Document

Report
The Non-anesthetic Substance
Abusing Provider
Colleen Amundson BSN, RN, SRNA
Shannon Bachman BSN, RN, SRNA
Objectives
• 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
The Addicted
Anesthesia Provider
• Dr. William S.
Halstead
developed an
addiction to
cocaine while
learning its
potential use as
an anesthetic.
Fast forward- to 1960 and beyond
• 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
Abuse vs. Addiction
*Abuse usually
precedes addiction
Contributing Factors
• Genetics
– Family history
– Genomics
• Personality
– Sensationseeking
– MacAndrew
Scale
• Psychological
– Underlying
mood disorders
– Selfdiagnose/selftreat
Zuckerman’s Sensation Seeking
Scale and MacAndrew Scale
Student Registered
Nurse Anesthetists
score higher on
these tests
indicating a higher
propensity for
alcohol abuse and
addiction
Psychological Factors
• “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)
Alcohol’s effect on the brain
•
•
•
•
•
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•
Nerve cells
Cerebral cortex
Frontal lobe
Cerebellum
Hippocampus
Hypothalamus
Medulla
Alcohol-related brain damage
• Premature aging
hypothesis
Signs and symptoms
What do you do if you suspect a coworker?
•
•
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CAGE questions
Personal questions
Intervention
What to expect
1. Supervised detox
2. Psychiatric evaluation
3. Inpatient treatment
4. Outpatient treatment
5. Individual and group
therapy sessions
6. Self help groups (12step program)
7. Family therapy
8. Story telling
Re-entry into Practice
• 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.
Pharmacologic Treatment
• Disulfiram
• Topiramate
Pharmacologic Treatment
• Naltrexone:
• Acamprosate:
AANA Standards and Drug-Testing
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
Rules regarding alcohol use in
anesthesia
• There are no time limits
on alcohol consumption • Should there be?
for anesthesia
providers.
There is No Shame in Recovery
• http://www.aana.com/resourc
es2/healthwellness/Pages/GettingHelp.aspx
• http://www.aa.org
• http://www.helpguide.org/me
ntal/alcohol_abuse_alcoholis
m_signs_effects_treatment.ht
m
References
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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 opioiddependance 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.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 cont.
•
•
•
•
•
•
•
•
•
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/nationwidetrends
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.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.
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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

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