Curiosity

SWS RN, ASN, RN · May 8, 2010

It's simple:

John Dillinger was once asked, upon being apprehended, "why do you rob banks"? He answered, "because that is where the money is!"

Same principle: THe Pysis-that is where the drugs are kept!

s

all_over_again · May 10, 2010

I used for over a year before anyone questioned my pyxis transactions.

jackstem · May 11, 2010

Trying to comprehend addictive thinking with logic works no better than trying to understand schizophrenic thinking with logic. There is a great deal of literature available regarding the pathophysiology of addiction. Since the target order of this disease is the brain, it makes sense that the brain's functioning will be altered. The areas involved include learning, memory, judgment, decision making, impulse control, motivation, and rewards. When the disease is active,

it makes sense that we would see alterations in learning (it's why we keep making the same stupid mistakes over and over),
poor (if any) recall of negative consequences
poor decision making, especially when those decisions involve our drug of (no) choice (like taking drugs from a monitored system)
poor impulse control (can't stop the urge to use even when driving , working, etc.)
drugs become the main motivator as the disease progresses (that's why we use instead of going to work, making the birthday party, etc.)
reward seeking, i.e. the effects of the drug or activity overrides the possibility of the "punishment" of the hangover or other negative consequences

The disease alters the brain which alters thinking and behavior. The thinking and behavior becomes more and more focused on obtaining and using the drug. As the disease reaches late stages the person obsessively thinks about their drug...obsessed with obtaining it. Once they have it, they compulsively use it until it's gone and then the cycle repeats in a downward spiral until they enter treatment or die. Very few addicts seek treatment voluntarily since the altered thinking convinces them they don't have a "problem". The potency of the drug determines the speed of progression. Alcohol can take up to 20+ years to reach late stage disease, while fentanyl can take no more than 6 - 12 months, and sufentanil may take only 3 - 6 months!

Jack

Sistermoon · May 11, 2010

Jack, what a wonderful, comprehensive reply! Working on a detox unit over the past 3 years, I've seen my fair share of nurses in recovery. There's nothing quite as tragic, as challenging, as bittersweet and humbling as coming face-to-face with a wounded healer, and seeing your own anguish in their eyes. May God bless us all; there's no such thing as "us" and "them". The organic changes that come with substance abuse can steal voices and the ability to make good choices, but the soul of a caregiver retains its inner beauty forever.

jackstem · May 11, 2010

Thanks! I've lived every part of that response, as have many of us have who visit and share here. If not for the intervention of my Higher Power I'd be dead...twice, actually. I lost my marriage, my career, and almost all of my worldly possessions as a result of this disease. That's why my passion has changed from anesthesia to advocacy for our colleagues who still suffer. It's extremely frustrating and maddening to see the level of ignorance that exists in the profession. Much of it is WILLFUL ignorance. Why do I say that? Because waaaay too many nurses don't seek CEUs to fill in the huge gap in the educational system. And when the opportunity presents itself, very few nurses take advantage of that opportunity. A nurse attorney and I designed 15 workshops for nurses in our area. Despite numerous announcements in newsletters, email to nurses, managers, training programs, etc. ONE person registered...ONE! After canceling the next 5 workshops and increasing our announcements (including on our web sites and blogs), and several press releases with no response, we canceled the remaining series.

As someone once said:

You can lead someone to knowledge, but you cannot make them think!

Working on a guidebook for the profession. It'll be interesting to see what the response will be.

Jack

SWS RN, ASN, RN · May 12, 2010

Once again Jack, BRAVO!:)

I want to buy the FIRST guidebook off the press! :)

sissiesmama, ASN, RN · May 12, 2010

Hello - My name is Anne, and I am an addict. I am an RNC with 19 yrs of experience. This summer, I will be celebrating 11 yrs of sobriety.

I started nursing in 91 and didn't get "caught" until August of 99. I started out getting a script for Ambien while going through a messy divorce. I took one every night and felt hungover the next am. So of course, instead of me taking half, or something like that, I got another MD to order me some Adipex. Started taking a pill every am, and started taking another 5 or 10mg of Ambien in the afternoon because I felt jittery and wanted to fit in a little nap. (I know - brilliant, huh?!)

I started having h/as, so I got yet another MD to order me some Lortab. The same doc saw me in his office and would give me a butt full of Demerol and I drove back home to sleep it off. Those h/as became more frequent, or shall I say the trips to the doc's office to get another shot increased.

When my luck ran out for the docs to keep writing me scripts, I started taking it from work, out of the pyxis. I tried all kinds of things to try not to get caught, pull out a med for a patient and "gibe the med", and tell another nurse later I couldn't find a witness." They would go in with me and witness with me. I got more and more careless as my using increased - but it was harder and harder to cover my actions. I even wrote md phone orders on one of my patients that I had never even called about increased pain and took those increasing doses too. I knew it was really easy to get caught with the pyxis but at that point, just didn't care. Guess I had the mindset, "Oh, I won't get caught. I'm not that stupid." Well, yes I was- thank goodness, because that was what happened to save me from dying of an overdose or running over someone and killing them.

Kind of rambling here, but hope it helps a little.

Anne, RNC

jackstem · May 12, 2010

hi anne,

thank you for sharing your story. congrats on your 11 years! i'm going to go through your post and provide some of my thoughts. none of this is meant with any malice or criticsm in any way. my intent is to illustrate how this disease starts, progresses, and can still lead to pain even after 11 years of being clean and sober. your post is an excellent illustration of how insidiously this disease develops in those with the genetic propensity to develop it. it also illustrates how our negative self talk can slow or impede our prgoress in recovery.

you didn't "choose" to become an addict! your choices were no different than many, many people...health care pro or not. but those choices, along with the ignorance of your health care providers and colleagues (as in lack of education...not the same as "stupid". it always cracks me up when a post is deleted when the word ignorant is used since it's simply a statement of fact...a lack of information or education) actually contributed to the development and progression of the disease.

i started nursing in 91 and didn't get "caught" until august of 99.

this is the only disease i know of where the person with it has to get "caught" instead of diagnosed.

i started out getting a script for ambien while going through a messy divorce. i took one every night and felt hungover the next am. so of course, instead of me taking half, or something like that, i got another md to order me some adipex. started taking a pill every am, and started taking another 5 or 10mg of ambien in the afternoon because i felt jittery and wanted to fit in a little nap. (i know - brilliant, huh?!)

this is similar to the person who starts drinking a little wine to get to sleep, and drinking coffee to wake up in the morning. while for most folks (see the end of the next paragraph) addiction isn't going to happen, it can and will lead to addiction in a certain percentage of people.

looking back at our actions with 20/20 hindsight and beating ourselves up because we didn't "see" that we were making "bad decisions" is common behavior for addicts (and many non-addicts). i'm not talking about the looking back and beating ourselves up (which we do), i'm talking about placing trust in medical science and pharmacology in seeking short term fixes for emotional, behavioral, and/or relational "issues". but that's part of our medical "culture". since managed care has placed a value on getting people in and out to maximize profit, the old model of the family doc (dr. marcus welby is the stereotype) is almost non-existent.

as health care pros we have become very comfortable with the healing power of medications. we see how effective they can be in those we care for on a daily basis. what begins as a short term fix for problems that can't and shouldn't be covered up, in many individuals becomes a major problem. using sleeping aids and "stimulants" (like coffee, colas, the "energy" drinks with tons of sugar and caffeine) to get going in the morning or to prevent the collapse in the afternoon. this prevents us from using healthy ways of dealing with emotional, behavioral, and/or relational issues by seeking the quick fix. for 85 - 90% of the population that might be ok. for the 10 - 15% (or more) of those with a genetic propensity to develop addiction, using chemicals for their short term benefits can be the beginning of the process leading to addiction.

there are some who will read this and poo-poo it as being crazy or going "overboard". yet when you read the research over the past 25 years, its explained very well. the reason so many nurses and other health care pros do this is lack of knowledge, ignorance! i don't know about you, but the training i received about addiction was pretty minimal. what i did get was mostly focused on the bad effects of addiction, not the disease itself. how can you "poo-poo" something you know almost nothing about? gee. our profession does it every day!

i started having h/as, so i got yet another md to order me some lortab. the same doc saw me in his office and would give me a butt full of demerol and i drove back home to sleep it off. those h/as became more frequent, or shall i say the trips to the doc's office to get another shot increased.

this is exhibiting "drug seeking behavior", but consider this, "drug seeking" is what addicts and chronic pain sufferers do when the pain isn't controlled. one pain is physical, the other a combination of physical, emotional, and spiritual! the bottom line is the behavior is the same but we, as health care professionals, see them as the same thing when they aren't. we as a profession have no idea how to respond to the signs and symptoms of 2 very serious diseases...chronic non-malignant pain, and addiction. put the 2 together and it gets even worse!!!!

the person in pain who seeks more medication because their pain is uncontrolled is frequently "diagnosed" (labeled is a more accurate term) as an addict or someone who could become an addict, so we withhold appropriate treatment out of an irrational fear. if they truly do have the disease of addiction, calling them an addict and withholding medication makes no medical sense. it allows them to go looking for another doctor and allows a chronic, progressive, potentially fatal disease to progress. this makes treatment more difficult and long term remission less likely. if you think about it, these are the 2 most common ways the profession approaches chronic pain and/or addiction. not very ehtical or professional in my book.

when my luck ran out for the docs to keep writing me scripts,

"luck" had nothing to do with it. what actually happened was the doctors and your nursing colleagues missed or ignored the signs and symptoms of a 2 chronic, progressive, potentially fatal diseases (chronic pain and addiction).

wait, you say. chronic pain isn't fatal!

well, if the pain isn't adequately controlled it can be fatal either through suicide or an accidental od when the person begins using a combination of prescribed pain meds, otc medications, and alcohol in an attempt to treat the very real pain! that was poorly evaluated and poorly managed. we all know addiction can be fatal, even though it's unnecessarily fatal in most instances.

i started taking it from work, out of the pyxis.

there is no doubt that the line from substance "abuse" to addiction had been crossed at this point. when this occurred can't be determined with any accuracy, but it really isn't important at this point. what is important is you were surrounded by health care professionals and they missed the early signs of addiction! as the addict you weren't going to "see it" because part of the disease process is pathological denial...an unconscious, unhealthy "protective" mechanism that allows the disease to continue to progress. denial can be healthy in situations that overwhelm even the most healthy individuals. but denial that prevents someone from seeing the continuing and escalating negative consequences of their continued addictive disease is anything but healthy...it's pathological and can be deadly!

see, the parts of the brain involved in addiction are also involved in survival and the reflexes involved in survival. this means your brain goes into survival mode. it sees the drug as more important than food, water, sex, even air. so, just like a non-addict will fight tooth and nail to get water or air when they are being deprived, so too will an addict when their "water or air" is cut off. would you break into a store and steal water if you were dying of dehydration? i think so. i think most people would (unless they were so incapacitated that they couldn't).

i tried all kinds of things to try not to get caught, pull out a med for a patient and "gibe the med", and tell another nurse later i couldn't find a witness." they would go in with me and witness with me. i got more and more careless as my using increased - but it was harder and harder to cover my actions. i even wrote md phone orders on one of my patients that i had never even called about increased pain and took those increasing doses too. i knew it was really easy to get caught with the pyxis but at that point, just didn't care. guess i had the mindset, "oh, i won't get caught. i'm not that stupid." well, yes i was- thank goodness, because that was what happened to save me from dying of an overdose or running over someone and killing them.

your final paragraph describes the out of control addictive thinking that arises as a result of the disease progressing, the brain changing and deteriorating, and no one recognizing the signs and symptoms of the disease and taking definitive, intervening actions that the addict can't take on their own! in other words, the health care professionals aren't making the diagnosis and providing the care a very ill colleague and friend needs. not professional or ethical. the reason the "pros" blow this so often and so consistently is the lack of education at all levels of training!

kind of rambling here, but hope it helps a little.

anne, anytime we share our story with another person going through the same garbage we've been through, it helps alot! you are such a wonderful person! much of my thinking was similar to that you so eloquently shared with us in your post. my thinking didn't begin to change significantly until i became a peer advisor and chair of the peer assistance committee for crnas in ohio. as a result of my training for the peer assistance role and the reading, writing, lectures i've prepared and provided, and the discussions with many, many recovering nurses, treatment providers, and those who love the the family/friend/colleague of the nurse with this disease, my thinking (and my recovery) has changed significantly for the better!

recovery is a program that requires lots and lots of hard work and plenty of time. it is also something we have to "do" everyday in order to continue to remain in and strengthen our recovery. you just did that for yourself, me, and everyone else who reads your post.

thank you for being so willing to be open about your journey. :yeah:

jack

KinshuKiba · May 13, 2010

Thanks to all of you for your comprehensive replies. Things do seem more clear to me, and let me say, once again, that it touches and moves me to listen to things you have been through and recovered from

SWS RN, ASN, RN · May 14, 2010

Jack,

Once again, BRAVO, BRAVO, BRAVISSIMO!!!

As always, I learn something new with each of your posts and I feel renewed after reading each one.

I just want to comment on one aspect. I have been a nurse now for 18 years, I did not have 1 minute of education on chemical dependancy vs members of the health profession at the school I attended.

Not 1 minute!!!

Is the curriculum any different now? Gee, I sure hope so! I may not change the (narrow) mind set there is in the profession regarding addiction but maybe education will make a difference.

One can only hope.

jackstem · May 14, 2010

Is the curriculum any different now?

Nope. (Not in very many schools and not to the extent that is needed in the ones that do.

Jack