Disorder

Nyamweya is a Kenyan scholar who has done many years of research on a diversity of topics


Conventionally, treatments for patients suffering from substance use disorders have always been different from those of other mental illnesses and even general care services. This owes to the fact that traditionally, substance abuse has been perceived as a criminal or social problem. Accordingly, prevention services were not typically regarded to be the obligation of health care systems (World Health Organization, 2016). This means that persons who required care for substance use disorders could only access a limited range of treatment options. In this respect, some of the healthcare needs of some of the patients, especially those in the chronic stage could not be affectively addressed. In this respect, empowerment and self management protocols have for a long time ignored. This project suggests that effective integration of recovery services, treatments and prevention across health care service is a critical aspect towards address the problem of substance use disorders alongside its implications. Furthermore, this approach represents the most hopeful way of improving the quality and access of the treatment offered to patients in this condition (Crowley, and Kirschner, 2015). This optimal care plan is purposed to address the healthcare needs of Jean, the 55 year old, New South Wale based woman who is suffering from substance use disorder.

The role of Nurses in Facilitating Empowerment and Self Management for Substance Disorder Patients to achieve a Good Quality of Life

In healthcare system, powerlessness is a jargon that implies a perceived lack of control over immediate happening or current situation. It may also refer a situation where an individual’s action may not have a significant implication on the outcome (Wayne, 2018). It simply means the patient is helpless in his or her current health situation and need intervention by a health care worker. In the scenario of the case study, Jean is considered powerless when it comes to stop smoking. She is said to smoke a minimum of ten cigarettes in just one day and although she is aware of the danger this habit poses to her health, she is unable to quite it on her own. Therefore, in this case, she is powerless and would definitely need an intervention of a healthcare provider to help in dealing with the situation.

Nurses dealing with patients suffering from substance abuse can make positive contributions through achieving a range of social and health related outcomes. They can do these by delivering initiating a wide range of interventions. For instance, they can provide enhanced awareness to the patient and her caregivers about her condition, related conditions, and the implication to their health, management and treatment options. Additionally, the nurse is also required to facilitate the patient’s access to a health professional or treatment facilities that deal explicitly to smoking addictions (Royal College of Nursing, 2017). In other words, the nurse is supposed to identify and persuade Jean to seek healthcare and psychological services in the best way possible. It should be considered that on a current level, the patient Jean does not like attending the hospital. This is because according to her, the people at the hospital are inconsiderate about her privacy, her needs and even lack of concern by the health staff at the health facility she visited. In this regard, the nurse should identify a hospital, talk to the staff about the patient and her concerns and then encourage Jean to visit that particular hospital. This way, the hospital staff will be able to understand the kind of employees they are dealing with while at the same time, the patient will get help she desperately need. It is believed that healthcare interventions with can help in reducing the severity of Jean’s issue.

To effective empower substance misuse patients to self-manage and address their conditions, research has since advocated for a “therapeutic alliance” as the best way of achieving the best treatment results. Many studies in the field of substance abuse have found a link between counselling effectiveness and the strength of therapeutic alliance (Gainsbury, 2017). For instance, a research by Marchand et al (2019) noted that a therapeutic alliance between client and clinician presented a positive prediction for the patient’s treatment participation, lifestyle change, drinking or smoking behaviour and other positive behaviours. In other words, when a nurse develops a good rapport with substance abuse patient, in this case Jane, he or she will be in a good position to convince her to change the lifestyle, as well as in taking up measures to help in addressing this condition, including treatment processes. Therefore, it is the responsibility of the nurse to develop a positive relationship with the client, in this case Jean, and her family, to achieve the best outcome. While doing so, the nurse should strive to act as a non-judgemental and nurturing ally rather than being critical with a focus to support the patient in addressing the issue.

When the patient is effectively empowered, both physically and emotionally, then she will find self- management of the problem possible. In healthcare context, self- management simply means a situation where a patient is able to take charge of his or her health. In other words, the patient is able to manage the condition and regaining control of his or her life (American Academy of Family Physicians, 2020). In the case scenario of Jean, who is the subject of this discussion, she currently does not have the power to self-manage her condition. This is because she is already addicted and the condition at her home does not encourage her to leave the habit. However, with the intervention of the nurse, she can be able to manage her situation and at one point, she will be able to reduce the number of cigarettes consumed in a day. It is also very possible that she will at one time be able to change her behaviour to the level of leaving smoking altogether.

Local Resources Available

Mrs Jean, her husband and family have the option of visiting Ryde Drug and Alcohol services which will be able to advice on their treatment options and behaviour change. They can also consider visiting St. Vincent’s Hospital Alcohol & Drug Service, located Darlinghurst, NSW Australia or the more popular, The Sydney Clinic, also found in NSW, Australia which specifically deals with people addicted to smoking and nicotine dependants. Furthermore, Jean, her husband and family members also need to visit counselling centres and behaviour change centres for substance misuse patients. Such centres include but not limited to Odyssey House NSW, The Banyans Wellness and Health, and Drug Counselling Sydney among others. By visiting these facilities, Mrs Jean will be able to get the necessary assistance so as to change her behaviour as well as realize effective treatment of her condition. It is also important that the nurse creates awareness to the patient and her family members verbally about the condition and the dangers it poses to their health and also provide necessary resources including pamphlets, newsletters, or health books to increase the clients knowledge on the condition, self management, treatment among others.


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In conclusion, there is no doubt that Jean who is the subject of this case study is powerless and unable to stop her smoking habit. This necessitates the intervention of a healthcare professional including a nurse to help in dealing with the situation. Alongside the regular treatment options, the nurse is obligated to empower the patient in self-management of the condition through a number of measures. Those identified in this paper include developing a rapport and therapeutic alliance with Jean which would culminate into a positive relationship. This will make the patient view the intervention measures positively and respond to them amicably. The nurse is also required to facilitate the patient’s access to professional health services including treatment and counselling services which are vital in full management of the conditions. The nurse is also supposed to provide a connection between the client and other third party health practitioners and ensure that the concerns and needs are fully addressed amicably.


American Academy of Family Physicians. (2020). Self-management; taking charge of your health. Retrieved from

Gainsbury S.(2017). Cultural competence in the treatment of addictions: theory, practice and evidence. Clin Psychol Psychother. 24(4):987–1001.

Marchand, K., Beaumont, S., Westfall, J. (2019). Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Subst Abuse Treat Prev Policy 14, (37).

World Health Organization. (2016). Health systems strengthening glossary, G-H. Health Systems. Retrieved from http://www​​/hss_glossary/en/index5.html.

Crowley., R, Kirschner, N. (2015). The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: Executive summary of an American College of Physicians position paper. Annals of Internal Medicine;163(4):298–299.

Royal College of Nursing. (2017). The Role of Nurses in Alcohol and Drug Treatment Services. Retrieved from

Wayne, G. (2018). Powerlessness. Retrieved from

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