I see that this catagory has been slow moving lately and I wanted to start a new thread with a different direction. I would like to get everyone's opinion (even the people that have never suffered with addiction). What do you think about your state's peer assistance/recovery program? Do you think it is too harsh or not harsh enough? What state are you in, and do you know the rules or guidelines of your states recovering nurses program?
I just want to get a general view of nurses' education on the matter. I have noticed lately in my hospital that the nurses do not know that there is a recovery program out there. They don't know that there are options and many are scared to report someone, especially if it is their friend. They are scared to report themselves if they need help.
I know that there are more impaired nurses out there than any of us want to admit. I think that if we were educated more on the matter, we could get a better grasp on the situation.
Specializes in Impaired Nurse Advocate, CRNA, ER,.
There has been a great deal of research into the pathophysiology of this disease. Unfortunately, very few health care practitioners seem to receive this information. 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 fatal disease with the brain as it's target organ. I will also add that death from chemical dependence is unnecessary as well. 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.
One of the most common ways for chemical dependence to develop is through drinking alcohol. This drug has become a part of our culture and society. Religious communities use it in some of their ceremonies. We celebrate all sorts of milestones (birth, death, marriage, divorce, promotions, etc.) with alcohol. Look at sports...you an buy beer, wine and even "cocktails" at professional and college sporting events. Despite the fact that alcohol is legal, a certain percentage of the population will become dependent on alcohol. This is genetically based!! The only way to totally prevent addiction to chemicals is to never ingest them. That's not practical or realistic. We know people will develop diabetes based on family history and genetics. If a family member has DM, then we keep our eyes peeled for early signs and symptoms. When we see them, we go to our MD and begin treating it. It takes significant alterations in a person's lifestyle to keep DM under control and hopefully limit the side effects of the disease. In some diabetics, no amount of aggressive treatment and follow up slows the progress of the disease. It's the reality of medicine that some people do not respond well to any interventions or treatments. Addiction is no different. The problem we have is ignoring the problem until that famous "bottom" is reached. By then, treatment isn't likely to lead to any significant periods of sobriety (i.e. abstinence). It's not because treatment doesn't work, it's because we waited to long to intervene and then used half baked methods of treating the individual.
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 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!
Our culture and our health care providers base their "opinions" on this disease on the "3 Ms"; Myth, Misbelief, and Misinformation. It's no surprise that we continue to see the high relapse rates. The only people showing a significant lack of knowledge regarding "right from wrong" are the health care professionals who refuse to remain up to date on the scientific information gathered over the past 25 years, and refusing to deal with this disease in a scientific manner. This disease will continue to take it's toll on our children and the rest of society as long as health care providers hold the attitude and "beliefs" expressed in your message.
As for the comment,
"Nurses who were drunks and druggies became "impaired nurses" who were called "valuable professionals" who deserved treatment and another chance."
, here are 2 addicts who were definitely valued professionals and provided some major breakthroughs in health care.
Dr William Stewart Halsted (1852 - 1922) is known as the father of American surgery. He pioneered the cancer saving operation, the mastectomy, at a time when cure from the disease was unknown. He popularized the use of rubber gloves in the operating theaters and introduced several other important advances in surgical technique including improved blood transfusion. He used daily morphine for most of his long life. He is one of the founders of Johns Hopkins Medical Center
Sigmund Freud The Father of Psychoanalysis.
Ignorance (From Wikipedia, the free encyclopedia)
Ignorance is the state in which one lacks knowledge, is unaware of something or chooses to subjectively ignore information. This should not be confused with being unintelligent, as one's level of intelligence and level of education or general awareness are not the same. The word "Ignorant" is an adjective describing a person in the state of being unaware. The term may be used specifically (e.g. "One can be an expert in math, and totally ignorant of history.") or generally (e.g. "an ignorant person.") -- although the second use is used less as a descriptive and more as an imprecise personal insult.
The concept of ignorance has social and legal implications. The legal principle that ignorantia juris non excusat, literally "ignorance of the law is no excuse", stands for the proposition that the law applies also to those who are unaware of it.
Here are just a few links with information about addiction and treatment. I hope you read them. 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.
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).
Specializes in Impaired Nurse Advocate, CRNA, ER,.
Jack, Congrats on 14 yrs.! You are an awesome inspiration to us all. I hope to do in Michigan what you are doing in Ohio. Lord knows we need it, especially in Mid-Michigan. Thanks so much for all you do. I would love to get an online AA/NA group for recovering nurses.
Thanks Tweet (I hope you don't mind me calling you Tweet ).
Here are some links to other recovering nurses message boards.
You can lead someone to knowledge, but you cannot make them think!
Specializes in Impaired Nurse Advocate, CRNA, ER,.
Neurocircuitry of Addiction
George F Koob* and Nora D Volkow
Committee on the Neurobiology of Addictive Disorders, The Scripps Research Institute, La Jolla, CA, USA; National Institute on Drug Abuse, Bethesda, MD, USA
Neuropsychopharmacology Reviews (2010) 35, 217-238; doi:10.1038/npp.2009.110; published online 26 August 2009
Specializes in Impaired Nurse Advocate, CRNA, ER,.
Like others in this thread have said, the program in my state saved my life.
It was frustrating at times because my ability to get an RN job with all the restrictions was severely compromised.
In fact, it took 18 months to find a job. But, looking back, I needed those 18 months to work on my recovery.
Ten years later, I can admit that self reporting was the best decision I ever made.
(But for all of those nurses still in the program I understand how it certainly did NOT feel like the best decision at the time!!)
My career is moving full speed ahead; I'm about to start my first job as a Psych NP.
I couldn't have done it without a good strong recovery foundation, and the Board of Nursing recovery program is a part of that foundation.
Your comments correlate very well with the time it takes for the brain to recuperate from the chronic use of mood altering substances (18 months to 2 years). We are all in such a hurry to return to work. Returning too soon can most definitely cause problems for our recovery and our profession. While relapse is a part of any chronic, progressive disease, it's not a requirement. In anesthesia, relapse can mean death. In fact, the first "sign" of relapse in 60% of anesthesia providers is death (it's because of the "rocket fuels" like fentanyl, sufentanil, and propofol).There is a strong correlation between length of time involved in treatment/recovery activities and decline in relapse rates. I attended a Symposium on prescription drug abuse over the weekend. One of the speakers said it generally takes 10 - 12 months of "treatment" (meaning a combination of inpatient/intensive outpatient and intensive aftercare) for a strong base of recovery. Rarely do we get adequate treatment, either because our insurance won't cover it, or we can't wait to get back to "normal". Like other chronic diseases, this one doesn't go away. And, if we don't stay on top of it (like diabetes and such) we end up with all sorts of complications, including premature death.
Congrats on all you've accomplished despite (or maybe because of) this disease. Your patients will most definitely benefit from your experience!
I am from Ohio.....our board has two different programs.....alternative to discipnary and the disciplinary program.....basically they are the same thing except alternative gets wiped off your licensure after 5 years....both you have to do at least monthly randomn drug testing(which invloves calling a number everyday) aa/na meetings and complete tx. but they do pretty much give everyone a second chance....unless you try to deny stuff.....there are also things such as temp or permanment rescritions: narcs, homehealth, agency, travel, being don or unit manager
my career in nursing goes all the way back to 1976 when i entered nursing school. in those long ago times, if a nurse was caught drunk or drugged at work or stealing narcotics from the hospital, their career was pretty much over.
ummmm...that is simply not true. only if someone came to work so inebriated that they didn't function, were they sent home to sober up. plenty of times i've known of co-workers who have come to work with etoh on their breath but they were "functional drunks" and it was overlooked unless it affected patient care if an addict was actually caught diverting were they fired.
and everyone knew this. that's why it had such a deterrent effect. your license was revoked and you had to find another way to make a living. in addition, nurses with these kind of problems were so stigmatized they wouldn't be able to find another job even if noone had the heart to notify the state board. people had no sympathy for nurses who did things like this. it was considered flat out disgraceful, a blot on the profession. people almost took it personally. sure, we had nurses with these problems. but they were truly rare. in the old regime of shame and punishment, few transgressed. only the worst chose to cross that line.
shame??? what gives you the right to judge if someone has shame over their addiction?? you have no clue. all of the recovering people (in the programs i'm familiar with) have a tremendous amount of shame...one reason for using your drug of choice, etoh, food, spending, gambling, fixing other people so you don't have to feel the pain that is lurking below.
then the 80's came along and the thinking changed. drug abuse was recast as a disease whose sufferers were in need of treatment. nurses who were drunks and druggies became "impaired nurses" who were called "valuable professionals" who deserved treatment and another chance. and above all, they were not to be judged or stigmatized by their peers. such sensibilities were felt to be part of the impaired nurses problem and we, their peers, were shamed into abandoning our old attitudes in favor of more enlightened approaches to the problem.
the 80's?? i don't know where you were but there were quite a few hospital based detox and treatment programs out there even at that time. some of the more upscale ones catered to professionals. aa (the great granddaddy of them all) was around even before that! what about the nurses that you worked with at that time that had untreated mental health issues and were just as much a threat?
so here we are in the 2010's and from the looks of more than twenty years of enlightened thinking we have done nothing but create a monster. sure, there are some nurses who come back from the brink. but from what i'm learning, most don't. all over the country, bon's are inundated and backlogged with complaints about impaired nurse practice. they can't find the staff or the funds to manage the caseload. and in the meantime, these nurses migrate from state to state, hide out in nurse registries, and fail to meet the demands of diversion programs. it is a critical, and growing, problem of national scope.
i have to question where you got this information. where are you getting your mis-information??
i have no quick, simple answers to offer. i have only to say that i think the situation is just one small part of a large scale retreat in our entire society from knowing the difference between right and wrong and possessing the motivation to act confidently on those convictions whether by exercising self control or calling others to account for their actions.
i guandamn tee you that if self control alone could cure addiction, all of us with our varying issues would be happy and healthy. everyone would be able to go their merry way. i see by your post that you have an addiction also.....an addiction to certainty.
Addiction are chronic progressive often fatal if untreated brain diseases that originate in a complex inferface between the addicts genome and their exposures. Other that "maybe" their first exposure there is nothing akin to free will involved. There is OVERWHELMING neuroscience that demonstates how actual morphology (dendritic sprouting ) occurs with addictive drug exposure. First PRIMITIVE reward pathways in the midbarin are subverted and the actual wiring to the orbitofrontal cortex changes and decision making becomes globally impaired around drug craving and seeking. You only need to step back from the emotionality and judgements and look at the behavior squarely to recognize that the decision making of the addicted brain is irrational and often frankly insane at least by Einstein's defintion of insanity.
As health care professionals we have a unwavering responsibility to look at the science and not in the myths and stigma that keep our colleagues from recovery. We owe them at least as much compassion and support with their struggles with these horrendously malignant diseases as we do our patients!
If you truly want definitive references on the current science feel free to visit the AANA' Peer Assistance and Wellness Webpages at:
Specializes in ICU, PICU, School Nursing, Case Mgt.
i guandamn tee you that if self control alone could cure addiction, all of us with our varying issues would be happy and healthy. everyone would be able to go their merry way. i see by your post that you have an addiction also.....an addiction to certainty.
Wow, recoveringRN. I already am paranoid because I am sure our peer program hear has at least that many participants per case worker. However, we can't just e-mail anything. We can...but there is a form for EVERYTHING in ours. And most our forms will only be accepted as original (not faxed or photocopied)
In our peer program, we can't e-mail them to tell them we started a new job. WE have to interview, be offered the job, then have the new job send a typed job description, and a contract from peer that outlines what we can and cant do. Must be signed by DON, Supervisor/nurse manager, and both our supervising RNs (we can have only two). Then we have to wait 1-5 days for the peer to tell us we are approved to work at this place (after they call the job, check the license of everyone on the contract, check out the facility, etc).
Good to hear your story.
I can say, in college, we weren't told about peer. We were just told if we drink too much, divert drugs, do drugs, etc....that we WILL get caught and WILL lose our license and WILL NEVER get the license back. We never questioned it. They probably though it was a good deterrent. But that is not the way to do it. I had heard about A peer program once or twice in the years since graduating nursing school. But never paid attention. Never thought I would need it. Thought it was for "bad" nurses. But I also knew how to drink responsibly then. Never understood alcoholics or addicts. Then, and I finally have gotten insight on the trigger through lots of counseling, I start abusing alcohol. More and more. many unfair things happen with peer...but it's better than the alternative (the one we were taught in school).
Are there any states that don't have any peer-type program? Which ones. What is the process for a nurse who wants help/is ordered help?
I would love to get an online AA/NA group for recovering nurses.
).
jackstem
670 Posts
There has been a great deal of research into the pathophysiology of this disease. Unfortunately, very few health care practitioners seem to receive this information. 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 fatal disease with the brain as it's target organ. I will also add that death from chemical dependence is unnecessary as well. 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.
One of the most common ways for chemical dependence to develop is through drinking alcohol. This drug has become a part of our culture and society. Religious communities use it in some of their ceremonies. We celebrate all sorts of milestones (birth, death, marriage, divorce, promotions, etc.) with alcohol. Look at sports...you an buy beer, wine and even "cocktails" at professional and college sporting events. Despite the fact that alcohol is legal, a certain percentage of the population will become dependent on alcohol. This is genetically based!! The only way to totally prevent addiction to chemicals is to never ingest them. That's not practical or realistic. We know people will develop diabetes based on family history and genetics. If a family member has DM, then we keep our eyes peeled for early signs and symptoms. When we see them, we go to our MD and begin treating it. It takes significant alterations in a person's lifestyle to keep DM under control and hopefully limit the side effects of the disease. In some diabetics, no amount of aggressive treatment and follow up slows the progress of the disease. It's the reality of medicine that some people do not respond well to any interventions or treatments. Addiction is no different. The problem we have is ignoring the problem until that famous "bottom" is reached. By then, treatment isn't likely to lead to any significant periods of sobriety (i.e. abstinence). It's not because treatment doesn't work, it's because we waited to long to intervene and then used half baked methods of treating the individual.
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 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!
Our culture and our health care providers base their "opinions" on this disease on the "3 Ms"; Myth, Misbelief, and Misinformation. It's no surprise that we continue to see the high relapse rates. The only people showing a significant lack of knowledge regarding "right from wrong" are the health care professionals who refuse to remain up to date on the scientific information gathered over the past 25 years, and refusing to deal with this disease in a scientific manner. This disease will continue to take it's toll on our children and the rest of society as long as health care providers hold the attitude and "beliefs" expressed in your message.
As for the comment,
, here are 2 addicts who were definitely valued professionals and provided some major breakthroughs in health care.Here are just a few links with information about addiction and treatment. I hope you read them. 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.
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!