A specialist drug and alcohol nurse says he will “fight forever” to get more nurses into the crucial field, which is still dealing with the effects of deep-rooted stigma and discrimination.

“If we could get people to see substance use disorders as a medical issue, not a behavioural issue, that would make such a difference”, said Darren Smyth, a drug and alcohol nurse practitioner from the Community Withdrawal Program at QuIHN.

“We need to remove that stigma and discrimination and realise that this isn't about Joe who is sleeping under the bridge down the road and is homeless", he told HealthTimes.

“If we could see that we’re talking about people from all walks of life, who may just need some extra help to medically manage their withdrawal so they come off their substance more safely, then people might have a little bit more compassion.”

“We'd see that if we don't do anything and we don't ask the right questions when they seek help because there's a stigma or an attitude about it, then we actually increase the problem and we increase the comorbidities that a patient experiences.”

“If we didn’t have the stigma and discrimination associated with it, we'd probably be in a much better space.”

“And I'll fight forever to get more and more nurses working in this area, and for more and more drug and alcohol nurse practitioners to lead the management of patients.”

Drug and alcohol nursing is a field that Mr Smyth came to work in by chance. In fact, his initial goal was to become a medical anthropologist. But having worked in this space now for more than 20 years, he’s seen what an excellent field it is to be a part of.

“It’s a great profession to work in – and you’ll learn a hell of a lot about yourself”.

Mr Smyth said the most rewarding part of his job is being able to work closely with patients to provide them with personalised care in their time of need.

“I see people come in, emotionally distraught due to the fact they've found themselves in this situation, and I work with them to provide that holistic care.”

“As nurse practitioners, we're able to give half an hour, 40 minutes or an hour to any patient who walks through the door, every time.”

“And I think that is probably the real difference that a patient can get from a nurse practitioner, or a nurse-led service, that they wouldn't get from a medical service.  We're not necessarily relying on Medicare, therefore we're not time restricted.”

“When someone comes in, we give them that holistic care and also try to wrap services around them on the side. That way, it's not just about their recovery, it’s also about asking ‘how's your dental?’, ‘how's your hearing?’, ‘how's your mental health?’, and ‘what's going on for you socially at the moment?’”

“We try to cover the whole gamut and coordinate a lot of care to assist that person so that when they complete that episode of care, there's been a few things that have been tied together to put them in a better space”, he explained.

Mr Smyth said that rapport building is central to the work of an addiction specialist nurse.

“Building relationships with people is so important – and for them to be able to see that we’re a one stop shop for them.”

“We'll sit down, we'll talk with you. It's very easy, and it makes a real difference when people feel relaxed, and that we’re on the same level as them. And I've had some great feedback from patient reported outcomes.”

“The rapport is especially important in the drug and alcohol space. If you go into the cardiac space, a cardiac nurse practitioner or specialist doesn't ask you, 'what medication would you like to be on?'”, said Mr Smyth.

“What we do is person-centred. We ask, ‘how can we work with you?’, ‘what is your goal?’, and ‘how can we work together to get you there?’

“They are at the centre of the care, not the clinician.”

Mr Smyth emphasised the importance of nurses making sure they are caring for their own health too, as well as their patients.

“I used to be the president of DANA (Drug and Alcohol Nurses Australasia) for quite a few years, and I was really interested in getting specialists who had a really good understanding of vicarious trauma.”

“When you're working in a detox centre – for 8 to 16 hours at a time – putting up with that can be really quite taxing.”

“Clinical supervision is really important, and that people have that understanding of how they are processing with each patient. Because it is an area where you can have your buttons pushed, and unless you know how to work within that, and know how to look after yourself, it can be quite destructive.”

Mr Smyth said it was essential to increase the number of nurse practitioners working in the drug and addiction field, because it’s not been an area where many medical practitioners want to step into.

“The reality is that if you go to a GP, they often don’t have the confidence or the knowledge, or the MBS item number, to actually provide a comprehensive treatment to patients with substance use disorders.”

“If we realised that and considered who else could provide that care, we’d see that nurse practitioners can provide better management and better treatment – because we do have the time to see people and we're not always reliant on Medicare to do so.”