Drug addicted nurses

Rascal1 · Apr 1, 2009

I am a pickle, I was a cucumber once a long time ago. I am guessing that a lot of us on this board thought someone had stolen their story when they read Longhorn's post. I can tell you that I identify and it takes me back to when I had three years clean; I will celebrate one year clean this month. I had the same reservations, the same excuses, and I really really believed that my brief stint with diversion and using "pharmaceutical heroin" was over. I am sad to say that it was that kind of thinking, that denial, and that feeling that I had "graduated". Today I know I am powerless. I know that I am an addict. They say that relapse is not a requirement, but for this addict it was. It was the truth hitting me smack in the face. If you have never needed drugs so badly that you would risk your life and your career, do anything to get more, then you might not have a problem. But if you are like me, then you know deep down, if you allow yourself to be open, honest and willing, that you can neyver go back to being a cucumber. I like pickles!

Yes !! ... Pickles are great !! This recovery business is really an eye opening experience and I'd never want to be a cucumber again. The love and compassion that is so abundant in "the rooms" helped me when I could'nt help myself.:heartbeat

Magsulfate, BSN, RN · Apr 1, 2009

I was told once by a CDC that he felt my disease of opiate addiction was "in remission". I believe that. It needs to be checked on and monitored, it is always a part of my life, it effects choices I make every day, but I don't let it dominate my daily life. I guess I don't like the label, the stigma, the person I had become as an ADDICT. I am back to the same person I was before I ever took a lortab. Mom to my kids, wife to my husband and a servant to my Heavenly Father. I may not agree with all that is offered here but I am a sponge and learn from what you all have to say. Thanks so much.

There is one thing you will never be again, and that is: you will never be the same person you were before addiction. Until you've realized this, your recovery is .... What I would describe as being on "thin ice".

Exactly how do you "monitor" your recovery if you are cured??? You can't.

Rascal1 · Apr 1, 2009

There is one thing you will never be again, and that is: you will never be the same person you were before addiction. Until you've realized this, your recovery is .... What I would describe as being on "thin ice".
Exactly how do you "monitor" your recovery if you are cured??? You can't.

Well, I would have to disagree with this thought. I am once again the daughter,sister,mother and friend to those I left behind,while" I was away" . Because I WAS taken hostage by that sneaky,slimy,blood thirsty disease of addiction. Whose ugly existence made my life an unbearable living hell. My gratitude grows in leaps and bounds for the chance to have a wonderful new lease on my life. Vigilance is my new "best friend". And what were those other great adjectives you used to describe this monster ? That was perfect !! :yeah:

jackstem · Apr 1, 2009

Well, I would have to disagree with this thought. I am once again the daughter,sister,mother and friend to those I left behind,while" I was away" . Because I WAS taken hostage by that sneaky,slimy,blood thirsty disease of addiction. Whose ugly existence made my life an unbearable living hell. My gratitude grows in leaps and bounds for the chance to have a wonderful new lease on my life. Vigilance is my new "best friend". And what were those other great adjectives you used to describe this monster ? That was perfect !!

First, let me say I appreciate everyone's kind words. A book? I'd need to have one hell-uv-an editor and a lot more discipline than I actually have at the present time.

Rascal, I don't think anyone is denying that you have regained much of the pre-addiction "you". The disease which was triggered as a result of your genetic predisposition, exposure to the right substance, for the right amount of time and under the right circumstances has caused permanent alterations in the Mesolimbic System (sometimes called the "pleasure center"). This area is the most primitive part of the brain and is responsible for our "instinctive" drives (those activities that generally promote reproduction and survival). A great example of this is a newborn's ability to breast feed immediately after birth. In 99.9 % of the babies born, none of them have to be taught how to suck. Babies cry when they are hungry, not because someone taught them, but because it's programmed into the mesolimbic system. When a mother is breast feeding, simply hearing a baby cry triggers the flow of milk. Cover a person's mouth and nose and they will fight with anything and everything they've got. So, when an addict goes "cold turkey" and begins to experience withdrawal, the brain begins to focus all of it's activity on "survival". The brain of someone with active addiction BELIEVES IT NEEDS THE DRUG TO SURVIVE! This is why people begin to do things outside their character, like stealing, prostitution (I'd go broke if I had to do that to survive!), diverting from the workplace, driving under the influence, etc... to obtain and use their drug of choice (just like the individual who can't breath will do ANYTHING AND EVERYTHING to get what it needs to survive...oxygen).

When our brains respond to an activity that is perceived as "good" (i.e. the activity promotes survival or reproduction) it rewards itself by producing a jolt of dopamine in the mesolimbic system. This jolt produces a "memory" at a subconscious level which is designed to make us repeat that activity.

In a person who takes a mood altering substance, it causes the brain to release dopamine, or it directly stimulates dopamine receptors in the mesolimbic system causing euphoria, a sense of "mellowness", or an increased awareness and energy. In the brain of a genetically susceptible person, this release of dopamine is hundreds if not thousands of times more intense than in a person without the gene (and the substance or activity a person calls their "drug of choice" is the trigger that get's the ball rolling). The dopamine receptors may be more sensitive to the direct effects of the drug meaning the same huge overresponse happens. This exagerrated response to mood altering substances almost guarantees the person will repeat the ingestion of the substance (or the activity) that triggered the response. This explains why gambling, eating, sex, shopping, etc. can trigger addiction. I remember reading a research paper that looked at those who over-eat. They discovered that the act of swallowing triggers a release of dopamine in the mesolimbic area. So it makes sense that in an individual with a genetic allele (an alternate version of a gene) specific to swallowing has that over-response when eating. For me, it was opioids, for some it's alcohol, others may respond to cocaine or meth.

So...what does the have to do with not being the same person you were before your addiction became active? It means that the changes in your brain that drive your craving and obsessive use never completely recover. Studies using PET scans and functional MRI's have shown the areas that "light up" when a mood altering drug is ingested. When they light up, your brain begins to go into overdrive requiring you to use the drug (a compulsion) if you have it, or to get the drug (craving) and use it if you don't have it.

It takes 18 - 24 months for the brain to recover as much as possible. But even after 2 years of abstinence, those areas are not back to their pre-addiction state. These areas can be stimulated by cues; the sounds, sites, smells, tastes, or activities/places associated with drug use. Even in person's with over 20 years of documented sobriety, had these areas of the brain light up when exposed to cues specific to them. And the really interesting discovery was most of the people weren't aware of the stimulation of these areas. This means that the process of relapse can be started and develop momentum before the recovering person is aware it's happening. As these areas respond more strongly with repeated or prolonged exposure to cues, the thought patterns and decision making abilities of the individual become distorted, which leads to behavioral changes, which lead to using mood altering substances or activities...our ever-present companion named RELAPSE. This is why surrounding yourself with recovering people who know you when you're clean and sober is so important. It's why you continue going to meetings for the rest of your life. Since we might not be aware of the early signs and symptoms of the relapse process (behavioral changes, decline in work production, and distorted thinking), we need to have people who can recognize them and who will call it to our attention.

Early in my recovery I had a difficult time using public restrooms because that's where I did a lot of my shooting up. I would actually get flushed, sweat, tremble and get nauseated. I gave a lecture to my old anesthesia department at the hospital I worked at when my addiction became active. I hadn't been in that hospital since January 16, 1991. That was the day I was fired because of a dirty urine. When I entered the hospital and passed the halllway where the lab was, I became flushed, broke out in a sweat and had a slight twinge of nausea. That's after 14 years of continuous recovery!!! Needless to say I was a little rattled by the experience.

Recovery is an active process. Terence Gorski ("Staying Sober" author and a leading expert in relapse prevention) describes it well:

Recovery is like walking up a down escalator. The escalator is the disease, walking is your recovery program. The harder you work at it, the higher you climb on the escaltor. Once you get to the top of the escalator it takes less effort to remain there, but you have to keep walking to remain in the same place. Stopping not only prevents you staying at the top (remission), it means the escalator will take you down (RELAPSE!), which is exactly what happens when we get complacent in working our program.

We all have done this. We get healthy, things in our life improve and we begin to think we're going to be OK. We start decreasing our meeting attendance, we stop reading and studying about the disease. We do what humans do...we get complacent! One of the best ways to prevent that complacency is to sponsor newcomers. By working with someone so new to recovery, we can see where we were at one time. By sharing our experience, strength and hope with other recovering people...especially newcomers, we strengthen our own program. I see it as working out...the more I do it, the more "in-shape" I become. If we stop working out, we begin to become "out of shape". And we all know it takes less time to become out of shape than it does to get into shape.

Here's one last sobering thought (pun intended). The first sign of relapse in a large number of recovering health care professionals is death from an overdose (because of the access we have to very potent medications). Death is the only "cure" for this disease. We don't want you (or any addict) to be "cured". We want you to recover (or remain in remission if that sounds more positive. Recovery = Remission)!!

I'm not the same person I was before my addiction...I'm a BETTER person...and so are YOU!

Lot's of love and hugs from Cincinnati!!!

Jack

nxtgr8RN · Apr 1, 2009

I am a student at a local community college and just received my ADN program acceptance yesterday. I start the program in August. My problem is that I have been in a methadone treatment program since January and with my acceptance into the program comes a drug test. Does anyone know for a fact if this is tested for. I was told most places do not test for it because the test is so expensive but don't know how true this is. Help!

longhornfan1 · Apr 1, 2009

I think the standard drug test check for the top 5 drugs or their metabolites. Opiates, Amphetamines, Marijuana, Cocaine and PCP. Google 5 drug urinalysis. Will give you info on times to metabolize out of your system too. But if you have a program and documentation, that should cover you. Also, you need to disclose your treatment to your Dean of the nursing program. Drug treatment has to be disclosed to the state BON when you submit your application to sit for boards. Be completely honest with all your instructors. I was allowed to finish my 4the semester of my RN program while participating in TPAPN. I was assigned extra work, extra care plans, and several of the instructors were openly judgmental, but I passed with a 4.0 that semester and finished clinical without incident. I was informed, however, that they were revising the admissions contract to include stipulations which would exclude anyone participating in a recovery program. I thought I was an outstanding example of how TPAPN is designed to work, allowing nurses to recover instead of punished, but, my efforts not withstanding, each applicant must be able to work without any restrictions on their ability to practice. I am sure they cleared it with the ADA, but it really sucks for those who are in recovery. Anyway.

subee, MSN, CRNA · Apr 1, 2009

I also believe that you need to "mourn" the fact that you cannot use ANY mood altering substances except under the most tightly prescribed circumstances (surgery, etc). But if you can successfully accept this change into your heart and mind, you can come to peace with it. It MAY be difficult in some social circumstances not to be able to drink but its not necessary to see it as a BAD thing. Its just who you are and its not only alcoholics that can't drink at weddings (you're NOT the only one in the room) but there are entire cultures and religions that frown on drinking. If you can see your brain changes as something that just IS and strip the emotions that come when you finally accept anything that just IS, the blame and shame will be over with. Its a much more peaceful place to be. Good luck. You've still got raw edges. It gets better. Peace.

NeedchangeofPace · Apr 1, 2009

Jackstem said

"Even in person's with over 20 years of documented sobriety, had these areas of the brain light up when exposed to cues specific to them. And the really interesting discovery was most of the people weren't aware of the stimulation of these areas. This means that the process of relapse can be started and develop momentum before the recovering person is aware it's happening."

Don't I know...I was 23 years into sobriety and was having some major issues at work. I was on a mini-vacation and found myself sitting at a bar and had ordered a double VO on the rocks and I just stared at it for the longest time, I started to shake, sweat and was just very very uncomfortable to say the least. I was going through a mental list of pros and cons of why I was sitting there. After about 5 intensive minutes of should I? Just One? I will be okay later,one wouldn't hurt........and a few serenity prayers, I paid the bartender tipped him $10 got up and left and found a meeting.......got back on track, but it was close.

Carlos Santana performed a song, "Put Your Lights On, it goes (in part):

Written by E. Schrody

There's a monster living under my bed

Whispering in my ear

There's an angel, with a hand on my head

She says I've got nothing to fear

There's a darkness deep in my soul

I still got a purpose to serve

So let your light shine, into my hole

God, don't let me lose my nerve

Lose my nerve

.....it ain't easy some days........

Mark

jackstem · Apr 1, 2009

Amen, Brother!!!

jackstem · Apr 1, 2009

I like your screen name nxtgr8RN :up:

FirstLab is one of the leading laboratorys for recovery monitoring. They say this about "routine" drug screens for "wellness" programs:

"Standard urine drug testing panels range from five to 10 drugs. Specimen validity testing is available to detect adulterants or specimen substitution resulting from a donor’s attempts to mask drug use. Expanded profiles for medical professional monitoring are also available."

They have information regarding all of your questions about testing. You can browse their site or contact them for more information. I'm sure there are other labs as well but LabCorp is the one I see monitoring 95+% of the clients I have contact with. They have a FAQ regarding toxicology, another for Web Tools that allow clients to track the process of their specimens, view chain of custody forms, etc. (No...I receive no "kickbacks" from LabCorp).

Now for the "tough part". First the disclaimer: I am not an attorney so none of this should be considered legal advice.

I've teamed with a nurse attorney in my area to produce a series of workshops for nurses. We did our first one this past Monday evening. Her topic was "2009 RN Renewal Application and the Ohio Board of Nursing". There were several questions on how to answer some of the questions on the renewal application regarding past legal actions and their potential impact on 2 specific things...ability to obtain/renew a nursing license and the ability to take the NCLEX exam (bottom line, you have to be elligible to obtain your nursing licnes to take the exam). After listening to her presentation and the Q&A that followed, I strongly recommend you consult with an attorney who specializes in administrative law and is experienced in dealing with the board of nursing where you will obtain your nursing license. (The American Association of Nurse Attorneys)

She said she has had a sharp increase in phone calls and clients who have graduated from a nursing program only to discover they were ineligible for the NCLEX exam. These clients were extremely angry (with good reason) that they didn't find out about this ineligibility BEFORE they took out student loans and completed the program. Not every case fits a cookie-cutter form, so what happened to one individual with a similar situation may have an entirely different outcome than the other individual. I know many, many nurses balk at hiring an attorney for licensure and board of nursing issues because of the expense of legal fees. "I can't afford an attorney" is the most common refrain.

Consider this: Can you afford to rack up significant debt for a degree you can't use because you can't obtain a license?

As health care professionals, we have to know and understand the laws that allow us to practice our profession. Since a non-lawyer won't know the intimate details of the laws, a conscientious professional seeks consultation for input to make appropriate decisions about practicing our chosen profession legally, responsibly, and ethically. We consult nurse specialists, physicians, pharmacists, and other health care professionals in order to practice clinical nursing. We should do the same when our practice involves legalities. Most MDs, RPhs, DDs, etc. would never consider representing themselves before their licensing board. Most nurses do just that. They only contact an attorney when things don't turn out as expected. Many times that's too late!

My final thought, and I don't want you take this the wrong way...I think the fact that you are in the process of recovering from this ugly disease has the potential to make you a better nurse. But, I'm not aware of any board of nursing that will allow an RN to practice while in a methadone maintenance program. Every monitoring contract I have ever seen specifically states a recovering nurse may not return to clinical practice while on opioids, benzodiazepines, barbiturates, etc.There is even a growing trend in which nurses who are receiving mood altering substances for a medical condition are placed on medical leave until the condition is resolved and the medication is no longer necessary (AND the nurse is no longer taking the medication).

Again, I urge you to consult with an attorney familiar with nursing law and dealing with these issues before the licensing board in your planned state of licensure!

I wish you luck and congratulate you for dealing with your chemical dependence! :up: :wink2:

Jack

iloveclay · Apr 2, 2009

I know I will be in the minority here but I need to tell my story. I was fired from my job in Sept 11, 1986 for drug diverting. I was taking Tylenol w/codeine. I went to tx the next day for 2 weeks and then to long term treatment 500 miles from my home. Talk about an adjustment. I felt like I was going to the end of the earth. I went on to find a job as a DON in a small nursing home. My nursing licence was suspended in 1988. I then decided to return to college and received a bachelor's degree in mechanical engineering. I attended AA meetings and had a sponser. I graduated in 1993 and moved back home.

While I was in college I had, what I was to later find out were mood swings. In 1996, I went to see a psychiatrist who diagnosed me with depression and put me on an antidepressant. Unfortunately I was misdiagnosed. I continued to have mood swings, crying spells with no reason for them. I had a good job, a new car, a great family and yet I was still unhappy.

I continued on this route til I saw a psychiatrist who diagnosed me bipolar and got on Lithium and Depakote and am now well controlled. I must interject that I was not using nor drinking alcohol but I was up and down til 2003. Haven't used anything since 1986.

I am doing really well and occasionally have a glass of wine or a beer. I have been prescribed pain med for 2 hip replacement surgeries. Oh, and no meetings.

I really don't consider myself an alcoholic or drug dependent. Maybe others would argue but I know myself and how I feel today and I have no urges to use drugs to deal with anything.

I'm not sure what others think but I know myself and I know that 23 yrs ago I was having some personal issues and it was just the start of my mental health issues that went on undiagnosed for a number of years. My psych doc says I was using to make up for the messed up nuerotransmitters in my brain.

Rascal1 · Apr 2, 2009

With regard to iloveclay's post, it becomes so apparent how vastly different our circumstances may be that drive some of us "to drink". But then can there be those who become addicted because it feels, they have repeated use... and then bam...the genetic switch is flipped ?

And those same individuals are not seeking a coping mechanism either consciously or subconsciously. For me, the theory I hold for myself is that , #1. My usage began as a coping mechanism for underlying difficulties,both conscious and subconscious ones. #2. There was sufficient exposure for my genetic makeup to become triggered. Thus, I know for a fact,that I can never drink again,ever. :twocents: