Colleen Amundson BSN, RN, SRNAShannon Bachman BSN, RN, SRNA

The Non-anesthetic Substance Abusing Provider

• 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

• Dr. William S. Halstead developed an addiction to cocaine while learning its potential use as an anesthetic.

The Addicted Anesthesia Provider

• 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

*Abuse usually precedes addiction

Abuse vs. Addiction

• Genetics– Family history– Genomics

• Personality– Sensation-

seeking– MacAndrew

Scale• Psychological

– Underlying mood disorders

– Self-diagnose/self-treat

Contributing Factors

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

• “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

• Nerve cells• Cerebral cortex• Frontal lobe• Cerebellum• Hippocampus• Hypothalamus• Medulla

Alcohol’s effect on the brain

• Premature aging hypothesis

Alcohol-related brain damage

Signs and symptoms

• CAGE questions• Personal questions• Intervention• What to expect

What do you do if you suspect a co-worker?

1. Supervised detox2. Psychiatric evaluation3. Inpatient treatment4. Outpatient treatment

5. Individual and group therapy sessions6. Self help groups (12-step program)7. Family therapy8. Story telling

• 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

• Disulfiram

• Topiramate

Pharmacologic Treatment

• Naltrexone:

• Acamprosate:

Pharmacologic Treatment

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

• There are no time limits on alcohol consumption for anesthesia providers.

• Should there be?

Rules regarding alcohol use in anesthesia

• 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

There is No Shame in Recovery

• 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.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

• 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

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 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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References cont.