Background: Substance dependence is a global public health challenge with significant consequences at an individual and societal level. Addiction arises through multifactorial causes and stigma is widespread, which also nurses may have adapted. Patients with substance addiction often report a loof and sometimes abusive attitudes from nurses. A good care relationship is crucial for the patient's recovery and the specialist nurse has a great responsibility for the caring encounter.

Aim: The aim of this study is to investigate nurses' attitudes towards patients with substance use and how this affects the quality of care.

Methods: A systematic literature review based on 14 qualitative articles, and three mixed methods, from three search engines (Cinahl, PubMed och Psycinfo) with high reliability.

Result: The results are presented in three themes: what are prevalent beliefs and views on substance dependence, which factors affect nurses' attitudes and how do attitudes affect care. These themes have 13 subthemes.

Conclusion: Nurses' attitudes affect the care of patients with substance dependence. Negative attitudes can reduce the quality of care, while positive and empathetic attitudes improve the care relationship and outcomes. Nurses should increase their understanding of substance addiction and be aware of how their attitudes affect care, as well as promote a respectful dialogue and involve patients in care decisions.