1. CHEMICAL DEPENDENCY

2. 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

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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, For assistance call ext 1

16. Other resources Alcoholics Anonymous www.AA.org 888-226-3632
Narcotics Anonymous 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 (HELP)