● Maintain a current state nursing license, including meeting competency and/or continuing education requirements. ● Complete a substance use, dependency, or mental health assessment. ● Complete treatment, continuing care, and after-care. ● Enter treatment and participate in all treatment recommendations. ● Cease nursing practice and agree an inactivated license until or unless approved to return to practice by the treatment professional and the alternative program. ● Provide counselors with the necessary forms to complete and return to the program. ● Undergo any additional evaluation as asked by the treatment provider or the alternative program. ● Agree to monitoringby the state board of nursing and the facility. Agree to various requirements relating to treatment and recovery monitoring that are generally mandated, including the following (NCSBN, 2018): ● Attending a minimum number of 12-step or other approved self-help meetings per week for the duration of the contract. ● Submitting required documentation to the alternative program at least monthly. ● Maintaining a consistent, active relationship with a sponsor. ● Participating in random drug screening on a schedule mandated by the alternative treatment program. ● After returning to practice, participating in drug screening as mandated. ● Reporting any prescriptions or over-the-counter medications to the alternative program within 24 hours. ● Providing the alternative program with contact information for one pharmacy, one healthcare provider, and one dentist. ● Notifying any healthcare providers of substance use history before receiving any prescription. ● Providing a written statement from the prescribing healthcare provider that verifies the provider’s awareness of the nurse’s history of substance use or dependence and their responsibility to confirm any prescription within 24 hours of prescribing.
● Having practitioners complete mediation verification forms and mediation logs provided by the program and submit them according to program mandates. ● Submitting medication logs quarterly. ● Obtaining a reassessment by a licensed addiction counselor in the event of a relapse or suspected relapse. ● Paying all expenses associated with being in the alternative program. ● Appearing in person for all routinely scheduled interviews or additional interviews as mandated by the alternative program. Ongoing education It is imperative that all employees receive education regarding SUD, including how to recognize it, how to report it, and options for recovery. Additional recommendations include: ● Beginning education on substance use disorder and other forms of addiction in the nurse’s primary nursing education; academic programs should include the topic as part of the nursing curriculum. ● Providing information on substance use disorder during orientation for new employees and as continuing education on an ongoing basis. ● Communicating clear protocols for reporting suspicion of substance use disorder as part of the education process. ● Establishing nurse well-being committees in the workplace; members should receive training to provide compassionate assistance to colleagues who need help. ● Promoting the establishment of a culture of safety; safety culture should be part of continuing education endeavors and the new employee orientation process. Nursing Consideration: Measuring success regarding recovery, patient safety, and appropriate referral to alternative treatment programs is essential. Success for the nurse dealing with substance use disorder is measured in terms of adherence to program standards, completion of treatment, maintenance of negative drug test results, and demonstration of safe nursing practice. Nurses must also adhere to mandates related to drug screening and follow-up monitoring (NCSBN, 2018).
CHANGE PRINCIPLES APPLIED TO SUBSTANCE USE DISORDER
Integrative therapy emphasizes change principles and looks beyond a single psychotherapy approach. The stages of change identify an individual’s readiness to change, which is the period and tasks completed to move toward the next stage Raihan & Cogburn, 2022). The stages are precontemplation, contemplation, preparation, action, and maintenance. Precontemplation occurs when change is not in the foreseeable future. Individuals in this stage are unaware or have limited awareness of the problem. Lack of insight prevents the individual from seeing the consequences of negative/addictive actions. It is essential to understand that the individual is in denial and tends to defend their actions. Resistant, unmotivated, and unwilling to change are descriptors for this stage. Additionally, the individual may obsess about the negative rather than focus on the benefits of change (Raihan & Cogburn, 2022). The second stage is contemplation and is marked by an awareness of the problematic behavior. However, the individual is still unsure whether the problem is worth correcting. Therefore, the avoidance of conflict results in no commitment to the matter. The problem is centered, but the individual does not act meaningfully. This causes the individual to remain stuck for about six months (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). In the third stage, the individual can acknowledge the problematic behavior and commit to correction. Preparation combines intentional behavior where individuals gather information from various sources like self-help books and
psychotherapy while developing an action plan. For example, individuals comment that opioids is terrible (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). Change happens during the fourth stage. Total abstinence is expected for less than six months. During this stage of action , the individual has confidence that willpower will improve the journey of change. Individuals are willing to receive assistance and support and develop short-term positive reinforcement, which counteracts potential triggers that lead to relapse. Unfortunately, many individuals confuse this stage of change and forego the work required to change their behavior (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). Maintenance , or continuing new behavior change, is the focus of the fifth stage. Individuals have maintained total abstinence for more than six months. This stage gives individuals the confidence to maintain positive lifestyle changes without significant fear of relapse. Thoughts of old habits often return, but the temptation is resisted. Individuals require support as they reevaluate their reasons for change, acknowledge success, and consider potential triggers (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). Ultimately, the goal is to create an action plan to prevent relapse, since the first three to six months of abstinence is difficult to achieve. After that, treatment becomes individualized with a fluid and dynamic evolution (Norcross & Beutler, 2019; Raihan & Cogburn, 2022).
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Book Code: AUS3024
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