the ups and downs of substance use disorder · 2018. 7. 20. · the ups and downs of substance use...
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TheUpsandDownsofSubstanceUseDisorder
PeggyMack,PHD,APRN,PMHCNSExecutiveDirector
DelawareBoardofNursing
January26,2017
2017NCSBNAnnualInstituteofRegulatoryExcellenceConference
ClearwaterBeach,Florida
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HowManyNursesDoYouKnow?
1:10
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Objectives
• Discusstheneurobiologyofsubstanceusedisorders;
• Identifynurses’risksforsubstanceusedisorders;
• Describenursingleaders’rolesinworkingwithnurses,withsubstanceusedisorders.
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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
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HowDoWeKnowWhatWeKnow?
• HowdoweknowthatSUDisachronicdisease?
• Research• i.e.AdverseChildhoodExperiences(ACE)
Source:http://www.cdc.gov/violenceprevention/acestudy/;
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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
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• Howdoweknowaboutneurobioanddevelopmentalchanges?
• BrainResearch…Imagingadvances
Source:https://www.drugabuse.gov/publications/brain-power
HowDoWeKnowWhatWeKnow?
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Whathasresearchtaughtusaboutthebrain’slimbicsystem?
AdvancesinScientificTechnology,suchasapositronemissiontomography(PET)
scanandthemagneticresonance
spectroscopy(MRS),gavenewviewsofthe
limbicsystem.
Source:https://cnx.org/contents/_Io4zP0c@7/The-Brain-and-Spinal-Cord
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Source:http://brainsinsight.com/limbic-system-emotional-brain/
NeurobiologicalAdvancesGiveInsightintotheLimbicSystem
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Source:http://hubpages.com/health/Anger-and-Addictions-as-a-Result-of-Stress
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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
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NatureandNurtureChallenges
• Negativeexperiences• Children- riskfactors• Adults- riskfactors
• Whatarenurses’environmentalriskfactors?
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NotetoNursingLeaders
• Wedon’tknowhowtoremediatetheenvironmentalanddevelopmentaltrajectories…
• Butasnursingleaders,weCAN• Prevent/teachnursesaboutSUD• Learnnurses’patternsofbehaviors,riskfactors,and
waysdiversionsoccur
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KnowPatternsofBehaviors
• Threephasesfordevelopingsubstanceabusedisorder:• Misuse• Dependency• Addictiontoalcoholorotherdrugs(legal/illegal)
Source:NCSBN,2011
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KnowtheTopRiskFactorsforNurses
• Access• Attitude• Stress• Lackofeducation
Source:NCSBN,SubstanceUseDisorderinNursing,2011
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KnowthePossibleSignsofDrugDiversion
• Behaviors– changes• Fromnormalemotionalpatterns• Moodswings,leavingunitforlongperiods• Pinpointpupils,needlemarks,bloodonclothing• Givingnarcoticstootherpatients’nurses
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KnowtheOtherSignsofPossibleDrugDiversion
• Inmedicationdocumentation• Signingoutnarcotics,notdocumenting• Painc/ofrompts,whousuallyhavepainresolved• Volunteerstomedicateotherpts’patients• Patientscontinuingtoc/opainafterbeing
medicatedby“x”nurse.
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AdditionalStrategiestoConsider
• Createasafeenvironment• Consider8hr ratherthan12hr staffingpatterns
• Monitorforbullying
• Notestaff’sc/o(pain,family,sleepdifficulties)
• Educaterisks,aftercare
• Intervenetimely• Cautionforsuicide• EAP,HRinterventions• DPHMP
• Understand,teachSUDisatreatable,chronicbraindisease.
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Resource:SubstanceAbuseandNurses
DPHMPisadministeredbyDPR,andservicesareprovidedbyReliantBehavioralHealth(RBH),anindependentbehavioralhealthservicesorganization.
www.delawaremonitoring.com
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DPHMPEnrollmentOptions
• Self-Referral• ThirdPartyReferral• OrderfromtheDelawareBoardofNursing
• Whatisavailableinyoursettings?
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KeyPoints
• Brainchangesintheaddictedbrainareirreversible.• Relapseisareoccurrence/exacerbationofthechronicdisease.(NCSBN2011)
• Relapseisalwayspossible.(NCSBN2011)• Wedon’tknowhowtoremediatetheenvironmentalanddevelopmentaltrajectories,butweknowhowtobenursingleadersinthishealthchallenge.
• Let’spartnertogether.
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InterestedinLearningMore?
• IntroductiontoSubstanceAbusePrevention“Thisfoundationalcourseofferspractitionersnewtothefieldofprevention,orworkinginrelatedfields,anintroductiontothehistoryofprevention,keyconceptsanddefinitions,specificdrugeffects,andanexcitingglimpseintotheeffectsofsubstanceuseandaddictiononthebrain.Regardlessofthesettingswhereyouwork,thisinformationwillhelptoprepareyoutopreventsubstanceabuseandpromotewellness.”
Source:https://captonline.edc.org/mod/page/view.php?id=19630
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Thankyou
PeggyMack,PhD,APRN302-744-4500
ExecutiveDirectorDelawareBoardofNursing
DivisionofProfessionalRegulation
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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
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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