CHEMICAL DEPENDENCY

Purpose of this Topic To inform providers on how to recognize the signs and symptoms of chemical dependency To help providers understand how to intervene To help with treatment and recovery Understand risks of relapse Assist in prevention and help facilitate return to work considerations

SUBSTANCE USE: an ingestion of mood-altering chemical substance or drug for beneficial purpose that is regulated for that purpose SUBSTANCE MISUSE: inappropriate use of any substance (alcohol, street drugs, prescription drugs and over the counter drugs SUBSTANCE ABUSE: unreasonable ingestion of mood-altering substance that causes harm to injury to the abuser CHEMICAL DEPENDENCY: a compulsive or chronic need for, or an active addition to alcohol or drugs

Understanding chemical dependency ETIOLOGY: Genetics – lack adequate production of dopamine and serotonin – when introduced to chemical feel “normal” for the first time Environment – availability and accessibility to mood –altering chemicals Psychological – uses substances to fill emotional voids (sadness, loneliness, and depression)

Chemical dependency No way to predict who will be affected Individuals do not get addicted to particular drug they get addicted to the feeling it produces Primary disease – has specific symptoms – don’t confuse with stress, poor relationships or unmanageable work demands Progressive – if untreated will be come worse Chronic – it is a relapsing disease and can not be cured – requires lifestyle change Fatal – many accidental overdoses, deaths and suicides associates with this disease

Chemical dependency and the health care provider Limited data because it is often unreported; available literatures estimates 10% - 15% of health care professionals are affected They prescribe and administer drugs everyday – accessible and available If stressed often self prescribe or take medication from their patients Often providers do not receive appropriate intervention and treatment needed because of the lack of proper identification of a dependency problem

Physical and Behavioral Indicators PERSONAL: Poor hygiene Multiple physical complaints Accidents Personality and behavior changes Many prescriptions for family and self Emotional and mental crisis Lying HOME AND FAMILY: Behavior excused by family and friends Drugs become priority Emotional outburst/ withdrawal from family and friends/ neglect children Inappropriate behavior of children Relationship issues – sex problems, affairs; separation, divorces and absences from home

Physical and Behavioral Indicators MEDICAL/ PHYSICAL FRIENDS / COMMUNITY Decline in health Weight changes Pupil changes; flushed, bloating Frequent ER visits Inability to focus in conversations Shakes, tremors, runny nose, N, V, D Slurred speech/ unsteady gait Isolation from friends Embarrassing social behaviors Driving under the influence Alcohol and drug related problems Neglect of social commitments Unpredictable behavior – impulsive, missing dates

Health care practice setting behavioral indicators of chemical dependency Workaholic behavior Disorganized schedule Unreasonable work behavior Inaccessibility to patients and staff Frequent trips to the restroom Decreased workload or workload intolerance Excessive drug prescriptions and supply Excessive ordering of drugs Frequent complaints by patients Prolonged lunch breaks Frequency absences or illness Sporadic punctuality Unsatisfactory work Withdrawal from professional committees Defensive is questioned or confronted Less creative

Health care practice setting behavioral indicators of chemical dependency Observed poor practical judgement Short absences from work with inadequate explanations Attempt to cover alcohol sent with mints and mouthwash Observed intoxication, drowsiness, or hypersensitivity to work hours Deadlines barely met or missed

Reasons peers do not report chemical dependency Uncertainty or disbelief Reluctant to identify the signs and symptoms Hope that things will “get better” Concerns of legal ramifications Risk to self

Signs and symptoms of enabling Ignorance to behavior Making excuses for the person or “covering” for them Trying to “protect” Making excuses for behavior Doing the person’s job for them

INTERVENTION FEAR is the #1 barrier to intervention (What if…I am wrong or he/she denies it) GOAL : Not to discuss alcohol or drug dependency but to make the problem recognizable before it brings about harm STEPS TO INTERVENTION: Documentation (date, time and place of witness behavior) Know the baseline work ethic of co-worker Understand the workplace policy on reporting substance abuse Do not discuss with colleagues

Relapse Prevention Issues Practice and licensure restriction Fear of criticism or avoidance of colleagues Colleagues suspicions and mistrust Self imposed stress to try and make up for past mistakes Stress in meeting treatments and recovery committments

www.pnap.org (Pennsylvania Nurse Peer Assistance Program) PNAP Mission Statement To identify, intervene upon, advocate for, monitor, and provide support, help, and hope to the Nurse or Nursing Student experiencing Substance Use Disorders, Mental Health Disorders, and/or Physical Disorders that may affect their ability to practice. Inception May 17, 2009 For assistance call 877-298-7627 ext 1

Other resources Alcoholics Anonymous www.AA.org 888-226-3632 Narcotics Anonymous www.na.org Vision: Every addict in the world has the chance to experience our message in his or her own language and culture and find the opportunity for a new way of life. Department of Drug and Alcohol Programs www.ddap.pa.gov 1-800-662-4357 (HELP)