Drug addicted nurses

jackstem · Mar 30, 2009

Thank you for sharing so much of yourself and your confusion in this post. I know it's never easy to do that, but I have found the more I share my story the less power my addiction(s) hold over me.

You describe a story that is repeated day after day in this country and most others on this planet.

There is a growing body of knowledge about the pathophysiology of this disease called addiction. More and more studies are pointing to the genetic "predisposition" for the development of the disease, as seen with so many other chronic, progressive, potentially fatal diseases (heart disease, certain cancers, diabetes, etc.). When someone with the genetic potential is exposed to the right substance, in the right amount, for the right amount of time, under the right circumstances, addiction occurs. The disease is preventable, by not using mood altering substances. Since that is pretty unlikely, especially in a culture in which the use of mood altering substances is so intimately interwoven. The use of alcohol is seen in religious ceremonies, major life events such as weddings, divorce, funerals, birthdays, new jobs, new house, new babies, graduation, sales meetings, sporting events, etc. Children are trying the drugs they find in their parents and grandparents medicine cabinets. People use alcohol and other substances to go to sleep, wake up, relax at the end of a "hard" day (aren't most days "hard"?), and to perform better (look at all the energy drinks).

For a majority of the population, these substances can be used "socially" without significant adverse consequences (other than an occasional hangover). For 10-20% of the population addiction will occur.

GENETICS + EXPOSURE = ADDICTION

Onset and prgression appears to be tied to potency and availability. The less potent substances like alcohol, marijuana, and the "weaker" opioids like codeine and propoxyphene may be abused for years before addiction develops. For the more potent substances like "crack" cocaine, crystal meth, and my drugs of "choice" (what an ironic term since addiction is loss of control and the ability to "choose" to use or abstain) fentanyl and sufentanil. For me, I went from first IM injection of fentanyl to almost dead, using sufentanil in a little over 5 months.

Addiction never gets better on its own. The longer we wait to obtain treatment, the sicker the addict becomes. As with any other chronic, progressive disease, early intervention improves the efficacy of treatment and the likelihood of long term recovery. Delayed treatment allows greater pathology to occur making treatment more difficult and less likely to result in prolonged recovery.

The brain is altered physically and chemically by the chronic epxosure in increasing amounts of mood altering chemicals AND the genetic makeup of the addict. Once the disease has been triggered, there is no "going back". As one recovering friend says there are cucumbers and pickles in this world. Once a cucumber becomes a pickle, it can never be a cucumber again.

In order for recovery to occur, abstinence is required. It takes approximately 18 - 24 months of abstinence for the brain to recover to the it's fullest extent. Since the brain never returns to it's pre-addiction state, there is always the possibility the active form of the disease can be reignited by cues. These are physical, emotional, situational, and environmental "things" the brain has associated withe the use of mood altering subsances or activities. When these cues occur the areas of the brain associated with pleasure, the areas where the drugs cause their effects are activated, leading to alterations in thoughts and feelings focused on drug use (euphoric recall). These cues and the activation of the brain can be at a subconscious level for the addict. While they may not be consciously noted, they can begin the cascade wich starts the relapse process which will end in chemical use again unless the signs are recognized and the addict uses their tools of recovery to stop the process. This is why lifelong, daily efforts are required to keep the disease in remission.

For the best description of this whole process I highly recommend the book "Staying Sober" by Gorski and Miller. It also has an accompanying workbook. If you want to really get the answer to most of your questions, get this book and read and reread it.

Prayers and hugs from Cincinnati!

Jack

Magsulfate, BSN, RN · Mar 30, 2009

I don't know the true answers to your questions.

From what you have written, my life experience is a lot like yours. Alcoholic father, bipolar- schizophrenic chronically depressed mother, baby at 15.....lortab to dilaudid,, tpapn,, .......

I could care less about a beer, or a margarita, or any other alcoholic beverage. They make me feel drunk, and I hate that.

I stay far away from any and all narcotics. It's funny that it took about a year, but I don't physically hurt anymore. I don't need pain killers, not even advil. All those years that I was taking hydrocodone, I really didn't need it. It was the drug that was making me hurt all the time.

I have been sober since October 9th 2006. Doesn't seem that long ago when I type it. But in my mind it has been forever. Because that is when I finally woke up and my life finally began.

I think to myself how lucky I am when I look around and I have my family, I have my home and all the material things in it. I have a good job and friends,, and the ability to get a new job and make the awesome money that I make. I never thought I would be so happy just sitting and looking around. I have never been so thankful in my life, about life,, than I am now.

I don't know how to answer your questions. I wish I did. I just know that I stay away from narcotics, because that is what almost cost me my life.

Magsulfate, BSN, RN · Mar 30, 2009

There, what he said.

:)

I knew jack would have an answer.

Thank you for sharing so much of yourself and your confusion in this post. I know it's never easy to do that, but I have found the more I share my story the less power my addiction(s) hold over me.
You describe a story that is repeated day after day in this country and most others on this planet.
There is a growing body of knowledge about the pathophysiology of this disease called addiction. More and more studies are pointing to the genetic "predisposition" for the development of the disease, as seen with so many other chronic, progressive, potentially fatal diseases (heart disease, certain cancers, diabetes, etc.). When someone with the genetic potential is exposed to the right substance, in the right amount, for the right amount of time, under the right circumstances, addiction occurs. The disease is preventable, by not using mood altering substances. Since that is pretty unlikely, especially in a culture in which the use of mood altering substances is so intimately interwoven. The use of alcohol is seen in religious ceremonies, major life events such as weddings, divorce, funerals, birthdays, new jobs, new house, new babies, graduation, sales meetings, sporting events, etc. Children are trying the drugs they find in their parents and grandparents medicine cabinets. People use alcohol and other substances to go to sleep, wake up, relax at the end of a "hard" day (aren't most days "hard"?), and to perform better (look at all the energy drinks).
For a majority of the population, these substances can be used "socially" without significant adverse consequences (other than an occasional hangover). For 10-20% of the population addiction will occur.
GENETICS + EXPOSURE = ADDICTION
Onset and prgression appears to be tied to potency and availability. The less potent substances like alcohol, marijuana, and the "weaker" opioids like codeine and propoxyphene may be abused for years before addiction develops. For the more potent substances like "crack" cocaine, crystal meth, and my drugs of "choice" (what an ironic term since addiction is loss of control and the ability to "choose" to use or abstain) fentanyl and sufentanil. For me, I went from first IM injection of fentanyl to almost dead, using sufentanil in a little over 5 months.
Addiction never gets better on its own. The longer we wait to obtain treatment, the sicker the addict becomes. As with any other chronic, progressive disease, early intervention improves the efficacy of treatment and the likelihood of long term recovery. Delayed treatment allows greater pathology to occur making treatment more difficult and less likely to result in prolonged recovery.
The brain is altered physically and chemically by the chronic epxosure in increasing amounts of mood altering chemicals AND the genetic makeup of the addict. Once the disease has been triggered, there is no "going back". As one recovering friend says there are cucumbers and pickles in this world. Once a cucumber becomes a pickle, it can never be a cucumber again.
In order for recovery to occur, abstinence is required. It takes approximately 18 - 24 months of abstinence for the brain to recover to the it's fullest extent. Since the brain never returns to it's pre-addiction state, there is always the possibility the active form of the disease can be reignited by cues. These are physical, emotional, situational, and environmental "things" the brain has associated withe the use of mood altering subsances or activities. When these cues occur the areas of the brain associated with pleasure, the areas where the drugs cause their effects are activated, leading to alterations in thoughts and feelings focused on drug use (euphoric recall). These cues and the activation of the brain can be at a subconscious level for the addict. While they may not be consciously noted, they can begin the cascade wich starts the relapse process which will end in chemical use again unless the signs are recognized and the addict uses their tools of recovery to stop the process. This is why lifelong, daily efforts are required to keep the disease in remission.
For the best description of this whole process I highly recommend the book "Staying Sober" by Gorski and Miller. It also has an accompanying workbook. If you want to really get the answer to most of your questions, get this book and read and reread it.
Prayers and hugs from Cincinnati!
Jack

Magsulfate, BSN, RN · Mar 30, 2009

thank you for sharing so much of yourself and your confusion in this post. i know it's never easy to do that, but i have found the more i share my story the less power my addiction(s) hold over me.
you describe a story that is repeated day after day in this country and most others on this planet.

sad, but true. i agree that you need to share your story to help in your recovery. i also believe that we, as recovering healthcare professionals have a responsibility to advocate and support our brothers and sisters in recovery. after all, if we don't do it, who will?

there is a growing body of knowledge about the pathophysiology of this disease called addiction. more and more studies are pointing to the genetic "predisposition" for the development of the disease, as seen with so many other chronic, progressive, potentially fatal diseases (heart disease, certain cancers, diabetes, etc.). when someone with the genetic potential is exposed to the right substance, in the right amount, for the right amount of time, under the right circumstances, addiction occurs. the disease is preventable, by not using mood altering substances. since that is pretty unlikely, especially in a culture in which the use of mood altering substances is so intimately interwoven. the use of alcohol is seen in religious ceremonies, major life events such as weddings, divorce, funerals, birthdays, new jobs, new house, new babies, graduation, sales meetings, sporting events, etc. children are trying the drugs they find in their parents and grandparents medicine cabinets. people use alcohol and other substances to go to sleep, wake up, relax at the end of a "hard" day (aren't most days "hard"?), and to perform better (look at all the energy drinks).

as always, jack defines addiction so effortlessly and well. i couldn't have explained it better.

for a majority of the population, these substances can be used "socially" without significant adverse consequences (other than an occasional hangover). for 10-20% of the population addiction will occur.
genetics + exposure = addiction
onset and prgression appears to be tied to potency and availability. the less potent substances like alcohol, marijuana, and the "weaker" opioids like codeine and propoxyphene may be abused for years before addiction develops. for the more potent substances like "crack" cocaine, crystal meth, and my drugs of "choice" (what an ironic term since addiction is loss of control and the ability to "choose" to use or abstain) fentanyl and sufentanil. for me, i went from first im injection of fentanyl to almost dead, using sufentanil in a little over 5 months.

jack is so eloquent with his words when he describes this, i'm voting for a book. a new addiction book by jack. we need to save these posts for future reference. jack, when you become rich from writing your books, you won't forget us little people will you?

addiction never gets better on its own. the longer we wait to obtain treatment, the sicker the addict becomes. as with any other chronic, progressive disease, early intervention improves the efficacy of treatment and the likelihood of long term recovery. delayed treatment allows greater pathology to occur making treatment more difficult and less likely to result in prolonged recovery.
the brain is altered physically and chemically by the chronic epxosure in increasing amounts of mood altering chemicals and the genetic makeup of the addict. once the disease has been triggered, there is no "going back". as one recovering friend says there are cucumbers and pickles in this world. once a cucumber becomes a pickle, it can never be a cucumber again.

i'm a cucumber. all of us recovering addicts are cucumbers. this is one of the first analogies that someone told me during recover that actually hit home. we can never go back to the person we were before addiction.

but you are here now, recovering, and asking questions about your addiction. this is good. maybe you're like me, and you knew all along, deep inside, that you could never go back. i require constant support from my peers and i advocate for other recovering nurses who need help. it keeps me in check, and i never forget i'm a cucumber.

in order for recovery to occur, abstinence is required. it takes approximately 18 - 24 months of abstinence for the brain to recover to the it's fullest extent. since the brain never returns to it's pre-addiction state, there is always the possibility the active form of the disease can be reignited by cues. these are physical, emotional, situational, and environmental "things" the brain has associated withe the use of mood altering subsances or activities. when these cues occur the areas of the brain associated with pleasure, the areas where the drugs cause their effects are activated, leading to alterations in thoughts and feelings focused on drug use (euphoric recall). these cues and the activation of the brain can be at a subconscious level for the addict. while they may not be consciously noted, they can begin the cascade wich starts the relapse process which will end in chemical use again unless the signs are recognized and the addict uses their tools of recovery to stop the process. this is why lifelong, daily efforts are required to keep the disease in remission.

lifelong, daily efforts. i agree. and just try to recognize the 'cues' in your life, so you can steer the addiction and tuck it away before it takes over again.

for the best description of this whole process i highly recommend the book "staying sober" by gorski and miller. it also has an accompanying workbook. if you want to really get the answer to most of your questions, get this book and read and reread it.
prayers and hugs from cincinnati!
jack

longhornfan1 · Mar 30, 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.

jackstem · Mar 30, 2009

There, what he said.
:)
I knew jack would have an answer.

Do you know my ex-wife?

jackstem · Mar 30, 2009

Actually, there is a huge shift that needs to occur in the paradigm surrounding addiction (chemical dependence or substance misuse syndrome if you prefer). One of the reasons we see so many "failures" with the current method of treatment is it's treated like an acute disease rather than what it is, a chronic, progressive disease of the brain that never goes away and the brain never returns to it's "pre-addiction" stage, just as the body never returns to the "pre-diabetes" stage.

Yes, we can get the disease into remission. Yes, we must be ever vigilant and follow our treatment plan (work our program) or we can expect what happens with other chronic diseases in which the paerosn doesn't alter their life style and follow their treatment plan...RELAPSE.

For the diabetic, that includes things like ketoacidosis, diabetic coma, increased infections, coronary artery disease, kidney disease, loss of vision, amputations, and as we are told several times per day on TV and radio...erectile dysfunction!

We know if we wait too long to treat cancer, diabetes, CAD, infections, etc., successful treatment is more difficult, less likely to be as successful as early treatment, have higher rates of relapse, and an increased risk of premature death.

Addiction is no different. Waiting until the signs are so horrible they can no longer be ignored, ineffective "dosing" of "weak" treatments (too short term in an inappropriate setting for health care professionals) with poor follow-up and inadequate monitoring and support. If we treated other diseases this way we wouldn't be surprised by a high failure rate. But because it's OK to stigmatize addicts, withhold payment or pay for inadequate treatment, insist the person return to work prematurely, deny disability insurance (which would allow focus on recovery) and then talk about the person behind their back when the do return, we have the mess we face today.

We have to be the catalyst for this shift in the current paradigm. If not us, who? If not now, when?

Jack

thmpr · Mar 31, 2009

Magsulfate;3534534

"Jack is so eloquent with his words when he describes this, I'm voting for a book. A new addiction book by Jack. We need to save these posts for future reference. Jack, when you become rich from writing your books, you won't forget us little people will you?"

Yes, I would like to know if I may be added to the list to purchase a copy of this book by Jack?

Rascal1 · Apr 1, 2009

Do you know my ex-wife?

Maybe Mag and Jack could co-author a best selling "how to" book for health care professionals about getting the right help one needs !!! How about it ? :wink2:

Magsulfate, BSN, RN · Apr 1, 2009

Jack can do all the fancy statistics and big words....

I can do the science fiction description of everything Jack says. :)

And yes, Jack, I have your ex wife in my pocket.

bezany · 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 never go back to being a cucumber. I like pickles!

sallyrnrrt, ADN, RN · Apr 1, 2009

:redbeathe

So, I am a recovering addict. I like to think of my addiction as "acute" "in remission" or dare I say it "cured". I never tried a drug until I became a nurse. I didn't take them simply because they were accessable. I took them because my body craved them so intensely that I would stoop to any level to get them. I made my decision making "drug focused". I worked in the ICU and used 10 mg Morphine vials multiple times for post-op patients. When a patient comes out of surgery it is really fast paced. The process of signing out and then wasting each unused drug took precious time away from our critical patients. Why waste 8 mg's of MS when you are going to be giving 2 mg's Q 10 mins immediately post-op. So, you would give 2 mg's and put the vial in your pocket. Then pull it out each time you needed it until the patient was comfortable and stable. Then you would gather your meds, chart the doses and waste the remaining with another nurse. So, one morning when I got home from work, I had forgotten to check my pockets. There it was. 6 mg's of MS. So, I set it aside and planned on taking it back on my next shift. But I had to hide it cause if my family saw it, what would they think. So, it happened over and over again, intentionally, maybe, maybe not. Never used it. It just sat there. I think I was afraid to use it cause what if I had a reaction? Or took too much and my kids found me on the floor unconscious? So, one day, I put it in my hip. I felt like I was energized. I got so much done at home that day. So, after about a month of IM Demerol and Morphine, I had a patient on dilauded. Took the excess drug home........along with an insulin syringe. I must have tried for 30 minutes to find a vein. I can find them blind-folded on my patients, but it is more difficult when your doing it upside down. After another month, I was shooting MS and demerol 4 or 5 times a day. But I did not believe I was an addict. It all started when I was prescribed Lortab after my tonsillectomy. I was more efficient, loving, attentive, and focused when I took opiates. I didn't have to use every day. I was PRN so I would go a week without working and without using. Went on vacation for 2 weeks and didn't have any problems. Came back and worked 1 shift, took some dilauded and used it when I got off. Was called in the next day, I thought to work a shift, and was confronted by the DON, HR and several Admin nurses. I denied using or diverting but said I had partied while on vacation and would probably test + on the UDS. So, ignorant as I was, I submitted the urine and went home totally freaked out. Knew it would be positive and could not begin to imagine what would happen next. Looking back, I should have just quit and dealt with their "suspicions" instead of giving them a dirty drug screen. But I didn't know I had a choice. So, I broke down and told my husband that I was suspected, tested and probably terminated for using. But I didn't tell him what I used or that I was diverting. Told him it was Lortab, but I didn't have a current RX for it. So, when I was terminated and reported to TPAPN, I had to finally tell him what really happened. He reamed me up and down. Not supportive, did not recognize a "problem", just called me a junkie and was ****** that I had potentially screwed my career. So, I have been sober since June 2 2006, the day after I got caught. Been through treatment, meetings and so on. I am working in LTC and have access to Lortab, MS tablets and Roxinal. Do I have cravings or feel compelled to take them? Nope. Did I learn my lesson? Yep. But if you ask the professionals if I am "cured" they say there is "no cure". Once an addict, always an addict. But why? If I never did drugs until they were prescribed. Simply because I am the child of an alcoholic, the sister of an addict and the daughter of an undiagnosed and untreated mother with depression and bi-polar. Since I was molested as a child and my father died when I was 16. Since I slept around during high school so I could avoid the abuse at home and wound up pregnant, had an abortion. Since I dated me twice my age until I met my husband and became a parent. Do all of these characteristic combined with the exposure to and subsequent physical addiction to Lortab define me as an addict for the rest of my life. Does that mean AA and NA meetings forever? Does that mean I can't drink at parties and dinner with friends because I might drink more often that it causes me to relapse to opiates? Someone please explain this to me. All addicts deny the addiction at some point in recovery, but don't people recover from the physical addiction and are strong enough to make the right choices when confronted with similiar situations? HELP Thanks

Bless you I could have almost wrote that some 22yrs. ago...... girlie, my friend, my sister, I do not hear recovery, ie: having worked , working the 12 steps, I heard a lot of excuses, and some resentments, and they may be valid..... But, In my case, and after repeating the above almost same life story over and over and over, every time I THOUGHT I was well..... and without the wonderful help of TPAPN, as they did not exist when I was messing up the first three times..... Finally, thank goodness after getting a GOOD sponsor, one that showed and told me what I needed to hear, rather than what I wanted to hear, I do not know what happened, but it has been 15-17yrs, since I thought of cravings, etc....... I do not know when the miracle, happened, but I do know that my life is better ( you know actually having the skill to do life on life's terms) I do not go to meetings like I use to, but I do go when I need to...... It is a life illness, does, coronary artery disease, hypertension or diabetes, go away just because we have taken care of it on a daily or somewhat regular basis. Your feelings are normal, we all have had them, succeed a time or two drinking at a party, but that is the last thing an addict or alcoholic needs is a few successful bouts of using without problems, geeez maybe that demerol would not hurt or I would not get in trouble this time............ it reminds me of me selling to myself that I could successfully use "this time" as I knew how to work the 12 steps....... honest, that was a line I used on myself in 1987.

I promise if you sincerely try, and work a honest program, in time your life will be better than ever, the resentment, etc.... fades, and you will probably even find some gratitude.....Luv ya kido, hang in there...... :yeah: