Nursing Interventions In the Management of
Mental Illness and Alcohol Use Disorders: A
Comprehensive Review
Hailu Xu1, Daoying Liu2
1 Department of VIP Ward, Aliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of
Medicine, Hangzhou, Zhejiang 310000, China
2 Department of e ird Psychiatry, Aliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University
School of Medicine, Hangzhou, Zhejiang 310000, China
GMJ.2023;12:e2999
www.gmj.ir
Correspondence to:
Daoying Liu,Department of The Third Psychiatry, Al-
iated Mental Health Center & Hangzhou Seventh Peo-
ple’s Hospital, Zhejiang University School of Medicine,
No. 305, Tianmushan Road, Xihu District, Hangzhou,
Zhejiang 310000, China.
Telephone Number: +86 0571 85126584
Email Address: dyliuxka066@163.com
Received 2023-04-04
Revised 2023-06-25
Accepted 2023-07-04
Abstract
Co-occurring mental health disorders (MHDs) and alcohol use disorders (AUDs) challenge
healthcare professionals. The complexity of these conditions can hinder accurate diagnosis and
eective treatment. Therefore, it is crucial for healthcare professionals to be aware of the po-
tential for co-occurring disorders and to provide appropriate care. Evidence-based interventions
in nursing are critical in managing these disorders and improving patient outcomes. Nurses
must be trained in these interventions to provide optimal care for patients with co-occurring
disorders. Patients should be encouraged to disclose any substance use or mental health issues
to ensure they receive the best care possible. This review provides a comprehensive overview of
nursing interventions for managing MHDs and AUDs. Nursing care is pivotal in managing these
disorders, and interventions can signicantly improve patient outcomes. By unifying the style
and using clear, concise, and appropriate language for a scientic audience, this review aims
to clarify the importance of nursing interventions in managing co-occurring MHDs and AUDs.
[GMJ.2023;12:e2999] DOI:10.31661/gmj.v12i0.2999
Keywords: Nursing Interventions; Mental Health; Alcohol Use; Quality Of Life
Introduction
There is a strong correlation between men-
tal health disorders (MHDs) and alcohol
use disorders (AUDs), with individuals expe-
riencing one condition being more susceptible
to developing the other [1]. Alcohol can of-
ten be used as a coping mechanism for those
with mental health illnesses, while substance
abuse could lead to the development of men-
tal illnesses such as depression and anxiety
[1-3]. َAlso, both conditions increase the risk
of suicidal thoughts and behaviors [3]. Hence,
providing professional aid is crucial for indi-
viduals struggling with either mental illnesses
or AUDs, as treating both conditions could
signicantly improve symptoms and overall
quality of life (QoL) [1, 4].
Also, children of parents with addiction and
AUDs are at a higher risk of experiencing
psychological and social problems due to
stress [5]. Incarcerated individuals with un-
pleasant experiences are more likely to violate
rules [5].
Managing MHDs and AUDs together is cru-
cial for better outcomes [2,4]; hence, nurses
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Xu H, et al. Role of Nursing Interventions In the Management of MHDs and AUDs
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play a vital role in helping individuals to man-
age AUDs and address MHDs [6]. Early inter-
ventions play a key role in preventing AUDs
from worsening, so professional counseling
and support groups are also important for in-
dividuals with dual diagnoses to learn healthy
coping strategies and manage their conditions
[7]. Therefore, MHDs and substance abuse
should always be treated together for the best
outcomes [1, 8, 9].
This comprehensive review evaluated the
current literature on nursing interventions for
managing MHDs and AUDs.
1. Assessment and Screening
Proper identication and diagnosis are essen-
tial for eective treatment planning and im-
proving patient outcomes [9]. Mental health
screening could help to identify individuals
who may need further evaluation and provide
a starting point for treatment [9]. However, it
is important to note that screening alone is not
sucient for diagnosis and treatment [9, 10].
Unfortunately, screening tools for AUDs are
often inadequate, and community providers
use them less frequently than academic agen-
cies [9, 11].
Clinical interviews are a fundamental step in
the assessment of MHDs [9]. Hence, through
structured or unstructured interviews, clini-
cians can evaluate individual’s symptoms,
personal history, overall functioning, and
mental health status [12]. However, it is es-
sential to recognize that interviews have in-
herent limitations, such as potential biases and
reliance on self-report [13].
1.1. The Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5)
The DSM-5 serves as an essential guideline
for diagnosing MHDs [14]. Also, these cri-
teria were used to establish the AUDs Iden-
tication Test (AUDIT) questionnaire, which
helped clinicians screen the risk of re-drink-
ing and AUDs [14].
Self-report measures, such as questionnaires
and rating scales, provide valuable insights
into mental health status [13]. These measures
assess the presence and severity of symptoms,
as well as various aspects of functioning [14].
Indeed, they oer a standardized and quanti-
able way to measure subjective experiences,
enabling clinicians to monitor progress and
treatment ecacy over time [12].
1.2. The Michigan Alcoholism Screening Test
(MAST)
The MAST is a diagnostic tool specically de-
signed to identify individuals suering from
alcoholism [15]. It has been utilized in vari-
ous settings, such as hospitals, for evaluating
the accuracy of alcoholism diagnoses with ac-
ceptable reliability, sensitivity, and specicity
[15, 16]. These situations include individuals
who have been convicted of drunk driving or
disorderly behavior due to alcohol consump-
tion [16]. However, the MAST should not be
used as a substitute for a clinical diagnosis
[17].
Over time, the MAST has been subject to sev-
eral modications, resulting in the creation
of the Short Michigan Alcoholism Screen-
ing Test (SMAST) [17] and the Brief MAST
(BMAST) [18]. The SMAST and BMAST
have proven reliable and could be self-admin-
istered as questionnaires [19].
1.3. The Cut Down, Annoyed, Guilty,
Eye-opener (CAGE) Questionnaire
The CAGE is a 4-question screening tool for
viable rapid diagnosis of alcoholism among
large groups when a two- or three-item criteri-
on is used [20]. Also, the CAGE questionnaire
has been used as a brief screening tool in pri-
mary care, and it is easy to use for older adults
[21]. Furthermore, laboratory tests may be
recommended to measure blood alcohol lev-
els and/or assess the consequences of alcohol
use on liver function and overall health [9]. 2.
Alcohol-Related Psychiatric Disorders
The most common alcohol-related psychi-
atric disorders include depression, anxiety,
post-traumatic stress disorder (PTSD), psy-
chotic disorders, and nicotine addiction [1,
22].
Depression is a signicant comorbidity
among individuals with AUDs, characterized
by persistent sadness, hopelessness, and loss
of interest and/or pleasure in activities [23]. In
the cases of alcohol abuse, depression can ex-
acerbate MHDs and decrease overall well-be-
ing [23].
The relationship between alcohol and depres-
sion is intricate, as alcohol abuse can contrib-
Role of Nursing Interventions In the Management of MHDs and AUDs Xu H, et al.
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3
ute to and result from depressive symptoms
[24]. Chronic alcohol consumption could
disrupt neurotransmitter functioning and al-
ter brain chemistry, intensifying depressive
symptoms [1, 23]. Additionally, individuals
with depression may turn to alcohol tempo-
rarily to alleviate emotional distress [23, 24].
Hence, identifying and addressing the co-oc-
currence of depression and AUDs is crucial
for providing appropriate interventions and
comprehensive care [24, 25].
Anxiety is another prevalent MHDs among
individuals with AUDs [26]. AUDs and anxi-
ety disorders often co-occur, creating a mutu-
ally reinforcing relationship. Anxiety in indi-
viduals with AUDs may arise from withdraw-
al symptoms, alcohol-induced changes in the
brain, or the consequences of their drinking
behaviors [26]. Conversely, individuals with
pre-existing anxiety disorders may use alco-
hol as a temporary relief from anxiety symp-
toms [1]. Indeed, it is imperative to assess and
treat both conditions concurrently to provide
more eective interventions and improve
overall well-being [1, 26].
PTSD is often observed among individuals
with AUDs, causing intrusive thoughts, ash-
backs, nightmares, and hyperarousal [27].
Therefore, integrated treatment is important
for better outcomes and improved QoL [1,
27].
Psychotic and aective disorders are prev-
alent in homeless individuals with AUDs,
challenging treatment and well-being [28].
Alcohol abuse worsens psychotic disorders,
e.g., schizophrenia, and produces more severe
symptoms [28].
Aective disorders such as depression and
bipolar disorder are also common [29]. So,
comprehensive care is needed to address their
mental health needs eectively [28, 29].
Nicotine use disorders, also known as tobac-
co use, are common among homeless indi-
viduals with AUDs [30]. Regarding various
challenges and stressors among homeless in-
dividuals that increase tobacco use as a cop-
ing mechanism [30], some factors, such as
high-stress levels, social isolation, and limited
resources, contribute to higher tobacco use
rates in low-income populations [30]. Hence,
treating nicotine dependence is essential for
the well-being of homeless individuals with
AUDs [31].
Integrated treatment approaches by target-
ing both alcohol and nicotine dependence, as
well as addressing the underlying causes of
homelessness, could improve outcomes [31].
Indeed, providing resources and support to re-
duce tobacco-related health risks is crucial for
this vulnerable population [30, 31].
3. Nursing Interventions
3.1. Managments of MHDs
Evidence-based nursing interventions have
been proven eective in improving patient
outcomes for individuals with co-occurring
MHDs and substance abuse [32].
For example, mindfulness-based interven-
tions (MBIs) have shown promise in this pop-
ulation and eectively reduced depression
and alcohol cravings [33-36]. So, healthcare
providers can consider MBIs as adjuvant
treatments to alleviate depression and alcohol
cravings [36, 37].
Also, Cognitive-Behavioral Interventions
(CBIs) have shown potential for managing
MHDs and substance use [38, 39]. Mehta et
al. [38] revealed that integrated CBIs deliv-
ered to individuals with AUDs and co-occur-
ring MHDs had a modest yet signicant im-
pact on reducing alcohol or drug abuse and
improving mental health symptoms.
Addressing substance use disorders in long-
term care settings, particularly among older
adults with AUDs, is crucial [15].
Nurses in these settings should be aware of the
possibility that older adults may struggle with
alcohol or substance addiction and should de-
velop eective strategies to address this issue
[4, 15].
Therapeutic communication signicantly im-
pacts establishing a strong alliance and pro-
moting recovery for individuals with co-oc-
curring AUDs and MHDs [40]. Therapists
could employ empathetic listening, valida-
tion, and active engagement to build trust and
enhance treatment outcomes [40].
Psychoeducation is another valuable inter-
vention for patients with AUD and MHDs
[41]. Psychoeducation enables individuals
to actively participate in their treatment and
make informed decisions by providing basic
knowledge about their conditions, treatment
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Xu H, et al. Role of Nursing Interventions In the Management of MHDs and AUDs
options, and coping strategies [41]. Indeed,
psychoeducational interventions have shown
positive outcomes, such as increased treat-
ment adherence, reduced substance use, im-
proved symptom management, and enhanced
recovery [41, 42].
Medication management support is crucial in
the treatment of MHDs associated with AUDs
[43]. Integrated interventions that combine
psychotropic medications with psychotherapy
have shown promise in reducing psychiatric
symptoms and promoting abstinence [43-45].
Individuals with AUDs and co-occurring
MHDs often face crises requiring immediate
intervention [46].
Indeed, crisis intervention aims to provide
immediate support, stabilization, and safety
for individuals in acute distress [47]. In other
words, eective interventions could prevent
symptom exacerbation, reduce substance use,
and facilitate access to appropriate ongoing
care [46, 47].
3.2. Managments of AUDs
AUDs lead to important challenges for long-
term recovery and behavioral change [45].
To promote sustained cessation and positive
behavior modication, application prevention
strategies, coping skills training, and social
support are critical [45, 48]. Indeed, these ap-
proaches help identify potential risk factors
for recurrence, developing eective coping
mechanisms and a supportive community to
reduce feelings of isolation and increase moti-
vation for recovery [45, 48, 49].
3.2.1. Relapse Prevention Strategies
Prevention strategies aim to identify high-risk
situations, triggers, and patterns associated
with alcohol consumption [50]. Cognitive-be-
havioral therapy (CBT), mindfulness-based
relapse prevention, and motivational enhance-
ment therapy have eectively reduced relapse
rates and promoted sustained recovery [50,
51].
3.2.2. Coping Skills Training
Individuals with AUDs need tools to handle
stress, negative emotions, and challenging sit-
uations without resorting to alcohol use [45].
By strengthening coping abilities, individuals
could reduce alcohol dependence as a mal-
adaptive coping mechanism and enhance their
capacity to navigate dicult situations with-
out relapsing [45, 51].
3.2.3. Social Supports
Social supports are essential to promoting
behavior change and maintaining recovery
from AUDs [51, 52]. Supportive networks
such as alcoholics anonymous, family thera-
py, and peer support groups provide a sense
of belonging, understanding, and accountabil-
ity [52]. These systems allow individuals to
share experiences, receive guidance, and gain
encouragement from others with similar chal-
lenges [52, 53].
4. Psychosocial Support and Therapeutic Re-
lationships
Nurses are responsible for providing emotion-
al support to patients and their families, as
well as educating them about their conditions
to ensure a comprehensive understanding [40,
48, 49].
One of the important ways that nurses could
oer psychosocial support is to establish sup-
port groups, which enhance a sense of com-
munity [40, 52]. Additionally, nurses can apli-
cated motivational interviewing techniques
to assist patients in reducing their alcohol
consumption [48]. This involves engaging in
open and non-judgmental conversations ex-
ploring the patient’s motivation for change,
and establishing goals [34, 48].
Nurses are educated to screen patients for sub-
stance use disorders, assess for alcohol abuse,
and refer individuals to appropriate treatment
programs [9]. Hence, collaboration with other
healthcare professionals is essential to ensure
comprehensive care [9, 14].
Therapeutic relationships in healthcare are
built upon empathy and patient-centered care,
which are fundamental to achieving positive
treatment outcomes [54]. These relationships
lead to eective communication, trust, patient
engagement, and satisfaction [54, 55]. Indeed,
to create a supportive and positive environ-
ment, healthcare providers must understand
patients’ perspectives, actively listen to their
concerns, and involve them in decision-mak-
ing processes [54].
Empathy within therapeutic relationships al-
lows healthcare providers to understand and
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Role of Nursing Interventions In the Management of MHDs and AUDs Xu H, et al.
share patients’ feelings, thus promoting trust
and collaboration [56]. Hence, it facilitates
eective communication, enabling healthcare
providers to address patients’ concerns and
tailor care to their needs [55], consequently
increasing patient satisfaction and treatment
adherence [56].
5. Medication Management and Pharmaco-
logical Interventions
Nurses play a vital role in medication man-
agement for individuals with dual diagnoses
of MHDs and AUDs [57, 58]. They conduct
comprehensive assessments to collect de-
tailed information about the individual’s men-
tal health history, substance use patterns, and
medication requirements [34, 48, 57]. This
information is then used to make informed
decisions regarding medication selection and
dosage, considering the complex interaction
between mental health and AUDs to achieve
safe and eective treatment outcomes [34,
35].
One of the key responsibilities of nurses is to
educate individuals with dual diagnoses about
their medications, including potential side ef-
fects and the importance of adhering to the
prescribed regimen [44, 57].
Moreover, nurses inform patients about the
risks associated with alcohol use concerning
medication ecacy and potential interactions
[34, 57]. Therefore, by providing this knowl-
edge, nurses could enable patients to actively
participate in their treatment and make in-
formed decisions regarding their well-being
[57, 59].
6. Prevention and Health Promotion
MHDs and alcohol abuse lead to signicant
public health concerns that could profoundly
impact an individual’s overall well-being [9].
Nurses play a pivotal role in addressing these
issues by implementing interventions that pro-
vide prevention and health promotion [32].
Education and awareness are essential to
nursing interventions for promoting mental
health and preventing AUDs [44]. Nurses
provide information about the risks associated
with alcohol consumption and emphasize the
signicance of maintaining optimal mental
well-being [9]. Moreover, they guide adopt-
ing healthy lifestyles such as regular exercise,
proper nutrition, and managing stress eec-
tively [60]. These interventions are delivered
through various means, including group ses-
sions, counseling, etc. [9, 60].
Finally, early intervention may involve re-
ferring individuals to specialized services or
providing ongoing support and monitoring.
These interventions can be implemented in
primary care clinics, community centers, or
schools [8, 60].
7. Ethical and Legal Considerations
Examining the ethical and legal considerations
in nursing care for individuals with dual di-
agnoses, particularly those with co-occurring
MHDs and AUDs, is paramount in delivering
appropriate care [45].
Integrated approaches are recommended, but
limited literature is available on the impact of
nursing practice.
Ronald et al.[25] highlights the signicance
of patient-reported treatment helpfulness in
ensuring quality patient-centered care. To ef-
fectively address dual diagnoses, nursing care
must consider ethical and legal aspects, in-
cluding patient autonomy, condentiality, in-
formed consent, and appropriate care [24, 61].
Nurses should undergo training to recognize
and meet the unique needs of individuals with
MHDs and AUDs, and healthcare systems
should prioritize integrated care approaches
[62].
Enhancing access to specialized services and
promoting patient persistence in seeking treat-
ment can improve outcomes [63].
Except in some situations, e.g., there is a risk
of harm to the patient and/or others, or when
mandated by law, maintaining condentiality
is essential for nurses to establish trust in their
patients and encourage open communica-
tion regarding their conditions and treatment
needs [61, 64, 65].
Indeed, mandatory reporting policies require
nurses to disclose specic circumstances, such
as suspected cases of child or elder abuse or
threats of harm towards oneself or others [61].
Informed consent refers to obtaining a pa-
tient’s voluntary agreement to participate in
treatment after providing relevant information
[64].
Nurses ensure that patients with MHDs and
AUDs comprehend their options, address
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Xu H, et al. Role of Nursing Interventions In the Management of MHDs and AUDs
concerns, and assess their capacity to provide
consent [66-68]. Hence, balancing patient
safety and maintaining condentiality is par-
amount for nurses in these situations [69, 70].
Conclusion
This review highlights the important role of
nursing interventions in managing individuals
with MHDs and AUDs. Hence, the objective
is to improve the knowledge of healthcare
professionals, educators, and policymak-
ers by integrating evidence-based practices
and interdisciplinary approaches to enhance
nursing care and patient outcomes. Nursing
assessments are crucial for early diagnosis,
leading to timely interventions and improved
outcomes. However, healthcare professionals
need increased utilization of these tools, along
with local validation, to ensure accuracy in
dierent populations and settings. Compre-
hensive assessments that include psychiatric
evaluations and substance use assessments are
essential to address the complex needs of indi-
viduals with dual diagnoses.
These assessments inform personalized treat-
ment plans, which should involve integrat-
ed strategies targeting both alcohol use and
MHDs. MBIs, CBT, mental health screen-
ings, and smoking cessation interventions
are eective interventions to consider. Also,
relapse prevention, coping skills training, and
support interventions signicantly promote
behavior change and long-term recovery.
Therefore, nurses play a vital role in provid-
ing psychosocial and emotional support, pa-
tient and family education, and collaboration
with other healthcare professionals. Also, they
have responsibilities in medication manage-
ment, including comprehensive assessments,
medication education, and patient-centered
care. These responsibilities contribute to the
safe and eective administration of medica-
tions and support individuals in their recovery
process.
Furthermore, ethical and legal considerations,
such as condentiality, informed consent, and
mandated reporting, must be navigated to pro-
vide appropriate care while respecting patient
autonomy and privacy. Future research, train-
ing, and practice development in these areas
are essential to enhance nursing practice and
optimize patient care.
Conict of Interest
None.
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Role of Nursing Interventions In the Management of MHDs and AUDs Xu H, et al.
