Colleen Amundson BSN, RN, SRNA Shannon Bachman BSN, RN, SRNA The Non-anesthetic Substance Abusing Provider

History, prevalence, and contributing factors Alcohol effects on the brain including signs and symptoms Alcohol addiction in the workplace AANA standards including comparisons in drug testing Objectives

Dr. William S. Halstead developed an addiction to cocaine while learning its potential use as an anesthetic. The Addicted Anesthesia Provider

1958- Recognition of addiction by State Medical Boards “Narcotics and the Anesthetist: Professional Hazard's” by Florence McQuillen, CRNA –Alcohol is a gate-way drug to narcotic use 1980: Addiction is declared a disease present day: AANA’s contributions to wellness/recovery Fast forward- to 1960 and beyond

*Abuse usually precedes addiction Abuse vs. Addiction

Genetics –Family history –Genomics Personality –Sensation- seeking –MacAndrew Scale Psychological –Underlying mood disorders –Self- diagnose/self- treat Contributing Factors

Student Registered Nurse Anesthetists score higher on these tests indicating a higher propensity for alcohol abuse and addiction Zuckerman’s Sensation Seeking Scale and MacAndrew Scale

“Evidence supports that many nurses and anesthesiologists with a chemical dependency have co-morbid psychiatric disorders” (Wright, E. L., McGuiness, T., Moneyham, L. D., Schumacher, J. E., Zwerling, A., & Stullenbarger, N. E., 2012, p. 122) Psychological Factors

Nerve cells Cerebral cortex Frontal lobe Cerebellum Hippocampus Hypothalamus Medulla Alcohol’s effect on the brain

Premature aging hypothesis Alcohol-related brain damage

Signs and symptoms

CAGE questions Personal questions Intervention What to expect What do you do if you suspect a co- worker?

1. Supervised detox 2. Psychiatric evaluation 3. Inpatient treatment 4. Outpatient treatment 5. Individual and group therapy sessions 6. Self help groups (12- step program) 7. Family therapy 8. Story telling

Should the recovering anesthesia provider return to the OR? -- Highly controversial topic Ongoing monitoring of the recovering anesthesia provider for at least 5 years is the recommended practice. Re-entry into practice is made on a case by case basis. The decision is based on the addiction psychiatrist's recommendations. Re-entry into Practice

Disulfiram Topiramate Pharmacologic Treatment

Naltrexone: Acamprosate: Pharmacologic Treatment

Current drug testing: Urine Hair Breathalyzer (0.068 and 0.08) Up and coming drug testing: Naltrexone assays EDAC blood test EtG/EtS urine test AANA Standards and Drug-Testing

There are no time limits on alcohol consumption for anesthesia providers. Should there be? Rules regarding alcohol use in anesthesia

es2/health- wellness/Pages/Getting- Help.aspxhttp:// es2/health- wellness/Pages/Getting- Help.aspx ntal/alcohol_abuse_alcoholis m_signs_effects_treatment.ht m There is No Shame in Recovery

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