MARGARET THOMPSONMARGARET THOMPSONPMHCNS –NP, BCPMHCNS –NP, BC

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

To feel good

To do better

Because everyone else is taking them

Curiosity

Experience of pleasure / award

Involved in reinforcement of basic instincts

Drugs / intoxicants over-stimulate this system

The award system if modified

Memory systems are modified

Higher brain functions are impacted, resulting in behavior of addiction

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

Usage despite adverse consequences

Compulsion to seek and consume Loss of control in limiting intake

Emergence of a negative emotional state in the absence of the drug

Tolerance

Withdrawal

Legal Problems

Black Outs

NursesPsychologyCounselorsPhysiciansDentistryPharmacyChiropractorOther Health Professions

Same Prevalence as the General Population

Inability to Practice

State Monitoring Programs

Providers well-being affects safety of the community

High level of denial

Difficulty with self-observation

Fearful of the consequences on professional lives

Taught to feel Unique – “grandiosity”

Long work days Fatigue Problems balancing career and

family Low self esteem Emotionally charged patient

situations

Control Issues Increased risk of becoming

cross addicted Death and Illness are ever

present Staff Shortages / Mandatory

overtime Unnatural work shifts

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

BurnoutCompassion 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

Professional Risks - Physicians

Final decision maker Medicine often dictates workaholics

Sense of control Ego

Professional Risks - Physicians

Training that workplace is sacred

Office / hospital last place that addiction manifests itself

Hospital setting remains protected

The Medical Marriage

Professional Risks - Physicians

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

Denial Family Secrets Maintain image of stability Loyalty Motivation Rationalization Ultimatums

Humanistic and Caretaking Missions Dedication / Commitment Common bond Alignment – Extended Family Shared Experiences Secrets unknown to laymen Graveyard Humor

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

Appearance

Absenteeism

Difficulty concentrating

Confusion

Memory problems

Lability of mood / Irritability

POOR DOCUMENTATION RELATED TO WASTING / ADMINISTRATION

UNOBSERVED WASTE WITHOUT SIGNATURES

ERRORS IN ADMINISTRATION

EXCESSIVE WASTE, SPILLAGE, BREAKAGE OF CONTROLLED SUBSTANCES

Signs out more controlled drugs then anyone else

Volunteers for additional shifts and work on unfamiliar units

Medicates other’s patients while they are on break

Patients being cared for report ineffective efficacy of pain medications

Seeks out MD on Duty for Personal Complaints of Pain

Doctor Shopping

Always Uses IM or IV and Maximum Dosages

Diversion

Possession

Possession

SaleSale

Manufacture

Manufacture

Distribution and Trafficking

Distribution and Trafficking

ForgeryForgery

Prescription Fraud

Prescription Fraud

Tool to assist prescribers in making more informed dispensing decisions

Law enforcement - assists with investigations of drug abuse and diversion

Covers schedule ii-iv controlled substances dispensed prescriptions

24/7 access within minutes

Thorough assessment Specialty treatment Aftercare Monitoring High accountability

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

Contract Abstinence Practice Restrictions Individualized drug screening

protocol Peer monitoring 12 step meetings Caduceus