Terms which are used on this website & in the field of addiction or chemical dependency, intervention and treatment
This term means no use-whatsoever, of any mood-altering, illegal or controlled substances. These substances include alcohol and all street drugs, hypnotics, opiates, controlled substances (also known as narcotics), all Schedule I-V drugs. Additionally, in the ISNAP program, over-the-counter medications, which contain any amount of alcohol, benadryl or ephedrine needs prior approval.
Alcohol & Drug Assessment or Thorough Evaluation:
As part of the intake process for ISNAP, the nurse is required to complete an assessment with a certified or accredited addictions specialist and also submit a urine specimen for testing. Typically the specialist is an Addictionist. Addictionists are medical doctors who are additionally certified by the American Society of Addiction Medicine (ASAM). If an Addictionist is not geographically convenient, a licensed social worker or licensed mental health counselor, who has been certified as a Certified Alcohol and Drug Addiction Counselor, will be identified as the evaluator.
Alcoholics Anonymous (AA):
A program of recovery from alcoholism based in the 12 steps of recovery. Their philosophy and history can be read in the AA Fact File.
Characterized by an individual being physically and/or psychologically dependent to the degree that personal, social and work-related relationships are impacted negatively. Reliance on alcohol or other drugs causes, in an individual, an observable continuum of increasingly severe consequences. Frequently, the first symptoms are related to difficulties in relationships.
The misuse or overuse of alcohol resulting in or from poor judgment. Abuse is the use of illegal substances OR the use and/or diversion of controlled substances (CS) OR the overuse/misuse of prescribed medications.
A requirement for remaining in monitoring with ISNAP. Individuals who do not maintain compliance will have their cases closed and forwarded to the Attorney General’s office for possible action against their license. Compliance is measured in several ways and condensed in a Quarterly Report. This review evaluates specific areas. The nurse is expected to remain in complete compliance with their contract. The randomized Urine Drug Screen (UDS) is a primary and essential aspect of the ISNAP program. The UDS is the only scientific measure test for abstinence. These test results; along with collateral quarterly reports from the licensee’s Addictionist, worksite monitor, therapist and sponsor; create a clinical picture of the individual’s rehabilitation. The nurse must also submit monthly self-reports and attendance logs for 12 step meetings in a timely fashion.
ISNAP is designed as a confidential program. This means a nurse who self-reports and maintains full compliance with their Recovery Monitoring Agreement (RMA) will not have their name presented to the Board of Nursing (BON) for a public hearing. If a nurse becomes non-compliant they will have their file closed with ISNAP and then their case may be heard before the BON at a public hearing.
ISNAP also maintains confidentiality in accepting reports of a danger to public safety from a concerned citizen, nurse or administrator until the Attorney General’s Office takes action against a nurse’s license. During the course of the investigation the identity of the individual who submits the report remains confidential. ISNAP is required by the board to obtain the name and address of the person who submits a report of suspected impairment or danger to public safety.
Consumer Protection or Public Safety:
A primary concern for any health care professional; but especially the nurse who is required by both law and nursing ethics to be a vigilant advocate for the care and safety of her/his patients.
Continuing Care or After-Care:
The second phase of rehabilitation that follows initial treatment. (In-patient or Out-patient)
Common among addicts is a refusal to recognize and admit to problems with the use/abuse/dependency of chemical substances, including alcohol. Denial of personal and/or relational problems, which are related to use, creates an inability to achieve quality sobriety. Individuals, other than the addict themselves, may also experience an inability to accept the diagnosis.
When a nurse is unable to meet the requirements of the professional code of ethics and standards of practice due to cognitive, interpersonal or psychomotor skills which are negatively affected by use/abuse/dependency.
Impairment from substances while off work is a concern especially when resulting in a Driving While Intoxicated (DWI) citation; an event demonstrating poor judgment, chemical misuse and an early indicator for a DSM IV diagnosis of abuse or dependency.
Intensive Out-patient Plan (IOP):
Recommended for individuals who experience difficulty getting and staying sober.
Consists of a presentation to the impaired nurse, of the specific facts regarding the impaired nurse’s behavior and the effects of this behavior. This presentation is direct, objective, non-judgmental and caring.
Nurse Support Meetings:
Attendance at Nurse Support Meetings (NSM) is generally a requirement of a Recovering Monitoring Agreement (RMA), with ISNAP. NSM are a place where recovering nurses can experience sobriety and recovery from other nurses who are further along than they in their monitoring. The 12 steps of Alcoholics Anonymous are used as a basis for the meetings.
Recovery Monitoring Agreement (RMA):
A contract an impaired nurse signs, which outlines the requirements for enrollment in the Indiana State Nurse Assistance Program (ISNAP).
Rehabilitation and/or Recovery:
on-going process, in which the individual’s growth and change is more than mere abstinence from substances.
A return to using the primary drug of choice or another mood-altering drug. However, many addiction professionals expand the definition to include the use or over-use of prescription drugs in the “controlled substance” category. Experts in addiction treatment identify the components of relapse as first – behavioral changes and second – use. A nurse with a substance use disorder frequently exhibits changes in mood, affect or behavior which predict an impending episode of use. Studies have determined that these behaviors are first seen in the home but are only identified at the workplace. Therefore, worksite monitors and co-workers are frequently the individuals who are likely to detect the return to use or the slide into relapse. Sponsors from 12 step groups are also well positioned to detect problems in the individual.