Percy Menzies, MPh. and Gary D. Clark, Ed.D., CRNA
September is designated as the National Alcohol and Drug Addiction Recovery Month. This is a good time to focus on the disease that crosses all boundaries of race, age, education and socioeconomic status. Healthcare professionals are particularly vulnerable to the misuse of narcotics and addiction because of the easy access to drugs and the pressures nurses face in today’s workplace. Indeed, misuse and addiction to narcotics is the single biggest hazard nurses face in their profession. Yet, we seem reluctant to discuss the topic out of fear or misperceptions.
The very nature of addiction compels the patient to continually deny its devastating effects and weave an elaborate web to protect drug seeking behavior. It is a ‘no holds barred’ behavior, an obsession, where the overriding goal becomes obtaining drugs or satisfying a behavior while ignoring the legal, medical, professional, personal and employment consequences of the actions. The behavior often gets reinforced and becomes even more brazen when the patient feels he or she is not noticed and therefore, can continue the behavior with impunity. To put it more clearly, the ultimate end of drug addiction if unchecked is death.
When a nurse is caught or confronted with the addiction, the consequences are devastating. There is a feeling of impending doom and that the world has collapsed around the individual. The individual is faced with a multitude of potential legal and employment issues, including charges for theft, termination, and sometimes incarceration. Unlike other professional groups, like physicians and attorneys, nurses do not have a recovery program and diversion legislation that would allow for immediate treatment and not negatively impact their licenses.
Locating a treatment program can be a daunting and sometimes difficult task. There are a plethora of programs each embracing very diverse philosophies for the treatment of addiction. Some questions commonly asked when trying to locate the best program should include: Is an inpatient program or an outpatient program the best? How long should the treatment last? Is pharmacotherapy appropriate for this addiction? The list of questions can seem endless. However, the best approach may be to consider outcomes. There are some programs that have better outcomes than others. Yet, there are no easy answers to any of these questions.
Nurses and other healthcare professionals are presented with another major challenge to face – reentry into the profession. After receiving treatment, nurses are expected to go back into a profession and into an environment that may have contributed to the problem. Will reentry trigger cues that could lead to a relapse? How will the employer accept the addict? How will co-workers treat the addict? Will the addict be a suspect each time narcotics are missing? Will the addict be able to handle the added stress placed upon them in the workplace?
Historically, treatment has seemed sporadic and limited for health care professionals until now. Addiction has been viewed as a moral weakness, or a personality flaw, and only the disadvantaged were afflicted. We now know these are antiquated and inaccurate stereotypes. Treatment programs have to take into consideration the personal issues of each patient when treating impaired nurses. There is general agreement that addictive diseases are in many ways no different than other medical diseases like diabetes, asthma and hypertension. They are chronic, progressive and can be controlled by a combination of medications and behavioral modification counseling. The intensity and duration of therapy is contingent on several factors like the length of drug use, co-morbid conditions, a patient’s acceptance of the problem, the compliance with the treatment program and the availability of a support system during and after treatment.
Although we do not have medications for every type of drug dependence or addiction, there are currently medications available for the treatment of alcohol and opiate addiction. Unfortunately, the authors are stymied by a reluctance to use pharmacotherapy in relapse prevention since it has been shown to have good outcomes. The hesitation to use medication is largely due to personal experiences or unfamiliarity with medications that are available. There is strong evidence that supports a treatment regimen that integrates behavioral modification therapies with medications that work well in the treatment of drug dependence. One such medication is naltrexone. Naltrexone has been specifically developed as an opioid blocker. The drug is like an ‘insurance’ policy to prevent compulsive or accidental use of opiates. If the patient on naltrexone ingests opioids, the patient will not feel the effects of the opioid and therefore, incentive to use opioids is diminished. The major shortcoming of this medication is that it does not produce euphoria, a “positive mood state” or a “high.” Patients can walk away from a treatment without experiencing the multitude of physiological withdrawal symptoms, which become prevalent when the opioid is terminated.
Any shortcomings that might exist regarding the use of naltrexone, do not appear to be a problem in treating a health professional’s addiction, primarily because of the contingencies associated with successful treatment and aftercare. Indeed, in some cases, ingestion of naltrexone is a condition of employment and patients show significantly better outcomes with its use.
Today’s Nurse – St. Louis, Missouri
September 16 – September 29, 2002