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Form and substance

The nature of alcohol and drug services is changing to match new patterns of use and abuse. 

The alcohol and drug specialty sector is in a major transition phase and it will have a direct impact on nurses in the field, experts say.

Over the last few years, there has been a great focus on developing skills to meet the growing substance abuse issues of younger people. However, the sector is now seeing the emergence of new issues and challenges.

Nurses will need quite substantial professional development in new areas to address and cater for these new patterns of demand on services, particularly those driven by older people or the use of prescribed medications.

The recent 2014 Drug and Alcohol Nurses of Australasia (DANA) Conference, themed “Speak up”, aimed to start the conversation about the important work being done in the sector and to discuss ways to deal with workforce concerns.

Keynote speaker Ann Roche, professor and director of the National Centre for Education and Training on Addiction (NCETA) at Flinders University, and DANA president Colleen Blums, say the profession has much to do to prepare.

Service and delivery

Roche says the importance of nurses to the drug and alcohol treatment sector is not stated strongly and clearly enough.

“If you look at the construction of the alcohol and drug sector and the way the services are configured, nurses are absolutely pivotal,” Roche says. “They are the building block and are crucial to the delivery and the effective running of our services.

They are the single largest discipline in the sector. She says a large part of their role involves opioid substitution therapy and, in the future, will increasingly be about managing chronic non-cancer pain.

She confirmed that the sector has gone through an infrastructure change over the last decade, risking potential loss of specific identity and uniqueness.

“We often talk about the need to move away from silo approaches to care and in the process of doing that it means greater integration of our services, which on the one hand is potentially a good thing but on the other hand we run the risk of diluting what we can provide and the services we offer,” she says. “That is a real risk and we are seeing that occurring around the country at the moment. So it’s kind of a double-edged sword in some ways.”

Blums agrees, having been a witness to the subsuming of treatments related to drug and alcohol within different services, particularly mental health teams.

“For instance, an isolated drug and alcohol nurse in a mental health team – their voice may not be heard about what that patient needs,” Blums says.

Ageing workforce and population 

It’s not news that the nursing workforce is ageing. According to AIHW’s most recent report, the average age of the nursing and midwifery workforce in 2012 was 44.6 years.

Nurses and midwives aged 50 made up just over 39 per cent of the workforce at the same date. Roche says this is starting to affect the drug and alcohol sector.

“There are huge workforce shortages in the health and human services area generally but in nursing particularly,” she says. “It is a shrinking pool of workers that many people are going to want to access both nationally and internationally.”

Blums confirmed there are just not enough nurses to meet future needs.

“It’s across the board,” she says. “It means each nursing specialty will be in competition with the others. In order to attract, we will have to sell drug and alcohol nursing as a preferred specialty. We are going to have to get a lot better at telling people what drug and alcohol nurses do, otherwise there will just not be enough nurses to meet the future need.”

To combat future shortages as well as a growth in demand from the ageing population, DANA is seeking new ways to engage with a new generation of nurses to try to encourage them into the field.

“That’s our challenge at the moment, and we are trying to do that through social media,” Blums confirms. “We have to talk the same language as the new generation that’s coming through.”

The ageing population carries its own set of challenges for the specialty, as many people are now carrying their drug use into their 50s, 60s and 70s.

“[This is something] we never expected to occur previously,” Roche says. “It has not been on our radar. So we now have retirement facilities that have clients who have previously been in opioid substitution programs and they don’t know how to manage them or what should be the appropriate treatment regimes within a retirement setting or a nursing home.

“We also have people – baby boomers – who have used alcohol in a way that has been different to previous generations and it’s unclear about when and where and how that might be contraindicated or what the safe levels of consumption of alcohol look like.”

New opioid patterns

New and emerging patterns of drug use will be a challenge for the sector into the future.

Both Blums and Roche say drug and alcohol groups are becoming increasingly concerned with the use of opioids and a number of other prescribed substances.

“As we have more people living with disabilities – surviving injuries for instance and living into older age and needing chronic pain management – there is a heavier reliance on prescribed opioids and we are now only coming to terms with some of the problems associated with that,” Roche says.

Blums says the number of pain killer prescriptions that have been written has increased exponentially, which raises concerns.

“There is a lot of data around to show that people get a prescription from their doctor and they think, well if I have a prescription from the doctor then the drug is safe, and they think they can use it without any kind of concern,” Blums says. “[Also], some of those drugs get diverted, which means they get sold on the illegal market. I am not saying that these drugs are always being over-prescribed because we do have more people with pain – but some people acquiring scripts are on-selling those drugs.”

Roche also confirmed that in recent times a growing number of people who have been prescribed opioids have moved on to heroin. “That’s a shift in direction that, again, we didn’t expect to see,” she says. “We certainly see it in the other direction – people who have been using illicit opioids moving to prescribed opioids – but not the reverse.”

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