Substance-abuse nursing: Much-needed specialty
Pulse editor
Sunday, February 15, 2009
Bill Greene, BSN, CARN, met a former patient in the hallway of the Atlanta VA Medical Center in Decatur, where he works in the Mental Health Emergency Annex.
“I didn’t even recognize him, but he stopped to thank me and tell me he was doing real well,” Greene said. “At the end of the day, that’s what makes this job worthwhile.”
BARRY WILLIAMS / AJC Special
Bill Greene is a nurse at the Atlanta VA Medical Center’s Mental Health Emergency Annex.
A nurse since 1993, Greene worked in geriatrics and med/surg before he decided to specialize in psychiatric nursing in 2001. After noticing a growing incidence of substance abuse in his patient population, Greene took the training and put in the required 2,000 hours to become a certified addictions registered nurse.
He also is president of the Georgia chapter of the International Nurses Society on Addictions.
“This is one of the least-known nursing specialties, and addiction is a disease that affects society in so many ways,” Greene said.
Addictions to alcohol, drugs, tobacco, gambling and conditions such as eating disorders are often misunderstood, Greene said.
“People don’t understand or take addiction seriously,” Greene said. “They view it as a weakness. If it were that simple, people would just stop.”
Addictions often end up putting people in crisis, and that’s when Greene encounters them in the emergency room.
“We intervene to protect the person from himself — in the case of suicidal tendencies — or to protect others,” Greene said. “People high on drugs or alcohol can become violent. That’s the
No. 1 thing we worry about, particularly with stimulant drugs.”
Greene provides short-term intervention and admits patients to the hospital or to another facility or program.
“Substance-abuse nursing takes acute listening skills,” Greene said. “Frequently, it’s not what the person says, but what he doesn’t tell you that is important. You have to learn to read between the lines and be extremely patient.”
A matter of trust
Trained in mental health, Greene knows that first impressions are important to patients.
“You have to get [patients] to trust you quickly,” he said. “It’s a stressful job, but my goal is for them to have the best experience possible with me. There is great satisfaction in knowing that I’m doing something that is really important and really needed.”
Military veterans who have suffered trauma are often susceptible to substance abuse, but the problem is found in all parts of the population.
“We’re seeing more substance abuse in the elderly, and you never read about that,” Greene said. “There is a problem in many nursing homes with people who are depressed and in pain.”
Addiction and many psychiatric disorders go hand-in-hand, said Barbara Berlin, RN, CARN, who works for the Veterans Affairs Substance Abuse Outpatient Program.
A nurse with Veterans Affairs for 33 years, Berlin helped start the first dual-diagnosis therapy group for people with psychiatric conditions complicated by drug or alcohol addiction.
“People could see it was advantageous and, in the mid-90s, the psychiatrists and staff at the VA began to realize that you can’t treat one without treating the other,” Berlin said.
Patients have to be stabilized and analyzed to see if they have a true psychiatric problem or a substance-
induced psychosis, Berlin said.
Treating the ‘whole patient’
“Medicine, psychiatry and substance-abuse staff must come together in order to treat the whole patient,” Berlin said. “We’ve come a long way in the last 20 years in learning how drug and alcohol impacts psychiatric conditions, and we know that patients can’t make any headway unless you treat both.”
Her program offers education and rehabilitation services to about 700 outpatients a year, with the aim of getting them clean and sober and then enabling them to live independently or in half-way houses.
“You have to have a passion for this type of work, because you are going to have a lot of personal contact with your patients, and relapse is very prevalent,” Berlin said. “But it’s so rewarding to see them start to put their life back together.”
Berlin believes all nurses need background in substance-abuse care.
“It affects every facet of nursing,” she said. “Nurses in the emergency room, critical care, surgical and post-operative areas all see it.”
Since the specialty is only covered briefly in nursing school, most nurses stumble into the field later in their careers.
“We’d love to have more nurses certified and working in this specialty,” Berlin said. “They are desperately needed.”