Managing Substance Abuse on Psychiatric Units : A Scoping Review

Alexandre Hudon^1,2,3,4,5*Jean-Philippe Cloutier-Tanguay⁶Joshua Levy¹William Dastous-Stampe¹Marie-Louise Daigneault⁷Cédric Lacombe^1,2François Noël^1,2Stéphanie Borduas Pagé¹

• ¹Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Canada
• ²Department of Psychiatry, Institut universitaire en santé mentale de Montréal, Montréal, Canada
• ³Centre de recherche de l'Institut universitaire en sante mentale de Montreal, Montreal, Canada
• ⁴Department of Psychiatry, Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada
• ⁵Groupe Interdisciplinaire de Recherche sur la Cognition et le Raisonnement Professionnel (GIRCoPRo), Université de Montréal, Montréal, Canada
• ⁶Department of Psychiatry and Neurosciences, Faculty of Medicine, Université Laval, Quebec, Canada
• ⁷Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada

Objective Substance use during psychiatric hospitalization compromises safety, treatment engagement, and post-discharge outcomes, but practical guidance for ward staff remains limited. This scoping review mapped the peer-reviewed literature on how psychiatric inpatient units detect, manage, and respond to alcohol or drug use that occurs on the ward itself, and summarised the effectiveness and breadth of reported strategies. Methods The review followed the PRISMA-ScR framework. PubMed, Embase, PsycINFO, and Google Scholar were searched from inception to April 2025 using controlled vocabulary and free-text terms for substance use, psychiatric inpatients, and management strategies. English-and French-language empirical studies, quality-improvement reports, policy evaluations, and scoping reviews were eligible if they described an intervention or protocol applied in an inpatient psychiatric setting. Reviewers independently screened titles/abstracts and full texts extracted data with a standardised spreadsheet, and applied Joanna Briggs Institute critical-appraisal tools. Results From the identified studies, 18 studies met inclusion criteria: 1 randomised trial, 3 quasi-experimental reports, 8 descriptive prevalence/cross-sectional studies, 2 policy case studies, 3 reviews/chapters, and 1 commentary. Seven recurring intervention domains were identified: systematic screening (n = 9 studies), brief motivational interventions, policy / protocol development, environmental or security measures, harm reduction strategies, staff training and culture change, and discharge planning. Structured screening improved detection rates up to two-fold; brief interventions such as SBIRT and BIMI increased post-discharge treatment engagement and reduced 30-day readmissions by up to 18 %. Zero-tolerance security measures showed inconsistent effects on contraband entry or aggression. Overall methodological quality was moderate, with most evidence derived from single-site implementations. Conclusions Existing evidence suggests that standardized screening, ward-adapted brief interventions, clear patient-centred policies, and targeted harm-reduction measures can feasibly improve management of inpatient substance use, while purely punitive security tactics are insufficient. Research gaps include rigorous multi-site evaluations, adolescent and forensic settings, and integrated harm-reduction protocols for substances other than nicotine.