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The Non-anesthetic S ubstance A busing P rovider

The Non-anesthetic S ubstance A busing P rovider. Colleen Amundson BSN, RN, SRNA Shannon Bachman BSN, RN, SRNA. Objectives. History, prevalence, and contributing factors Alcohol effects on the brain including signs and sym ptoms Alcohol addiction in the workplace

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The Non-anesthetic S ubstance A busing P rovider

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

  2. 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

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

  4. 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

  5. Abuse vs. Addiction *Abuse usually precedes addiction

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

  7. 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

  8. 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)

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

  10. Alcohol-related brain damage • Premature aging hypothesis

  11. Signs and symptoms

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

  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. 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.

  15. Pharmacologic Treatment • Disulfiram • Topiramate

  16. Pharmacologic Treatment • Naltrexone: • Acamprosate:

  17. AANA Standards and Drug-Testing Up and coming drug testing: • Naltrexone assays • EDAC blood test • EtG/EtSurine test Current drug testing: • Urine • Hair • Breathalyzer (0.068 and 0.08)

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

  19. There is NoShame in Recovery • http://www.aana.com/resources2/health-wellness/Pages/Getting-Help.aspx • http://www.aa.org • http://www.helpguide.org/mental/alcohol_abuse_alcoholism_signs_effects_treatment.htm

  20. References • 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-dependancetreatments.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.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

  21. 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/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.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

  22. References cont. • 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 HegedornHTrafton J A 2013 Pharmacotherapy for alcohol dependence: Perceived treatment barriers and action strategies among veterans health administration service providers.20130303201619257948756

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