Signs and Symptoms of Substance Use Disorder
Early intervention is key to patient safety and positive recovery outcomes. Learn the signs and symptoms of substance use disorder and speak up to save lives. The following is a partial list:
Signs of Impaired Practice
- Smells of alcohol or cannabis
- Narcotic discrepancies
- Frequent errors
- Changes in drug ordering patterns
- Patient complaints about the lack of pain relief
- Offers to administer medications for other nurses
- Volunteers for extra shifts
- At the facility on days off/at odd hours
- Leaves the worksite frequently and unexpectedly
- Bizarre behavior
- Poor work performance
Symptoms of SUD
- Increased Isolation
- Avoids eye contact
- Defensive
- Lethargic or jittery
- Deteriorating appearance
- Verbally/physically aggressive
- Rapid change in weight
- Poor judgment or concentration
- Dishonesty
- Slurred and/or rapid speech
- Boundary violations
Washington Health Professional Services can help
WHPS came into existence on August 1, 1991. This voluntary, structured, supportive monitoring program was designed to assist nurses with treatment and recovery.
The WHPS program includes:
- Confidential consultation with the health professional, employer, or other concerned referring individual
- Referral for evaluation and treatment
- Individualized participation plan and case management
- Peer support
- Education and outreach
Alternative to Discipline Referrals (Voluntary Participation)
Nurses, employers, and others may contact WHPS directly instead of filing a formal complaint with the nursing commission.
WAC 246-16-220 states, "When there is no patient harm, reports of inability to practice with reasonable skill and safety due to a mental or physical condition may be submitted to one of the approved impaired practitioner or voluntary substance abuse programs or to the department." A report of substance misuse concerning WHPS meets mandatory reporting requirements.
WABON supports contacting WHPS as a first action before filing a complaint. WHPS will review the circumstances and provide appropriate guidance.
Advantages of Voluntary Participation
Nurses who voluntarily participate in WHPS are not subject to disciplinary action, and the Board of Nursing will not be aware of their participation if they meet WHPS requirements.
Voluntary participation carries the advantage of immediate intervention and referral to treatment, bypassing what may otherwise be a long legal process before formal intervention.
To self-report or refer a colleague to WHPS please call 360-236-2880, option 1.
Frequently Asked Questions (FAQs)
- What happens if I slip up or relapse while in WHPS?
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What happens if I slip up or relapse while in WHPS?
Relapse usually results in temporary removal from practice and referral for a substance use evaluation to determine appropriate modifications to the participant’s treatment/recovery plan. Monitoring requirements may be modified (i.e., increased drug testing, contract extension) as appropriate.
In some cases, it may be determined by a nursing board panel that the nurse is no longer suitable for monitoring and a referral for disciplinary action will be made.
- How will participation in WHPS affect my healthcare credentials?
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How will participation in WHPS affect my healthcare credentials?
It depends on the circumstances of the individual participant. In general, if a participant enters the program through a voluntary self-referral and no legal or investigative action has or will be taken regarding their credential, the participant’s credential will be unaffected. In cases where an administrative legal order has been issued regarding a credential, this is a matter of public record. In such cases, a participant’s credential may be listed as “On Probation” or “Under Conditions” pending successful completion of WHPS.
- How do I get started?
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How do I get started?
Contact WHPS at 360-236-2880 (Option 1) or email us for more information at whps@doh.wa.gov
- How much does participation in WHPS cost?
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How much does participation in WHPS cost?
Although there are no fees for participation in WHPS, we advise prospective participants to plan on budgeting at least $200/mo., because nurses are still responsible for all costs associated with WHPS participation not covered by third-party payers (i.e., insurance).
Nurses must pay out-of-pocket for drug tests, and the costs associated with participating in a weekly peer support group (PSG) (if participation is required). Weekly PSGs are about $25 per week, but all PSG facilitators use a sliding fee scale and charge based on a nurse’s income. Routine drug tests range from $45 to $65 with a “collection fee” that may exceed $25. Nurses can expect at least 14 to 24 drug tests per year.
- May I be readmitted to WHPS following an unsuccessful termination?
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May I be readmitted to WHPS following an unsuccessful termination?
Yes, a nurse may reapply following the requirements of their Agreed Order after unsuccessful termination from WHPS.
- What happens if I slip-up or relapse while in WHPS?
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What happens if I slip-up or relapse while in WHPS?
Relapse usually results in temporary removal from practice and referral for a substance use evaluation to determine appropriate modifications to the participant’s treatment/recovery plan. Monitoring requirements may be modified (i.e., increased drug testing, contract extension) as appropriate.
In some cases, it may be determined by a nursing commission panel that the nurse is no longer suitable for monitoring and a referral for disciplinary action will be made.
- What medications are acceptable for me to take?
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What medications are acceptable for me to take?
Class A and B medications and potentially impairing over-the-counter medications (i.e., medications containing alcohol or dextromethorphan) are not permitted without the approval of the WHPS medical director. WHPS uses the Talbot Medication Guide to determine whether a medication is appropriate.
- What does monitoring include?
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What does monitoring include?
Monitoring generally includes, but is not limited to:
- Referral for third-party clinical evaluation and recommendations for treatment
- Development of an individualized monitoring contract
- Structured return to practice plan (incl. employer notification and worksite monitoring)
- Random drug testing
- Medication monitoring
- Peer support group attendance
- Routine report submission by the nurse, employer, treatment providers, and prescribers.
Monitoring allows the nurse to document recovery and safety to practice.
- Will there be restrictions placed on my practice?
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Will there be restrictions placed on my practice?
When first enrolled in WHPS most nurses have a set of practice restrictions designed to support recovery and patient protection. Restrictions may be lifted over time and most nurses do not have any restrictions during their last year of participation. Common restrictions include:
- No home health or contract service work
- No night shift work
- Limited to a single employer
- Limits on overtime and on-call work
- No access to scheduled medications for 6-12 months (except for alcohol and cannabis use disorder)
- Do I need to inform my employer of my participation in WHPS?
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Do I need to inform my employer of my participation in WHPS?
Yes, because ensuring safe practice is the primary goal of WHPS, and monitoring a nurse’s ability to practice with reasonable skill and safety is required via worksite monitoring through employers.
- Is "participation" in WHPS voluntary?
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Is "participation" in WHPS voluntary?
Yes. Even in cases where a legal order has been issued regarding a participant’s credential, it is in the form of an “agreed order” that the participant has signed agreeing to be evaluated for a monitoring contract through WHPS—either instead of discipline or as a condition of issuing or reissuing a credential.
- How will participation in WHPS affect my healthcare credential?
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How will participation in WHPS affect my healthcare credential?
It depends upon the circumstances of the individual participant. In general, if a participant enters the program through a voluntary self-referral and no legal or investigative action has or will be taken regarding their credential—the participant’s credential will be unaffected. In cases where an administrative legal order has been issued regarding a credential, this is a matter of public record. In such cases, a participant’s credential may be listed as “On Probation” or “Under Conditions” pending successful completion of WHPS.
- Is participation in WHPS confidential?
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Is participation in WHPS confidential?
Yes. WHPS records are not subject to the normal public disclosure requirements of most state records. No information regarding the participant may be disclosed without written authorization from the participant. Authorized disclosures are generally limited to verification of participation in the program and overall compliance.
- I’ve already completed treatment for my substance use problem. Why do I need to enter WHPS?
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I’ve already completed treatment for my substance use problem. Why do I need to enter WHPS?
If a nurse can document five or more years of continuous abstinence recovery, a WHPS monitoring contract may not be recommended. All cases are reviewed individually to determine if a nurse is suitable for enrollment in WHPS. The length of a monitoring contract usually ranges from three to five years but depends on the severity of the substance use disorder and the length of abstinence recovery.
- How long is the WHPS contract?
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How long is the WHPS contract?
3 – 5 years is the usual length of a monitoring contract but will depend on the severity of the substance use disorder, and length of abstinence-recovery. Unfortunately, in many cases, the nurse has developed a severe substance use disorder before self-reporting or being referred to WHPS, so five years of supportive monitoring has been proven to produce the best long-term outcomes.