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?

A. Hanging out with friends who serve as a support system is a positive coping mechanism and does not indicate problematic alcohol use. Social interaction alone is not a criterion for substance use disorder. B. The client’s statement, “I have lost 15 pounds! I just don’t want to eat lately,” is concerning because unintentional weight loss and decreased appetite can result from excessive alcohol use. Combined with reports of work-related problems (reprimands for being late after drinking), this demonstrates impairment in social, occupational, and physical functioning, which are key criteria for a substance use disorder according to the DSM-5. The client shows continued use despite negative consequences, which is central to the diagnosis. Other warning signs include frequent intoxication, neglect of self-care, and risky behaviors. C. Engaging in art lessons to relieve stress is a healthy coping strategy and does not indicate substance misuse. It shows the client is trying to manage stress without substances. D. Being focused and having goals may reflect motivation or ambition and does not suggest impairment or dysfunction from alcohol use. Substance use disorder is characterized by loss of control over substance intake, neglect of responsibilities, and physical or psychological harm, not goal-directed behavior.