Working Wounded: Preventing and Coping with Impairment in Helping Professionals Terrence D. Walton, MSW, CSAC

1. Working Wounded: Preventing and Coping with Impairment in Helping Professionals Terrence D. Walton, MSW, CSAC Pretrial Services Agency for the District of Columbia

2. Here’s What’s Coming • Job Effectiveness & Satisfaction • Impairment • The Disorders • The Warning Signs • The Train Wreck • Drinking and Drugging • Wellness

4. Two Essential Coping Skills

5. An impaired professional is one who has an illness or problem that prevents him or her from adequately performing required occupational duties.

6. I Can’t Get No Satisfaction

7. Impairment Arenas

8. Occupational Impact • Not as good as I used to be • Not as good as I could be • Not as good as I need to be

9. Impairment Levels

10. Sources of Impairment

12. 7 Work-related Contributors • Excessive, un-realistic demands • Monotony • Compassion fatigue • Bullied or rejected • Workplace conflict • Lack of mechanisms for resolution or venting • Triggering events (counter transference)

14. Defining Mental Health How a person thinks, feels, and acts when faced with life’s situations. Mental Health is how people look at themselves, their lives, and the other people in their lives; evaluate their challenges and problems; and explore their choices. This includes handling stress, relating to other people, and making decisions.

15. Threats to Wellness • Lifestyle Choices, Job Changes, Tragedy, Sickness • Substance Use Problems • Mental Health Problems

16. Mental Health Continuum Wellness MH Problems Common MH Problems Disorders Mental Illness

17. Common Mental Health Problems • Stress • Grief & Loss • Adjustment Difficulties • Anxiety • Juvenile Misbehavior • Marital or Family Discord • Discontent & Dissatisfaction • Unhappiness

18. Mental Disorder

20. Borderline Personality Disorder and Impairment • Unstable relationships; extremes; shifting views of others • Fear of being abandoned • Feelings of emptiness and boredom • Frequent displays of inappropriate anger • Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting • Intolerance of being alone • Repeated crises and acts of self-injury, such as wrist cutting or overdosing

21. 10 Warning Signs • Increased incidence of professional errors and oversights • Shows a decreased concern for defendant well being • Increased defendant complaints about the quality of service or manner, style, and tone of communications

22. 10 Warning Signs • Increased absence from work, social functions, or family outings • Frequently disappears for extended periods during the day • Deterioration of personal hygiene and/or appearance • Appears sleep deprived or distracted

23. 10 Warning Signs • Appears under the influence at work • Emotionally labile • Crying spells or uncharacteristic outburst

24. Five Ways to Wreck Your Career • Deny • Deflect • Deceive • Detach • Detonate

25. New DSM-5 • Diagnostic Statistical Manual of Mental Disorders (5th edition) • “Substance use disorder” and “addiction”, instead of “substance abuse” or “substance dependence” • Underlying change in brain circuits that may persist beyond detoxification for those with severe disorders

26. Substance Use Disorder and other Addictive Disorders A maladaptive pattern leading to clinically leading to clinically significant impairment or distress for at least 12 months. • 10 classes of drugs; 11 criteria (symptoms)

27. The Symptoms Two or more of: • Recurrent substance use leading to failure to fulfill major obligations • Associated social and interpersonal problems • Use in situations that are physically hazardous • Tolerance • Withdrawal effects

28. The Symptoms Two or more of: • Taking the substance in larger amounts and for longer than intended • Unsuccessful efforts to stop or cut down • Spending excessive time to obtain or use the substance • Giving up other activities • Continuing use despite the problems • Craving the substance

29. Substance Use Disorder

30. SubstanceRelated Disorder

31. How Many?

32. Addiction: A New Definition A medical condition characterized by impairment within the brain’s reward center and resulting in compulsive, repetitive, self-destructive behaviors

33. Medial Forebrain Bundle Prefrontal Cortex Ventral Tegmental Area Nucleus Accumbens

34. Neurotransmitter Action Reuptake Release of NT Receptor

35. How Drugs Work • Interact with neurochemistry • Results: • Feel Good – euphoria/reward • Feel Better – reduce negative feelings

36. Drug-Interacting Neurotransmitters • Dopamine – excitement & reward • Serotonin – feel – “normal” • Endorphin/Enkephalin – pain relief, reward, craving • GABA – lowers anxiety

37. Behavior Pathways • Rewarding behaviors urgently pursued • Obsessive, preoccupation, compulsion • “Subconscious” control of the behavior • Difficult to extinguish behaviors • Resistant to change

38. Brain Command Center Delay Discounting Demand Elasticity

39. Dopamine Tone • Amount of dopamine produced • Length of time dopamine is available • Number of dopamine receptors

40. Five Ways to Preserve Your Career • Decompress • Deliberate • Depend • Delegate • Deposit

41. Get Support • Employee Assistance Program • Human Resources • Professional Treatment • Faith Community • Support Groups • Trustworthy Colleague • Management Team

42. Social Work Code of Ethics Social workers who have direct knowledge of a social work colleague's impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.

43. Social Work Code of Ethics Social workers who believe that a social work colleague's impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

44. Reaching Out • Established, positive working relationship: • Raise the issue • Encourage them to get help • Discuss with supervisor • Honor your professional obligations • Don’t gossip

45. Healthy Agencies… Encourage personal wellness and work-life balance Create safe environments for staff to acknowledge impairment Don’t punish disclosure Provide support Expect the impaired to take responsibility for restoration

46. Working Wounded: Preventing and Coping with Impairment in Helping Professionals Terrence D. Walton, MSW, CSAC Pretrial Services Agency for the District of Columbia Terrencedwalton@gmail.com