Self-care is paramount for addictions nurses.
As a professor of nursing at the University of Alabama at Birmingham (UAB), Susanne Fogger DNP, PMHNP-BC, CARN-AP, FAAN, FAANP, combines teaching on behavioral health issues with a psychiatric practice integrated into a UAB infectious disease clinic. Fogger also serves as president of the International Nurses Society on Addictions USA and as a long-standing member of its board of directors. An Alabama State Nurses Association member, she also co-chairs the American Association of Nurse Practitioners’ large psychiatric/addictions community. Fogger spoke with the American Nurses Association about some of the distinct aspects of her specialty.
How did you become an addictions RN?
I was assigned to an alcohol treatment unit while on active duty in the Air Force Nurse Corps in the 1980s. I soon discovered that substance use disorder (SUD) is complex and intertwined with both medical and psychiatric issues. Years ago, substance use treatment and mental healthcare were separate and often did not address co-occurring problems. We now know that more than 50% of patients with psychiatric issues have underlying SUD.
At the time, armed services patients were either ordered to treatment or voluntarily sought help for alcohol use. The 12 steps and 12 traditions of Alcoholics Anonymous were a major component of the treatment program. Nurses co-chaired group therapy sessions and met with patients individually to support their efforts to remain substance free. Often patients had unresolved traumas from childhood, which played a role in their substance use, and they needed additional therapy after completing the program. I found it meaningful to treat individuals who had lost control of their lives and who worked daily to learn how to live without alcohol.
What are the current best practices for SUD treatment?
Harm reduction is now understood as an evidence-based, practical approach to SUD treatment. Patients living with SUD may know that substance use can be harmful or lethal but nonetheless can’t stop using. Nurses work with them to consider how they can reduce their risk of use by changing some of the factors of use. The concept of risk reduction helps guide nurses to work with patients without demanding that they stop using as a proviso of receiving care.
This treatment concept meets the person where they are in the change process and helps to reduce risk of substance use. Needle exchanges, safe using spaces, and creating expectations for safe use can all be part of this process. This goes against the abstinence-only treatment model but helps a clinician develop a relationship with their patient that will decrease risk of death, overdose, infectious diseases, and other negative aspects of substance use. Treatment options are discussed throughout the process, but the patient retains autonomy over their use.
What do you want nurses to know about working in the addictions field?
Most nurses have experience caring in one form or another for individuals with SUD either with patients or with family members or friends. It’s common for even the most experienced addiction nurses to struggle with feelings of guilt when a patient or loved one isn’t responding to SUD treatment. But no one can force a person into recovery. “Helping” in the field of addictions looks different than in typical nursing care. A nurse’s isolation and feelings of helplessness can impair their ability to care for others. That makes it paramount that nurses in this area of practice have strong peer networks, personal self-care plans, and a system that encourages them to seek supervision for stressful clinical situations.
American Nurse Journal. 2023; 18(12). Doi: 10.51256/ANJ122328
