: Biological drug testing is a tool that provides information about an individual's recent substance use. Like any tool, its value depends on using it correctly; that is, on selecting the right test for the right person at the right time. This document is intended to clarify appropriate clinical use of drug testing in addiction medicine and aid providers in their decisions about drug testing for the identification, diagnosis, treatment, and recovery of patients with, or at risk for, addiction. The RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) process for combining scientific evidence with the collective judgment of experts was used to identify appropriate clinical practices and highlight areas where research is needed. Although consensus panels and expert groups have offered guidance on the use of drug testing for patients with addiction, very few addressed considerations for patients across settings and in different levels of care. This document will focus primarily on patients in addiction treatment and recovery, where drug testing is used to assess patients for a substance use disorder, monitor the effectiveness of a treatment plan, and support recovery. Inasmuch as the scope includes the recognition of addiction, which often occurs in general healthcare settings, selected special populations at risk for addiction visiting these settings are briefly included.

SBIRT education and training for undergraduate nursing students might help mitigate some of their stigma toward working with patients who have mild to moderate alcohol and opioid use problems.

Cultural competency principles can be embedded in teaching the broader evidence-based practice of screening, brief intervention, and referral to treatment with undergraduate students. This is a replicable teaching methodology that could be adapted in other schools of nursing.

BACKGROUND: Alcohol and/or opioid stigma perceptions are barriers to screening, brief intervention, and referral to treatment (SBIRT) implementation. AIM: To examine SBIRT education and clinical exposure efficacy at decreasing nursing students’ stigma perceptions toward caring for patients affected by alcohol and/or opioid use problems. METHOD: A single-sample, pretest–posttest design with N = 124 nursing students. The students had a 1.5-hour SBIRT education session and a 12-week clinical experience with some patients who had alcohol and/or opioid use problems. RESULTS: The participants’ stigma perceptions improved toward patients who had alcohol and/or opioid use problems. CONCLUSIONS: SBIRT education and clinical exposure may provide a basis for promoting understanding of alcohol and/or opioid use–related stigma and can be used as an intervention to decrease some of stigma’s negative effects.

The American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management provides guidance on the identification and management of alcohol withdrawal in adults with varying degrees of syndrome severity. The guideline addresses both ambulatory and inpatient care and considers special patient populations. The Guideline was primarily developed following the RAND/UCLA Appropriateness Method (RAM), a process to determine the appropriateness of a set of clinical procedures. This process included a review of gray and empirical literature published between January 2012 and October 2017. Nineteen existing guidelines, 112 reviews, and 150 research studies were used to develop draft guideline statements that were assessed by a panel of physicians experienced in withdrawal management and representing a diverse range of settings and patient populations. Recommendations were included in the Guideline where consensus on appropriate clinical practice was identified by the panel. Areas where additional research would provide valuable information for determining best practices were highlighted.

Although substance use is prevalent in the United States, the majority of people who misuse substances do not receive appropriate treatment. This paper describes, (1) an interprofessional education (IPE) program for health professionals to provide Screening Brief Intervention and Referral to Treatment to rural substance use patients, and (2) compares registered nurses' [RNs] and behavioral health professionals' [BHPs] attitudes to work with those patients and their perceptions on IPE. A data analysis of 62 RNs and 36 BHPs shows statistically significant increases in both attitudes and perceptions. This paper discusses the implications of the IPE program vis-á-vis substance use treatment.

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Background Opioid use and opioid use-related problems contribute significantly to increased morbidity rates and premature deaths as well as an increased economic burden. Nurses have key roles in providing care to this patient population; however, they often report low motivation toward working with these patients. Examining personal and professional attitudes associated with nurses’ motivation to work with this population can present a valuable opportunity to enhance their willingness to intervene at an earlier stage when patients do not have a diagnosable opioid use disorder. Methods A descriptive, correlational design was used. Nurses were recruited from four hospital settings in Southwestern Pennsylvania. Data on nurses’ demographic/background characteristics, personal attitudes, professional attitudes, and motivation related to working with patients with opioid use and opioid use-related problems were collected via a paper/pencil survey and analyzed using linear regression. Results A sample of 234 nurses were included in the final analyses. Personal attitudes associated with nurses’ motivation included personal experience with a family member related to alcohol and/or other drugs, and stigma perceptions (familiarity, perceived dangerousness, fear, social distance and personal responsibility beliefs). Professional attitudes associated with nurses’ motivation included working experience with substance use (SU), SU education as continuing education or other educational resources, role security, therapeutic commitment, role responsibility, and self-efficacy. Conclusions This study's findings provide valuable information regarding the bivariate relationships between nurses’ personal attitudes, professional attitudes, and motivation to work with patients with opioid use and opioid use-related problems. The study provides a base for future studies aimed at developing interventions to enhance nurses’ motivation to work with this patient population particularly related to preventing the progression of opioid use to a diagnosable disorder.