Introduction
• Substance Use Disorders (SUDs) are chronic and relapsing mental health
conditions characterized by the harmful or hazardous use of psychoactive
substances such as alcohol, opioids, stimulants, cannabis, or sedatives
• The development of SUDs results from a complex interplay of biological,
psychological, and environmental factors.
• The most affected age group is 18–35 years, especially in urban and marginalized
populations. Globally, around 600,000 deaths annually are attributed to drug-
related causes.
• A 2020 report by UNODC estimated that around 500,000 people in Myanmar
engage in high-risk drug use, especially involving heroin and methamphetamines.
• With a comprehensive approach involving medical, psychological, and social
interventions, long-term recovery is achievable, though continuous care is often
necessary.
Background Information
Definition
A substance use disorder (SUD), often referred to as addiction, is a complex
disease that affects the brain and behavior, causing an inability to control the use of
a legal or illegal drug or medicine. It's characterized by compulsive substance use
despite harmful consequences, and can involve a wide range of substances like
alcohol, tobacco, or other psychoactive substances.
Classification of substance
Alcohol, Opioids, Heroin, CNS depressants, CNS stimulants, Cocaine,
Amphetamine, Hallucinogens, Cannabinoids, Inhalants
DSM-5 Criteria for substance used disorders
DSM-5 points out 11 criteria and these criteria fall under four basic categories —
impaired control, physical dependence, social problems and risky use:
1.Using more of a substance than intended or using it for longer than you’re meant to.
2.Trying to cut down or stop using the substance but being unable to.
3.Experiencing intense cravings or urges to use the substance.
4.Needing more of the substance to get the desired effect — also called tolerance.
5.Developing withdrawal symptoms when not using the substance.
6.Spending more time getting and using drugs and recovering from substance use.
7.Neglecting responsibilities at home, work or school because of substance use.
8.Continuing to use even when it causes relationship problems.
9.Giving up important or desirable social and recreational activities due to substance use.
10.Using substances in risky settings that put you in danger.
11.Continuing to use despite the substance causing problems to your physical and mental
health.
3 Levels of Severity
-One symptom could indicate an individual is at risk.
-Two or three criteria point to a mild substance use disorder.
-Four or five symptoms show someone has a moderate substance use disorder.
-Six or more criteria indicate a severe substance use disorder, which signals an addiction to
that substance
Etiology
1. Biological Factors (Genetics, Neurobiology, Gender and Age)
2. Psychological Factors (Mental health disorders, Personality traits ,Coping mechanisms)
3. Environmental and Social Factors (Family dynamics ,Peer pressure ,Socioeconomic
status ,Availability of substances )
Signs and symptoms
(1) Behavioral Signs:
- Compulsive Use: Inability to reduce or stop substance use despite attempts
- Neglect of Responsibilities: Poor work/school performance, failure to meet obligations
- Risky Behaviors: Using in dangerous situations (e.g., driving), legal problems
- Social Withdrawal: Isolation from family/friends, loss of interest in hobbies
- Secrecy: Hiding substance use, lying about consumption
(2) Physical Signs:
- Tolerance: Needing larger amounts to achieve the same effect
- Withdrawal Symptoms: Physical discomfort when not using (e.g., nausea, tremors, sweating)
- Changes in Appearance: Poor hygiene, weight loss/gain, bloodshot eyes
- Slurred Speech: Incoordination, unsteady gait (especially with depressants like alcohol)
- Track Marks: Needle marks (in opioid users)
(3) Psychological Symptoms:
- Cravings: Intense urges to use the substance
- Mood Swings: Irritability, anxiety, or euphoria depending on use
- Cognitive Impairment: Poor memory, difficulty concentrating
- Denial: Minimizing or rationalizing substance use
- Mental Health Decline: Worsening depression, paranoia, or psychosis (with stimulants)
Complication - Infectious Diseases: HIV, hepatitis B/C (from
(1) Medical Complications: needle sharing), endocarditis
- Cardiovascular: Hypertension, arrhythmias, - Gastrointestinal: Pancreatitis, gastritis,
heart failure (especially with malnutrition
cocaine/amphetamines) •(2) Psychiatric Complications:
- Respiratory: Chronic bronchitis, lung damage •- Mood Disorders: Major depression, bipolar
(from smoking/inhaling drugs) disorder exacerbation
- Hepatic: Liver cirrhosis (alcohol, opioids), •- Anxiety Disorders: Panic attacks, generalized
hepatitis (IV drug use) anxiety
- Neurological: Seizures, stroke, cognitive
impairment, peripheral neuropathy
- Psychotic Disorders: Substance-induced - Relationship: Divorce, domestic violence, child
psychosis (especially stimulants) neglect
- Suicidal Behavior: Increased risk of suicide - Homelessness: Loss of housing due to addiction
attempts/completion (4) Special Populations:
- Cognitive Decline: Memory loss, executive - Pregnancy: Neonatal abstinence syndrome, birth
dysfunction defects
(3) Social Complications: - Adolescents: Stunted brain development,
- Occupational: Job loss, decreased productivity academic failure
- Financial: Bankruptcy, poverty - Elderly: Increased fall risk, medication
interactions
- Legal: Arrests, incarceration (DUIs, drug
possession)
Brief History
• The name of the patient is Ko Saw Wai. He is 22 years old and he is single. His address is
Thanlyin township, Yangon. His admission date and time is 14.6.2025( 10: 24 am ). His
admission number is 252508. His religion is Buddhism and ethnic group is Bamar. His hair
color is black and eye color is hazel. He is admitted from home and admitted with his
mother.
• The information is obtained from his family (mother). The emergency contact is his mother,
Daw San San Win, Thanlyin township, and she works randomly.
• The reason for admission is he broke household items and he had frustration because his
mother did not allow him to work in another township. His medical diagnosis is substance
use disorder. His current health problems are grandiose delusion, suspicious, headache
(mild), slurred speech, red eye and aggression.
• In past health history, he has no history of psychiatric history and hospitalization.
• His previous health history is he had auditory and visual hallucination, talking alone
and staying alone in his room, grandiose delusion, outgoing from home, aggressive
behavior, destruction property, and fever. And also he exorcised before hospitalization.
• His height is 5 feet 5 inches and weight is 130 lb. His temperature is 98.6*F,
respiration rate is 18 bpm , pulse rate is 101 bpm and blood pressure is 140/94 mmHg.
He has no allergy to drugs and food. He has no allergic reactions ( rash, nausea,
vomiting, anaphylaxis ). He has no allergic treatment and medication ( last 3 months ).
• He is smoked 3 to 4 cigars per day since he was 14 years old. He use marijuana,
heroin, designer, WY and K. He uses drugs since 14 years old and the last ingestion is
last 2 weeks ago. He drinks alcohol 4 cups at once and he chew one to two betel at
once, since 14 years old and last drink is 2 weeks go. He drinks alone and with others,
too. But he does not drink every day.
• His father was an alcoholic and dies of a cereberal hemorrhage. His
younger is a smoker
• There are no problems in skin, oral , activity, eating , sleeping, bowel
elimination
• In his developmental stage, he started to attend the school ( Grade 1 )
when he was 9 years old. And he was dropped out by Headmaster
because he fought his classmate frequently.
• He worked and he began to use drugs since he was 14 years old.
Treatment 20.6.2025. Dz 50mg 0_1/2, Sizidon
14.6.2025. Urine tests 2mg 1/2_1
AMP (+) Encorate 300mg 0_1,
ACA2mg 1/2_0
THC(-)
TCA 23.6.2025
MOP(-)
23.6.2025. ACA2mg omit
16.6.2025. Risperidone 2mg 1_1/2,
Encorate 300mg 1_1 Other CST
RV _ Wednesday TCA 26.6.2025
18.6.2025. CST, RV 20.6.2025
Mental Status Examination
• 1.General description
(a) Appearance
-appropriate with dress in place, weather, age
-good personal hygiene
-relaxed posture and normal gait
-good eye contace
(b)Speech
-Normal rate, volume, no pressured speech and slurring of words
• (c ) Motor activity
-there is no abnormal motor activity
(d) Interaction during interview
-friendly and cooperative
2.Emotional State
-elevated and aggressive behavior at sometime
-no lack of affect and la belle indifference
3.Perception
-no hallucination and illusion
4.Thinking
-thought content: grandiose delusion
5. Sensorium and cognition
-level of consciousness and orientation are good
-all remote, recent, immediate memories are good
-well concentration
-last grade is grade 2 , knows differences and similarities with apple and
mango
-judgment is good
Mini Mental Status Examination
-orientation ( time ) 5/5
-orientation ( place ) 5/5
-orientation ( person ) 5/5
-immediate call 3/3
-attention 5/5
-delay recall 2/3
-naming 2/2
-repetition 1/1
-3 stage command 3/3
-reading coping 1/1
-writing 1/1
-copying 1/1
-total scoring 28/30 ( normal cognitive impairement )
Assessment Data
Subjective data Objective data
Patient said that: I observed that:
-“ I saw dragons and ghost when I close
my eyes”
-“I’m related with dragons and I can -Grandiose delusion
destroy the world with these powers.” -Suspicious ( feeling that others cannot
-“ Are you taking video record?” be trusted)
-“ I want to destroy things and hit -Risk for violence(others)
someone when I’m angry” -Slurred speech
-“ I get a little headache sometimes” -Red eye
-“ I’ll take prescribed medications and -Lack of insight
I’ll also use substances when I’m -Peer influence
together with my friends after discharge -Previous injury on left palm
from hospital”
-“I only use substances when I am with
my hobbies”
-“I’ll will never comeback this place
again.”
-“ I came here to study this place” -Knowledge deficit
-“ I have only attended Grade 2” -Poor environment
-“There is the place to buy the
substances” -Aggressive behavior
Patient attendance said that: -Long term use of drug
-“ He is impatient” -Temperature- 98.6*F
-“ He used the drugs when he was 14 -Pulse Rate- 101 bpm
years old.” -Respiration Rate- 18 bpm
-Blood Pressure- 140/94 mmHg
-“ He used the drugs when he was 14 -. Urine tests
years old.” AMP (+)
He had fought his classmates when he THC(-)
was young and he had problems with MOP(-)
others and destroyed things because of -History of violence
his uncontrolled mind
Nursing Diagnosis of Prioritization
(1) Risk for violence ( others ) related to history of aggressive behavior as evidenced
by destruction to the objects and attack to others.
(2) Disturbed thought process related to grandiose delusion as evidenced by
verbalization of destruction of the world with dragon power.
(3) Noncompliance related to lack of insight as evidenced by continued smoking and
verbalization of continuing substance use.
(4) Impaired social interaction related to suspicious as manifested by feeling that
others cannot be trusted.
(5) Potential for injury related to aggressive behavior as evidenced by previous injury
on left palm.
(6) Insufficient knowledge related to socioeconomic patterns as manifested by peer
influence.
Nursing Care Plan 1
• Nursing diagnosis - Risk for violence ( others ) related to history of
aggressive behavior as evidenced by destruction to the objects and
attack to others.
• Expected Outcome - The patient will not harm to others.
• Nursing Interventions
- Assess for early signs of aggression such as restlessness, loud speech,
or threatening gestures to intervene before violence occurs.
- Maintain a calm and respectful manner when interacting with the
patient to help reduce tension and prevent escalation.
-Set clear and consistent limits on behavior, explaining what is acceptable and the
consequences of aggression to establish structure and predictability.
- Ensure a safe environment by removing objects that could be used as weapons and
keeping the room clutter-free to minimize risk.
-Use verbal de-escalation techniques, such as active listening, acknowledging
feelings, and offering choices to help the patient regain control.
-Collaborate with the healthcare team to initiate behavioral plans or administer
prescribed medications if necessary to manage aggressive behavior.
-Educate the patient on anger management and coping skills, encouraging
participation in therapy (especially group therapy) to promote long-term behavior
change and reduce the risk of future violence
Evaluation - The patient does not harm to others.
Nursing Care Plan 2
• Nursing Diagnosis - Disturbed thought process related to grandiose delusion as
evidenced by verbalization of destruction of the world with dragon power.
• Expected outcome - The patient will reduce delusional thinking and demonstrate
improved ability to engage in reality.
• Nursing Intervention
- Assess the patient’s thought content and speech regularly to determine the extent
and impact of the grandiose delusions on their behavior and daily functioning.
- Avoid directly confronting or arguing with the delusions, as this can lead to
increased defensiveness, agitation, or mistrust toward staff.
- Acknowledge the patient’s feelings without reinforcing the delusional beliefs,
helping to build rapport while gently guiding the patient toward reality.
-Provide consistent, reality-based information in a calm and respectful manner to
help the patient gradually distinguish between delusion and reality.
- Promote participation in structured, reality-oriented activities, group therapy,
which can help reduce focus on delusional thinking and increase engagement with
the environment.
- Ensure the environment is safe and free of stimuli that may trigger or reinforce
delusional behavior, especially the patient believes they have power or status that
may lead to risky actions.
Evaluation - After nursing intervention, the patient demonstrated a reduction in
delusion and has increased reality orientation
Nursing Care Plan 3
• Nursing diagnosis - Noncompliance related to lack of insight as evidenced by
continued smoking and verbalization of continuing substance use.
• Expected outcomes - The patient will participate counseling or education session and
demonstrate increased insight into the impact of substance use on his health.
• Nursing Interventions
-Establish a non-judgmental and trusting relationship to encourage open
communication and reduce resistance to care.
-Assess the patient’s personal beliefs, motivations, and perceived benefits of
continued substance use to understand his perspective.
-
- Use motivational interviewing to explore the patient’s ambivalence and help him
reflect on how substance use affects his health goals.
-Reinforce the known risks of substance use in a respectful way by linking them to
the patient’s current health condition.
-Encourage small, realistic behavior changes such as reducing use or avoiding
known triggers, instead of insisting on immediate abstinence.
- Involve the patient in creating a flexible care plan that supports his autonomy
while addressing health concerns.
- Recommend counseling or support groups to provide encouragement, peer
understanding, and long-term behavioral support.
• Evaluation - The patient participates in counseling or education session and
demonstrate increased insight into the impact of substance use on his health.
Discharge Planning
1. Advise to take all prescribed medications for addiction treatment exactly as directed to help
reduce cravings and prevent relapse.
2. Encourage to attend all scheduled follow-up appointments with healthcare provider, counselor,
or psychiatrist to support recovery process.
3. Encourage patient to participate in individual or group therapy, such as cognitive behavioral
therapy, to develop healthy coping strategies.
4. Avoid contact with people, places, or situations that may trigger patient’s urge to use substances.
5. Advise to join a recovery support group like Narcotics Anonymous (NA) or Alcoholics
Anonymous (AA), MHPPS Working Group Myanmar and services like Aung Clinic, Call Me
Today to stay motivated and connected.
6. Inform a trusted family member or friend about the patient’s recovery plan so they
can provide support and encouragement.
7. Instruct do not stop any medication suddenly on his own and inform this may cause
withdrawal symptoms or complications.
8. Encourage the use of harm reduction strategies (e.g., needle exchange, safety use,
education, counseling and referrals) to minimize the physical and psychological risks
of continued substance use.
9. Advise the client to avoid mixing substances, especially central nervous system
depressants, to reduce overdose risk.
10. Recommend never using substances alone and to stay in contact with someone
who can assist in an emergency.
11. Refer the client to harm reduction services and community-based support programs
for continued guidance and resources.
12. Encourage attendance at counseling or support groups, even if abstinence is not the
immediate goal.
13. Schedule regular follow-up appointments to monitor mental and physical health and
assess readiness for future treatment.
14. Provide education about recognizing early signs of overdose and withdrawal
complications.
15. Instruct to maintain a daily routine, including adequate nutrition, sleep, physical
activity, and hygiene, to support general health.
16. Educate the client and family members about applying safety measures in place.
-Safety measures: Avoiding places where you know drugs and alcohol will be
available, surrounding yourself with friends who don’t use drugs, knowing how to
resist temptation, learning how to cope with stress and relax without drugs, and
distracting yourself with activities like exercise or listening to music.
17. Ensure the client understands that recovery is a continuous process and
treatment remains available at any time he chooses to reduce or stop substance use
and also it is an important part of his success.
Conclusion
• Substance Use Disorder (SUD) is a long-term and serious condition that affects
how a person thinks, feels, and behaves due to the repeated use of harmful
substances like alcohol, tobacco, opioids, methamphetamines, or other drugs.
• There are many ways to treat and manage SUD, and with the right support,
recovery is possible. The most effective approach usually includes a combination
of medication, counseling, and behavioral therapy, group therapy and community
support.
• Family support, a safe living environment, and access to education or employment
are also important parts of recovery.
• Many people can fully recover and lead healthy lives, especially if they receive
early treatment and stay in therapy. However, SUD is a chronic condition, and
some people may relapse or need long-term care.
• . With time, patience, and the right kind of help, people with SUD can regain
control of their lives.
