Transcript Addictions in Health Care Providers

MARGARET THOMPSON
PMHCNS –NP, BC
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Understand the disease model of addiction
Identity risk factors for healthcare
professionals
Review enabling behaviors
Recognize behaviors that accompany increasing
Alcohol / Drug usage
Review legal implications and treatment
resources
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To feel good
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To do better
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Because everyone else is taking them
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Curiosity
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Experience of pleasure / award
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Involved in reinforcement of basic
instincts
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Drugs / intoxicants over-stimulate this
system
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The award system if modified
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Memory systems are modified
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Higher brain functions are impacted,
resulting in behavior of addiction
-Impairment of impulse
control
Brain reward system
hijacked by dopamine
Memory functions in limbic
system modified
-Loss of ability to delay
gratification
- Diminished motivation
and goal direction
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Drugs effect other neurotransmitters
GABA
Dopamine
Endorphins
Norepinephrine
 Chronic relapsing disorder
 Progressive - serious detrimental
health outcomes.
 Characterized by frequent episodes of
intoxication / highs
 Preoccupation with usage
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Usage despite adverse consequences
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Compulsion to seek and consume
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Loss of control in limiting intake
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Emergence of a negative emotional state in
the absence of the drug
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Tolerance
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Withdrawal
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Legal Problems
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Black Outs
Nurses
Psychology
Counselors
Physicians
Dentistry
Pharmacy
Chiropractor
Other Health Professions
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Same Prevalence as the General
Population
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Inability to Practice
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State Monitoring Programs
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Providers well-being affects safety of the
community
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High level of denial
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Difficulty with self-observation
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Fearful of the consequences on professional
lives
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Taught to feel Unique – “grandiosity”
Long work days
Fatigue
Problems balancing career and family
 Low self esteem
 Emotionally charged patient
situations
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Control Issues
Increased risk of becoming cross
addicted
 Death and Illness are ever present
 Staff Shortages / Mandatory
overtime
 Unnatural work shifts
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Demands of practice
Lack of time for leisure, family and self
Perfectionism
Excessive dedication to work
Guilt
The beeper and the telephone
Preoccupation and emotionally
unavailable
Burnout
Compassion Fatigue
One study has shown
that up to 80% of nurses
come from families with
at least one alcoholic
member
Highly caring by nature
Caretaking: Highly emotional
and draining
 Superhero role
 Unique draw of profession
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Professional Risks Physicians
Professional Risks Physicians
Final decision maker
Medicine often dictates
workaholics
 Sense of control
 Ego
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Professional Risks Physicians
Training that workplace is sacred
Office / hospital last place that
addiction manifests itself
 Hospital setting remains
protected
 The Medical Marriage
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PHARMACOLOGIC
OPTIMISM
Self Prescribing Behavior
ACCESS AND KNOWLEDGE
Geographic Mobility
Myth of Immunity
Myth of Entitlement
REFERS TO THOSE REACTIONS OR
BEHAVIORS OF FAMILY MEMBERS,
FRIENDS, INSTITUTIONS, OR
PEERS OF ADDICTS THAT SHIELD
THEM FROM EXPERIENCING THE
HARMFUL CONSEQUENCES OF
THEIR ALCOHOL OR OTHER DRUG
USE
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Denial
Family Secrets
Maintain image of stability
Loyalty
Motivation
Rationalization
Ultimatums
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Humanistic and Caretaking Missions
Dedication / Commitment
Common bond
Alignment – Extended Family
Shared Experiences
Secrets unknown to laymen
Graveyard Humor
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Face Uncertainly and Death
Excessive time Together / Long Hours
Professional Family
Membership : Legal Documentation /
Licensure
Maintain image of Prestigious Group
Protection
FACT: Any Addict is a
Potential Suicide
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Appearance
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Absenteeism
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Difficulty concentrating
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Confusion
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Memory problems
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Lability of mood / Irritability
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POOR DOCUMENTATION RELATED TO WASTING
/ ADMINISTRATION
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UNOBSERVED WASTE WITHOUT SIGNATURES
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ERRORS IN ADMINISTRATION
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EXCESSIVE WASTE, SPILLAGE, BREAKAGE OF
CONTROLLED SUBSTANCES
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Signs out more controlled drugs then
anyone else
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Volunteers for additional shifts and work on
unfamiliar units
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Medicates other’s patients while they are on
break
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Patients being cared for report ineffective
efficacy of pain medications
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Seeks out MD on Duty for Personal Complaints
of Pain
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Doctor Shopping
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Always Uses IM or IV and Maximum Dosages
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Diversion
Distribution and
Trafficking
Possession
Prescription
Fraud
Manufacture
Sale
Forgery
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Tool to assist prescribers in making more
informed dispensing decisions
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Law enforcement - assists with investigations
of drug abuse and diversion
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Covers schedule ii-iv controlled substances
dispensed prescriptions
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24/7 access within minutes
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Thorough assessment
Specialty treatment
Aftercare
Monitoring
High accountability
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Legislated in 1998 as an alternative to
disciplinary action
Monitoring services
Operated by Virginia Commonwealth
University department of psychiatry,
under contract with department of health
professions
Eligibility
Nature of impairments
 Strong
peer group setting
 board involvement
 Drug testing
 Licensure restrictions
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Contract
Abstinence
Practice Restrictions
Individualized drug screening protocol
Peer monitoring
12 step meetings
Caduceus