Affidavit of Freedom from Problematic Substance Use

Elite Recovery requires that all individuals directly responsible for providing services to our clients demonstrate freedom from abusing prescription medication or being in any manner under the influence of a chemical that impairs the individual’s ability to provide services or care. Staff must have no current problems with substance use which would negatively impact their job performance. Previous episodes of problematic substance use must have occurred no less than one year ago, and the staff member must attest to that fact as a condition of employment. For staff members with a history of problematic substance use between 12 and 24 months immediately preceding employment, an exception request must be completed at the time of application that describes their situation and indicates any ongoing treatment they are receiving as well as involvement of any supervisory or oversight board.

Problematic Substance Use

Elite Recovery considers the following behavior and/or circumstance(s) to be evidence of problematic substance use:

1. Receiving treatment for substance use within the period specified in the staff position qualification requirements as outlined below;
2. Program managers, supervisors, nurses, counselors, interns, and other professionals are required to be free from problematic substance use for two years prior to date of hire with the program.
3. Paraprofessionals, treatment coordinators and technicians are required to be free from problematic substance use for one year prior to date of hire with the program.
4. Substance use that has a negative impact on the staff member’s job performance;
5. Substance use that affects the credibility of treatment services with clients, referral sources, or other members of the community;
6. Symptoms of intoxication or withdrawal on the job.

Medication-Assisted Treatment

Medication-Assisted Treatment may not be considered “treatment” for the purpose of Item #1. To determine if an employee is able to provide services based on this provision, the treatment director will consider the following:

1. Whether the employee has been on a stable dose for at least two years;
2. Whether the employee demonstrates any other examples of problematic substance use;
3. The specific requirements and policies of the program for which the applicant wishes to work.

All employees must disclose their MAT status on this form and discuss their specific situation with the treatment director to determine the best course of action.

Health Professional Services Program (HPSP)         

Professional staff members who are working with the Health Professional Services Program (HPSP) due to a professional impairment may be eligible to continue/maintain employment so long as the treatment director and the HPSP assigned case worker believe that returning to work does not pose a threat of harm to the staff member and the clients they serve. The staff member must also have no other disqualifying “problematic substance use” and be cleared by their licensing board to work.  Staff must discuss their involvement in the HPSP program prior to signing this affidavit.

Attestation

By signing this form, I attest to the following:

1. I have been free from problematic substance use, as explained above, for the time period indicated above.
2. I have not received Medication-Assisted Treatment within the time period indicated above, or I have discussed my MAT with program management and received approval to move forward with this attestation.
3. I am not currently involved with the Health Professional Services Program, or I have discussed my involvement with HPSP with program management and received approval to move forward with this attestation.