Social Worker Wants Me In an Impaired Nurse Program--I am NOT Impaired

[Mezcalero]

In 10/09 I was hired as a graduate nurse at a fairly large hospital. I was hired into the float pool, which made things even harder since I had to know different procedures for different units, etc. My preceptor operated on mostly negative reinforcement which made my orientation a nightmare. In any event, I made it through on 2/10 and have since been succefully taking care of patient assignments. My supervisor and co-workers seem happy with my work and everything seemed fine. I was always stone-cold sober, on top of my game, and ready for work. I should also mention my PCP prescribed some Xanax and Ambien for me to compare to see what worked best for my chronic insomnia. I chose Ambien and always awoke rested and refreshed for work.

Unfounately, around 3/15 I started acting loopy: driving in for work in the morning when I work the night shift, acting strange during reports, etc. I couldn't understand what was wrong. My night supervisor thought I was on drugs and sent me to the ER for evaluation and a blood draw. As it turns out, I had been hit by a virus (probably at work) that had decimated my kidneys and put me into acute renal failure (ARF). My BUN and creatinine levels were eight times the normal level and there was also damage to the left ventricle of my heart. I was placed in the progressive care unit (PCU), a unit for people who are more critical than those on a med-surgical floor.

For four days, the docs didn't know if the damage was permanent (making me a permanent dialysis pt), though the cardiologist said there was a good chance that my heart would get at least 80% of its function back with beta-blocker therapy. A kidney biopsy two days later revealed Acute Tubular Necrosis (ATN), a reversible condition in which the body repairs itself and the tubules regenerate. As you can imagine, I was quite relieved.

After all this, the docs wanted to send me down to mental health for three days. I was incensed and couldn't understand why they would be sending down there when I just wanted to go home and recuperate. Turns out that immediately upon getting down there, the head psychiatrist converted my involuntary status to voluntary status and explained he wanted me there so he could officially put into the record that my loopy behavior was the result of my medical condition. In other words, he wanted to ensure the safety of my career.

Now to the chase. Two days later I had a follow-up visit with a mental health social worker. She wanted to know my drug-taking history--and instead of being smart and lying through my teeth--I was a dummy and told her about all the stuff I did when I was young and reckless 25 years ago. I also told her about my cocaine addiction, which I successfully quit cold-turkey two years ago (Jan 2008) and haven't touched since. My current drug usage is about four beers a week, maybe two during dinner on my days off.

A day later she called saying she wanted to put me in an impaired nurse program . What?! I'm clean, sober, and no longer use drugs. She mentioned benzos showing up on the toxicology screen (for which I had a prescription) and also said that marijuana showed up as well (a bald-faced lie since I haven't used pot in almost six years). I immediately drafted a notarized letter dictating that she no longer could share information with other health care workers. I also called my union rep who labeled this individual a "crackpot," who appears to be railroading people like me into such programs because--let's face it--addiction recovery is a big business racket.

In any event, I have a another followup with my PCP on 4/19, and he has these recommendations on his desk. It's his decision whether I be placed--clean and sober--into an impaired nurse program. Of course, my license will be affected adversely, getting jobs will be next to impossible, and I'll be sitting in groups with people who don't realize they can quit their addiction by just stopping putting **** up their noses, in their veins, or down their throats.

I'm not in recovery. I'm recovered. I'm sober. I am not an impaired nurse and I refuse to enter such a program. My doctor is a reasonable guy, I don't think he wants to wreck my career. I'm a good nurse (for a beginner), but I will quit the profession if they do this.

Sorry about the rant, but I needed to get this off my chest and maybe some opinions.

[caliotter3]

You made a very foolish decision to tell this person, not your friend in any type of reality, about prior drug use and now you will pay the price. Hopefully, you can get over this with your career intact.

[SuesquatchRN, BSN, RN]

Gah.

Fingers crossed.

[Mezcalero]

Agreed. In this case honesty was the worst policy and in my still-exhausted state I was naive about the nature of the "interview." My union reps tell me there is no case for an "impaired nurse status" determination and they will be at my side during any further decisions. Thanks for the replies and the good wishes. :)

[incodebrown]

I'm sorry for you. I'm going through CA Diversion for a similar situation becaue I want to keep my license intact. It's been so stressful and I feel like I'm being treated like a criminal and the Board can do whatever they want!

My thoughts are with you!

[jackstem]

I hope your physical recovery continues and you regain your previous level of health.

One suggestion...if you haven't hired a license defense attorney I strongly recommend you obtain one. Someone familiar with administrative law and experience facing the board of nursing in your state. At this early stage in your career bad, uninformed decisions can lead to restrictions on your license. Trying to defend yourself before the board isn't the wisest decision. There is a general consensus in the nursing profession that there is no need to hire an attorney when facing board of nursing investigations or hearings. Nothing could be further from the truth. I consult with an attorney when she has clients with impairment issues. Most nurses wait too long to seek the services of a good attorney. If you have your own professional Liability Insurance with a license defense clause your attorney's fees will be covered. After 5 years as a peer assistance advisor it's clear that very few nurses have their own liability insurance and most wait too long before retaining an attorney. The board has an attorney advising them on how to proceed, you too should have legal representation to obtain the best outcome. Contact The American Association of Nurse Attorneys referral hotline: [phone]

As for your comment:

I'll be sitting in groups with people who don't realize they can quit their addiction by just stopping putting **** up their noses, in their veins, or down their throats.

.

This comment is so far from being accurate, but is one of the most common myths held by our society...including health care providers. NO ONE would maintain an "addict's lifestyle" if they could quit any time they want. I wanted to quit and couldn't. I tried quitting hundreds of times without success. If you don't understand the disease process of addiction it's very easy to believe the myths, misinformation and misbeliefs that our culture holds on to, despite the overwhelming evidence regarding the pathology involved. There has been a great deal of research into the pathophysiology of this disease, but this info doesn't make it to frontline health care provider. While that is partially the fault of the current health care educational system, continued ignorance by "old timers" (I graduated in 1978) as well as new graduates, is the fault of the individual clinician. The information is available, yet no one is interested in obtaining the information.

Chemical dependence is a chronic, progressive, ultimately (and unnecessarily) fatal disease with the brain as it's target organ. Can you imagine the outrage if we approached other diseases (cancer, heart disease, etc.) in this fashion? As a result of genetics, a portion of the population is at risk to develop the disease when exposed to the proper chemical (or activity) in the right dose for the right amount of time under the right circumstances. Exposure can come from "experimentation" or as a result of prescriptions, most commonly pain management. But we can also see individuals develop addiction when treated for insomnia, anxiety, and other medical conditions.

How do we "treat" this disease currently? By waiting until the person hits "rock bottom" (the equivalent of waiting until a person with heart disease is having a heart attack), then placing them in an "Intensive Outpatient" treatment program for 3 - 6 weeks (the equivalent of giving less than effective doses of medication for high blood pressure, chest pain, etc.), with little if any follow up care (which is the same as discontinuing all medications and little if any follow up care). And when this person shows up in the ER again with another heart attack, we become angry at them and blame them for not remaining well!

Ridiculous, right? But all too true. We wait for them to hit bottom (which is death in many of those addicted, especially with medications like fentanyl, oxycontin...crushing the tablet releases all of the oxycodone at once, leading to overdose in many addicts). Then they enter treatment, usually in an "Intensive Outpatient" program. Those first few months are key to getting the addict on a solid road to recovery. They are in a protected environment, away from drugs (legal or illegal) and alcohol, allowing their brain to begin recovering (which takes 18 - 24 months of abstinence from mood altering substances). Even after that time the brain is still susceptible to cues and triggers which can begin the process called relapse. The earlier these signs are recognized it's possible to short circuit the process before the person begins using chemicals again (relapse is a process not an event). This venue makes it difficult to share all the information we now know about addiction, treatment, and recovery. Here are a few links with information about addiction and treatment. I hope you read them and share them with colleagues. It sucks to be suspected of being an addict. You can use this incident to learn more about substance abuse and addiction in order to help change the way addicts are treated. A patient you care for may reap the benefit of your new knowledge. Who knows, it might even save the life of a family member.

If I can help you gain additional information or help you understand this disease better let me know. Follow the links below to gain insight into this chronic, progressive, potentially fatal disease.

Jack

The Science of Addiction

Resources for Health Care Professionals

Principles of Drug Addiction Treatment: A Research-Based Guide - Second Edition

Principles of HIV Prevention in Drug-Using Populations - including a Q&A section

Drug Abuse & Mental Illness (Comorbidity)

NIDA Networking Project

Drug Testing

Stress & Drug Abuse

Treatment Approaches for Drug Addicion. Summary of current treatment methods and types of treatment programs.

Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research Based Guide. Guide for treating drug abusers within criminal justice settings.

Principles of Drug Addiction Treatment: A Research-Based Guide (Second Edition). Summarizes the principles of effective treatment, answers common questions, and describes types of treatment, with examples. (Manual).

NIDA Clinical Toolbox. Science-based materials for drug abuse treatment providers. Links to treatment manuals, research reports, and more. (List of links).

Costs and Substance Abuse Treatment Programs. Uses step-by-step instructions, exercises, and worksheets to help professionals determine the cost effectiveness and benefits of treatment programs. (Manual).

WHAT IF WE REALLY BELIEVED THAT ADDICTION WAS A CHRONIC DISORDER ?

Jack

Addicts aren't bad people trying to become good. They have a potentially lethal disease and they are trying to become well!

[Mezcalero]

Thank you for the information, and the time you took to type all that out.

But I should tell you that I quit cocaine on my own through 80% willpower and 20% through the use of an African psychedelic called ibogaine. Ibogaine resets the neuroreceptors that have been damaged after years of chronic stimulant abuse.

In essence, the brain compensates for the overabundance of dopamine in the synaptic cleft caused by cocaine use. It decreases the number of dopamine receptors, so when there's no cocaine, withdrawal symptoms such as anhedonia and hypersomnia set in. Somehow ibogaine helps reset the brain (at least partially) to it's pre-addicted state. I have no doubt it helped me get through the first two tough weeks after I stopped using, and began feeling somewhat "normal" again.

But "willpower" was 80% of the process, and it would be a mistake to assume that some people can't stop on their own. I sometimes think people stop being addicted to drugs and become addicted to "recovery." It's a multi-billion dollar industry in this country convincing people that "once an addict, always an addict." I for one don't subscribe to this myth, though my voice may be coming from the wilderness.

Again, though, your contribution is greatly appreciated.

[jackstem]

We are all entitled to our own opinions on this or any other topic. I'd be interested in reading some of the research on ibogaine. If you have access to peer reviewed, double blind studies let me know where I can find them.

Jack

[Mezcalero]

Start here:

http://www.amc.edu/research/CNN/cnnresearcher.cfm?ID=130

http://www.ibogaine.desk.nl/

[Mezcalero]

Also, an interview with Dr. Deborah Mash:

http://pdr.autono.net/mash.htm

[exnursie]

Thank you for the information, and the time you took to type all that out.

But I should tell you that I quit cocaine on my own through 80% willpower and 20% through the use of an African psychedelic called ibogaine. Ibogaine resets the neuroreceptors that have been damaged after years of chronic stimulant abuse.

In essence, the brain compensates for the overabundance of dopamine in the synaptic cleft caused by cocaine use. It decreases the number of dopamine receptors, so when there's no cocaine, withdrawal symptoms such as anhedonia and hypersomnia set in. Somehow ibogaine helps reset the brain (at least partially) to it's pre-addicted state. I have no doubt it helped me get through the first two tough weeks after I stopped using, and began feeling somewhat "normal" again.

But "willpower" was 80% of the process, and it would be a mistake to assume that some people can't stop on their own. I sometimes think people stop being addicted to drugs and become addicted to "recovery." It's a multi-billion dollar industry in this country convincing people that "once an addict, always an addict." I for one don't subscribe to this myth, though my voice may be coming from the wilderness.

Again, though, your contribution is greatly appreciated.

Regardless of what you choose to think as far as the disease concept and addiction, anyone who wants to stop using has to really want to stop using in order to succeed. This fact is one of the only commonalities among all the many methods available to people for ending active addiction, ie RR, AA, SOS, just quitting, religion, loss of job or family, prision, etc,,,, Unless someone WANTS to stop, nothing will work. Willpower is part of any process and this includes AA... and is the logic behind many of their slogans,such as ODAAT, just don;t use, avoid PPP, and why they encourage freq meetings initially for support and provide people with ideas on how to stay strong and not use.

As to your opposition to addiction as a disease related to ibogaine,,, your links don't support you at all. In the interview, it is clearly stated that addiction is a disease that people cannot control and use despite destruction consequences, and is why Dr Mash started her clinical trials.

[Mezcalero]

Well explain 2 years clean after a 24-year addiction, with no desire to return to use.

All without NA, AA, support groups, outpatient therapy, etc. Sure, the desire to stay clean has to be there, and that involves willpower. Ibogaine can make it easier, is all. If the desire to quit isn't there, NOTHING will help.

I just knew that 12-step programs wouldn't work for me. Sure, a psychedelic that causes profound hallucinations and forced introspection is a real scary monster to Westerners, but maybe sometimes pygmies (the discoverers of the shrub and the first to base a religion around it) and other third-world cultures know more about certain things in the universe than our "sophisticated society." If our sophisticated society were so fantastic, why is there so much pain that leads to addictions in the first place?

And I never said addiction wasn't a disease. But it's a disease like many others. One can be diagnosed with cancer and choose to go to chemotherapy. One is often undiagnosed with addiction (but knows the disease is there), but again, must choose to treat the disease.

How they do that is up to them and whatever works for any given person is the successful treatment. Whether it's 12-step or ibogaine, if the result is termination of the disease and return of the the brain changes to their pre-addicted state, then the protocol used--in the end--doesn't really matter.