Substance Use Disorder (SUD) Essay

Substance Use Disorder (SUD) Essay

In West Virginia and across the nation, drug and alcohol abuse is a major issue that affects the healthcare system on multiple levels (local, state, and federal). Mental illness often accompanies SUD and the many chronic diseases and health conditions that arise from the disorder (Phomane, 2018). There is very limited access to treatment and support for patients with substance use disorder (SUD) and mental health disorders within this state. The lack of access to necessary care leads to excessive emergency room visits, high rehospitalization rates, and overall poor outcomes for the patient, and the community (Phomane, 2018). This vicious cycle will not stop until significant changes at all healthcare levels are achieved and positive impacts and changes spread outward from the local level (Amalberti et al., 2019).

Impact on my workplace

Each day, as I step into my role as a bedside nurse at this local hospital, I encounter a patient either currently experiencing withdrawal from an abused substance or requiring extensive medical treatment for a physical and mental health crisis as a direct result of SUD.

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For example, I worked as the charge RN on the medical-surgical and telemetry unit in today’s shift. I assisted with the care and treatment of a patient my age with liver failure while answering the multiple questions her family had regarding her mental and physical state and the availability of support for these conditions. Unfortunately, there was little information about the mental health support I could provide; the best that the hospitalist team could offer was a referral to the local state-funded support group that serves four counties. As for medical treatment, short of a liver transplant that the patient and her Medicaid insurance plan have declined, there is only supportive care via medications, which the patient has been noncompliant with.

The stress of managing a patient requiring SUD and mental health monitoring has negatively impacted this facility. Bedside RNs must now manage these patients in addition to clinically complex medical and post-surgical patients and maintain the safety of all patients and staff members. Increased workload, decreased training, and an increased admission rate have led to excessive staff call-outs, increased patient dissatisfaction, and behavioral outbursts toward staff, all resulting in increased work-related stress (Greco et al., 2022).  Rehospitalization rates and poor patient outcomes result from poor health standards on all levels, local, state, and federal, as well as from underskilled staff and caregivers (Amalberti et al., 2018).

Social determinants

This is only one of the many daily cases seen at this hospital alone, where the population is plagued with low education, low income, and limited specialty care. Many of the clients served are without private insurance, have Medicaid insurance, or are uninsured, homeless, or house adult children with SUD. There are no psychological practices within the county; a State-funded agency provides one location with limited hours available at this location, and the town is near two state borders and a major interstate known for human and drug trafficking.

Possible solutions

In previous years, this hospital operated as an independent facility. It provided access to medically assisted withdrawal/treatment (MAT) programs, telehealth, inpatient psychiatric care, and specialized staff to care for these individuals. The hospital is now owned and operated by a larger organization, and the MAT program has been dissolved, leaving no distinction between the specialized needs of patients and the staff caring for them. On the positive side, this hospital is now designated as a rural health teaching campus for one of West Virginia’s schools of medicine programs, opening doors for increased access to care Substance Use Disorder (SUD) Essay.

In the meantime, solutions to this issue include reinstating the MAT program within the hospital, involving the psychiatric interns in patient care, and working with the local inpatient crisis addiction center to support their efforts in combating SUD and providing mental health support. A designated safe unit or safe sector of the hospital floor with increased security officers, limited visitors, trained staff, and video surveillance can also be implemented to ensure the safety and wellbeing of staff and patients for SUD and mental health management. SUD and mental health disorders, lack of training, increased stress, and low staffing are among the leading risk factors for hospital violence (Menendez et al., 2024).

Local and state initiatives

The hospital has adopted a remote patient monitoring system to decrease 1:1 observation by a staff member. This system may also be used to assist with monitoring patients in active withdrawal, mental health crises, or other conditions requiring continuous monitoring that do not meet ICU admission requirements (seizure risk, choking, fall, etc.). This does not include suicidal patients who still require a bedside attendant.

Senate Bill 508 was introduced to the WV State Senate on February 17, 2025, and outlines a plan to create mental hygiene regions with provisions for mental hygiene evaluations and proceedings conducted by video technology, temporary observation releases, and statewide coverage for mental hygiene evaluations and requires Certified Community Mental Health Centers to have continuous coverage in each region (WV legislature, 2025). Senate Bill 2436 was introduced in 2023 and took effect in 2024, mandating WV hospitals to develop and implement an acuity-based staffing model to improve patient outcomes and mitigate the extreme nurse staffing shortages in WV hospitals (WV legislature, 2023) Substance Use Disorder (SUD) Essay.

Challenges

Cost-effectiveness for specialized and designated staff for an MAT unit, the ongoing staffing crisis at my current hospital, and changes to funding by federal and state agencies and insurance company coverages for MAT programs. An overwhelming number of open nursing positions currently remain unfilled at this hospital, leaving staff overwhelmed and on the verge of burnout.

The hospital is now operated by a for-profit company. The dynamics and culture of the facility have shifted from government-funded to private entities, resulting in a reduction of programs deemed necessary by the hospital. In addition, many insurance formularies have changed and have eliminated medications such as Vivitrol and Antabuse from their preferred lists, as well as Medicaid guidelines for coverage (West Virginia Department of Health and Human Resources, 2025) Substance Use Disorder (SUD) Essay.

Conclusion

Small changes at the local level are obviously necessary. Improvements in staff and provider training on the availability of local and state resources and hospital management involvement with staffing levels, unit structure, and staff support are a must.

Each shift that I work, I gain new insight into the health of my community and the surrounding areas served by my workplace. The increase in mental health issues and the lack of knowledge and resources in my community are alarming. I have started a catalog of available services for community outreach, referrals, and insurance availability that the providers, case management, and social services have utilized. This has been greatly beneficial to our patients and families Substance Use Disorder (SUD) Essay

References

Amalberti, R., Vincent, C., Nicklin, W., Braithwaite, J. Coping with more people with more illness. Part 1: The Nature of the challenge and the implications for safety and quality, International Journal for Quality in Health Care, Volume 31, Issue 2, March 2019, Pages 154–158, https://doi.org/10.1093/intqhc/mzy235Links to an external site.

Greco, E., Graziano, E. A., Stella, G. P., Mastrodascio, M., & Cedrone, F. (2022). The impact of leadership on perceived work-related stress in healthcare facilities organisations. Journal of Organizational Change Management, 35(4/5), 734-748 https://doi.org/10.1108/JOCM-07-2021-0201Links to an external site.

Menendez, C. C., Arespacochaga, E., Begley, R., Bhatnagar, M., Ross, P., Schaefer, M. E., Spring, C., & Tisdale-Pardi, J. (2024, May 29). Prioritizing our healthcare workers: The importance of addressing the intersection of workplace violence and mental health and wellbeing. Centers for Disease Control and Prevention (CDC). https://blogs.cdc.gov/niosh-science-blog/2024/05/29/hcw_violence_mh/Links to an external site.

Phomane, M. (2018). Perceptions of Nurses Working in Primary Health Care Facilities on the Implementation of the National Mental Health Policy Framework and Strategic Plan 2013-2020 in OR Tambo District in the Eastern Cape Province (Order No. 31798739). Available from ProQuest One Academic. (3161869818). https://www.proquest.com/dissertations-theses/perceptions-nurses-working-primary-health-care/docview/3161869818/se-2Links to an external site.

West Virginia Department of Health and Human Resources. (2025). WV State Medicaid Plan. https://dhhr.wv.gov/bms/CMS/SMP/Pages/WV-State-Medicaid-Plan.aspx.

West Virginia (WV) Legislature. (2023). House Bill 2436: Patient safety and transparency. https://www.wvlegislature.gov/bill_status/bills_text.cfm?billdoc=hb2436%20sub%20enr.htm&yr=2023&sesstype=RS&billtype=B&houseorig=H&i=2436.

West Virginia (WV) Legislature. (2025). Senate Bill 508.  https://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=sb508%20intr.htm&yr=2025&sesstype=RS&i=508Links to an external site. Substance Use Disorder (SUD) Essay