Abstract
Substance abuse is the most preventable health problem in the United States and has become the most common disease encountered by health care providers. Nurses and other health care professionals who abuse substances are hesitant to admit it, to seek help for it and to enter treatment for it. Those who do enter treatment for substance abuse generally do so at the instigation of others, usually from workplace interventions or complaints filed for impaired practice. Alternative diversion programs for nurses and drug courts for offenders offer initial diversion into treatment and rehabilitation for substance abuse in lieu of more formal sanctions. Even though both drug courts and alternative diversion programs are voluntary programs, legal or formal coercion is a component of the referral process. The perception of coercion may also be present in both populations because of the potential consequence of sanctions for noncompliance with the treatment and monitoring program. Issues related to internal motivation that also influence treatment entry and program participation are considered.
Alternative diversion programs for nurses and drug court programs for offenders offer rehabilitative justice through social contracting principles and the application of sanctions and rewards via compulsory supervision of participants. Research has verified the value of drug courts and effectiveness of legal coercion in improving retention and outcome in treatment. Research has also verified the effectiveness of alternative diversion programs. Research is lacking on the impact of formal coercion, the influence of perceived coercion, and the outcome of nurses entering and participating in alternative diversion programs.