5. Maintenance . Continuing new behavior change is the focus of the fifth stage. Individuals have maintained total abstinence for more than 6 months. This stage gives individuals the confidence to maintain positive lifestyle changes without fearing relapse. Thoughts of old habits often return, but the temptation is resisted. Individuals require support as they reevaluate reasons for change, acknowledge success, and consider potential triggers (Norcross & Beutler, 2019; Raihan, N & Cogburn, M., 2022). Ultimately, the goal is to create an action plan to prevent relapse since the first 3-6 months of abstinence is difficult to achieve. After that, treatment becomes individualized with a fluid and dynamic evolution (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). ● Volunteer to serve on committees, task forces, and so on to improve the safety culture of the organization, as a culture of safety must be maintained. (Collins et al., 2018) The current emphasis is on helping the nurses with substance use disorder recover and continue with their careers, not punishing them and taking disciplinary action against them. However, to benefit from this treatment emphasis, nurses have an obligation to participate in an approved alternative treatment program and adhere to all of its mandates, as well as to the mandates of state law and rules of their respective State Board of Nursing. Addition- ally, all nurses have an obligation to complete continuing educa- tion courses on the topic of substance use disorder, to act in the best interests of the patient, and to facilitate the treatment and recovery of their colleagues. HB6095. (2021). Scheduling of drug products containing cannabidiol. Florida Senate. https://www.flsenate.gov/Session/Bill/2021/6095/Analyses/h6095z1.PPH.PDF Hoffman, R. S., & Weinhouse, G. L. (2023). Management of moderate and severe alcohol withdrawal syndromes. https://www.uptodate.com/contents/management-of-moderate- and-severe-alcohol-withdrawal-syndromes#H26 Kene, M., Bhopale, S., Eaton, A., Awsare, S. V., & Reed, M. E. (2022). Opioid safety initiative associated with decreased emergency department opioid prescribing. The American Journal of Managed Care, 28 (6), e203-e211. https://doi.org/10.37765/ ajmc.2022.89158 Kreitzer, M. J., & Koithan, M. (2019). Integrative nursing (2nd ed.). Oxford University Press. Kroenke, K., Alford, D, Argoff, C., Canlas, B., Covington, E., Frank, J., Haake, K., Hanling, S. Hooten, W. Kertesz, S., Kravitz, R., Krebs, E., Stanos, S., & Sullivan, M. (2019). Challenges with implementing the Centers for Disease Control and Prevention opioid guideline: A Consensus Panel report. Pain Medicine, 20 (4), 724-735. https://doi. org/10.1093/pm/pny307 Kuerbis, A. (2020). Substance use among older adults: An update on prevalence, etiology, assessment and intervention. Gerontology, 66 , 249-258. Jahan, A. R., & Burgess, D. M. (2022). Substance use disorder. https://www.ncbi.nlm.nih. gov/books/NBK570642/ LaBruyere, R. M. (2022). Attorney General Garland reconfirms the DOJ’s hands-off approach toward federal marijuana prosecution. The National Law Review . https://www. natlawreview.com/article/attorney-general-garland- reconfirms-doj-s-hands-approach- toward-federal-marijuana Lande, R. (2018). Nicotine addiction. Medscape Drugs, and Diseases. https://emedicine. medscape.com/article/287555-overview#a2 Mariani, J. (2013). Alcohol related disorders. In G. Gabbard (Ed.), Treatment of psychiatric disorders (5th Ed.). American Psychiatric Association. Mihic, S., & Mayfield, J. (2023). Hypnotics and sedatives. Brunton, L. L., & Knollmann, B. C. (Eds.), Goodman & Gilman's: The Pharmacological Basis of Therapeutics (14th Ed.) . McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=3191§i onid=269719266 National Conference of State Legislatures (NCSL). (2019). Prescribing policies: States confront opioid overdose epidemic. https://www.ncsl.org/research/health/prescribing- policies-states-confront-opioid-overdose-epidemic.aspx National Council State Boards of Nursing. (2018). A nurse’s guide to substance use disorder in nursing. https://ncsbn.org/public-files/SUD_Brochure_2014.pdf National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2021). The cycle of alcohol addiction. https://www.niaaa.nih.gov/sites/default/files/publications/31954_NIAAA_ The_Cycle_of_Alcohol_Addiction_v4_508.pdf National Institute on Drug Abuse (NIDA). (2019). Methamphetamine. DrugFacts . https:// nida.nih.gov/download/1076/methamphetamine-drugfacts.pdf?v=04b49969b52aade62 7329386a3e9d265 National Institute on Drug Abuse (NIDA). (2021). Hallucinogens. DrugFacts . https://nida. nih.gov/publications/drugfacts/hallucinogens National Institute on Drug Abuse (NIDA). (2022). What are inhalants? DrugFacts https:// nida.nih.gov/publications/research-reports/inhalants/what-are-inhalants National Institutes of Health. (2023). HEAL Initiative®. https://heal.nih.gov/about Norcross, J., & Beutler, L. (2019). Integrative psychotherapies. In Wedding & Corsini (Eds.), Current psychotherapies (11th Ed.), 527-556. Cengage. Opioid Response Network (ORN). (2021). Opioid regulations: State by state guide. https://www.acep.org/globalassets/sites/acep/media/by-medical-focus/opioids/opioid-guide- state-by-state.pdf Pak, D. J., Yong, R. J., Kaye, A. D., & Urman, R. D. (2018). Chronification of pain: Mechanisms, current understanding, and clinical implications . Current Pain and Headache Reports, 22 (2), 9. https://doi.org/10.1007/s11916-018-0666-8. PMID: 29404791 Paxos, C., & Teter, C. (2019). Substance related disorders. In M. Chisolm- Burns, T. Schwinghammer, P. Malone, J. Kolesar, K. Lee. & Bookstaver (Eds.), Psychopharmacotherapy: Principles and practice (5th Ed.). McGraw-Hill. Pino, C. A., & Wakeman, S. E. (2022). Prescription of opioids for acute pain in opioid naïve patients. UpToDate . https://www.uptodate.com/contents/prescription-of-opioids-for- acute-pain-in-opioid-naive-patients Preda, A. (2018). Stimulants. Medscape Drugs and Diseases https://emedicine.medscape. com/article/289007- overview PsychDB. (2021). Benzodiazepines. https://www.psychdb.com/teaching/clinical-practice- guidelines- cpg#benzodiazepines Rainhan, N., & Cogburn, M. (2022). Stages of change theory. https://www.ncbi.nlm.nih. gov/books/NBK556005/#_NBK556005_pubdet_ Riva, J. J., Noor, S. T., Wang, L., Ashoorion, V., Foroutan, F., Sadeghirad, B., Couban, R., & Busse, J. W. (2020). Predictors of prolonged opioid use after initial prescription for acute musculoskeletal injuries in adults: A systematic review and meta-analysis of observational studies. Annals of Internal Medicine . https://doi.org/10.7326/M19-3600 Robinson, A., Wilson, M. N., Hayden, J. A., Rhodes, E., Campbell, S., MacDougall, P., & Asbridge, M. (2021). Health care provider utilization of prescription monitoring programs: A systematic review and meta-analysis. Pain Medicine, 22 (7), 1570-1582. https://doi. org/10.1093/pm/pnaa412 SB63. (2021). Missouri Senate modifies provisions relating to the monitoring of certain controlled substances. https://www.senate.mo.gov/21info/BTS_Web/Bill.aspx?SessionTy pe=R&BillID=54228843
plan. For example, individuals comment that smoking is terrible (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). 4. Action . Change happens during the fourth stage. Total abstinence is expected for less than 6 months. During this stage, 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 need clarification on this stage of change and forgo the work required to act on changing behavior (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). Intent to change practice Some critical elements can be used to change practice and enhance recognition, intervention, and return-to-work issues. But first, everyone must take an active role in changing practice outcomes. Some elements of intent to change practice include the following: ● Encourage the delivery of and participation in SUD education. ● Review/establish specific policies and procedures that guide SUD recognition, reporting, consequences of not reporting, and support and treatment options for the person dealing with SUD. ● Encourage the development of programs that educate spe- cific staff members as interventionists when confrontation is necessary. ● Examine one’s own attitudes toward people with SUD and how they influence intervention. References Altekruse, S., Cosgrove, C., Altekruse, W., Jenkins, R., & Blanco, C. (2020). Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC). PLOS ONE , 15 (1), e0227966. https://doi.org/10.1371/journal.pone.0227966 American Academy of Family Physicians (AAFP). (2021). AAFP chronic pain toolkit. https://www.aafp.org/dam/AAFP/documents/patient_care/pain_management/cpm-toolkit.pdf American Association of Nurse Practitioners (AANP). (2022). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment American Medical Association (AMA). (2021). Report shows decreases in opioid prescribing and increases in overdoses. https://www.ama-assn.org/press-center/press- releases/report-shows-decreases-opioid-prescribing- increase-overdoses American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). APA. Anheyer, D., Haller, H., Lauche, R., Dobos, G., & Cramer, H. (2022). Yoga for treating low back pain: A systematic review and meta-analysis, Pain, 163 (4), e504-e517. https://doi. org/10.1097/j.pain.0000000000002416 Boland, R., & Verduin, M. (2022). Substance use and addictive disorders. In Kaplan & Saddock’s Synopsis of Psychiatry (12th Ed.). Wolters Kluwer. Bounds, C., & Nelson, V. (2022). Benzodiazepines. StatPearls. https://www.ncbi.nlm.nih. gov/books/NBK470159/#_NBK470159_pubdet_ Brannon, G. (2019). Inhalant related psychiatric disorders. Medscape Drugs & Diseases https://emedicine.medscape.com/article/290344-overview Broderick, S. (2023). What does vaping do to your lungs? Health, Johns Hopkins University, https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-does- vaping-do-to-your-lungs Centers for Disease Control and Prevention (CDC). (2021). Understanding the epidemic. https://www.cdc.gov/drugoverdose/epidemic/index.html Centers for Disease Control and Prevention. (2022a). Pocket guide: Tapering opioids for chronic pain. https://www.cdc.gov/drugoverdose/prescribing/clinical-tools.html Centers for Disease Control and Prevention (CDC. (2022b). About CDC’s opioid prescribing guideline. https://www.cdc.gov/opioids/providers/prescribing/guideline.html Centers for Disease Control and Prevention (CDC). (2022c). Calculating total daily dose of opioids for safer dosage. https://www.cdc.gov/drugoverdose/pdf/calculating_total_ daily_dose-a.pdf Centers for Disease Control and Prevention (CDC). (2022d). Provisional drug overdose death counts . https://www.cdc.gov/media/releases/2022/s0210-prescribing-opioids.html Ciraulo, D. (2013). Sedative, hypnotic, or anxiolytic related disorders. In G. Gabbard (Ed.), Treatment of psychiatric disorders (5th Ed.). American Psychiatric Association. Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic pain: An update on the burden, best practices, and new advances. The Lancet, 397 (10289), P2082–2097. https://doi. org/10.1016/S0140-6736(21)00393-7 Collins, F., Koroshetz, W., & Volkow, N. (2018). Helping to end addiction over the long- term: The research plan for the NIH HEAL Initiative. JAMA 320(2), 129–130. https://doi. org/10.1001/jama.2018.8826 Council of State and Territorial Epidemiologists (CSTE). (2019). Healthcare associated infections, drug diversion planning and response toolkit for state and local health departments. https://cdn.ymaws.com/www.cste.org/resource/resmgr/pdfs/pdfs2/Drug_ Diversion_Toolkit_LiveL.pdf DeBar, L., Mayhew, M., Benes, L., Bonifay, A., Deyo, R.A., Elder, C. R., Keefe, F. J., Leo, M. C., McMullen, C., Owen- Smith, A., Smith, D. H., Trinacty, C. M., & Vollmer, W. M. (2022). A primary care–based cognitive behavioral therapy intervention for long-term opioid users with chronic pain: A randomized pragmatic trial. Annals of Internal Medicine . https://doi.org/10.7326/M21-1436 Dowell, D. Ragan, K., Jones, C., Baldwin, G., & Chou, R. (2022). CDC clinical practice guideline for prescribing opioids for pain—United States. MMWR Recommendations and Reports 71 (No. RR-3), 1-95. https://doi.org/10.15585/mmwr.rr7103a1 Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain: United States. MMWR Recommendations and Reports , 65 (RR-1), 1-49. https://ddoi.org/10.15585/mmwr.rr6501e1 Drugs.com (2022). Acamprosate. https://www.drugs.com/acamprosate.html Drugs.com (2023). Naloxone. https://www.drugs.com/naloxone.html Erlach, S. (2022). Sedative, hypnotic, anxiolytic use disorders clinical presentation. Medscape Drugs & Diseases. https://emedicine.medscape.com/article/290585-clinical Forrest, J. (2020). Hallucinogen use. Medscape Drugs and Diseases. https://emedicine. medscape.com/article/293752-overview Goldstick, J. E., Guy, G. P., Losby, J. L., Baldwin, G., Myers, M., & Bohnert, A. S. B. (2021). Changes in initial opioid prescribing practices after the 2016 release of the CDC guideline for prescribing opioids for chronic pain. JAMA Network Open, 4 (7), e2116860. https://doi.org/10.1001/jamanetworkopen.2021.16860 govtrack.us. (2019). S. 724 (116th): John S. McCain Opioid Addiction Prevention Act https://www.govtrack.us/congress/bills/116/s724/summary Halpape, K., Jorgenson, D., Ahmed, A., Kizlyk, K., Landry, E., Marwah, R., Raiche, T., & Wiebe, A. (2022). Pharmacist-led strategy to address the opioid crisis: The Medication Assessment Centre Interprofessional Opioid Pain Service (MAC iOPS). Canadian Pharmacists Journal/Revue Des Pharmaciens Du Canada, 155 (1), 21-25. https://doi. org/10.1177/17151635211045950 Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 9(CD009790). https://doi.org/10.1002/14651858.CD009790.pub2
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