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

2. 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

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

4. 1958- Recognition of addiction by State Medical Boards 1962- “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 1983- present day: AANA’s contributions to wellness/recovery Fast forward- to 1960 and beyond

5. *Abuse usually precedes addiction Abuse vs. Addiction

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

7. 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

8. “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

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

10. Premature aging hypothesis Alcohol-related brain damage

11. Signs and symptoms

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

13. 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

14. 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

15. Disulfiram Topiramate Pharmacologic Treatment

16. Naltrexone: Acamprosate: Pharmacologic Treatment

17. 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

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

19. http://www.aana.com/resourc es2/health- wellness/Pages/Getting- Help.aspxhttp://www.aana.com/resourc es2/health- wellness/Pages/Getting- Help.aspx http://www.aa.org http://www.helpguide.org/me ntal/alcohol_abuse_alcoholis m_signs_effects_treatment.ht m There is No Shame in Recovery

20. AANA (2013, January). Health & wellness and peer assistance. Retrieved January 15, 2013, from http://www.aana.com/resources2/health-wellness/Pages/default.aspx Alcoholics Anonymous (2013, January). Alcoholics anonymous. Retrieved January 15, 2013, from http://www.aa.org Baldisseri, M. R. (2007). Impaired healthcare professional. Critical Care Medicine, 35(2), S106-S116. doi:10.1097/01.CCM.0000252918.87746.96 Baser O Chalk M Fiellin D A Gastriend D R 2011 Cost and utilization outcomes of opioid-dependance treatments.Baser, O., Chalk, M., Fiellin, D. A., & Gastriend, D. R. (2011). Cost and utilization outcomes of opioid- dependance treatments. American Journal of Management Care, 17(8), 235-248. 20130303202611713154912 Baser O Chalk M Rawson R Gastfriend D R 2011 Alcohol dependence treatments: Comprehensive healthcare costs, utilization outcomes, and pharmacotherapy.Baser, O., Chalk, M., Rawson, R., & Gastfriend, D. R. (2011). Alcohol dependence treatments: Comprehensive healthcare costs, utilization outcomes, and pharmacotherapy. American Journal of Management Care, 17(8), 222-234. 20130303202218260570287 Berge, K. H., Seppala, M. D., & Schipper, A. M. (2009). Chemical dependency and the Physician. Mayo Clinic Proceedings, 84(7), 625-631. Retrieved January 15, 2013, from http://www.mayoclinicproceedings.comhttp://www.mayoclinicproceedings.com Bryson, E. O., & Silverstein, J. H. (2008). Addiction and substsnce abuse in anesthesiology. Anesthesiology, 109(5), 905-917. Retrieved February 28, 2013, from www.anesthesiology.org Bryson E Hamsa H 2011 Drug seeking anesthesia care provider.Bryson, E., & Hamsa, H. (2011). Drug seeking anesthesia care provider. International Anesthesiology Clinics, 49(1), 157-171. Code of Ethics for the Certified Registered Nurse Anesthetist. Park Ridge, IL: American Association of Nurse Anesthetists; 2010.201303031756591233269215 Edenberg, H. J. (2012). Genes contributing to the development of alcoholism. Alcohol Research, 336-338. Federal Aviation Administration 2011Federal Aviation Administration (2011). (Section 91.17). Washington, DC: U.S. Government Printing Office. 201303032027481967980385 Federal Aviation Administration Department Of Transportation Section 91.17.Federal Aviation Administration. Department Of Transportation (2011). Alcohol and Drugs, Section 91.17. Retrieved March 3, 2013, from http://www.gpo.gov/fdsys/pkg/CFR-2011-title14-vol2/pdf/CFR-2011-title14-vol2-sec91-17.pdf References

21. Federal Railroad Administration. Department of Transportation (2007). Control of Alcohol & Drug Use (January 2007). Title 49, Part 219. Subpart B 219.101. Retrieved March 3, 2013, from http://www.fra.dot.gov/eLib/Details/L02581 49 CFR Part 219201303032030091428754211 Harasymiw, J., Seaberg, J., & Bean, P. (2004). Detection of alcohol misuse using a routine test panel: The early detection of alcohol consumption (EDAC) test. Alcohol and Alcoholism, 39(4), 329-335. doi:10.1093/alcalc/agh061 Harris, A. H., Ellerbe, L., Reeder, R. N., Bowe, T., Gordon, A. J., Hegedorn, H.,...Trafton, J. A. (2013). Pharmacotherapy for alcohol dependence: Perceived treatment barriers and action strategies among veterans health administration service providers. Psychological Service. Lederman, L. C., & Menegatos, L. M. (2011). Sustainable recovery: The self-transformative power of storytelling in alcoholics anonymous. Journal of Groups on Addiction & Recovery, 6, 206-227. doi:10.1080/1556035X.2011.597195 McDonough, J. P. (1990). Personality, addiction, and anesthesia. Journal of the American Association of Nurse Anesthetists, 58(3), 193-200. National Institute On Drug Abuse 2012 DrugFacts: Nationwide TrendsNational Institute on Drug Abuse (2012). DrugFacts: Nationwide Trends. Retrieved from http://www.drugabuse.gov/publications/drugfacts/nationwide- trends National Institutes On Health National Institute On Alcohol Abuse And Alcoholism 2004 Alcoholism and the brain: An overviewNational Institutes of Health, & National Institute on Alcohol Abuse and Alcoholism (2004). Alcoholism and the brain: An overview. Retrieved from pubs.niaaa.nih.gov/publications/arh27-2/125-133.htm 201303032045081701370478 National Institutes Of Health (2013). National institute of alcohol abuse and addiction. Retrieved January 15, 2013, from http://www.niaaa.nih.govhttp://www.niaaa.nih.gov New York State Office Of Alcoholism And Substance Abuse Services 2011New York State Office of Alcoholism and Substance Abuse Services (2011). Topiramate: An anticonvulsant for addiction. Washington, DC: U.S. Government Printing Office. Retrieved March 3, 2013, from http://www.oasas.ny.gov/AdMed/FYI/fyitopiramate.cfm References cont.

22. Quinlan, D. (2009). Imagining in time: Peer assistance reaches its 25th year. American Association of Nurse Anesthetists, 77(4), 254-258. Retrieved January 15, 2013, from http://www.aana.com/aanajournal.aspx RS EDEN (2013). EtG alcohol testing. Retrieved February 14, 2013, from http://www.rseden.org/ Room, R., Babor, T., & Rehm, J. (2005). Alcohol and public health. Lancet, 365, 519-530. Retrieved January 15, 2013, from www.thelancet.com Skipper, G. E., Campbell, M. D., & DuPont, R. L. (2009). Anesthesiologists with substance use disorders: A 5-year outcome study from 15 state physician health programs. Anesthesia and Analgesia, 109(3). doi:10.1213/ane.0b013e3181adc39d Skipper, G. E., & DuPont, R. L. (2009). Anesthesiologists returning to work after substance abuse treatment. Anesthesiology, 110(6),. Wright, E. L., McGuiness, T., Moneyham, L. D., Schumacher, J. E., Zwerling, A., & Stullenbarger, N. E. (2012). Opioid abuse among nurse anesthetists and anesthesiologists. American Association of Nurse Anesthetists, 80(2), 120-128. Retrieved January 15, 2013, from http://www.aana.com/aanajournalonline.aspx Harris A H Ellerbe L Reeder R N Bowe T Gordon A J Hegedorn HTrafton J A 2013 Pharmacotherapy for alcohol dependence: Perceived treatment barriers and action strategies among veterans health administration service providers.20130303201619257948756 References cont.