“We have a primary health focus. Our national ideological framework is harm reduction,” says Drug and Alcohol Nurse Practitioner Darren Smyth of the specialty’s core objective.
“It’s not about abstinence, it’s about meeting that person where they’re at, looking at their goals and providing them information, resources and education to reduce the harm associated with their substance use.”
As a teenager growing up in NSW, nursing wasn’t on Darren’s radar when he was contemplating what path to take in life.
Back in 1988, he began volunteering at a counselling centre in Western Sydney while studying ‘welfare’ at TAFE.
It led to working for the then Department of Community Services (DoCS) for a few years establishing group homes and supporting the care of people with mental health and drug and alcohol issues.
He later moved to the Northern Territory and worked in Aboriginal communities before settling in WA, working in a group home specialist unit for people with acquired brain injuries and drug and alcohol issues, while studying anthropology at university.
He relocated to Adelaide to complete the degree, and began working to support the male sex worker population.
After finishing his anthropology degree, Darren turned to nursing, studying for two years, then undertaking placements on the Torres Strait Islands, before eventually returning to Sydney and drug and alcohol nursing in detox and rehab units.
“It didn’t feel like much of a change,” he says.
“Even though I hadn’t been nursing in the other jobs, there was a lot you could carry forward from working with sex workers, people with mental health issues and acquired brain injuries and Indigenous groups. It just had a slightly different focus.”
Over the past two decades, Darren has worked across regional and remote Australia in various settings including drug and alcohol withdrawal units, rehab programs, research, hospital consultation and liaison, management and the prison system.
He is currently a Senior Clinical Nurse Consultant and Nurse Practitioner, as well as the president of the Drug and Alcohol Nurses of Australasia (DANA), the peak nursing body representing drug and alcohol nurses.
DANA runs conferences and education events, offers scholarships, and access to evidence-based information.
Darren, who also tutors a post-graduate course run by the Australian College of Nursing (ACN), says the pathway to practicing as a drug and alcohol nurse remains inconsistent across the country.
Several years ago, DANA developed drug and alcohol competencies, but Darren says there is still very little drug and alcohol specific education within undergraduate nursing degrees.
“We’re looking at doing some research across Australian universities to explore how much content they have in their curriculum and we’re offering free membership to nursing students at the moment.
“What we’ve said in the competencies, is if you’re a registered nurse, for the first three years you’re really at the novice level. It’s not until you’ve been around for a bit longer that you actually really start to apply that knowledge.”
Drug and alcohol nurses work across extremely broad settings like inpatient withdrawal units, management and education.
DANA is currently in the process of trying to adapt a Drug and Alcohol Workforce Framework, developed by Sydney LHD, across the country to offer nurses clearer advice on career pathways.
When he tutors students, Darren promotes the specialty as a diverse and interesting place to work, highlighting its numerous sub-specialties such as working with drug and alcohol in pregnancy, opioid treatment programs or counselling.
About 2,000 nurses in Australia classify themselves as drug and alcohol nurses.
Darren says the key attributes required to succeed in the speciality include resilience, a sense of fairness and pragmatism.
“It’s an interesting space to work,” Darren says.
“It can be challenging but rewarding. It’s very different from general nursing. It’s more knowledge-based than it is skills-based and that’s probably the biggest issue we have, if you don’t get taught it, it takes a while to get any momentum up.”
Darren says the speciality has an ageing cohort, with the majority of nurses aged over 50, and that he believes it remains undervalued and endures longstanding stigma.
“There’s considerable discrimination and stigma still that people with a substance use disorder face. It’s not exactly seen as an attractive area [to work in].
After working in the drug and alcohol nursing field for two decades, Darren says becoming a nurse practitioner allowed him to broaden his scope.
For example, he no longer has to challenge the importance of prescribing medications for patients in withdrawal.
“For me, it provided a larger scope and the ability to utilise my knowledge within a recognised framework. I found that quite rewarding and challenging too, because it [drug and alcohol] still in a lot of ways is not understood by some clinicians, whether that be nursing, medical or others.
“The nurse assessment we [NPs] provide is not a five-minute process. We’re provided an opportunity where we can carry out those lengthy, comprehensive assessments and really get an understanding.”
In his varied roles, Darren continually tries to educate nurses around him of the value of working in drug and alcohol and that it is a specialty.
He believes the global COVID-19 pandemic will trigger an increase in people with substance abuse issues and that policymakers must look at increasing the ability of services to respond to demand.
“There’s going to be considerable ramifications following people’s loss of jobs, the predicament they find themselves in, and the impacts of isolation,” Darren says.
“We’ve already seen alcohol consumption increase yet there hasn’t been a lot of discussion in regards to drug and alcohol. We are not mental health. So when they [the government] talk about giving money to mental health services and domestic violence services and so forth, they really need to consider drug and alcohol because we’re going to be hit during and after this.”
Worryingly, Darren says the COVID-19 pandemic has led to many services, such as residential rehabilitation programs, scaling back.
A lot of 12 steps support groups, such as Alcoholics Anonymous (AA), also went online in the wake of the pandemic and social distancing restrictions, he adds.
“It’s going to have an increased impact obviously in people’s not just mental health, but their substance use, which quite often influences mental health. I’m just hoping there’s adequate resources available so people can access support and care. I hope this gives us an opportunity to say to the government that we need sufficient funding.”
Darren says his role as the DANA president gives him a platform to advocate for the vital role that drug and alcohol nurses play within the health system.
He says he remains continually inspired by his colleagues and is driven by wanting to support their professional development so that they can effectively provide care to people experiencing drug and alcohol issues.
“What continues to inspire and drive me is being able to utilise my professional skills and knowledge as a drug and alcohol nurse to work with people with lived experience and improve the specialty of drug and alcohol nursing.”