The Reality of Impaired Nurses. 

For nurses, addiction is the most frequent cause of practicing while impaired. Many nurse addicts are not identified as impaired and continue to practice, placing patients and themselves at great risk. Impaired nursing is a serious public health crisis. Connecticut does not have 'a formalized, structured monitoring program to deal with this crisis, a program that 37 other states currently have. We can no longer afford to ignore, ostracize, or punish our fellow nurses who have this progressive and fatal disease. We need to learn more about addiction as a disease, what recovery really is, and be advocates for those of us affected.

We will sift through some of the myths and explore the facts of addictive disease and chemical dependency. When we refer to "addiction" and "addicts" in this article, we are referring to alcoholism and alcoholics as well. The terms are interchangeable. The only distinction is the drug of choice.

In general, it is estimated that 10% of the population has the disease of addiction. Nurses are equally as susceptible to alcoholism, but are at a higher risk for drug addiction. Some studies have indicated that it may be 50% higher than the general population. There are 60,000 nurses in Connecticut, 45,000 in active practice. Applying these statistics to the nursing community in our state means that 4,500-6,000 nurses are at risk for this disease.

Addiction is a disease. A simple definition of a disease is "anything that interferes with the ability of a human to function normally."

Addiction is the use of mood-altering substances manifested by a loss of control, a compulsion or craving, the need to use in spite of the risk and adverse consequences, and interference with the functioning in the family and society. It is a brain disease that develops over time as a result of initial voluntary behavior of using drugs and alcohol. These long-lasting brain changes are responsible for the distortions in cognitive and emotional functioning that characterize addicts. Addiction is a belief in the efficacy of drugs (especially true for nurses). Denial of a problem is the hallmark of addiction. The addict needs to abstain from all mood-altering substances for a permanent recovery.

Compulsions overwhelm all other motivations.

Addiction as a disease can be described in the following ways:

PRIMARY: It is a disease in its own right, not a symptom of another disease. It causes its own signs and symptoms.

ACUTE: Addicts frequently display symptoms, such as overdoses and acute withdrawal, or accidents that necessitate the need for emergency care.

CHRONIC: It is permanent. It requires changes of the individual over the course of their lifetime. it requires a commitment to adherence of a daily regimen to maintain optimum health, much like diabetes.

PROGRESSIVE AND PREDICTABLE:

Addiction only gets worse without treatment affecting more systems with increasing severity. Even if an addict is clean and sober for many years, the disease itself is still progressing. Symptoms that haven't been observed for many years return as soon as the addict relapses. They pick up right where they left off; no matter how much time has gone by. The illness is well under way before the victim is aware that they have it. In other words, they have no idea at what point they turned from a "cucumber to a pickle."

INCURABLE AND IRREVERSIBLE: There are no effective cures. There is only management of the symptoms to prevent an acute episode. The addict can return to a normal life only as long as the drinking,or drug use stops completely.

FATAL: Death may come as the result of an acute event like an overdose or an accident or by the chronic effects of the disease over time. With alcohol in particular, no system is immune from the effects of chronic consumption.

Addiction effects the four spheres that make us human-physical, psychological, social and spiritual. No sphere is resistant, immune, or in any way unaffected.

Addiction can also be defined as a disease because it responds to treatment.

There is much confusion about the concept of addiction, which comes from trying to make a distinction as to whether specific drugs are physically or psychologically addicting. This historically revolves around whether physical withdrawal symptoms occur when abstinent from that substance. The physical withdrawal symptoms of opiate and alcohol addiction can be managed with medication in a safe setting. The most dangerous and addictive drugs do not produce physical withdrawal symptoms. They include:

* Cocaine/Crack

* Ritalin

* Marijuana

* Inhalants

* Ultram

* Methamphetamine

* Ecstasy

* Hallucinogens

* Stadol