When working in the medical care system, the combination of a high stress environment, long work hours, and unsatisfactory working conditions can lead to a reliance on or increased usage of various substances, both legal and illegal. When discussing the substances most commonly abused among medical professionals, it is important to consider the ease of access that many professionals have to opiates and Central Nervous System depressants, and the effect that this accessibility may have on their tendency to abuse the substances.
For example, studies have shown that nurses are, compared to the general population, much more likely to use prescription drugs than other substances, such as cocaine or marijuana (Trinkoff, Storr, & Wall, 1999). This disproportionate use of prescription substances stems mainly from the ability of healthcare professionals to obtain these drugs easily and often, as well as the common misperception by many professionals that their knowledge of the drug will enable them to “control” the drug use (Dunn, 2005).
More specifically, different specialties can promote different drug abuse tendencies. For example, professionals working in critical care units (emergency rooms, intensive care units, operating rooms or post-anesthesia care units) are reported as more likely to use prescription drugs as a result of easy access when compared to non-critical care medical professionals. Aside from drug accessibility, critical care settings contain “increased frequency of dealing with death, [an] unpredictable work pace, the immediacy of the nursing intervention, reliance on pharmacologic agents, [and] heavy work demands” (Dunn, 2005). These numerous pressures make stress alleviation through drug use an increasingly common occurrence.
When faced with the pressure of long working hours and high stress work conditions, many healthcare professionals turn to tobacco and alcohol to “de-stress”. However, as innocent as these substances seem initially, a reliance on these legal substances can in fact result in a drug related “slippery slope” effect, making it “easy for medical professionals to get initiated into substance use and promote subsequent addiction” (Bhan, 2009).
In a 2008 medical study performed among several thousand medical students from 76 different colleges; 7.1% used alcohol, 6.1% used oral or smoking tobacco, and 6.7% admitted to lifetime use of illicit drugs (Rai, Gaete, Girotra, Pal, & Araya, 2008). Given the fact that drug use problems often become even more exacerbated once medical students complete their education and face the new stresses of the professional world, these statistics present a major problem facing the medical system overall. In fact, among nurses alone, a recent study has shown that approximately 10% of the nursing population has a drug abuse problem, and that 6-8% of nurses abuse drugs to the extent that it may impair their professional judgment.
Overall, while medical professionals do not often use substances that many conceive of as dangerous drugs, the increasingly common abuse of alcohol, tobacco, and prescription drugs represents a momentous problem amidst the health care world that should not be taken lightly.
See what Rebecca Mason, RN, CNS, CEAP thinks about this question, and why she believes these substances are used: VIDEO http://www.youtube.com/watch?v=uxXxar_YbUM
Resources:
Dunn, D. (2005, October). Substance abuse among nurses: defining the issue. Retrieved November 20, 2009, from BNET webste: http://findarticles.com/p/articles/mi_m0FSL/is_4_82/ai_n15754444/pg_2/?tag=content;col1
Rai D., Gaete J., Girotra S., Pal H.R., & Araya R. (2008). Substance use among medical students: Time to reignite the debate? The National Medical Journal of India 21(2), 75-78.
Trinkoff, A.M., Storr C. L., & Wall M.P. (1999). Prescription-type drug misuse and workplace access among nurses. Journal of Addictive Diseases, 18(1), 9-17.
How do you recognize a drug-impaired co-worker?
Depending upon the situation, the person, and the duration of the addiction, there are many signs and symptoms used to recognize a drug-impaired co-worker. In general, here are some common signs and symptoms:
Background Indicators:
· Family History of Drug Abuse/Misuse
· Past Medical History Requiring Pain Control
· Reputation as a Responsible Employee
Changes in Behavior:
· Increasing Isolation from co-workers, friends, family
· Social Avoidance at Work
· Frequent Reports of Illness, Minor Accidents, and Emergencies
· Complaints from Others about Poor Work Performance
· Mood swings, Irritability, Depression, or Suicide Threats
· Frequent trips to the bathroom or other Unexplained brief absences
· Difficulty meeting schedules and deadlines
· Illogical or Sloppy Charting
· Strong interest in Patient’s Pain Control and use of pain control medications
· Elaborate or Inadequate Excuses for Tardiness or Absence, which includes taking long lunch hours or using sick leave immediately after days off
Physical Signs and Symptoms:
· Shakiness
· Tremors of Hands
· Slurred Speech
· Diaphoresis/Sweating
· Unsteady Gait/Unsteady Balance
· Increasing Carelessness about Personal Appearance
Although the signs and symptoms noted above are related to recognizing a drug impaired co-worker in general, there are also more specific signs and symptoms to use to detect drug impairment related to a certain type of drug. For example, the signs and symptoms related to a Narcotic issue include:
· Frequently incorrect Narcotics counts
· Apparent alteration to Narcotics vials
· Large amounts of Narcotics wasted
· Issues between the patient reports and hospital records of pain medication
· Significant changes in the amount of drugs required on the hospital unit
· Use of long sleeved clothing for a long period of time, even during warm weather
In some cases, recognizing a co-worker who has a problem with substance abuse may be difficult because the co-worker may conceal the addiction really well. For instance, the chemically dependent co-worker may use excuses such as fatigue or the use of cough syrup or antihistamines to justify the reason for his or her drunken appearance. Even though these excuses may work once or twice, a continual pattern of excuses should raise awareness to the possibility of an impairment related to substance abuse. Surprisingly, job performance is usually the last thing to be affected by chemical dependency (Haack, & Hughes, 1989).
Even though it may be difficult to accept, as a friend and a co-worker it is important to seek help for the person if there is reason to believe that the person is misusing substances.
To take a look at Dr. Audrey Snyder's and Dr. Daniel Becker’s answers related to recognizing a drug impaired co-worker, see the VIDEO: http://www.youtube.com/watch?v=2FgmeE0M2j8
Resources:
Haack, M R, & Hughes, T L. (1989). Addiction in the nursing profession. New York: Springer Publishing Company.
Sullivan, E, Bissell, L, & Williams, E. (1988). Chemical dependency in nursing. Menlo Park, California: Addison-Wesley Publishing Company.
*For more information on Recognizing a Drug Impaired Co-Worker:
http://www.deadiversion.usdoj.gov/pubs/brochures/drug_hc.htm#how
http://www.georgianurses.org/nurse_advocate.htm#chem
Background Indicators:
· Family History of Drug Abuse/Misuse
· Past Medical History Requiring Pain Control
· Reputation as a Responsible Employee
Changes in Behavior:
· Increasing Isolation from co-workers, friends, family
· Social Avoidance at Work
· Frequent Reports of Illness, Minor Accidents, and Emergencies
· Complaints from Others about Poor Work Performance
· Mood swings, Irritability, Depression, or Suicide Threats
· Frequent trips to the bathroom or other Unexplained brief absences
· Difficulty meeting schedules and deadlines
· Illogical or Sloppy Charting
· Strong interest in Patient’s Pain Control and use of pain control medications
· Elaborate or Inadequate Excuses for Tardiness or Absence, which includes taking long lunch hours or using sick leave immediately after days off
Physical Signs and Symptoms:
· Shakiness
· Tremors of Hands
· Slurred Speech
· Diaphoresis/Sweating
· Unsteady Gait/Unsteady Balance
· Increasing Carelessness about Personal Appearance
Although the signs and symptoms noted above are related to recognizing a drug impaired co-worker in general, there are also more specific signs and symptoms to use to detect drug impairment related to a certain type of drug. For example, the signs and symptoms related to a Narcotic issue include:
· Frequently incorrect Narcotics counts
· Apparent alteration to Narcotics vials
· Large amounts of Narcotics wasted
· Issues between the patient reports and hospital records of pain medication
· Significant changes in the amount of drugs required on the hospital unit
· Use of long sleeved clothing for a long period of time, even during warm weather
In some cases, recognizing a co-worker who has a problem with substance abuse may be difficult because the co-worker may conceal the addiction really well. For instance, the chemically dependent co-worker may use excuses such as fatigue or the use of cough syrup or antihistamines to justify the reason for his or her drunken appearance. Even though these excuses may work once or twice, a continual pattern of excuses should raise awareness to the possibility of an impairment related to substance abuse. Surprisingly, job performance is usually the last thing to be affected by chemical dependency (Haack, & Hughes, 1989).
Even though it may be difficult to accept, as a friend and a co-worker it is important to seek help for the person if there is reason to believe that the person is misusing substances.
To take a look at Dr. Audrey Snyder's and Dr. Daniel Becker’s answers related to recognizing a drug impaired co-worker, see the VIDEO: http://www.youtube.com/watch?v=2FgmeE0M2j8
Resources:
Haack, M R, & Hughes, T L. (1989). Addiction in the nursing profession. New York: Springer Publishing Company.
Sullivan, E, Bissell, L, & Williams, E. (1988). Chemical dependency in nursing. Menlo Park, California: Addison-Wesley Publishing Company.
*For more information on Recognizing a Drug Impaired Co-Worker:
http://www.deadiversion.usdoj.gov/pubs/brochures/drug_hc.htm#how
http://www.georgianurses.org/nurse_advocate.htm#chem
If you believed a co-worker was having a substance abuse problem, what would you do to help?
Within the professional world it is often hard to recognize impaired or struggling co-workers, especially relating to substance addiction or abuse, which can often lie under the surface and remain unnoticeable to the casual observer. However, if you do in fact suspect a coworker to have a drug abuse problem it is crucial that you act to get the individual help, especially when they are working in a medical setting.
The imperative nature of this type of issue is made quite clear by The Nursing Code of Ethics, which states that:
There are numerous options available in this type of situation, and while the most important aspect of the process is getting help for the addicted individual, it is important to realize that various methods can be used to go about this process.
Steps available to you include:
1. Utilizing an Employee Assistance Program offered by your employer:
Most medical systems have created an Employee Assistance Program to aid workers in their personal and professional struggles. One common portion of this type of program includes coping with substance abuse in the workplace. The resources related to substance abuse may include counseling services, group seminars, and recommendations to treatment or recovery facilities.
Additionally, this resource may be able to offer assistance to you as the outside observer about ways to approach the issue.
- For example, the University of Virginia Employee Assistance Program offers a tutorial on “How to Intervene With an Employee Who Might be Impaired”
http://www.healthsystem.virginia.edu/internet/feap/supervisor/intervene-impaired-employee.cfm
More examples of Employee Assistance Programs can be found at the EAP Directory site, located at:
http://www.eap-sap.com/
2. Contacting your employer or the state board about the individual to initiate further investigation.
This is often a helpful approach for the further investigation of co-workers, given the ability of employers and the state board to much more thoroughly and legally look into the behavior and professional record of the individual under scrutiny. However, professionals are often hesitant to take this path because of misgivings or uncertainty about the truth of their suspicions (Peck, 2009).
3. Recommending the individual to the Professional Recovery Network (Professional Recovery Network, 2009).
This option presents numerous benefits to the concerned coworker as a result of its professional nature and its “non-coercive and non-punitive” philosophy (Profesional Recovery Network, 2009). The Network offers a range of outpatient services; including consultation (12 Step programs etc.), interventions, recovery monitoring, relapse management, and advocacy (the ability of PRN to argue for the individual’s continued medical practicing if they have demonstrated abstinence and recovery).
Additionally, the Professional Recovery Network presents an option for co-workers to remain anonymous in their concern by referring the affected individual’s information to PRN and allowing them to make initial contact. The option of remaining anonymous presents a helpful way to get a co-worker the assistance they need without taking on the onus of being “the bad guy”.
Here is a link to a PRN site, take a look!
http://www.southworthassociates.net/recovery-enhancement-program.html
4. Recommending the co-worker to the Caduceus Group (Caduceus group, 2009).
The Caduceus Group is an outpatient, confidential treatment resource for recovering healthcare professionals that is located in various locations throughout the country. Benefits of this program include individual treatment plans, varying levels of offered therapy (ranging from individual, to group, to family), and the availability of regulation of recovery through a system of reporting.
This is an example of a Caduceus Group site in Illinois:
http://www.carle-clinic.com/Recovery_Center/Pages/CaduceusGroup.aspx
While these options are certainly not the only answer, nor are they guaranteed to be successful, they offer much helpful insight into the process of recovery, and the ways which concerning outsiders can truly help to make this process a success.
The imperative nature of this type of issue is made quite clear by The Nursing Code of Ethics, which states that:
“Nurses must be vigilant to protect the patient, the public and the profession from potential harm when a colleague’s practice, in any setting, appears to be impaired . . . nurses in all roles should advocate for colleagues whose job performance may be impaired to ensure that they receive appropriate assistance, treatment and access to fair institutional and legal processes. This includes supporting the return to practice of the individual who has sought assistance and is ready to resume professional duties.” (Sect 3.6 Addressing Impaired Practice)
There are numerous options available in this type of situation, and while the most important aspect of the process is getting help for the addicted individual, it is important to realize that various methods can be used to go about this process.
Steps available to you include:
1. Utilizing an Employee Assistance Program offered by your employer:
Most medical systems have created an Employee Assistance Program to aid workers in their personal and professional struggles. One common portion of this type of program includes coping with substance abuse in the workplace. The resources related to substance abuse may include counseling services, group seminars, and recommendations to treatment or recovery facilities.
Additionally, this resource may be able to offer assistance to you as the outside observer about ways to approach the issue.
- For example, the University of Virginia Employee Assistance Program offers a tutorial on “How to Intervene With an Employee Who Might be Impaired”
http://www.healthsystem.virginia.edu/internet/feap/supervisor/intervene-impaired-employee.cfm
More examples of Employee Assistance Programs can be found at the EAP Directory site, located at:
http://www.eap-sap.com/
2. Contacting your employer or the state board about the individual to initiate further investigation.
This is often a helpful approach for the further investigation of co-workers, given the ability of employers and the state board to much more thoroughly and legally look into the behavior and professional record of the individual under scrutiny. However, professionals are often hesitant to take this path because of misgivings or uncertainty about the truth of their suspicions (Peck, 2009).
3. Recommending the individual to the Professional Recovery Network (Professional Recovery Network, 2009).
This option presents numerous benefits to the concerned coworker as a result of its professional nature and its “non-coercive and non-punitive” philosophy (Profesional Recovery Network, 2009). The Network offers a range of outpatient services; including consultation (12 Step programs etc.), interventions, recovery monitoring, relapse management, and advocacy (the ability of PRN to argue for the individual’s continued medical practicing if they have demonstrated abstinence and recovery).
Additionally, the Professional Recovery Network presents an option for co-workers to remain anonymous in their concern by referring the affected individual’s information to PRN and allowing them to make initial contact. The option of remaining anonymous presents a helpful way to get a co-worker the assistance they need without taking on the onus of being “the bad guy”.
Here is a link to a PRN site, take a look!
http://www.southworthassociates.net/recovery-enhancement-program.html
4. Recommending the co-worker to the Caduceus Group (Caduceus group, 2009).
The Caduceus Group is an outpatient, confidential treatment resource for recovering healthcare professionals that is located in various locations throughout the country. Benefits of this program include individual treatment plans, varying levels of offered therapy (ranging from individual, to group, to family), and the availability of regulation of recovery through a system of reporting.
This is an example of a Caduceus Group site in Illinois:
http://www.carle-clinic.com/Recovery_Center/Pages/CaduceusGroup.aspx
While these options are certainly not the only answer, nor are they guaranteed to be successful, they offer much helpful insight into the process of recovery, and the ways which concerning outsiders can truly help to make this process a success.
Take a look at what Audrey Snyder, PhD, RN, ACNP-CS, FAANP, CMT and Daniel Becker, MD, MPH, MFA, Center Director, Professor of Internal Medicine and Public Health Sciences, had to say on the subject: VIDEO http://www.youtube.com/watch?v=67PVwLcu9qA
Resources:
Caduceus group. Retrieved November 20, 2009 from the Carle Clinic website: http://www.carle-clinic.com/Recovery_Center/Pages/CaduceusGroup.aspx
Code of Ethics for Nurses with Interpretive Statements. (2001a). Retrieved November 20, 2009 from the American Nurses Association website: http://nursingworld.org/ethics/code/protected_nwcoe813.htm
Peck, A. (2009, August 23). Substance abuse in healthcare professionals. Retrieved November 20, 2009 from the Student Doctor Network website: http://www.studentdoctor.net/2009/08/substance-abuse-in-the-healthcare-professions
Professional recovery network: Addiction and recovery services for health professionals. Retrieved November 20, 2009 from the Southworth Associates: Professional Recovery Network website: http://www.southworthassociates.net/professional-recovery-network.html
At what point do most healthcare professionals turn to treatment for help?
Healthcare professionals are very good at hiding their problem and are not usually intervened upon until they have become impaired at work, which is when their addiction is in the end stage (CODA report, 2009). Most healthcare professionals do not display job impairment until late in their substance abuse problem because the workplace is usually their drug supply source. Since initial symptoms occur in the individual’s personal sector, these problems can continue unnoticed by colleagues. Some indications of professionals potentially diverting drugs include: “signing out more controlled substances than co-workers, reporting more medication spills or wastes, excessively administering PRN (take as needed) pain medications to patients, waiting until alone to open narcotics, evidence that someone has tampered with the medication containers, and being defensive when questioned about medication errors” (CODA report, 2009). New measures taken by The Joint Commission are in place to hopefully prevent this from happening and include limiting and securing opiates and narcotics in floor stock and implementing witnessed wasting of narcotics by a second licensed professional.
Rebecca Heck, BSN, RN, MPH, program director of the Nursing Peer Health Assistance program at Peer Assistance Services in Denver, stated that they are seeing more nurses come forward seeking assistance with their substance abuse, but it may be due to the increased media coverage of drug thefts by healthcare professionals in the (Mucci, 2009). This media coverage may be influential in convincing healthcare professionals to seek help, instead of waiting until a coworker recognizes them after becoming impaired at work.
Rebecca Heck, BSN, RN, MPH, program director of the Nursing Peer Health Assistance program at Peer Assistance Services in Denver, stated that they are seeing more nurses come forward seeking assistance with their substance abuse, but it may be due to the increased media coverage of drug thefts by healthcare professionals in the (Mucci, 2009). This media coverage may be influential in convincing healthcare professionals to seek help, instead of waiting until a coworker recognizes them after becoming impaired at work.
Take a look at the video to see what Rebecca Mason, RN, CNS, CEAP, and a FEAP Consultant has to say… She states that there is a fear of loss of licensure and legal consequences, which, coupled with denial, causes a reluctance to seek treatment: VIDEO http://www.youtube.com/watch?v=9gM7zw7g_F4
Resources:
CODA report :Health professionals and substance use. (2009, May). Retrieved November 15, 2009 from the Council on Drug Abuse, website: http://drugabuse.ca/newsletter_pdfs_v01_i07/Health_Professionals_and_Substance_Use.pdf
Mucci, K. (2009, August 3). More Nurses seek help for substance abuse. Nurse Manager Weekly, 9(30), Retrieved from: http://www.strategiesfornursemanagers.com/content/236793/868.cfm
What is the first step to recovery?
Ultimately, the first step to recovery is admitting you have a problem. Even though admitting a problem with substances may be difficult for everyone in society, there are certain factors which may further inhibit healthcare professionals from admitting to chemical dependency.
From pharmacists and dentists, to nurses and physicians, healthcare professionals are provided with so much information concerning substance abuse and addiction that many believe themselves to be “immune” from the problem. Professionals begin to believe they can “handle it” because they are aware of the issues concerning substance abuse. In order to overcome the conception of immunity from chemical dependency, healthcare professionals have to “unlearn” the assumptions before they are able admit to having a substance abuse problem (Sullivan, Bissell, & Williams, 1988).
As a society, many people believe health care professionals are supposed to and should already know better than to abuse substances. Through the years, society’s negative connotation to chemical dependency among health care professionals has resulted in discipline or dismissal of chemical dependent professionals from the healthcare setting (Darbo, 2005). Because of the stigma society has created concerning substance abuse and healthcare professionals along with the unsupportive reactions from the healthcare setting, many health care professionals are afraid to admit to having a problem. Feelings of shame and guilt develop among nurses and doctors because they are constantly surrounded by society’s stigma. Many feel that “to admit weakness or inadequacy is dangerous to the well-being of other people” (Sullivan, Bissell, & Williams, 1988).
As Addiction in the Nursing Profession states:
“Even those of our colleagues who recognize substance dependence as an illness commonly enter into the conspiracy of silence rather than risk retribution by confronting the reality and dealing with it.” (Haack, & Hughes, 1989)
Even though it may be difficult for people to admit a substance abuse problem, many people finally do admit to a having a problem. In many cases, health care professionals report a pivotal event or crisis which triggers a realization to the substance abuse problem. Losing a license to practice or putting a patient at risk for serious complicationa are events that might trigger a health care professional to recognize a problem. To the general population, the pivotal event may be also known as “hitting rock bottom.”
If someone is unsure as to whether or not they may have a substance abuse problem, there are simple self-tests available, including the CAGE test for alcoholism and the “Am I an Addict? Test created by Narcotics Anonymous, to help begin the process of admitting to a drug problem.
Once the substance abuse problem is acknowledged by the individual, the road to recovery may begin.
To hear what Rebecca Mason, RN, CNS, CEAP, has to say concerning the first step to recovery, view the VIDEO: http://www.youtube.com/watch?v=W5-MN1UPemQ
Resources:
Darbo, N. (2005). Alternative diversion programs for nurses with impaired practice:completers and non-completers. Journal of Addictions Nursing, 16(4), 169-185.
Haack, M R, & Hughes, T L. (1989). Addiction in the nursing profession. New York: Springer Publishing Company.
Sullivan, E, Bissell, L, & Williams, E. (1988). Chemical dependency in nursing. Menlo Park, California: Addison-Wesley Publishing Company.
*To View the CAGE or MAST Test for Alcohol:
http://www.ncadd-sfv.org/symptoms/mast_test.html
https://www.merck.healthinkonline.com/merckTools/AssessMerckSourceCAGE.asp
*Other Self-Tests:
http://www.na.org/admin/include/spaw2/uploads/pdf/litfiles/us_english/IP/EN3107.pdf
From pharmacists and dentists, to nurses and physicians, healthcare professionals are provided with so much information concerning substance abuse and addiction that many believe themselves to be “immune” from the problem. Professionals begin to believe they can “handle it” because they are aware of the issues concerning substance abuse. In order to overcome the conception of immunity from chemical dependency, healthcare professionals have to “unlearn” the assumptions before they are able admit to having a substance abuse problem (Sullivan, Bissell, & Williams, 1988).
As a society, many people believe health care professionals are supposed to and should already know better than to abuse substances. Through the years, society’s negative connotation to chemical dependency among health care professionals has resulted in discipline or dismissal of chemical dependent professionals from the healthcare setting (Darbo, 2005). Because of the stigma society has created concerning substance abuse and healthcare professionals along with the unsupportive reactions from the healthcare setting, many health care professionals are afraid to admit to having a problem. Feelings of shame and guilt develop among nurses and doctors because they are constantly surrounded by society’s stigma. Many feel that “to admit weakness or inadequacy is dangerous to the well-being of other people” (Sullivan, Bissell, & Williams, 1988).
As Addiction in the Nursing Profession states:
“Even those of our colleagues who recognize substance dependence as an illness commonly enter into the conspiracy of silence rather than risk retribution by confronting the reality and dealing with it.” (Haack, & Hughes, 1989)
Even though it may be difficult for people to admit a substance abuse problem, many people finally do admit to a having a problem. In many cases, health care professionals report a pivotal event or crisis which triggers a realization to the substance abuse problem. Losing a license to practice or putting a patient at risk for serious complicationa are events that might trigger a health care professional to recognize a problem. To the general population, the pivotal event may be also known as “hitting rock bottom.”
If someone is unsure as to whether or not they may have a substance abuse problem, there are simple self-tests available, including the CAGE test for alcoholism and the “Am I an Addict? Test created by Narcotics Anonymous, to help begin the process of admitting to a drug problem.
Once the substance abuse problem is acknowledged by the individual, the road to recovery may begin.
To hear what Rebecca Mason, RN, CNS, CEAP, has to say concerning the first step to recovery, view the VIDEO: http://www.youtube.com/watch?v=W5-MN1UPemQ
Resources:
Darbo, N. (2005). Alternative diversion programs for nurses with impaired practice:completers and non-completers. Journal of Addictions Nursing, 16(4), 169-185.
Haack, M R, & Hughes, T L. (1989). Addiction in the nursing profession. New York: Springer Publishing Company.
Sullivan, E, Bissell, L, & Williams, E. (1988). Chemical dependency in nursing. Menlo Park, California: Addison-Wesley Publishing Company.
*To View the CAGE or MAST Test for Alcohol:
http://www.ncadd-sfv.org/symptoms/mast_test.html
https://www.merck.healthinkonline.com/merckTools/AssessMerckSourceCAGE.asp
*Other Self-Tests:
http://www.na.org/admin/include/spaw2/uploads/pdf/litfiles/us_english/IP/EN3107.pdf
What does treatment consist of? What aids in successful treatment?
One of the main steps to the treatment process is to achieve complete abstinence from the substance being misused. For many, this step becomes quite a challenge to accept because the substances being misused may have highly addictive properties and serious physical withdrawal symptoms. Depending on the type and amount of drug being used, the duration of time the drug was used, and the physical and psychological response of the individual using the drug, the detoxification process may also have to be involved in treatment. The goal of detoxification is to not only protect the individual from complications associated with withdrawal but also minimize the level of discomfort.
To help with the abstinence process, treatment also consists of in-patient and outpatient services. While in-patient treatment centers allow for more medical attention related to the dependency, out-patient treatment centers allow for individuals to continue a normal day to day lifestyle. Within the in-patient and out-patient centers, individuals use group and individual therapy to help in the process of overcoming chemical dependency. Once a treatment center program is complete, individuals may also use “aftercare” services or continuing care to maintain the recovery process.
Another important part of successful treatment includes the use of self-help groups. Using self-help groups such as Alcoholics or Narcotics Anonymous allows for individuals to talk about their addiction stories while surrounded by a supportive group of people. Healthcare professionals may also use Employee Assistance Programs to receive individual and confidential assistance concerning issues with overcoming substance misuse in the workplace. Designed to be a safe haven where employees can talk openly without management being informed, Employee Assistance Programs may be an alternative form of treatment for healthcare professionals to use.
Even though legal action is sometimes involved to initiate treatment, the healthcare profession aims more at providing alternative ways of treatment rather than relying on disciplinary action to achieve recovery. In 1982, the American Nurses Association created a resolution which urged states to create “peer assistance programs” for healthcare professionals to use (Haack, & Hughes, 1989). Using the peer assistance programs as an alternative to discipline programs, healthcare providers are able to focus more on treatment services rather than worry about losing their position as a healthcare professional.
In order to understand the treatment process and promote successful treatment, people have to realize treatment has to be individualized. Needs are different for every person. While some people may just need a strong sense of support which they may receive from self-help groups and other colleagues, other people may need a lot of in-patient treatment time and a change in profession to overcome the dependency. For healthcare professionals, it is important to find treatment that understands healthcare professional’s unique problems with substance abuse.
Another important concept to recognize about treatment is that treatment is a long term process. Both the National Institute of Health and the National Institute on Drug Abuse support the idea of long term treatment (Fogger, & McGuinness, 2009). Treatment and recovery cannot be expected to be achieved in a matter of months; often times it takes years of continual efforts to remain substance free. People cannot expect the treatment process to always be successful on the first attempt at recovery; preparations also have to be made for the possibility of relapse.
With the help of successful and on-going treatment, individuals can overcome a substance abuse problem.
To see what Rebecca Mason, RN, CNS, CEAP, has to say about successful treatment, please view the VIDEO: http://www.youtube.com/watch?v=phBN33tQ5pM
*To learn more about available self help groups, view:
Alcoholics Anonymous (http://www.aa.org/) or Narcotics Anonymous (http://www.ne.org/)
*To View UVa Health System's Employee Assistance Program:
http://www.healthsystem.virginia.edu/internet/feap/home.cfm
Resources:
Fogger, S, & McGuinness, T. (2009). Alabama's nurse monitoring programs: the nurse's experience of being monitored. Journal of Addictions Nursing, 20(3), 142-149.
Haack, M R, & Hughes, T L. (1989). Addiction in the nursing profession. New York: Springer Publishing Company.
To help with the abstinence process, treatment also consists of in-patient and outpatient services. While in-patient treatment centers allow for more medical attention related to the dependency, out-patient treatment centers allow for individuals to continue a normal day to day lifestyle. Within the in-patient and out-patient centers, individuals use group and individual therapy to help in the process of overcoming chemical dependency. Once a treatment center program is complete, individuals may also use “aftercare” services or continuing care to maintain the recovery process.
Another important part of successful treatment includes the use of self-help groups. Using self-help groups such as Alcoholics or Narcotics Anonymous allows for individuals to talk about their addiction stories while surrounded by a supportive group of people. Healthcare professionals may also use Employee Assistance Programs to receive individual and confidential assistance concerning issues with overcoming substance misuse in the workplace. Designed to be a safe haven where employees can talk openly without management being informed, Employee Assistance Programs may be an alternative form of treatment for healthcare professionals to use.
Even though legal action is sometimes involved to initiate treatment, the healthcare profession aims more at providing alternative ways of treatment rather than relying on disciplinary action to achieve recovery. In 1982, the American Nurses Association created a resolution which urged states to create “peer assistance programs” for healthcare professionals to use (Haack, & Hughes, 1989). Using the peer assistance programs as an alternative to discipline programs, healthcare providers are able to focus more on treatment services rather than worry about losing their position as a healthcare professional.
In order to understand the treatment process and promote successful treatment, people have to realize treatment has to be individualized. Needs are different for every person. While some people may just need a strong sense of support which they may receive from self-help groups and other colleagues, other people may need a lot of in-patient treatment time and a change in profession to overcome the dependency. For healthcare professionals, it is important to find treatment that understands healthcare professional’s unique problems with substance abuse.
Another important concept to recognize about treatment is that treatment is a long term process. Both the National Institute of Health and the National Institute on Drug Abuse support the idea of long term treatment (Fogger, & McGuinness, 2009). Treatment and recovery cannot be expected to be achieved in a matter of months; often times it takes years of continual efforts to remain substance free. People cannot expect the treatment process to always be successful on the first attempt at recovery; preparations also have to be made for the possibility of relapse.
With the help of successful and on-going treatment, individuals can overcome a substance abuse problem.
To see what Rebecca Mason, RN, CNS, CEAP, has to say about successful treatment, please view the VIDEO: http://www.youtube.com/watch?v=phBN33tQ5pM
*To learn more about available self help groups, view:
Alcoholics Anonymous (http://www.aa.org/) or Narcotics Anonymous (http://www.ne.org/)
*To View UVa Health System's Employee Assistance Program:
http://www.healthsystem.virginia.edu/internet/feap/home.cfm
Resources:
Fogger, S, & McGuinness, T. (2009). Alabama's nurse monitoring programs: the nurse's experience of being monitored. Journal of Addictions Nursing, 20(3), 142-149.
Haack, M R, & Hughes, T L. (1989). Addiction in the nursing profession. New York: Springer Publishing Company.
Does receiving treatment for substance abuse affect one's standing as a health care professional?
Take a look at the VIDEO: http://www.youtube.com/watch?v=rNYSqwqMe4g to see what Rebecca Mason, RN, CNS, CEAP has to say…
She states that “if a healthcare professional does not receive treatment its likely that the DISEASE will progress and they will have a negative consequence at work that might involve patient harm.” Inflicting patient harm would be more likely to have professional consequences than just receiving treatment. Many states have alternative programs that allow licensed professionals to remain in their profession as long as they are compliant with the requirements of treatment. Rebecca Mason addresses the program in the state of Virginia that follows licensed professionals in treatment for 5 years to ensure that they are safe to practice.
“Since the early 1980s, all the major professional nursing associations, such as the ANA, the NCSBN, and the International Nurses Society on Addictions (IntNsa), and the National Student Nurses Association (NSNA) have advocated alternative-to-discipline programs prior to initiating more formal disciplinary proceedings. These organizations recognized that more supportive recovery efforts helped keep valuable practitioners in a profession facing catastrophic labor shortages. Despite these recommendations, not all states have implemented alternative programs and there is little consistency in the approaches they use. ” (Monroe, Pearson, & Kenaga, 2008). There needs to be a national standard for substance abuse treatment programs for all healthcare providers focused on rehabilitating these licensed professionals. The treatment must be individualized and the professionals’ involvement in health care during treatment must be assessed in order to prevent patient harm.
Resources:
Monroe, T., Pearson, F., & Kenaga H. (2008). Prcedure for handling cases of substance abuse among nurses: a comparison of disciplinary and alternative programs. Journal of Addictions Nursing. 19(3), 156-161. doi: 10.1080/10884600802306024
She states that “if a healthcare professional does not receive treatment its likely that the DISEASE will progress and they will have a negative consequence at work that might involve patient harm.” Inflicting patient harm would be more likely to have professional consequences than just receiving treatment. Many states have alternative programs that allow licensed professionals to remain in their profession as long as they are compliant with the requirements of treatment. Rebecca Mason addresses the program in the state of Virginia that follows licensed professionals in treatment for 5 years to ensure that they are safe to practice.
“Since the early 1980s, all the major professional nursing associations, such as the ANA, the NCSBN, and the International Nurses Society on Addictions (IntNsa), and the National Student Nurses Association (NSNA) have advocated alternative-to-discipline programs prior to initiating more formal disciplinary proceedings. These organizations recognized that more supportive recovery efforts helped keep valuable practitioners in a profession facing catastrophic labor shortages. Despite these recommendations, not all states have implemented alternative programs and there is little consistency in the approaches they use. ” (Monroe, Pearson, & Kenaga, 2008). There needs to be a national standard for substance abuse treatment programs for all healthcare providers focused on rehabilitating these licensed professionals. The treatment must be individualized and the professionals’ involvement in health care during treatment must be assessed in order to prevent patient harm.
Resources:
Monroe, T., Pearson, F., & Kenaga H. (2008). Prcedure for handling cases of substance abuse among nurses: a comparison of disciplinary and alternative programs. Journal of Addictions Nursing. 19(3), 156-161. doi: 10.1080/10884600802306024
What is your opinion concerning society's stigma about health care professionals knowing better than to abuse substances?
“One would like to believe that nurses, who have studied the physiologic effects of alcohol and drugs on the system, would avoid such abuse” (Nursing in today's world: trends, issues & management, 2004).
Although people believe that healthcare professionals should know better than to abuse substances because they are the ones helping others, healthcare professionals are people too and make mistake, much like the saying ‘to err is human’. (CODA report, 2009)
The reality is that doctors and nurses might be more susceptible to substance abuse because of the stress of the job and easy access to controlled substances. They must cope with caring for extremely ill and dying patients and most deal with the stress of long hours and rotating shifts (CODA report, 2009). It is not only the controlled substances that health care providers abuse, but they also turn to tobacco and alcohol to help deal with the stressors of life and the job. To cope with the long hours and rotating shifts, doctors and nurses often turn to caffeine to remain alertness during long shifts and night shifts, when the circadian rhythm is thrown off.
Take a look the following video to see how Daniel M. Becker, MD, MPH, MFA, and Audrey E. Snyder PhD, RN, ACNP-CS, CEN, FAANP, answered this question from thier personal experiences: VIDEO http://www.youtube.com/watch?v=vwnalEkAPCY
Resources:
CODA report: Health professionals and substance use. (2009, May). Retrieved November 15, 2009 from the Council on Drug Abuse, website: http://drugabuse.ca/newsletter_pdfs_v01_i07/Health_Professionals_and_Substance_Use.pdf
Ellis, J.R. & Hartley C.L., (2004). Nursing in today's world: trends, issues & management, 8ed. Philadelphia, PA: Lippincott Williams & Wilkins. 349
Although people believe that healthcare professionals should know better than to abuse substances because they are the ones helping others, healthcare professionals are people too and make mistake, much like the saying ‘to err is human’. (CODA report, 2009)
The reality is that doctors and nurses might be more susceptible to substance abuse because of the stress of the job and easy access to controlled substances. They must cope with caring for extremely ill and dying patients and most deal with the stress of long hours and rotating shifts (CODA report, 2009). It is not only the controlled substances that health care providers abuse, but they also turn to tobacco and alcohol to help deal with the stressors of life and the job. To cope with the long hours and rotating shifts, doctors and nurses often turn to caffeine to remain alertness during long shifts and night shifts, when the circadian rhythm is thrown off.
Take a look the following video to see how Daniel M. Becker, MD, MPH, MFA, and Audrey E. Snyder PhD, RN, ACNP-CS, CEN, FAANP, answered this question from thier personal experiences: VIDEO http://www.youtube.com/watch?v=vwnalEkAPCY
Resources:
CODA report: Health professionals and substance use. (2009, May). Retrieved November 15, 2009 from the Council on Drug Abuse, website: http://drugabuse.ca/newsletter_pdfs_v01_i07/Health_Professionals_and_Substance_Use.pdf
Ellis, J.R. & Hartley C.L., (2004). Nursing in today's world: trends, issues & management, 8ed. Philadelphia, PA: Lippincott Williams & Wilkins. 349
Substance Abuse Within the Emergency Department
ER Nurses are 3.5 times as likely to use substances as general practice or pediatric nurses (Storr, & Trinkoff, 1998).
In your experience, have you found this to be true?
Take a look this video to see how Audrey E. Snyder, PhD, RN, ACNP-CS, FAANP, CMT answered this question: VIDEO http://www.youtube.com/watch?v=iDFr0CSbVo8
Resource: Storr, CL, & Trinkoff, AM. (1998). Substance use among nurses: differences between specialties. American Journal of Public Health, 88(4), Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508454/
Do you believe substance abuse among healthcare professionals is a significant problem our society faces today?
Substance abuse among healthcare professionals is a unique challenge that our society faces today in that this harmful behavior not only affects the substance abuser, and his loved ones but also the patients that he cares for (CODA report, 2009). While substance abuse among physicians, nurses, dentists, and pharmacists can affect their personal life, it is also linked to medical errors, liability and a decline in patient safety (McBeth & Ankel, 2006).
Kristen Diane Parker, a former surgical technician at Rose Medical Center, admitted to stealing syringes filled with Fentanyl, a strong narcotic, and replacing them with used saline syringes (Mucci, 2009). Parker is said to have contracted Hepatitis C through using heroin and sharing dirty needles in 2008. She is said to have caused possible Hepatitis C exposure to thousands of patients (Spellman, 2009). The Denver Post reports that there have been 20 confirmed cases of patients who have contracted Hepatitis C as a result of this case (Mucci, 2009).
Over the past year, a rising number of nurses have come to receive help at Peer Assistance Services in Denver, Colorado, a nonprofit organization focused on providing quality, accessible prevention and intervention services in workplaces for substance abuse and related issues. Rebecca Heck, BSN, RN, MPH, program director of the Nursisng Peer Health Assistance program at Peer Assistance Services, says that the problem of substance abuse among healthcare professionals reflects that of the general public, and isn't necessarily increasing just because Peer Assistance Services is seeing a rise in the number of nurses seeking help (Mucci, 2009). Rather an increase in the number of nurses seeking treatment for substance abuse may be attributed to the recent case surrounding Kristin Parker, the realization that substance abuse can have a profound negative impact on patient care and the importance of seeking help (Mucci, 2009).
"Nurses, risk managment, and nurse educators do all of this work to make hospitals safer for patients, but we are all missing this huge element; to make nurses [and all healthcare providers] safer to provide patient care," says Heck (Mucci, 2009).
Take a look at what Rebecca M. Mason, RN, CNS, CEAP and Daniel Becker, MD, MPH, MFA have to say on the subject: VIDEO http://www.youtube.com/watch?v=mfmLF1Ze1Qk
Resources:
McBeth, BD, & Ankel, FK. (2006). Dont ask, dont tell: substance use by resident physicians . Journal of Academic Emergency Medicine, 13(8), 893-895.
Mucci, K. (2009, August 3). More Nurses seek help for substance abuse. Nurse Manager Weekly, 9(30), Retrieved from http://www.strategiesfornursemanagers.com/content/236793/868.cfm
As a society, how do you think we should address this problem?
Cultural reform that involves changing our perception of healthcare professionals to consider them people just like anyone else who “make mistakes… and are not immune to substance abuse” (CODA report, 2009). Our society must discard the idea that addiction is a “personal weakness or moral failing” and recognize the reality of substance abuse and addiction which is a disease process presented with physiologic changes just like any other disease rampant in our society today such as diabetes or hypertension (McBeth & Ankel,2006).
Pop culture may be one reason why substance abuse among healthcare professionals is an issue today. Brian Mcbeth, MD and Felix K. Ankel, MD suggest in their article, “Don’t Ask, Don’t Tell: Substance use by resident physicians,” that a “barrier to the diagnosis of the chemically impaired resident is related to the culture of residency,” where “alcohol and even drug use is accepted as a reasonable method of dealing with the stress of residency training (so called self-treatment)” (McBeth & Ankel, 2006) Medical drama television series such as ER and Grey’s Anatomy and popular novels such as Samuel Shem’s House of God contribute to this “culture” that McBeth and Ankel speak of as they show residents and other hospital staff drinking alcohol to deal with the stress of a long shift, cope with a patient trauma that has caused distress, and personal life issues (McBeth & Ankel, 2006). Our society can address this issue by bringing an end to such media that portrays acceptance of substance abuse among healthcare professionals as a way to relieve stress and instead provides examples of intervention and professionals seeking treatment.
Brian D. McBeth, MD and Felix K. Ankel, MD have suggested a “three-pronged approach” to address the issue of substance abuse among healthcare providers (McBeth & Ankel, 2006). The first component to address this problem involves a greater investment in research. The government has attempted to identify high risk groups, and understand the prevalence of substance abuse to best employ diagnosis and treatment resources by “investing in ongoing annual studies of representative populations” (McBeth & Ankel, 2006). McBeth and Ankel suggest that this approach also be used to focus on substance abuse among healthcare professionals. In their article, they state that an “ongoing anonymous annual survey that looks at representative groups of residents across specialties is needed” (McBeth & Ankel, 2006). McBeth and Ankel speak directly to groups of residents, but this approach could be applied to all groups of healthcare professionals. Resources should be directed toward developing ways to study the trends of substance abuse among healthcare providers which would in turn allow for more effective prevention strategies and treatment options.
Delayed recognition and diagnosis of substance abuse among healthcare providers is a huge barrier to timely treatment. The second component of the three-prong approach by McBeth and Ankel addresses this barrier by suggesting improvements in education (McBeth & Ankel, 2006). The Council On Drug Abuse (CODA) report published in May 2009 also addresses the necessity of improvements in education as an important part of prevention, early identification and intervention of substance abuse among providers. The CODA report states that, “medical and nursing school curricula should cover topics pertaining to substance abuse among the profession. As well, hospital and professional organizations should put programs in place to acknowledge the need of education about substance abuse among health-care professionals” (CODA report, 2009). For example, it should be taught that the behavior of a healthcare professional who abuses substances may be different from the behavior evident among non-healthcare providers. Typically, a drug abuser would be frequently absent from work. However, a healthcare provider who is abusing substances might not be frequently absent from work because the workplace is generally where the healthcare provider who abuses substances is getting his drug supply. “A change in their personal relationships and a decrease in community involvement” are typical, early signs of a healthcare provider who abuses substances (CODA report, 2009).
The third component of the three-prong approach involves making clinical treatment for healthcare providers available at every institution. Most large institutions have a 24-hour hotline that can provide counseling services to healthcare professionals in time of crisis. Smaller institutions that do not have this service accessible can contract with larger institutions to make this service and others such as specialists in addiction medicine to aid with intervention and treatment available to healthcare providers (McBeth & Ankel, 2006).
Take a look at the video to see what Rebecca Mason, RN, CNS, CEAP and Dr. Daniel Becker, MD, MPH, MFA have to say: VIDEO http://www.youtube.com/watch?v=l0HnYBPOYRE
Resources:
McBeth, BD, & Ankel, FK. (2006). Dont ask, dont tell: substance use by resident physicians . Journal of Academic Emergency Medicine, 13(8), 893-895.
CODA, Report. "Health Professionals and Substance Use." http://www.drugabuse.ca/. May 2009. Council on Drug Abuse, Web. 15 Nov 2009. <http://drugabuse.ca/newsletter_pdfs_v01_i07/Health_Professionals_and_Substance_Use.pdf>.
Medical & Nursing School Curriculum
During your time as a medical or nursing student, were you educated about healthy ways to relieve stress and deal with trauma? If not, do you believe alternatives to relieving stress should be added to the curriculum for future students? Do you think this would have any effect on preventing health care providers from abusing substances?
Take a look at VIDEO http://www.youtube.com/watch?v=dVwlLnInUQw to listen to responses by Audrey E Snyder, PhD, RN, ACNP-CS, FAANP, CMT & Daniel M. Becker, MD, MPH, MFA
Take a look at VIDEO http://www.youtube.com/watch?v=dVwlLnInUQw to listen to responses by Audrey E Snyder, PhD, RN, ACNP-CS, FAANP, CMT & Daniel M. Becker, MD, MPH, MFA
Popular Media Clips
1. Alcoholism on Professional Performance:
(Grey’s Anatomy clip of Dr. Webber) VIDEO http://abc.go.com/watch/greys-anatomy/93515/241074/new-history#sl-0 (view 40:23 to 42:38)
This clip depicts the adverse affects of alcoholism in relation to professional interactions and in this case, management of a hospital and medical care.
Do you think these symptoms and results of alcoholism in the medical profession are accurately portrayed?
Some of the topics presented include: neglect of family, uncharacteristic reactions to conflicts, increasing inability to deal with numerous stresses of the workplace, and increasing inattentiveness to procedures.
Does it depict alcoholic relapse well?
It presents the idea that co-workers are unable to identify Dr. Webber’s issue, though it has clearly resulted in various negative consequences. This corresponds to the commonality of co-workers being unaware, sometime for long periods of time, that another individual in the workplace is either abusing a substance for the first time, or has relapsed.
Additionally, the clip shows the inability of Dr. Webber to stop using the substance (alcohol in this case), though he is aware of the negative effects it has on his professional and personal life.
2. Prescription Drug Theft:
(Scrubs, “My Drug Buddy” Season 1) VIDEO http://www.youtube.com/watch?v=uqJQEw14JGk
In this clip, after Percocet pills are reported missing from the hospital, the main character (JD) discovers that they have been stolen by his new girlfriend (Alex), who is a hospital social worker addicted to the drug.
Does the clip work to realistically portray who drug abusers are and what their motivations are?
This clip identifies drug addicts as everyday people, possibly even “someone you thought you could really like”, as JD states. It also touches on the idea that it is difficult to identify a drug abuser from surface observation by portraying the addict as an attractive and successful medical professional.
Also, the show spends sometime on the rationalization of the drug dependency, citing topics such as high levels of stress in the workplace, and the ability to control the dependency (“It’s not like I have a problem!).
Finally, to address the problem, JD advises the drug abuser of resources and people to contact concerning getting help, but this is as far as he goes.
In your opinion, does JD handle the situation well? If not, how might you handle this type of situation differently?
3. Intervention
Group of co-workers and professional superiors assemble to conduct an intervention for Dr. Carter, who is addicted to painkillers.
Does the clip depict the intervention realistically?
It depicts the arguments commonly encountered when confronting drug addicts (such as denial of a problem, arguing that it can be controlled, and defensive anger). The clip also mentions treatment methods, such as inpatient treatment facilities.
However, the clip doesn’t involve any professional assistance in the intervention, which is usually encouraged to make the intervention as effective as possible.
4. Medical Drug Abuse in the News
ABC Report: VIDEO http://a.abcnews.com/Health/story?id=8375255
This news report covers the recent medical drug abuse of a strong sedative substance named Propofol.
The report shows the extremely potent nature of the drug by demonstrating the ability of the sedative to stop breathing in a sedated patient.
Also, the report interviews a formerly addicted nurse anesthetist, who describes the drugs as a solution to her emotional and physical pain. This works in tandem with the research posted in other entries concerning the prevalence of drug abuse in high stress medical specialties.
However, the special report does include a notion of the public stigma associated with medical drug abuse; that being the idea that health care professionals should “know better” than to abuse the drugs they understand so well.
Is it justifiable for the public to feel this way about medical substance abuse?
Other Opinions...
Take a look at this video to see what Reba Moyer Childress, MSN, RN, APRN-BC, FNP, Assistant Professor of Nursing, Director-Clinical Simulation Learning Center, has to say about substance abuse among healthcare professionals: VIDEO http://www.youtube.com/watch?v=dbhREQQZglQ
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