TheUpsandDownsofSubstanceUseDisorder

PeggyMack,PHD,APRN,PMHCNSExecutiveDirector

DelawareBoardofNursing

January26,2017

2017NCSBNAnnualInstituteofRegulatoryExcellenceConference

ClearwaterBeach,Florida

HowManyNursesDoYouKnow?

1:10

Objectives

• Discusstheneurobiologyofsubstanceusedisorders;

• Identifynurses’risksforsubstanceusedisorders;

• Describenursingleaders’rolesinworkingwithnurses,withsubstanceusedisorders.

ParadigmShift

1930’sUnderstanding• SubstanceAbuser• Moralflaw,lackingwillpower

• Punish,ratherthantreat

NewUnderstanding• SubstanceUseDisorder• Chronicbraindisease,treatablehealthproblem

• Preventand treat

Sources:https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/prefacehttp://www.npr.org/sections/health-shots/2016/02/25/468085130/treating-addiction-as-a-chronic-disease

HowDoWeKnowWhatWeKnow?

• HowdoweknowthatSUDisachronicdisease?

• Research• i.e.AdverseChildhoodExperiences(ACE)

Source:http://www.cdc.gov/violenceprevention/acestudy/;

ACEvsWellnessVERYNEGATIVE

CHILDHOODEXPERIENCESHEALTHIMPACT LONG-TERM EFFECTS

Abuseofchild *Neurobiologicaleffects Diseaseanddisability

Recurrentsevereemotionalabuse *Disruptedneuro-development Ischemicheartdisease

Contactsexualabuse Difficultcontrollinganger CancerchroniclungdiseaseRecurrentphysicalabuse Depression Chronicemphysema

Traumainchild'shousehold Hallucinations Asthma

Substanceabuse Anxiety- panicreaction Liverdisease

Parentalseparationordivorce Multiple(6+)somatic c/o Skeletalfractures

Depressedorsuicidalhousehold Sleepproblems Poorself-ratedhealth

Mothertreatedviolently Impairedmemory SexuallytransmitteddiseasesImprisonedhouseholdmember Flashback HIV/AIDS

Lossofparent Dissociation SERIOUSSOCIALPROBLEMSNeglectofChild HEALTH RISKBEHAVIORS Homelessness

Unmetphysical/emotionalneeds Smokingsevere Prostitution

Abandonment Severeobesity Delinquency,violence,crimes

Source:Jennings,A.(n.d.).Adversechildhoodexperiencesand

healthandwell-beingoverthelifespan.RetrievedJuly31,2015,from

http://www.theannainstitute.org/ACE-HWB-CHART.html

Physicalinactivity InabilitytosustainemploymentSuicideattempts Re-victimization:rape,DV

*Alcohol/drugabuse Compromisedabilitytoparent50+sexpartners IntergenerationaltransmissionofabuseEatingdisorders Long-termbehavioralhealth

Interpersonalviolence Correctionalandsocialservices

• Howdoweknowaboutneurobioanddevelopmentalchanges?

• BrainResearch…Imagingadvances

Source:https://www.drugabuse.gov/publications/brain-power

HowDoWeKnowWhatWeKnow?

Whathasresearchtaughtusaboutthebrain’slimbicsystem?

AdvancesinScientificTechnology,suchasapositronemissiontomography(PET)

scanandthemagneticresonance

spectroscopy(MRS),gavenewviewsofthe

limbicsystem.

Source:https://cnx.org/contents/_Io4zP0c@7/The-Brain-and-Spinal-Cord

Source:http://brainsinsight.com/limbic-system-emotional-brain/

NeurobiologicalAdvancesGiveInsightintotheLimbicSystem

Source:http://hubpages.com/health/Anger-and-Addictions-as-a-Result-of-Stress

NatureandNurture

• KeyPoint:• Ourlimbicsystemisimpactedbygeneticsand

environmentaltriggers.

Sources:NationalInstituteonDrugAbuse.GeneticsandEpigeneticsofAddiction.Retrievedfromhttps://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addictionandWhydoourbrainsgetaddicted?[NPRvideo].Retrievedfromhttp://www.tedmed.com/speakers/show?id=309051

NatureandNurtureChallenges

• Negativeexperiences• Children- riskfactors• Adults- riskfactors

• Whatarenurses’environmentalriskfactors?

NotetoNursingLeaders

• Wedon’tknowhowtoremediatetheenvironmentalanddevelopmentaltrajectories…

• Butasnursingleaders,weCAN• Prevent/teachnursesaboutSUD• Learnnurses’patternsofbehaviors,riskfactors,and

waysdiversionsoccur

KnowPatternsofBehaviors

• Threephasesfordevelopingsubstanceabusedisorder:• Misuse• Dependency• Addictiontoalcoholorotherdrugs(legal/illegal)

Source:NCSBN,2011

KnowtheTopRiskFactorsforNurses

• Access• Attitude• Stress• Lackofeducation

Source:NCSBN,SubstanceUseDisorderinNursing,2011

KnowthePossibleSignsofDrugDiversion

• Behaviors– changes• Fromnormalemotionalpatterns• Moodswings,leavingunitforlongperiods• Pinpointpupils,needlemarks,bloodonclothing• Givingnarcoticstootherpatients’nurses

KnowtheOtherSignsofPossibleDrugDiversion

• Inmedicationdocumentation• Signingoutnarcotics,notdocumenting• Painc/ofrompts,whousuallyhavepainresolved• Volunteerstomedicateotherpts’patients• Patientscontinuingtoc/opainafterbeing

medicatedby“x”nurse.

AdditionalStrategiestoConsider

• Createasafeenvironment• Consider8hr ratherthan12hr staffingpatterns

• Monitorforbullying

• Notestaff’sc/o(pain,family,sleepdifficulties)

• Educaterisks,aftercare

• Intervenetimely• Cautionforsuicide• EAP,HRinterventions• DPHMP

• Understand,teachSUDisatreatable,chronicbraindisease.

Resource:SubstanceAbuseandNurses

DPHMPisadministeredbyDPR,andservicesareprovidedbyReliantBehavioralHealth(RBH),anindependentbehavioralhealthservicesorganization.

www.delawaremonitoring.com

DPHMPEnrollmentOptions

• Self-Referral• ThirdPartyReferral• OrderfromtheDelawareBoardofNursing

• Whatisavailableinyoursettings?

KeyPoints

• Brainchangesintheaddictedbrainareirreversible.• Relapseisareoccurrence/exacerbationofthechronicdisease.(NCSBN2011)

• Relapseisalwayspossible.(NCSBN2011)• Wedon’tknowhowtoremediatetheenvironmentalanddevelopmentaltrajectories,butweknowhowtobenursingleadersinthishealthchallenge.

• Let’spartnertogether.

InterestedinLearningMore?

• IntroductiontoSubstanceAbusePrevention“Thisfoundationalcourseofferspractitionersnewtothefieldofprevention,orworkinginrelatedfields,anintroductiontothehistoryofprevention,keyconceptsanddefinitions,specificdrugeffects,andanexcitingglimpseintotheeffectsofsubstanceuseandaddictiononthebrain.Regardlessofthesettingswhereyouwork,thisinformationwillhelptoprepareyoutopreventsubstanceabuseandpromotewellness.”

Source:https://captonline.edc.org/mod/page/view.php?id=19630

Thankyou

PeggyMack,PhD,APRN302-744-4500

ExecutiveDirectorDelawareBoardofNursing

DivisionofProfessionalRegulation

References

• AngerandAddictionasaResultofStress.(2012).RetrievedfromSource:http://hubpages.com/health/Anger-and-Addictions-as-a-Result-of-Stress

• Brainanatomy(2014).Retrievedfromhttp://brainsinsight.com/limbic-system-emotional-brain/

• Cares,A,Pace,E.;Denious,J.,Crane,L.A.(2015).SubstanceUseandMentalIllnessAmongNurses:WorkplaceWarningSignsandBarrierstoSeekingAssistance.SubstanceAbuse,vol.36,(1),DOI:10.1080/08897077.2014.933725.

• CDC.AdverseChildhoodExperiences.(2016).http://www.cdc.gov/violenceprevention/acestudy/

• CDC.Drugs,Brains,Behaviors.TheScienceofAddiction.(2014).https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain

References

• DrugAbuse,Genetics,andEpigeneticsofAddiction.(2016).Retrievedfromhttps://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction

• Hellem,T,Shi,X,Latendresse,G.,Renshaw,P.(2015).TheUtilityofMagneticResonanceSpectroscopyforUnderstandingSubstanceUseDisorders:ASystematicReviewoftheLiterature.JournaloftheAmericanPsychiatricNursesAssociation,July/August,vol.21,(4),244– 275.

• Jennings,A.(n.d.).Adversechildhoodexperiencesandhealthandwell-beingoverthelifespan.Retrievedfromhttp://www.theannainstitute.org/ACE-HWB-CHART.html

• NationalCouncilofStateBoardsofNursing.(2011).SubstanceUseDisorderinNursing:AResourceManualandGuidelinesforAlternativeandDisciplinaryMonitoringPrograms.Chicago,IL.:Author.

• McLellanT.A.(Feb.25,2016)TreatingAddictionasaChronicDisease.[NPRvideo].Retrievedfromhttp://www.npr.org/programs/all-things-considered/2016/02/25/468074273

• Richmond,S,Russell,K.(2013).UnderstandingSubstanceAbuseDisorderinNursing.RetrievedfromNationalCouncilofStateBoardofNursing(NCSBN)https://learningext.com

• Volkow,N.(2014).Whydoourbrainsgetaddicted?[NPRvideo].Retrievedfromhttp://www.tedmed.com/speakers/show?id=309051