A nurse is caring for a client who reports frequent social use of alcohol. The client tells the nurse that they have been reprimanded at work for being late several times after they had been out late drinking. Which of the following statements by the client might indicate that the client has developed a substance use disorder?

Choice A reason: Taking art lessons to relieve stress suggests a healthy coping mechanism, not a substance use disorder. Alcohol use disorder involves impaired functioning, like work performance, not positive activities like art, which indicates adaptive behavior rather than addiction. Choice B reason: Loss of appetite can indicate alcohol use disorder, as chronic alcohol consumption disrupts appetite-regulating hormones (e.g., ghrelin) and causes gastrointestinal irritation, reducing desire to eat. Combined with work reprimands from drinking, this suggests impaired functioning, a hallmark of substance use disorder. Choice C reason: Being focused with many goals does not indicate a substance use disorder, which typically impairs concentration and goal-directed behavior due to alcohol’s neurotoxic effects. This statement suggests intact functioning, inconsistent with the negative consequences described in the scenario. Choice D reason: Having supportive friends is a positive factor, not indicative of substance use disorder. Alcohol use disorder often leads to social isolation or strained relationships, not reliance on a support system, making this statement unrelated to addiction criteria.