Alcohol and Chemical Addiction Contract

CAMRO Program Confidential Agreement

for alcohol and drug or chemical dependency recovery

 

I, __________________________, minister’s credential # ___________________, agree to participate in the CAMRO confidential monitoring program for chemically dependent ministers. I have voluntarily chosen to participate in CAMRO and will adhere to the terms below.

I agree to:

  1. Participate in the CAMRO program for a minimum of three years. If I experience a relapse, I agree to stay in the CAMRO program another three years from the most recent self-report date or from the most recent agency or church complaint date.
  2. Completely abstain from the use of alcohol and all other mind/mood altering medications and controlled and/or addictive substances.
  3. Immediately begin attending a minimum of three (3) Alcoholics Anonymous, Narcotics Anonymous, or equivalent 12-step recovery-based program meetings each week and to submit the CAMRO provided attendance sheet by the last work day of each month. I will also obtain an Alcoholics Anonymous sponsor within sixty (60) days of entering CAMRO and maintain a relationship with my sponsor during my CAMRO program.
  4. Within seven (7) calendar days, enroll in a random drug screening program and submit the screens to my supervisor. I agree to a minimum of two (2) urine drug screens per month for the first eighteen months. Thereafter, I am eligible to have my urine drug screens reduced to once per month. The reduced drug screens are contingent on maintaining significant CAMRO compliance with drug screens and compliance with AA meetings, and require written authorization from my supervisor. Random EtG/EtS (special test for alcohol use) and hair sample testing may be required. Any confirmed positive drug screen for which CAMRO has not received appropriate notification and documentation from a prescribing provider will be considered a relapse.
  5. Within fourteen (14) calendar days, enter into a licensed chemical dependency treatment program. The program may be inpatient, an intensive outpatient program (IOP), or variation. I agree to abide by all recommendations of the program regarding ongoing treatment and discharge planning. Documentation of name of program, therapist and/or counselor, date of entry, attendance, progress, completion, and recommendations must be submitted to CAMRO.
  6. Refrain from all public ministry and counseling ministry for sixty days after entering the licensed chemical dependency treatment program and until the licensed chemical dependency treatment program director/therapist and CAMRO has approved my re-entry into active ministry.
  7. Within twenty-one (21) calendar days, submit to my health care provider the attached form describing CAMRO, drug restrictions, and the required documentation if any medications are prescribed either currently or at any time while participating in CAMRO. Additionally, I agree to notify any and all of my health care providers of my participation in CAMRO prior to receiving treatment. If my health care provider prescribes a narcotic or mood altering medication, I shall ensure that the prescribing provider notifies CAMRO immediately and submits monthly reports to CAMRO regarding the continued need for the narcotic or mood-altering medication. These monthly reports will continue until I am no longer in need of the medication(s).
  8. Refrain from taking any over-the-counter medication (except ibuprofen, plain aspirin, acetaminophen, and/or multivitamins) unless I have obtained a written authorization from my health care provider. Using the appropriate CAMRO form, I will maintain a log of all medications taken and will submit the log to CAMRO by the last work day of each month.
  9. Within seven (7) calendar days of completion of the intensive phase of the treatment program (inpatient or IOP), enter a licensed aftercare/continuing care program for a minimum or six (6) months. If possible, the aftercare program should be facilitated by the original chemical dependency treatment program. A CAMRO aftercare report, using the required form, must be submitted to CAMRO by the last workday of; each month. In addition, upon successful completion of aftercare, a letter documenting my completion must be submitted to CAMRO by the aftercare program coordinator/therapist.
  10. Attend a weekly recovery group for ministers. Attendance should begin no later than the day I enter into the aftercare/continuing care phase of the CAMRO program. If no minister recovery group exists within forty (40) miles of my home, I will attend an additional 12-step recovery-based meeting each week.
  11. Submit a completed CAMRO self-report form to CAMRO by the last workday of each reporting month. While participating in CAMRO, my reporting months are as follows:________________________________________________________________ _____________________________________________________________________________________
  12. Immediately notify CAMRO if I am hospitalized or must undergo any procedures requiring the administration of medication, including dental procedures, and to provide all required documentation from all health care providers.
  13. Give prior notification of any inability to screen to the lab and to CAMRO. If I fail to notify CAMRO and If I feel too ill to submit a drug screen, I must obtain documentation from my treatment provider verifying I have been seen in his/her office and could not test.
  14. Notify within five (5) calendar days CAMRO and the lab of any change in my home and/or employment phone number and /or address.
  15. Report immediately to CAMRO any relapse and immediately cease all public ministry and counseling of others. Relapse is any actual use of mood or mind altering chemicals, including alcohol. If employed, my employer will be notified immediately of my relapse.
  16. Understand that if I relapse, I will be re-evaluated for continued participation in CAMRO that will include an evaluation by a licensed therapist specializing in chemical dependency. I may not return to public ministry or counseling of others until I have received written approval from CAMRO. If I relapse a second time, I understand that I may be discharged from the CAMRO program.
  17. Inform any and all ministry employers of my participation in CAMRO and provide a copy of my Agreement to them and to my assigned supervising minister PRIOR to accepting any ministry offering or work in a capacity requiring my ministry credentials.
  18. Notify CAMRO of any change in my employment status including transfers with the same facility within five (5) calendar days of change.
  19. Ensure that my direct supervisor completes the CAMRO provided performance evaluation form in time to allow for the reports to be received by CAMRO by the last workday of the month.
  20. Observe the following work and lifestyle restrictions:
    • Refrain from all public ministry and counseling ministry for sixty days after entering the CAMRO program or a relapse. I will refrain from public  ministry and counseling others until the licensed chemical dependency treatment program director/therapist and CAMRO has approved my re-entry into active ministry.
    • Will not travel more than 15 miles from my normal work assignment/location more than once every 60 days or longer than five (5) calendar days.
    • Will not travel more than 15 miles from my normal work assignment/location except after notifying CAMRO of travel location and dates of travel.
    • Will not work more than 40 hours per week, including time of ministry on Sundays.
    • Will obtain a minimum of 8 hours of sleep every night.
    • Will not accept a new senior pastor position for one (1) year.
    • Will exercise aerobically for at least 30 minutes every day.
    • Will obtain at least 30 minutes of direct sunshine every day except on overcast days.
    • Will socialize for at least 30 minutes every day with at least one non-relative outside of my home (except when too ill to leave my house).
  21. Will see a licensed chemical dependency therapist at least once per month.
  22. After completing my first year in CAMRO, undergo an evaluation by a licensed chemical dependency therapist to identify any deficiencies in my recovery program. I agree to abide by his/her recommendations.
  23. Sign all release of information forms relevant to my treatment and health care, especially those authorizing communication between CAMRO and my treatment providers.
  24. Appear in person for any requested interviews, given reasonable notice by CAMRO.
  25. Accept that any and all expenses incurred while enrolled in CAMRO are my responsibility.
  26. Inform CAMRO in writing of pending relocation to another city.
  27. Notify CAMRO within 48 hours of any arrest, charges filed, and/or criminal conviction. I agree to provide CAMRO with all related police and court documentation.
  28. Acknowledge that if I am noncompliant with the terms of this agreement in any respect, the CAMRO representative will notify my employer, church and agency of the noncompliance. Additionally, if I am noncompliant, the terms of the agreement may be extended and/or modified, or I may be discharged from CAMRO.
  29. Acknowledge that any complaint received by CAMRO about me will be investigated and may result in discharge from CAMRO.
  30. I understand that if discharged for any reason, all records of my participation in this program are no longer confidential and will be shared with anyone wanting to review the information. The church agency may suspend my ministry credentials.

I hereby certify that I have read this document, have had an opportunity to ask questions and I understand the agreement. Modification to these terms are subject to the approval of CAMRO and must be documented in an addendum and signed by myself and a CAMRO representative.

 

__________________________________         __________________________________

Minister’s Supervisor                                             Minister entering the CAMRO program

 

__________________________________                     _________________________________

CAMRO Representative                                                                          Witness

 

Date: ___________________________

© 2013 Nathan Davis

 

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