Substance use disorders (SUDs) are defined by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) as the “association of cognitive, behavioral, and physiological symptoms that indicate that the person continues to use a substance despite significant problems related to that substance” [1]. Globally, substance use represents a major public health concern and contributes substantially to the burden of disease, being associated with increased mortality, disability, and chronic conditions, such as liver disease, cancer, and infectious diseases [2-4]. SUDs commonly coexist with psychiatric disorders, particularly mood and anxiety disorders, which complicate treatment and worsen prognosis [3,5,6]. Consequently, SUDs can have a profound impact on a person’s identity, causing individuals to lose their sense of self, which can manifest itself as a change in values and priorities, a deterioration of self-image, social disconnection, or a break with previous roles [5,6].

This individual impact underscores why SUDs represent a global challenge with serious consequences at the individual level. In 2025, there were 51,255 admissions to treatment for psychoactive substance dependence in Spain, representing an increase of 9.7% over the previous year [7]. Moreover, adherence to rehabilitation programs is often limited, with high dropout rates reported internationally and frequently linked to psychosocial vulnerability and difficulties in establishing therapeutic relationships with health care professionals [3].

Beyond physical and mental health consequences, SUDs also affect identity and social functioning, contributing to stigma, social disconnection, and loss of social roles [3]. In Europe, treatment demand continues to rise, with 51,255 admissions for psychoactive substance dependence recorded in 2025, representing a 9.7% increase compared with the previous year [7,8].

Although SUDs affect people of all genders, treatment-seeking populations in community addiction services are often predominantly male, which may lead to the underrepresentation of women’s experiences in qualitative studies [6-8]. This is of relevance given the established role of gender in shaping pathways into substance use, the associated stigma, exposure to violence or trauma, caregiving responsibilities, and help-seeking behaviors. These factors might shape how nursing care is perceived and what forms of support are most beneficial. Therefore, incorporating a gender perspective might be essential when interpreting patients’ accounts and designing nursing interventions in community addiction treatment centers [9].

Evidence-based rehabilitation programs have been shown to reduce the use of illegal opioids and improve patients’ physical and mental well-being, as well as their quality of life [8]. These programs adopt a holistic approach, with a multidisciplinary team comprising nurses, psychologists, physicians, social workers, and occupational therapists. Furthermore, the centers where these programs are implemented administer substitution treatment and provide social support and nursing care [8,10]. The ideal outcome of substance use rehabilitation is a state of balance and control, where the person feels empowered to manage their life without relying on substances that alter their mental state [7,8]. This process involves a reconstruction of the individual’s identity through a series of behavioral modifications, facilitated by health care professionals [7,9,10]. However, it is estimated that up to 40% of patients withdraw from these programs. In this context, the support and participation of a multidisciplinary team, including nurses, is an empowering element in addressing this condition [11].

The concept of care is understood as a natural phenomenon. The patient’s world, vulnerability, health, and suffering form the core of this concept [12]. The science of care not only facilitates the treatment of disease but also addresses patients’ emotional and social needs, thereby promoting their overall well-being. The quality of care is known to improve when health care professionals make a conscious effort to understand the world from the patient’s perspective. This, in turn, strengthens the therapeutic relationship and promotes better care outcomes. A profound understanding of the experiences and perspectives of patients with SUDs is imperative for the development of patient-centered care. This knowledge facilitates the design of personalized interventions, tailored to the specific needs of this vulnerable population [13,14]. By exploring the subjective experiences of these patients in relation to their care, areas for improvement in health services can be identified, more empathetic and culturally sensitive practices can be promoted, and barriers to access and adherence to treatment can be addressed. This comprehensive strategy for addressing SUDs has the capacity to markedly enhance patients’ quality of life, diminish the social disapproval associated with substance use, and ensure optimal long-term therapeutic outcomes [15].

Despite the presence of nursing in SUD rehabilitation programs, the literature indicates that its role continues to be invisible and poorly understood by both patients and society. In community and outpatient settings, nursing work tends to be diluted within the multidisciplinary team, making it difficult to identify its specific functions [13,14]. However, in addiction treatment centers (CATCs), nurses carry out key interventions that include comprehensive patient assessment, clinical follow-up, health education, administration and supervision of substitution treatments, early detection of relapses, crisis care, and, especially, the establishment of a therapeutic relationship based on trust and continuous support during the rehabilitation process [16]. This apparent contradiction between the relevance of care and the low social recognition of the nursing role justifies the need to explore how users themselves perceive and understand this care [13,17].

However, there is a significant gap in the literature on the perception of patients with SUDs regarding the role of nurses in rehabilitation programs [16,17].

The primary aim of this study is to explore the experiences and perceptions of patients with SUDs regarding the nursing care they receive in outpatient and community settings in Spain. Specifically, the study seeks to analyze patients’ perception of the role of nursing staff, considering both the technical and relational dimensions of nursing care as experienced by users and to describe the organizational and care role that users attribute to Red Cross CATCs in Madrid (Spain), including resources, routines, and processes involved.

The researchers were interested in how patients recover from SUDs and how they perceive the role of nurses in this process. It was therefore determined that qualitative research would best meet the objective. To gain a deeper understanding of this experience, a phenomenological study was conducted, as in-depth interviews allow the emotional, social, and personal nuances of the rehabilitation process to be captured, as well as the importance of support from nurses [19-21]. This research was conducted based on the recommendations of the COREQ guide [22].

Patients diagnosed with SUDs according to the DSM-5 [1] were selected.

Initially, the researchers identified the various support structures for treatment and posttreatment within the Red Cross organization. In-depth interviews were conducted at 2 Red Cross CATCs in Madrid (Spain).

The management team and the multidisciplinary team at the centers were contacted, and meetings were organized to discuss the research objective and obtain the help of the various professionals in identifying participants. Participants were recruited through purposive sampling, following a preliminary presentation of the study to patients at the Red Cross centers together with the center’s management team. Factors that would facilitate a more nuanced categorization of the work were considered, particularly regarding the perception of the nursing role in individual interviews.

In-depth, individual, semistructured interviews were conducted in person with 15 participants. One participant decided to leave the interview after 14 minutes of recording, so a total of 14 patients completed the interviews. The average interview duration was 45 (SD 15.3) minutes, and the interviews were conducted in convenient settings, such as individual rooms at the CATCs, to ensure privacy. The interviews were conducted between January and April 2023. All interviews commenced with the following opening statement: “Please provide a brief overview of your professional background and the circumstances that led to your involvement in this field.” The flexibility of this qualitative interview methodology enabled participants to share their experiences from their own perspective. Open-ended questions and prompts were strategically used to explore turning points, support, situations, and coping strategies when participants were reluctant to share them. The following questions and prompts were included: “Please find below a list of the key responsibilities that nurses in this institution typically have” (Multimedia Appendix 1). With the prior consent of the participants, the interviews were audio recorded. The data collection protocol for the interviews was consistent for all patients. Interviews were transcribed immediately after completion. Data collection ceased once sample saturation was reached [23].

The criteria used to ensure reliability, in accordance with Guba’s contributions to naturalistic research, encompass credibility, transferability, dependability, and confirmability [24].

The transcriptions of these recordings were then produced. Subsequently, a comparison was made between the recordings and transcripts to ensure accuracy. Thereafter, a systematic condensation of the text was carried out in the analytical process, with the following 4 steps [25]: first, the transcripts were read to obtain an overview and identify preliminary themes, with annotations made in the text. Second, a series of codes and code groups were developed. In the event of the emergence of divergent codes, the most appropriate ones were agreed upon to develop a shared understanding. Third, each code group was identified and condensed into categories, which were incorporated into the report, with relevant quotes selected for inclusion. Finally, the condensed subgroups were synthesized to generalize descriptions and concepts of the patients’ experiences [26,27]. The data analysis was iterative and began concurrently with data collection, using the constant comparison method as described by Strauss and Corbin [23] to identify commonalities and variations across cases progressively incorporated.

The ATLAS.ti program (version 25.0.1) was used for the analysis, as were the Office suite and Microsoft Excel for descriptive data analysis, and Microsoft Teams for facilitating digital collaboration during coding.

This study has been approved by the Ethics Committee of the Complutense University of Madrid (Reference: CE_20221215‐06_SAL). Furthermore, the study was conducted in accordance with the principles set out in the Declaration of Helsinki. In addition, to comply with the code of ethics for good practice in the collection of information for this research project, the resources provided by the Complutense University of Madrid have been accessed. The data have been anonymized, with all names appearing in the text being fictitious (Table S1 in Multimedia Appendix 1). Reasonable and appropriate physical, administrative, and technical measures have been taken to protect personal data from loss, misuse, unauthorized access, disclosure, alteration, or destruction. Participants were at liberty to accept or decline participation, and those who agreed to participate signed consent forms. It is important to note that no form of compensation was provided or offered to any of the participants.

All participants had received a confirmed diagnosis of SUDs prior to the interview. Of the 15 participants, 14 were male, 8 (54%) were single, 5 (33%) were divorced, and 2 (13%) were married. The mean age of the subjects was 48.2 years (SD 9.28). The substances most frequently consumed were cocaine—used by 13 (86%) of the participants—cannabis and alcohol (Multimedia Appendix 2). The mean number of previous admissions to rehabilitation centers within the sample was 2.5 (SD 2.4).

In the following section, the results of the empirical investigation will be presented. The data obtained from the interviews have been organized into 2 overarching categories, which are related to the research objectives and questions (Figure 1). All these categories have been framed from the perspective of the users.

Patients with SUDs perceive nursing care positively, although they predominantly highlight relational aspects, such as accompaniment, active listening, and trust. In some cases, there appears to be a lack of awareness regarding nursing functions, particularly those within the scientific and technical domains. The results of this study provide valuable insight into how patients with SUDs value and interpret the nursing care they receive in outpatient and community-based rehabilitation programs in Spain.

From a phenomenological perspective, understanding patients’ perceptions of the role of nursing requires first delving into their personal history of substance use. This is not merely a chronological account of events; it is a complex network of lived experiences, emotions, social relationships, and meanings attributed to the substance and its effects [28]. The mean number of previous admissions to rehabilitation centers in the sample was 2.5 (SD 2.4). This aspect also frequently features in patients’ accounts, highlighting the chronic nature of SUDs and the difficulties in achieving sustained rehabilitation over time [4,7,28].

Participants offered a largely favorable evaluation of the center, regarding it as a vital asset in their rehabilitation process. This positive perception appears to be associated with the multidisciplinary team, comprising doctors, psychologists, social workers, occupational therapists, and nurses. The team’s role is to address both the physical and psychological aspects of treatment and provide comprehensive support that extends beyond a purely clinical approach [12,13,15]. In their testimonies, participants highlight the professional and emotional support they received, as well as the feeling of belonging to a safe and structured environment that not only distances them from problematic consumption environments but also provides for their basic needs and offers opportunities for improvement in various areas.

On the other hand, participating in a variety of group activities, such as physical exercise, healthy leisure initiatives, and workshops focusing on integrating patients into the workplace and fostering personal relationships, was considered vital for sustaining abstinence. Physical exercise is widely used as a complementary therapy in SUD treatment. It is considered a healthy practice, as well as a meaningful and socially integrative activity [29,30]. Similarly, the other leisure workshops offered at the center are seen as potentially transformative by providing entertainment in environments unrelated to substance use and fostering a sense of belonging to a social group [28,29]. One possible explanation for these findings is that the center is perceived not only as a protective factor against relapses, but also as a safe resource for well-being and ongoing support. This finding is consistent with other studies addressing this issue but contrasts with previous studies documenting experiences of stigmatization and discriminatory treatment in hospital settings. The role of the multidisciplinary team could be pivotal in generating a positive overall experience that encourages adherence to the rehabilitation program and social integration [30,31]. This approach is consistent with the Schlossberg transition process model, in which the authors recommend that, to effectively cope with a transition—namely, rehabilitation from SUDs—people need access to diverse types of support [32]. These support categories can range from interpersonal relationships (such as sponsors and spouses) to more distant support systems (such as institutions and communities), including rehabilitation centers [33]. Consequently, rehabilitation programs that adopt a holistic perspective—combining respect for patient autonomy with a flexible and adaptable support structure—align not only with international standards but also with a patient-centered approach [7,10].

Regarding nursing care, the participants in our study recognize nurses as key figures in the rehabilitation programs of the Red Cross CATCs. Most of the nursing practices identified as beneficial by the participants in this study pertain to relational care interventions. They emphasize their close working relationships, active listening skills, and emotional support as key differentiating factors compared to other health care professionals in the multidisciplinary team. Furthermore, they place a high value on the involvement of nursing staff, particularly in health education, support in times of crisis, and management of withdrawal symptoms. This finding aligns with the results of other studies, which indicate that patients with SUDs perceive increased support and reduced judgment from nursing professionals [34,35]. As demonstrated in previous research, the provision of compassionate care is of paramount importance, even in relation to other populations [36,37].

This evidence indicates that the therapeutic relationship is fundamental for patients, regardless of their age or care setting. Skills, such as listening, communicating, and providing reassurance, are valued and recognized as essential, not as inferior or merely technical skills [38]. In addition, other studies have shown that relational interventions generate a wide variety of positive health outcomes. Research has demonstrated that effective therapeutic relationships can enhance treatment adherence and rehabilitation and reduce perceptions of stigma, as outlined in Parkhideh et al [39]. As demonstrated in the literature and as evidenced by our own findings, there is clear evidence of the importance that patients attach to being treated with respect and as people rather than as problems or diseases [40].

Among the recommendations expressed by users, the one that stands out is the suggestion that health care personnel show greater patience during care. This demand reflects a need for more humane and empathetic treatment and highlights the importance of the therapeutic relationship component. Patience is seen as a sign of understanding, respect, dignity, and a willingness to listen, which are all basic elements in building an effective working relationship. This is particularly relevant in contexts involving vulnerable populations, such as individuals with SUDs. Integrating this perspective into clinical practice has the potential to enhance the quality of care and ensure adherence to treatment [35,38].

However, there is a lack of knowledge regarding the roles performed by each member of the health care team. Although the role of the nurse remains constant within the team, participants confuse their role with those of doctors and social workers during the discussions. This is also evident from the absence of any codes or categories relating to other areas of nursing care. One potential explanation for these findings is that patients may not have had sufficient time to comprehend the nature of nursing work. However, it should be noted that all participants had previously been admitted to at least 1 other rehabilitation program. Therefore, the lack of knowledge about nursing work may not be attributable to a lack of contact with nursing staff, but rather to the invisibility of care. The extant literature supports this assertion. In both this population and the general population, care is often not directly associated with nursing. This may mean that the specific and specialized role of nurses in various contexts is not fully recognized. This lack of knowledge about nursing care reflects an underlying problem, which contributes to its social and professional devaluation [41,42].

The participants’ accounts also allow us to infer a structural reality that affects the professional practice of nursing: the low institutional and social value placed on this group. This situation is evident in working conditions that often fail to reflect the complexity of the care required by patients with SUDs. These conditions include a lack of financial recognition, excessive workloads, a shortage of adequate rest areas for staff, and limited participation by nurses in decision-making spaces. This invisibility stands in stark contrast to the pivotal role that patients themselves ascribe to nurses in their recovery processes, particularly regarding human support, active listening, and the establishment of long-term therapeutic bonds [43]. This structural invisibility might help explain why some participants were uncertain about the specific responsibilities of each professional, occasionally mixing up nursing functions with those of other team members. This confusion may also arise from overlapping interdisciplinary tasks, inconsistent role introductions—particularly at admission or during care-plan changes—and contextual factors in SUD care, such as time pressure, staff turnover, and psychosocial vulnerability. Therefore, strengthening role communication and increasing the visibility of nursing responsibilities might enhance patients’ understanding and recognition of nursing care within community addiction services [41]. Role ambiguity may also limit patients’ ability to actively seek nursing support. Brief standardized introductions at admission, visible role identification, and, when feasible, assigning a reference nurse may improve clarity. Future research should further explore patients’ perspectives on strategies to enhance understanding of nursing roles in care [41,44].

This study is one of a limited number of research projects conducted in Spain that address the perceptions of a particularly challenging-to-reach demographic, such as patients with SUDs. However, it is vital to understand the experiences of individuals with SUDs and their interactions with nursing care in order to improve and personalize interventions and establish effective improvement strategies within this particularly vulnerable population. Nevertheless, this study presents some limitations. Most of the participants in the sample are male, and most of them self-identify as such. This finding is consistent with the available evidence, which points to a higher prevalence of substance use among men [2]. From a gender perspective, this pattern may be influenced by social constructs associated with masculinity. These constructs include the normalization of risk, pressure to demonstrate strength or autonomy, and perceived lower access to emotional support networks [4]. These factors may facilitate the initiation and maintenance of use and therefore bias the findings. Conversely, the participants were members of merely two centers belonging to the same rehabilitation Red Cross program, which may have exerted an influence on the results due to the absence of variety in the care received. Furthermore, no distinction was made between different types of nursing care (specialized, hospital-based, or based on the years of experience of the professionals). To expand the knowledge base regarding this population’s perceptions of the nursing role, future studies involving samples of patients from diverse rehabilitation programs and incorporating a gender perspective are essential. Women’s perspectives may be insufficiently captured in this study, and future research should purposively recruit more women (and gender-diverse participants when possible) to better inform gender-responsive nursing care in community addiction services.

This study demonstrated that SUD is a chronic condition, with multiple admissions to rehabilitation programs. Participants have provided a positive evaluation of the rehabilitation center, emphasizing the comprehensive support provided by the multidisciplinary team and the safe environment it offers, beyond clinical treatment. Group activities and ongoing support are key factors in maintaining abstinence and promoting social integration.

Patients with SUDs place a high value on the role of nursing, particularly relational interventions over technical interventions. However, this assessment contrasts with a lack of knowledge about certain functions of the nursing profession, which limits their ability to recognize and take advantage of their capacity for action in community settings.

These findings emphasize the necessity to enhance care models through a holistic approach, considering patients’ life contexts and recognizing both individual care and structural conditions. Nurses can play an essential role in designing patient-centered interventions to achieve sustainable recovery and a positive therapeutic experience.