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 is a positive coping mechanism and does not indicate a substance use disorder. Engaging in creative activities can help reduce anxiety and promote emotional regulation. This statement reflects adaptive behavior rather than maladaptive patterns associated with substance misuse. Choice B reason: Hanging out with friends who are a support system is also a protective factor against substance use disorder. Social support networks can provide accountability, encouragement, and emotional stability. This statement demonstrates healthy social engagement rather than evidence of a disorder. Choice C reason: Being focused and having goals is a sign of motivation and future orientation. Individuals with substance use disorders often struggle with impaired functioning, lack of direction, and diminished motivation due to the effects of substance misuse. Therefore, this statement does not indicate a disorder. Choice D reason: Unintentional weight loss and loss of appetite can be associated with substance use disorder. Alcohol misuse can disrupt metabolism, impair nutrient absorption, and suppress appetite. The client’s report of losing 15 pounds and not wanting to eat suggests physiological consequences of alcohol use, which is consistent with substance use disorder. This finding reflects maladaptive changes in health and functioning.