Nurses for Nurses...

I wish that I could find one of those meetings near me! I'm sure you will learn a lot at these meetings, and get support from other nurses who are in the same boat.

I attended my first "Nurses for Nurses" meeting this week ! There were about ten of us and all referred to theselves as "addicts" and I was the only who referred to myself as an "alcoholic". All or most had problems with their licenses, except for me. I shared about myself ,my struggles,my pain and I felt close to tears. I felt accepted by the group and hope that will continue to be the case. I did fail to find out or ask if there have to be license difficulties in order to attend these meetings. Or does it not matter ? Because I am certainly struggling with employment issues such as how to explain why I haven't worked in all these months. And of course there is the one, "Why did you leave there?" Any thoughts please ?

Alcoholic means you are addicted to alcohol, it;s your "drug of choice". Addiction is a disease in which our brain LOVES the effect of a chemical OR activity to the extent where we begin to seek that feeling over other things. Our brains become altered chemically and physically. These alterations make it difficult to say no to the chemical or activity that makes us feel OK. I strongly recommend that you read as much as you can on the pathophysiology of the disease of addiction. It really helps to understand what's going on in your brain, and why abstinence is an important part of recovery.

The areas of the brain affected and altered by this disease are the most primitive. The function of these areas are basically 2 fold. First, to keep the organism alive...survival. The second is to keep the species alive...procreation.

When a person does something the brain interprets as fulfilling one of these 2 things, it rewards itself with a jolt of dopamine which causes "pleasure" or reinforcement of that activity. Examples include sex (keeps the species alive), eating (keeps the organism alive), and caring for offspring (keeps the species alive), etc. As our species evolves, our brain rewards other activities it interprets as good for itself and the species. Doing a good job at work (it keeps money coming in which pays for food and shelter allowing us to "survive", allowing us to have children, etc).

In a certain number of people, there is a genetic possibility for addiction. In these individuals, exposure to a substance (alcohol, opioids, cocaine, etc.) or engaging in an activity (sex, gambling, shopping, exercise, etc,) specific to them, causes an exaggerated response by their brain. In other words, when I ingest an opioid, my brain releases larger amounts of dopamine in the ventral tegmental area (VTA) of my brain causing euphoria. My brain says "This is wonderful, I must do this again." As I repeat the exposure to this substance under certain conditions, for an appropriate amount of time, and as a result of my genetic makeup, my brain begins to change. Eventually the genetic "switch" is flipped and I move from substance "misuse" (also called abuse) to addiction. Now, my brain believes if I am deprived of my drug of choice it will die. It now sees the use of opioids as necessary to survive. It will do whatever it can in order to get the opioid. Just like we will struggle and fight for every breath of air we now struggle and fight for our next hit or drink (or sexual encounter, chocolate bar, spin of the roulette wheel, etc). If that means stealing money or drugs, then that's what we'll do. If it means driving under the influence in order to buy more alcohol because I just drank the last beer, then I will. If it means having sex with that person at work, even though my spouse is going to leave me if I do...then that's what I'll do.

In the genetically susceptible person, with the right substance/activity, in the right amount, for the right amount of time, under the right ctrcumstances, addiction will occur. It's not about the specific substance or activity...it's the changes in the brain that lead to compulsive use regardless of the negative consequences.

Interestingly, research shows that the areas of the brain used for judgement and learning become less and less active, while the area affected by the substance or activity become more active. This why the addict never seems to learn from their mistakes and always seems to make the wrong decisions.

It takes 18 - 24 months of abstinence for these areas of the brain to recover from the changes occurring while the disease is active. That means it is difficult for the addict to learn new ways of dealing with life in the first couple of years recovery. The most difficult time appears to be the first 90 - 180 days. Alcoholics Anonymous figured this out over the years. This is why they place special importance on the first 24 hours, 30 days, 60 days, 90 days and 6 months and provide recognition and small "rewards" at those times. It helps us stimulate the brain with that reward of being clean and sober foe those time periods.

Unfortunately, the brain of an addict never returns to it's pre-addiction state. PET scans and functional MRI's have demonstrated activity in the VTA of recovering people when they are "shown" cues for their particular addiction, even at a subliminal level. This is in individuals with documented abstinence of 20 or more years! This is why relaxing in our recovery program can set us up for a relapse 20 or 30 years from now. Also disturbing is the activation of the pleasure centers can be belwo the person's level of awareness. An individual shown a cue (a syringe or pipe) subliminally with activation of the VTA may not even be aware of that activity. Even so, repeated exposures to cues can begin to alter the addicts brain until their addictive thinking begins again. Eventually, if they don't recognize the early signs of this altered thinking, they eventually reach the point where using again seems perfectly acceptable. This is called the process of relapse. It's why establishing friendships with other recovering people is an important part of recovery. Rarely does the addict recognize their altered thinking. But their recovering "family" most probably will see it and call attention to it. This helps the addict recognize the problem early and take steps to intensify their recovery program by attending more meetings, talking with sponsors, therapists, and increasing service work. It's also why one of the earliest signs of the relapse process is a decrease in the number of meetings the person attends. After all, I certainly don't want to be around people who would recognize relapse behavior or thinking.

As for having a license problem as a requirement to attend nurses for nurses meetings...it's never been part of any meeting I've attended of the years. But if you hadn't gone through treatment or begun attending meetings, is there any doubt you would have license issues at some point in your career? Attending a nurse group is similar to AA or NA...the only requirement is a desire to stop using AND be a nurse. Sometimes others at a non-professional 12 Step meeting get freaked out when they hear a nurse or doctor say "I did many a case under the influence." (Gee Jack, Ya THINK!?)

I'll tell you what the counselor who helped me "get it"said to me...don't focus on the differences of others at a meeting, notice the similarities. It doesn't matter what your drug of choice was...it's what we did when under the influence of that substance that messed up our lives and the lives of those we love and work with.

Read a book called "Staying Sober" by Terence Gorski/ It's the best overall explanation of this disease I've read to date.

If I can ever help give a yell!

Jack