Treatment goals The goal of identification and intervention is to encourage the nurse with SUD to participate in appropriate treatment and alternative programs rather than face punitive actions. Research shows that early identification and referral of persons to treatment programs leads to the following: ● Increased success in a treatment program. ● Better outcomes after treatment. ● Reduced time practicing with an undetected substance use disorder. ● Reduced number of relapses. ● Improved social and interpersonal functioning. ● Reduced threats to public health and safety. (NCSBN, 2018) Treatment and monitoring programs generally require that the nurse sign an agreement that identifies the responsibility of the nurse and treatment facility (NCSBN, 2018). Nursing Consideration: Mandates may vary or change depending on individual state laws and specific programs. Therefore, nurses must understand that to receive current information, they must carefully review any alternative program mandates prior to participation. To enter into an alternative treatment program, the healthcare provider must meet the following requirements: ● Abstain from all alcohol and alcohol-containing products unless prior approval is obtained from the alternative program. ● Abstain from drug use, including all over-the-counter medications and other mind-altering substances unless lawfully prescribed with prior approval of the alternative treatment program. ● 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 to inactivate 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. Ongoing education All employees must receive education regarding SUD, how to recognize and report it, and options for recovery. Additional recommendations include: ● Beginning education on substance use disorder and other forms of addiction in the nurse’s basic nursing education. Academic programs should include the topic as part of the nursing curriculum. ● Providing information on substance use disorder during orientation of 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 in order to provide compassionate assistance for colleagues who need help.
● Undergo any additional evaluation as asked by the treatment provider or the alternative program. ● Agree to monitoring by the state board of nursing as well as the facility. (NCSBN, 2018) Several requirements relating to treatment and recovery monitoring are generally mandated, including but not limited to the following: ● 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 contact information for one pharmacy, one health care provider, and one dentist to the alternative program. ● 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 every quarter. ● 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. (NCSBN, 2018) Other clinicians should check with their state boards to determine requirements and alternative programs. ● Promoting the establishment of a culture of safety. Safety culture should be part of continuing education endeavors and part of the new employee orientation process as well. Nursing Consideration: Success is measured in terms of recovery, patient safety, and appropriate referral to alternative treatment programs. Success for the nurse who is 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 any and all mandates of drug screening and follow-up monitoring (NCSBN, 2018).
CHANGE PRINCIPLES APPLIED TO SUBSTANCE USE DISORDER
1. Precontemplation is where change is not in the foreseeable future. Individuals in this stage need to be made aware of the problem. Lack of insight prevents the individual from seeing the consequences of harmful/addictive actions. It is important to understand that the individual is in denial and tends to defend the actions. Resistant, unmotivated, and unwilling to change are descriptors for this stage.
Integrative therapy emphasizes change principles rather than limited techniques and looks beyond a single psychotherapy approach. The stages of change identify an individual’s readiness to change, which is the period of time and tasks completed to move toward the next stage (Norcross & Beutler, 2019). The stages are precontemplation, contemplation, preparation, action, and maintenance:
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