Nursing and Substance Abuse - Ohio

Mark Twain once mused that “Quitting smoking is easy. I've done it a hundred times.” Anyone who has ever wrestled with alcoholism, drug addiction, or any other form of substance abuse can almost certainly relate to the struggle at the heart of this observation.  

While navigating the challenges of substance abuse can be alienating, it's important to understand that if you're grappling to more successfully manage your relationship with alcohol or drugs, you are certainly not alone. According to the federal Substance Abuse and Mental Health Services Administration, in 2022 alone, 48.7 million Americans over the age of 11 struggled with a substance abuse disorder. No age, background classification, or employment type immunizes Americans from this risk. People who struggle with substance abuse are teachers and students, managers and line workers, incarcerated individuals and lawyers, physicians, and nurses.  

If you spend your working hours serving the community as a nurse in Ohio and you're one of the tens of millions of Americans who struggle with substance abuse, know that you have nothing to be ashamed of. As substance abuse among nurses rose during the unimaginable stresses of the COVID-19 pandemic, there is a greater-than-average number of nurses weathering the kinds of struggles you're facing right now. Those struggles may include professional disciplinary action and legal trouble. If so, you're likely feeling very anxious about safeguarding the career you've worked so hard to earn. Know that in Ohio, there is an alternative substance abuse program that you may be in a position to participate in.  

As there are both benefits and drawbacks to participation in this program, it may benefit you to speak with the Lento Law Firm's Professional License Defense Team about your eligibility and the specifics of your situation. Our knowledgeable team can help you to make an informed decision designed to reflect your goals related to your career, health, and overall well-being. Call us today at 888-535-3686 or schedule a consultation online to learn more. You are not alone.  

Ohio Nurse Regulatory Body 

The Ohio Board of Nursing (OBN) is the agency responsible for licensing nursing professionals who work in Buckeye State and disciplining them in the event of professional wrongdoing. The OBN regulates licenses and certificates for professional nurses and nursing-adjacent professionals, including the following: 

  • Advanced Practice Registered Nurses (APRNs) 
  • Community Health Workers (CHWs) 
  • Dialysis Technicians (DTs)  
  • Licensed Practical Nurses (LPNs) 
  • Medication Aides (MA-Cs) 
  • Military & Veteran Nurses 
  • Registered Nurses (RNs) 
  • Volunteer Nurses  

The OBN is comprised of 13 board members, although a number of additional volunteers serve on the seven special groups and committees that the OBN operates on a continual basis. OBN describes its primary purpose as aiming to “efficiently license the nursing workforce and remove unsafe practitioners from practice in a timely manner.” 

It is in pursuit of these twin goals that the Board takes disciplinary action against nursing professionals – and their professional licenses – as it sees fit. Some disciplinary actions end in reprimands or probation. Others end in license suspension or even license revocation. However, there are also scenarios in which concerns do not end in formal disciplinary action. For example, the OBN's Alternative Program for Substance Use Disorder (Alternative Program) serves as “a non-disciplinary, non-public monitoring program for licensees or certificate holders who have a substance use disorder.” 

Ohio Nursing Laws 

Each state is empowered to pass its own laws and procedures that govern the profession of nursing. In Ohio, there is a single law that primarily governs the rights, responsibilities, and professional risks associated with operating as a nurse. The Ohio legislature sets the foundation for these concerns in the Ohio Nurse Practice Act. The OBN has adopted the rules outlined in Chapters 4723-1 through 4723-27 of the Ohio Administrative Code in order to “establish regulations for licensure and certification, standards of practice, discipline, and pre-licensure nursing education.” As such, professional, legal, and ethical concerns related to the nursing profession are primarily scrutinized through this lens.  

Notification of Substance Abuse to the Ohio Board of Nursing  

As a result of your struggle with substance abuse, you may fear that your employer and/or the OBN will be notified of your challenges. Or, perhaps your situation has already been brought to the attention of one or both. Perhaps a colleague voiced concern and felt obligated to follow mandatory reporting protocols. The law in Ohio states that “if a licensee or registrant has knowledge or reason to suspect that a licensed colleague or registrant, or other licensee or registrant, who is not a client, is acting in an unethical way or is incompetent or impaired they shall report that practitioner to the board.” 

It is also possible for patients, employers, and members of the public to report concerns to the OBM. Sometimes, nurses even choose to come forward proactively so that they can seek assistance and hopefully avoid harsh penalties in deference to their willingness to pursue help. Sometimes, it can be a wise move to self-report, especially if one's situation is starting to spiral out of control, and it is only a matter of time until the OBN finds out about a nurse's challenges in a less proactive and thoughtful light. This kind of forward-looking effort can also potentially help nurses act before they unintentionally harm others and place their licenses in jeopardy as a result.  

Eligibility for the Ohio Board of Nursing's Alternative Program for Substance Use Disorders 

In the event that licensed nurses and certificate holders struggle with substance abuse disorders, state law, and OBM administrative rules permit the Board to refrain from taking disciplinary action against them in favor of offering those affected the opportunity to participate in the Alternative Program. However, the extension of this opportunity is subject to numerous eligibility requirements. 

Participants in the Alternative Program must hold a current, valid license or certificate to practice their nursing or nursing-adjacent profession in Ohio. This license or certificate will be subject to a temporary surrender within 10 business days of when an applicant for the Alternative Program is mailed an application for the program. This application must be completed and returned within 60 days of the aforementioned mail date. 

When preparing an Alternative Program application, a nurse must submit the following: 

  • Signed receipt and release of information waivers 
  • Documentation of a substance use disorder diagnosis 
  • Evidence of a comprehensive bio-psycho-social evaluation concerning this diagnosis performed by a licensed healthcare provider who has demonstrated expertise in the diagnosis and/or treatment of substance abuse disorders 
  • An organized treatment plan 

Within the application, it must be demonstrated that the applicant is capable of being effectively treated for their substance abuse disorder and monitored effectively in compliance with the requirements of the Alternative Program.  

What Is a Bio-Psycho-Social Evaluation? 

When nurses undergo a bio-psycho-social evaluation, their mental health and social well-being are assessed by a licensed medical professional. It is important, when scheduling an evaluation, to seek the services of a practitioner who has demonstrated expertise concerning substance abuse diagnosis and/or treatment, as this is an application requirement for the Alternative Program.  

Through the assessment, the licensed expert will aim to understand the patient, their ability to function, the nature of their substance abuse challenges, and the course of treatment most likely to result in a favorable outcome.  

As these kinds of evaluations can be expensive, it's important for nurses who need to be assessed as part of their Alternative Program applications to determine whether the process is covered by insurance. Clarity, when it comes to financial challenges, is important, especially due to the fact that a temporary suspension of a nurse's license during the application process may necessitate some tough decisions in order for an applicant and their family to remain afloat during this time.  

How Is an Application for the Alternative Program Evaluated? 

Once it is determined that an applicant for the Alternative Program is eligible to participate in this opportunity, the OBM still needs to decide whether to approve the application or not. There are a variety of reasons why the OBM may not approve an application, which is one of the many reasons why it's so important to seek legal guidance prior to submitting application materials. This effort can help to ensure that an applicant's proposal is as strong, supported, and clearly stated as possible. 

Some of the primary considerations that the OBM will weigh when determining the fate of an application are as follows: 

  • The applicant's criminal history, if any 
  • The nature of the applicant's history of substance abuse 
  • The applicant's history of employment as a nurse 
  • The applicant's broader nursing practice record 
  • The length of the applicant's status as a licensed/certified practitioner 

Additionally, the OBM will consider whether the applicant in question self-reported their struggles with substance abuse or whether their challenges were brought to the attention of the OBM due to the applicant's abuse of a position of authority, patient negligence, or other concerning professional conduct. If you are interested in submitting an application for the Alternative Program, know that the Lento Law Firm's Professional License Defense Team will tailor our strategic approach to your application to the specifics of your unique situation. This personalized effort will help to ensure that your application is viewed in the best possible light under the circumstances.  

What Are the Requirements of the Alternative Program? 

Once an applicant has been approved for participation in the Alternative Program, they must successfully complete all of the program's requirements before they can be relieved of the risk of traditional disciplinary action, which may include long-term license suspension or revocation. For better and for worse, the requirements of the Alternative Program are truly numerous.  

First, a nurse must enter into an Alternative Program Participation Agreement, which is essentially a contract that details the expectations of the program. Then, they will be subjected to four years of monitoring. This is not an insignificant requirement, as the anxiety that some people experience when being held accountable to authority in this way for this long can be depleting.  

As long as a nurse is enrolled in the program, they are required to refrain from using alcohol or drugs, with the exception of properly prescribed medications, taken as directed. They must also enter into a substance use disorder treatment program that has been certified by the Ohio Department of Mental Health & Addiction Services. Alternatively, a program can be certified by the Joint Commission. Any other substance abuse programming may or may not be beneficial, but participation in it will not “count” for the purposes of Alternative Program requirements.  

During a nurse's four-year monitoring period, they will be subject to random alcohol and drug screens to ensure compliance with the abstinence requirement mentioned above. They'll also be compelled to submit personal reports related to their circumstances and participate in interviews with the monitoring agent assigned to their case.  

Self-reported evidence of a nurse's circumstances is important in this process, but evidence of a nurse's situation provided by others is also required. Specifically, reports must be submitted by treating health care practitioners, and employer reports must be submitted as well.  

Returning to employment – in a full-time position capacity – for an aggregate period of 12 months is also a requirement of the Alternative Program. This return can only occur after official approval to seek and accept nursing-related employment has been granted to a participant. Documented sobriety must be achieved before this return-to-work permission will be granted.  

What Are the Pros and Cons of Participating in the Alternative Program? 

There are many considerations that you should carefully assess before deciding – one way or the other – how you'd like to approach the Alternative Program opportunity. Thankfully, you don't have to make this assessment alone. When you meet with the Lento Law Firm's Professional License Defense Team, we can help you evaluate the pros and cons of this opportunity as it applies to your unique situation. The following are a few of the most pressing, discussed in a generalized way. Again, our Team can help you weigh them in a personalized fashion.  


Depending on how serious your substance abuse issue is, you may be at the point of “needing all the help you can get.” You may not be in a position to work your recovery effectively without the kind of support and disciplined participation that are features of the Alternative Program. Additionally, as the stresses of your job almost certainly exacerbate the challenges that may have thwarted recovery in the past, participating in a program that is designed uniquely for your profession could help you in ways that other substance abuse treatment programs simply could not. As you deserve health and pathways to genuine, sustainable well-being, this opportunity may be the best available option tailored to help you achieve those goals.  

On a professional level, choosing to enter the Alternative Program will allow you to avoid disciplinary action – that could endanger your license or certification – provided that you successfully complete all program requirements. This opportunity will allow you to continue in your chosen profession without consequential disciplinary records weighing you down until you retire.  

Finally, because one of the greatest challenges associated with sobriety is accountability, you'll benefit from structured accountability on several levels while working through the Alternative Program. Your employer, monitoring agent, and healthcare team will all need to submit reports about your progress. You may be used to hiding your challenges from others. In the Alternative Program, you'll be held to account in ways that can inspire you to remain on track when times get tough.  


Four years of monitoring is a significant challenge. While accountability is often key to recovery, feeling that the ups and downs of your recovery are being professionally scrutinized for this long can be frustrating. Additionally, because you will be held to such strict standards during this time, any slip-up could cause you to land back at square one or worse. If you thrive on discipline and accountability, this might not be a problem. But, if you are concerned that the anxiety inspired by this monitoring could do you more harm than good, you'll need to carefully consider whether this is the best way forward for you, personally and professionally. 

As previously mentioned, the short-term suspension of your license during the application process will leave you without income, which you may not be in a position to afford. Additionally, once your application is accepted by the OBN, you will need to seek treatment. This will take time. You won't be able to seek and accept employment again until you have received permission, which means that you could be lacking income indefinitely. You may or may not be accepted back at your previous position after taking leave. Any substance abuse treatment programs that you participate in may end up costing thousands of dollars on top of these other financial burdens. While financial challenges related to this process may be mitigated in a variety of ways, they are consequential in nature and should be assessed carefully as a result.  

Are There Any Alternatives to the Alternative Program That Can Preserve My Nursing License? 

It is important to note that simply because the Alternative Program may be an option for you, you are not obligated to apply for participation in this opportunity. Depending on the unique details of your situation, it may be preferable to go through the process of facing disciplinary charges. Your Lento Law Firm Professional License Defense attorney will do everything possible to build a solid case on your behalf. You may be in a position to receive nothing more serious than a reprimand or probation, which would likely allow you to remain gainfully employed. Especially if your substance abuse issues can be effectively managed in an outpatient program, you may not need the strict and intensive structure of the Alternative Program to achieve health and greater well-being.  

It is important to be nakedly honest with yourself about the nature of your situation and the extent of your substance abuse challenges. After all, if you opt to defend against the charges you're facing in hopes of a lenient disciplinary outcome, you won't be doing yourself any favors if you fail to work on your recovery and end up unintentionally making a mistake that can cost you your license forever. With that said, if you're in a position to tell your side of the story, work to manage your recovery in a less intensive environment, and you believe that this is a better way forward – all things considered – we can help you to navigate your disciplinary process accordingly.  

Additional Resources 

Ohio has established a state agency that is devoted entirely to fostering the well-being of those impacted by mental health and substance abuse challenges. As you navigate your struggle with a substance abuse disorder, you may ultimately benefit from checking out some of the resources, programs, and services provided by the Ohio Department of Mental Health & Addiction Services.  

Retain the Lento Law Firm Today 

You have worked so hard to earn your career path. You deserve to find a way forward while you're navigating the ups and downs of substance abuse recovery. The Lento Law Firm's Professional License Defense Team has a nationwide presence, and we can help you to fight for your interests whether you're currently residing in Ohio or you've used your Ohio license to assume a traveling position and you are currently stationed elsewhere. We can help you navigate the challenges of your situation and weigh the benefits and drawbacks of the Alternative Program as a viable option, just as we have so many other Ohio nurses before. You are not alone. Call us today at 888-535-3686 or contact us online to learn more. We look forward to speaking with you.  


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