Substance Use Disorder: An Experienced Nurse Practitioner’s Perspective
Evidence-Based Approaches for Nurse Practitioners Managing Substance Use Disorders in Outpatient and Correctional Settings
Zachary J. Rios, MSN, APRN, AGNP-C
Rios Enterprise LLC
January 29, 2026
Abstract
Substance Use Disorder (SUD) continues to present a major public health challenge in the United States, with opioids, benzodiazepines, and alcohol among the most prevalent substances of misuse. Nurse Practitioners (NPs) sit at the forefront of screening, diagnosis, and treatment in both outpatient and correctional settings. This article explores the NP’s clinical experience treating SUDs, synthesizes current evidence-based guidelines, and highlights best practices for comprehensive care.
Introduction
Substance Use Disorder is a chronic, relapsing disease defined by compulsive substance use despite harmful consequences (CDC, 2024). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines criteria that categorize SUD across a spectrum of severity, from mild to severe. Clinicians, including NPs, must apply these criteria to accurately diagnose and initiate appropriate treatment across diverse settings and patient populations.
NPs practicing in outpatient and correctional environments encounter a wide range of clinical presentations—from early risky use to severe dependence complicated by co-morbidities such as mental illness, homelessness, and chronic medical conditions. This perspective underscores the need for evidence-based, trauma-informed approaches to improve outcomes and reduce morbidity associated with SUD.
Opioid Use Disorder
Clinical Manifestations and Diagnosis
Opioid Use Disorder (OUD) is characterized by impaired control, cravings, and continued use despite negative consequences. In clinical practice, screening tools such as the CAN-MAT and structured patient interviews assist with early detection.
Guideline-Based Treatment
Current CDC guidance emphasizes medication for opioid use disorder (MOUD)—including buprenorphine, methadone, and naltrexone—as foundational treatments associated with reduced overdose risk and mortality (CDC, 2024).
- Buprenorphine: A partial opioid agonist that reduces withdrawal and cravings; it can be prescribed in office-based settings without special waivers under current DEA authority.
- Methadone: A full opioid agonist dispensed through certified Opioid Treatment Programs (OTPs) with supervised daily dosing.
- Naltrexone: An opioid antagonist that requires opioid abstinence prior to initiation to avoid precipitated withdrawal; it is best suited for patients able to complete detoxification.
Integrated Care Considerations
Psychosocial support, naloxone education, and assessment of co-occurring substance use are recommended adjuncts to MOUD (CDC, 2024). Within county jails, collaboration with correctional health services to continue MOUD during incarceration and coordinate reentry care is critical to reducing post-release overdose risk.
Benzodiazepine Use Disorder
Complexity of Benzodiazepine Dependence
While benzodiazepines play an important role in treating anxiety, insomnia, and seizure disorders, they are associated with significant dependence, cognitive impairment, and overdose risk—particularly when combined with opioids (ASAM, 2025).
Guideline-Supported Tapering
Recent clinical guidance strongly supports gradual, individualized tapering for patients with benzodiazepine dependence (ASAM, 2025). Recommended strategies include dose reductions of 5–10% every 2–4 weeks, with slower tapers for long-term use. Abrupt discontinuation should be avoided, as it may precipitate severe withdrawal symptoms, including anxiety and seizures.
Clinical Practice Integration
NPs must evaluate benzodiazepine use in the context of concurrent opioid or alcohol use due to heightened risk of respiratory depression. Decisions regarding tapering should be collaborative, patient-centered, and focused on safety and tolerability.
Alcohol Use Disorder
Screening and Identification
Alcohol Use Disorder (AUD) is prevalent in both outpatient and incarcerated populations and carries significant medical and social consequences. Standard screening tools include AUDIT-C, with CIWA-Ar used when withdrawal is suspected.
Withdrawal Management
Benzodiazepines remain the first-line treatment for moderate to severe alcohol withdrawal in both ambulatory and inpatient settings due to their effectiveness in preventing seizures.
Medication-Assisted Treatment
Evidence supports the use of acamprosate, oral or extended-release naltrexone, and disulfiram as pharmacologic treatments for AUD, particularly when combined with psychosocial therapies such as cognitive behavioral therapy or motivational interviewing. Naltrexone, for example, reduces alcohol cravings by blocking dopaminergic reward pathways.
Holistic Care
NPs integrate counseling, social support services, and community recovery programs into treatment plans. Provider training programs such as SAMHSA’s PCSS-MAUD enhance clinician capacity to deliver evidence-based AUD care.
Integrative and Patient-Centered Strategies
Harm Reduction and Education
Overdose prevention education, including naloxone distribution, is essential for patients and their support systems. Motivational interviewing and shared decision-making improve engagement, particularly for individuals ambivalent about change.
Correctional Health Challenges
In correctional settings, priorities include managing acute withdrawal, initiating or continuing MOUD and AUD pharmacotherapy, and ensuring continuity of care upon release. Collaborative care models and warm handoffs to community providers represent best practices.
Conclusion
Substance Use Disorders involving opioids, benzodiazepines, and alcohol require comprehensive, evidence-based approaches. Nurse Practitioners practicing in outpatient and correctional environments can significantly impact patient outcomes through guideline-informed pharmacotherapy, psychosocial support, and harm-reduction strategies. Staying current with evolving recommendations and delivering individualized care remain central to effective SUD treatment.
