Substance Use, Abuse & Addition r/t Nursing Practice

Substance Use, Abuse & Addiction r/t Nursing Practice Terri Ivory, MSN,RN,C EFFECTIVELY TREATING SUBSTANCE ABUSE AMONG HEALTH CARE PROFESSIONALS IT IS IMPORTANT TO UNDERSTAND THE COMPONENTS OF ADDICTION. THE WORD ADDICTION IS OFTEN USED AS AN UMBRELLA TERM TO DESCRIBE A GROUP OF PROBLEMS SUCH AS: DRUG ADDICTION ALCOHOLISM

SUBSTANCE USE DISORDER CHEMICAL DEPENDENCE ALL OF THESE TERMS DESCRIBE AN ADDICTION TO BRAIN-REWARDING CHEMICALS. ADDICTION A CUNNING, BAFFLING AND POWERFUL DISEASE.

Substance Use, Abuse & Addiction r/t Nursing Practice Institute for Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centers Commission on Accreditation. P100-7/2018 Planners and Presenters have declared that they have nothing to disclose. To successfully earn a contact hour certificate, participants must stay for the entire program and complete an evaluation form. Institute for Nursing the foundation of the New Jersey State Nurses Association 1479 Pennington Road, Trenton, New Jersey 08618 OUTCOMES What is Addiction? Drug addiction is a brain

disease that can be treated. National Institute on Drug Abuse Substance Use, Abuse & Addiction r/t Nursing Practice Substance Use, Abuse & Addiction r/t Nursing Practice These substances, along with alcohol, can produce a feeling of

pleasure, relaxation or relieve negative feelings (Feltenstein & See, 2008). As the dependence or addiction progresses the benefits of using substances decreases and more drugs or alcohol are needed to feel the same level of pleasure. There is a genetic component that is influenced by environmental and social factors.

The National Institute of Drug Abuse estimates that genetic factors account for 40 to 60 percent of a persons vulnerability to addiction. The estimate includes the projected effects of environment on gene expression and function (NIDA, 2008). Substance Use, Abuse & Addiction r/t Nursing Practice

Source: From the laboratories of Drs. N. Volkow & H. Schelbert Substance Use, Abuse & Addiction r/t Nursing Practice Overall risk factors, especially those that tend to make all individuals more susceptible to developing a substance use disorder have been divided into general categories. Psychological factors: Depression Anxiety

Low self-esteem Low tolerance for stress Other mental health disorders (such as learning disabilities) Feelings of desperation

Loss of control over circumstances in ones life Feelings of resentment Substance Use, Abuse & Addiction r/t Nursing Practice Behavioral factors:

Alienation and rebelliousness (such as reckless behavior) School-based academic or behavioral problems (including dropping out, involvement with the criminal justice system or the first illegal use at an early age)

Peers using alcohol and drugs Social or cultural norms acceptance of alcohol and drug use Use of other substances

Aggressive behavior in childhood Conduct disorder (such as anti-social personality disorder) Avoidance of responsibilities

Impulsivity and risk-taking behavior Substance Use, Abuse & Addiction r/t Nursing Practice Social factors: Condoning the use of drugs and alcohol Expectations about the positive effects of the drugs

and alcohol Access to or an availability of drugs Demographic factors: Male gender Inner city or rural residence combined with a low socio-economic status Lack of employment opportunities

Are Nurse Different? Why Nurses? Nurses also comprise the largest group of health care professionals, therefore those who do develop issues with abuse and addiction are not only more visible, they are usually more stigmatized in the general health care population and receive more severe sanctions than physicians (Shaw, McGovern, Angres, & Rawal, 2004). Scope of the Addiction Among Nurses Top Four Risk Factors

Substance Use, Abuse & Addiction r/t Nursing Practice Family factors: Use of alcohol and drugs by parents, siblings or spouse Family dysfunction such as inconsistent discipline

Lack of positive family rituals and routines Poor parenting skills Family trauma (such as a death or divorce) Genetic factors: Inherited genetic predisposition to alcohol or drug dependence

Deficits in natural neurotransmitters such as serotonin Absence of aversive reactions Comparison of Relapse rates of Drug Addiction vs Other Chronic Illness

Conspiracy of Silence Conspiracy of Silence This Photo by Unknown Author is licensed under CC BY-NC-ND Enabling the Nurse 1. Accepting the nurses responsibilities and duties 2. Avoiding, withdrawing from situation 3. Denying condition, minimizing severity of problem 4. Protecting the nurse from

consequences of using by lying or protecting the nurses image 5. Accepting nurses rationalizations and excuses 6. Confronting with opinions or judgments (Quinlin,1995) Barriers to Treatment Impairment! Be aware Be aware

Physical Behavioral Slurred speech Defensiveness Nodding off or Napping

Irritability Unkempt, long sleeves Frequent mood swings

Smell of alcohol on breath; excess use of mints/gum/ Increased isolation from colleagues mouthwash Be aware

Frequent, long trips alone; Unexplained absences Frequent tardiness Inconsistent performance

Impaired memory or attention Excessive number of mistakes Sloppy or illogical charting Be aware Dedicated worker always volunteering for overtime, stays late, medicates

Leaving workplace on break Coming into work on days off Excessive uses of PRN medications

Patients report being under medicated for pain Narcotic discrepancies, wastes. When Mollie hurt her back and was using the Percocets as prescribed. Experimentation/use After a stressful day at work, where two other nurses called out and then they had to work short staffed Mollie took a couple of percocets she had leftover from when she hurt her back last year. Misuse, she is using the prescription not for its intended p urpose Rather than waste the second PRN Percocet her patient didnt want, Mollie takes it. Then four hours later when the patient is due for the PRN medication again, Mollie signs the meds out even though the patient doesnt want them.

Abuse, there are now negative consequences to this behavior Mollie is taking 20-25 Percocets a day. She has seen a few doctors to get prescriptions for the percocets, however it is not enough and she is purchasing pills on the street and has taken home full blister packs of pills from work. Dependency, if Mollie stops taking the pills she experiences withdrawal symptoms, immediate intervention is necessary, not able to think clearly The Beginning Mollie has been showing up late the last few shifts and cant s eem to get herself organized. At first she complained to the charge nurse that she was up late the night before helping her daughter with a school project. The next shift, it was car trouble that caused her to get a ride to her moms house and borrow her moms car, now she is stressed about the cost and cant focus. Again the charge nurse gives her a light assignment.

Each day is another elaborate excuse. One of your colleagues mentions that usually Mollie is so put together but lately she doesnt look like she is brushing her hair before work. You followed Mollie yesterday and you observed that she documented that her patients all had AM care but you note that they look disheveled and unwashed. When you ask Mollie why she failed to document i/os or vital signs from 4pm she gets very agitated and defensive. She finds the figures and inputs them into the medical record. You hear from another nurse that Mollie was missing for about hour around dinner time - she overhears and begins an argument with the nurse, claiming she was in a patients room. 3.6 Addresses Patient Protection & Impaired Practice HealthCare Professional Responsibility and

Reporting Enhancement Act Why Should We Act ? What Can We Do!!! A Health professionals addiction is typically advanced before identification and intervention This Photo by Unknown Author is licensed under CC BY-NC Alternative to Discipline

Common Goals of Alternative to Discipline Programs 1. Provide for the publics safety & welfare through the early detection, treatment & monitoring of nurses with substance use disorders (SUDs) 2. Decrease time between identification, entry into treatment, compliance & practice monitoring 3. Provide

a process for nurses to recover from substance abuse disorders through a non-punitive & non-public process NCSBN2011 Discipline Nurses are NOT eligible to participate in ATD: Patient care negligence Patient care abuse Prescription fraud

Noncompliance with RAMP contract will lead to report to BON and disciplinary action What Happens When a Nurse Is Reported? Five year Monitoring Components RAMP Return to Work Prior to returning, the nurse must:

Complete treatment Demonstrate a strong recovery Be compliant with program Have an active license

Collaborative process and decision to return to work between the: Nurse, RAMP staff, peers, facilitators, therapists, healthcare providers if appropriate The Workplace Supervised, supportive environment Limitations on shifts and specialty areas

Restrictions on hours and overtime Narcotic restrictions Temporary, usually lifted between 3-6 months after starting work, based on individual Decision is collaborative process including employer

Determined for each individual nurse Maintaining the nurses confidentiality is essential. THE MESSAGE RAMP ATD

This Photo by Unknown Author is licensed under CC BY-ND Peer Assistance Established in 1981, the Peer Assistance Program has been conducting nurse led support groups for 30 years. The peer groups are self-help, smoke free groups facilitated by a nurse who understands substance use and mental health disorders and the recovery process. Nurses in RAMP are required to attend peer group meetings weekly. 24/7 hotline: 1-800-662-0108 Contact Information RAMP www.njsna.org 609-883-5335

DirectorTerri Ivory RN MSN ext. 152 Intake Coordinator Emily Gannon, MA, CAADC ext. 124 Case Managers Benita James, RN ext. 134 Joan Peditto, RN, BSN ext. 123

William Philhower, RN, BSN ext. 113 Tamara Richards, RN, BSN, ext. 121 Communications Coordinator Annemarie Edinger ext. 115 Case Manager Assistant Deborah Robles ext. 102 Peer Assistance Hotline 1-800-662-0108 Available 24/7 and Confidential Answered by experienced Nurse Peer Leaders Information

NJSNA website www.njsna.org NJ Board of Nursing http://www.njconsumeraffairs.gov/nursing/ NCSBN Substance Use Disorder Forum https://www.ncsbn.org/2106.htm Recovery & Monitoring Program

If we are facing in the right direction, all we have to do is keep on walking. Zen proverb References American Society of Addiction Medicine (ASAM),(2011) Public Policy Statement: Definition of Addiction. Retrieved from http://www.asam.org/forthe-public/definition-of-addiction.

Anthony, J. , W. and Trinkoff, A. (1991). The Prevalence of Substance Abuse Among Registered Nurses. Nursing Research, 40 (3). 172-175. Epstein, P. , Burns , C. , Conlon, H. A. (2010). Substance Abuse among Register Nurses. AOHN, 58 (12). 513-516. National Institute of Drug Abuse (NIDA).(2012). Principles of drug addiction treatment: A research based guide (3rd ed.)(NIH Publication No (.09-4180). Retrieved from http://drugabuse.gov/podat/podatindex.html

National Institutes of Health. Fourth printing, 2010.; The Brain :Understanding neurobiology. ( NIH Publication No ( 00-4871). Retrieved from http://science education.nih.gov/supplements/nih2/addiction/guide/pdfs/Entire.pdf References National Council of State Board of Nursing (2011) Substance Use Disorder in Nursing, A Resource Manual for Guidelines for Alternative and Disciplinary Monitoring Program.

Quinlan, D. (2003). Impaired Nursing Practice: A National Perspective on Peer Assistance in the U.S. Journal of Addiction Nursing (14), 149-155. Substance Abuse and Mental Health Services Administration(SAMHSA) .Results from the 2007 National Survey on Drug Use and Health: National Findings. DHHS Publication No. (SMA) 08-4343. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2008, p. 71. References

Substance Abuse and Mental Health Services Administration. (SAMSHA).(7/2011)State Estimates of Substance Use and Mental Disorders from the 2008-2009 National Survey on Drug Use and Health (NSDUH). Retrieved from http://store.samhsa.gov/shin/content/SMA11-4641/SMA114641.pdf

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