Substance Use Disorders

Substance use disorder (SUD) is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences. The neurobiology centers on the mesolimbic dopamine reward pathway: drugs of abuse hijack the natural reward system by flooding the nucleus accumbens with dopamine at levels 2-10x greater than natural rewards (food, social bonding). With repeated use, neuroadaptation occurs: the brain downregulates dopamine receptors (tolerance) and reduces natural dopamine production, creating a state where the individual needs the substance just to feel normal (dependence) and natural rewards become less pleasurable (anhedonia). The prefrontal cortex (decision-making, impulse control) shows decreased activity in addiction, explaining the loss of control over substance use despite awareness of consequences. Withdrawal occurs when the neuroadapted brain is suddenly deprived of the substance: the opposite of the drug's effects emerge (alcohol/benzodiazepine withdrawal causes CNS hyperexcitability because GABA suppression is removed; opioid withdrawal causes sympathetic hyperactivity because opioid suppression of the locus coeruleus is removed). The practical nurse monitors for withdrawal syndromes, administers prescribed withdrawal management medications, provides non-judgmental care, and supports recovery.