5 Ways to Enhance Your Approach to Individuals with Substance Use Disorders
- Charon Burda, DNP, PMHCNS, PMHNP-BC, CARN-AP, assistant professor
- Katherine Fornili, DNP, MPH, RN, CARN, FIAAN, assistant professor
By Libby Zay
(from the fall 2018 issue of Nursing For/um magazine)
"Unlike other chronic disorders, substance use disorders can be successfully modified with belief in the treatment and with the support to succeed," explains Charon Burda, DNP ’16, MS ’03, PMHNP-BC, CARN-AP. She and Katherine Fornili, DNP ’16, MPH, RN, CARN, FIAAN, are assistant professors at UMSON who combine individual- and population-based perspectives to provide interprofessional solutions for patients with co-occurring psychiatric and substance use diagnoses. Their work has been published in the Journal of Addictions Nursing, and they both have served on the board of the International Nurses Society on Addictions; Burda is in the middle of her first term as a director at large, and Fornili will begin her fourth term on the board in October, this time as president.
In 2010, the pair co-developed the course Addictions, Society, and the Role of the Nurse, which has become one of the most popular undergraduate electives at UMSON. “It is exciting for us to witness the attitudinal transformation in our students from when they complete a baseline reflection paper at the beginning of the semester to when they complete another reflection paper at the end of the semester,” Fornili says. In those papers, students have described an increased awareness of how our society creates a culture of judgment that allows addiction to continue and have reported that working with patients with substance use disorders (SUDs) is less challenging once they have an increased understanding of the addictions process and are aware of resources and interventions. Burda and Fornili recommend using the guiding principles below to enhance your own ability to respond to individuals with SUDs.
1. Use appropriate language.
The way we think about others is reflected in how we communicate with them, and nurses should never embarrass, shame, or isolate their clients. The Substance Abuse and Mental Health Services Administration (SAMHSA) gives an example: If you label a plant a weed, you will treat it very differently than you would a flower that you intend to grow. In the same way, stating a person is an "alcoholic" identifies him or her negatively. Remember that we are all people first; we are never just one label, disorder, or descriptor.
2. Check your biases.
All professionals should routinely reexamine their stereotypes and know their own biases. Awareness is the first step to change. Individuals coming for treatment need to be informed, connected, and hopeful regarding their recovery, and sincerity, respect, and equality can enhance mutual alliance.
3. Focus on strengths.
Treatment should be strength based, patient centered, and customized. Personalized approaches should include strategic interventions
for the individual, acknowledging their current circumstances and unique abilities and resources. Addiction crosswalks with the psychological, social, cultural, intellectual, spiritual, and environmental aspects of an individual’s life.
4. Use a trauma-informed approach.
SAMHSA calls on providers to build trauma-informed care upon the best evidence available and to engage, empower, and collaborate with individuals, families, and communities. The organization developed six key principles of a trauma-informed approach to care:
- trustworthiness and transparency
- peer support
- collaboration and mutuality
- empowerment, voice, and choice
- cultural, historical, and gender issues.
5. Stay educated and informed.
Scientific research in the addictions field is proliferating. Psychopharmacology has been fine-tuned, and evidence-based practices such as Medication Assisted Therapy (MAT); motivational interviewing; and Screening, Brief, Intervention, Referral, Treatment (SBIRT) have been proven effective. Applying this knowledge and research to your practice can help you provide care that is more understanding, compassionate, and efficient.