Predictors of relapse for nurses participating in a peer assistance program
The study purpose was to investigate if certain variables predicted relapse of 158 nurses with substance use disorder (SUD) who were peer assistant program (PAP) participants. The average age and years of nursing experience of the participants respectively, were 39.37 and 10.6 years. A review of the related literature and the study's guiding framework, Brown's Dynamic Model of Alcohol Recovery, guided the selection of possible predictor variables. Using a data collection worksheet designed and validated by the principal investigator, data were collected from past PAP participant files, 78 who had not relapsed and 80 who had. The intrarater reliability estimate using intraclass correlation coefficient was .9973. Using logistic regression, 14 selected variables were entered as independent variables (IVs) with relapse status (i.e., relapse or no relapse) as the dependent variable. Crude odds analysis identified 7 variables predictive of relapse at p < .05 (i .e., having other types of SUD treatment besides intensive outpatient, no advocate within two months of PAP participation, psychiatric co-morbidities, life stressors, job termination, hydrocodone as substance of choice, and non-compliance with self-help group attendance). Binary logistic regression was conducted using the forward stepping method resulting in a model containing only three IVs that significantly identified relapse (i.e., non-compliance with self-help group attendance, job termination, and no advocate within two months of PAP participation). The importance of these three IVs was supported by (a) a good model fit indicated by a -2 Log Likelihood equal to 78.145, (b) an explanation of over 40% of the variance of relapse, ( c) chi-square results indicated that the model with the three predictors was statistically reliable in distinguishing between relapse and non-relapse status, and ( d) correct classification of 82.3% of all the cases. Major study conclusions indicated that (a) relapse is better predicted by a collection of variables rather than a single variable and (b) Support and job termination are predictors of the relapse status of the SUD nurse. The expanded understanding of relapse predictors could lead to the development of a relapse checklist to by used by treatment providers, PAP case managers, and others working with SUD nurses.