Addictions Nursing

Overview

Addictions Nursing (often referred to as substance abuse nursing) deals with the nursing care of individuals suffering from one or more addictions. Addictions Nursing is considered a subspecialty of Psychiatric Nursing. Patients may be suffering from the addiction alone or may have one or more co-occurring psychiatric diagnoses: this is termed dual- or multiple-diagnosis.

People often think of addictions only in terms of alcohol, painkillers, or street drugs such as heroin. In addition to the aforementioned, addictions can also include:

• methadone
• benzodiazepines such as Valium and Xanax
• ADHD/amphetamine medications
• non-opiate pain medications
• other prescription medications
• OTC medications such as:
  • cough medications
  • inhalants
  • nicotine
  • caffeine

Also, addictions are not limited to drugs only. Patients may also be suffering from addictions to sex, gambling, or shopping. In addition, eating disorders fall under addiction medicine.

Addictions Nursing is one of the more "medical" psychiatric nursing subspecialties, in that patients experience physiological as well as psychological addiction to a substance or behavior. Eating disorders have numerous physiological sequelae, many of which are severe or even fatal. Cessation of the addictive substance or behavior (detox) often causes physiological complications, some of which are fatal.

Duties

• therapeutic communication
• rapid, comprehensive assessment
• pain management
• development of nursing diagnoses and plans of care
• administration of medication
• patient education
• crisis intervention
• family support

Addictions nurses care for patients during detox/withdrawal as well as during their recovery. In addition to the physiological complications of withdrawal, patients frequently have medical comorbidities that will also require nursing care.

Practice Settings

When it comes to where addictions nurses can work, most people probably think first of places like the Betty Ford Center. That is just one of many places an Addictions nurse can practice.

Addictions nurses are found in a variety of settings such as:

• freestanding psychiatric hospitals
• psychiatric units in mental hospitals
• intensive outpatient and partial hospitalization programs
• residential (short- or long-term) treatment centers
• mental health clinics
• private practices
• public schools
• community agencies

Professional Organizations

The main professional organization for Addiction nurses is the International Nurses Society on Addictions (IntNSA). Membership is open to RNs, however, Licensed Practical/Vocational Nurses (LPN/LVN) and non-nurses may join as associate or affiliate members, though they may not vote or hold office.

Since addictions nursing is related to psychiatric nursing, addiction nurses may also be interested in joining the American Psychiatric Nurses Association (APNA) and the International Society of Psychiatric-Mental Health Nurses (ISPN).

Nurses can also join the American Society of Addiction Medicine (ASAM). It is, "a professional medical society representing over 6,000 physicians, clinicians and associated professionals in the field of addiction medicine".

The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency within the U.S. Department of Health and Human Services (HHS). This agency, "leads public health efforts to advance the behavioral health of the nation and to improve the lives of individuals living with mental and substance use disorders, and their families".

Educational Requirements

• Graduate from an accredited Practical/Vocational Nursing (LPN/LVN) program or Registered Nursing (RN) program
  • LPN/LVN: certificate, diploma or degree
  • RN: Diploma, ADN, BSN, or MSN
• Successfully pass the NCLEX-PN or NCLEX-RN
• Current, unencumbered LPN/LVN or RN license in U.S. state of practice

Nurses can work in addictions as an RN or an LPN/LVN. Other countries may have additional requirements for practicing as an Addictions nurse.

Certification

International Nurses Society on Addictions (IntNSA)

The following addictions nurse certifications are available for the RN and the Advanced Practice Nurse (APN):

• Certified Addiction Registered Nurse (CARN)
• Certified Addiction Registered Nurse – Advanced Practice (CARN-AP)

The Addictions Nursing Certification Board (ANCB) offers the certifications supported by the IntNSA.

The certifications are available for RNs or advanced-practice RNs only and are valid for 4 years.

CARN eligibility (not all-inclusive)

• Current, unencumbered RN license in U.S. state of practice
• 30 hours of continuing education credits
• Evidence of 2000 hours with experience in addictions nursing within the last 3 years

CARN-AP eligibility (not all-inclusive)

• Current, unencumbered RN license as an RN in U.S. state of practice
• Master of Science in Nursing (MSN) degree or higher
• 45 hours of continuing education
• Minimum 500 supervised hours in addictions and 1500 hours of nursing experience in addictions as an Advanced Practice Nurse (APN) within the last 3 years practice in addictions

American Nurses Credentialing Center (ANCC)

RNs and Nurse Practitioners (NP) may also apply for the following certifications by the ANCC*:

• Psychiatric-Mental Health Nursing Certification (RN-BC) {for the Registered Nurse}
• Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) {for the Nurse Practitioner}

*LPNs/LVNs are not eligible for these certifications

Psychiatric-Mental Health Nursing Certification (RN-BC): eligibility (not all-inclusive)

• Graduate from an accredited RN nursing program with a Diploma, ADN, or BSN degree or higher and successfully passed NCLEX-RN
• Current, unencumbered RN license in U.S. state or territory or hold the legally recognized equivalent in another country
• 2 years full-time as an RN
• Minimum 2,000 hours clinical practice in psychiatric–mental health nursing within last 3 years
• Completed 30 hours of continuing education in psychiatric–mental health nursing within last 3 years

Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC): eligibility (not all-inclusive)

• Current, unencumbered RN license in U.S. state or territory or the legally recognized equivalent in another country and successfully passed NCLEX-RN
• Master of Science in Nursing (MSN), post-graduate, or nursing doctoral degree from an accredited psychiatric-mental health NP Program
• Minimum 500 faculty-supervised clinical hours must be included in the psychiatric-mental health NP Program

Salary (2020)

According to salary.com, the average hourly wage for an Addictions Nurse in the U.S. is $34 and falls between $31 and $38.

According to ZipRecruiter, the average annual pay in the U.S. is $62,104 a year with salaries as high as $132,000 and as low as $22,000, depending on education, experience, and location.

If You Are the One in Recovery ...

Psychiatric nursing tends to attract a lot of nurses recovering from their own addictions issues, and Addictions Nursing seems like it would be a natural fit for the recovering nurse. However, you do NOT need to be in recovery (I.e., have your own addiction problem) in order to be an addictions nurse. Nor does being a recovering addict ensure that you will be good at addictions nursing. You will, however, need to self-assess to determine your own beliefs about and attitudes towards addiction, so that you can provide competent patient-centered care.

Recovering Nurses that Tend to Do Well in Addictions Nursing

Those who have a good handle on their own recovery. They have been clean/sober for at least a year, if not more. They are able to keep their own recovery separate from their patient's recovery. They do not try to impose their own values, beliefs, or "this is what I would do" on the patient. They are also cognizant of boundaries: while some may choose to share their own addiction and recovery experience (keep in mind that a nurse is NEVER required to share this), they always keep the focus on the patient and the patient's recovery. They are aware of what could trigger a relapse and work to avoid or mitigate these triggers.

Recovering Nurses that Do Not Do Well in Addictions Nursing

Those who are newly in recovery, having been clean/sober only for a few months and are still finding their own path. They are looking to Addictions nursing to take the place of therapy or to meet unfulfilled needs. They tend to see the patient in terms of their own (the nurse's) recovery, and have a hard time understanding or even just accepting a patient's decisions or actions. Instead, they may try to impose their own beliefs and choices on the patient.

In short, the nurse can make the patient's recovery about themselves and not about the patient. Or, they can be at risk of having their own relapse triggered by their working environment.

Only you can decide if you are able to work in Addictions Nursing as a recovering nurse.