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The Impaired Health Care Professional “Focus on Addiction”

MARGARET THOMPSON PMHCNS –NP, BC. The Impaired Health Care Professional “Focus on Addiction”. Objectives. Understand the disease m odel of addiction Identity risk f actors for healthcare p rofessionals Review enabling b ehaviors

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The Impaired Health Care Professional “Focus on Addiction”

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  1. MARGARET THOMPSON PMHCNS –NP, BC The Impaired Health Care Professional“Focus on Addiction”

  2. Objectives • 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

  3. Addiction is a Brain Disease

  4. The Basics – “Where the action is”

  5. Why do people take drugs? • To feel good • To do better • Because everyone else is taking them • Curiosity

  6. All drugs of addiction interact with the dopamine system • Experience of pleasure / award • Involved in reinforcement of basic instincts • Drugs / intoxicants over-stimulate this system

  7. The Brain in Addiction • The award system if modified • Memory systems are modified • Higher brain functions are impacted, resulting in behavior of addiction

  8. Progression of Addiction

  9. Other neurotransmitters • Drugs effect other neurotransmitters • GABA • Dopamine • Endorphins • Norepinephrine

  10. Characteristics of Addiction • Chronic relapsing disorder • Progressive - serious detrimental health outcomes. • Characterized by frequent episodes of intoxication / highs • Preoccupation with usage

  11. Characteristics of Addiction • 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

  12. Characteristics of Addiction • Tolerance • Withdrawal • Legal Problems • Black Outs

  13. Denial

  14. High Accountability Concept • Nurses • Psychology • Counselors • Physicians • Dentistry • Pharmacy • Chiropractor • Other Health Professions

  15. Impaired Health Care Practitioners • Same Prevalence as the General Population • Inability to Practice • State Monitoring Programs

  16. High Accountability Concept • 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”

  17. Professional Risks • Long work days • Fatigue • Problems balancing career and family • Low self esteem • Emotionally charged patient situations

  18. Professional Risks • Control Issues • Increased risk of becoming cross addicted • Death and Illness are ever present • Staff Shortages / Mandatory overtime • Unnatural work shifts

  19. Professional Risks • 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

  20. Professional Risks Burnout Compassion Fatigue

  21. One study has shown that up to 80% of nurses come from families with at least one alcoholic member

  22. Professional Risks - Nurses • Highly caring by nature • Caretaking: Highly emotional and draining • Superhero role • Unique draw of profession

  23. Professional Risks - Physicians

  24. Professional Risks - Physicians • Final decision maker • Medicine often dictates workaholics • Sense of control • Ego

  25. Professional Risks - Physicians • Training that workplace is sacred • Office / hospital last place that addiction manifests itself • Hospital setting remains protected • The Medical Marriage

  26. Professional Risks PHARMACOLOGIC OPTIMISM

  27. Professional Risks Self Prescribing Behavior

  28. Professional Risks ACCESS AND KNOWLEDGE

  29. Professional Risks Geographic Mobility

  30. Professional Risks Myth of Immunity

  31. Professional Risks Myth of Entitlement

  32. Enabling… 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

  33. Concepts of Enabling • Denial • Family Secrets • Maintain image of stability • Loyalty • Motivation • Rationalization • Ultimatums

  34. Concepts of Enabling • Humanistic and Caretaking Missions • Dedication / Commitment • Common bond • Alignment – Extended Family • Shared Experiences • Secrets unknown to laymen • Graveyard Humor

  35. CONCEPTS OF ENABLING • Face Uncertainly and Death • Excessive time Together / Long Hours • Professional Family • Membership : Legal Documentation / Licensure • Maintain image of Prestigious Group • Protection

  36. Whatif they end up killing themselves?

  37. FACT: Any Addict is a Potential Suicide

  38. General Indicators of Addiction • Appearance • Absenteeism • Difficulty concentrating • Confusion • Memory problems • Lability of mood / Irritability

  39. Indicators of Addiction in Health Care Providers • Poor documentation related to wasting / administration • Unobserved waste without signatures • Errors in administration • Excessive waste, spillage, breakage of controlled substances

  40. Indicators of Addiction in Health Care Providers • 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

  41. Indicators of Addiction in Health Care Providers • Seeks out MD on Duty for Personal Complaints of Pain • Doctor Shopping • Always Uses IM or IV and Maximum Dosages • Diversion

  42. Legal Considerations Possession Distribution and Trafficking Prescription Fraud Manufacture Sale Forgery

  43. Virginia Prescription Monitoring Program • 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

  44. Treatment Resources • Thorough assessment • Specialty treatment • Aftercare • Monitoring • High accountability

  45. Virginia Health Practitioners Monitoring Program • 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

  46. Treatment Resources • Strong peer group setting • board involvement • Drug testing • Licensure restrictions

  47. Monitoring Components • Contract • Abstinence • Practice Restrictions • Individualized drug screening protocol • Peer monitoring • 12 step meetings • Caduceus

  48. Caduceus

  49. Virginia Dell Cassidy

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