Chapter 11: Substance Use Disorders in Acute Care

Substance use disorder is characterized by recurrent use of alcohol, tobacco, or other drugs that causes significant impairment in health functioning, social responsibilities, and interpersonal relationships, with severity classified along a spectrum from mild to severe based on diagnostic criteria. Healthcare providers utilize evidence-based screening tools and the Screening, Brief Intervention, and Referral to Treatment framework to identify at-risk patients and facilitate appropriate interventions. The chapter provides comprehensive coverage of major substance categories including nicotine, which causes tobacco use disorder and leads to complications such as chronic obstructive pulmonary disease, cardiovascular disease, and e-cigarette or vaping-associated lung injury, managed through cessation strategies including nicotine replacement therapy and pharmacological agents like varenicline and bupropion. Alcohol use disorder represents a significant clinical challenge requiring assessment for acute intoxication, alcohol withdrawal syndrome, and potentially life-threatening alcohol withdrawal delirium, with treatment protocols involving benzodiazepine administration, thiamine supplementation, and Clinical Institute Withdrawal Assessment monitoring. Stimulant substances including cocaine, methamphetamine, and amphetamines produce central nervous system stimulation leading to cardiovascular complications, psychosis, and withdrawal syndromes characterized by depression and intense cravings. Depressant substances encompass both sedative-hypnotics and opioids, with overdose management requiring specific antidotes such as naloxone for opioid reversal and flumazenil for benzodiazepine toxicity, while withdrawal management involves careful tapering protocols and supportive medications. Additional substances covered include inhalants causing neurological damage, cannabis producing both acute effects and withdrawal symptoms, and caffeine with its associated toxicity and dependence patterns, with special consideration given to vulnerable populations including older adults who may use substances to cope with grief, pain, or social isolation.