Treatment

So, what happens now? The addict is unable to stop taking drugs despite the consequences. Remember-addiction is a powerful brain disease expressed in the form of compulsive behavior, a medical condition that demands formal treatment. Recovery is an ongoing process requiring abstinence from mood-altering substances and changing one's thinking patterns, attitudes, behaviors and lifestyle. As in any building process, recovery must begin with a strong foundation-a comprehensive, bio-behavioral, individualized, treatment plan. Important components of treatment are:

* DETOXIFICATION: The first phase for those with physical withdrawal symptoms must be performed in a safe setting.

* EDUCATION for the addict about the disease of addiction.

* GROUP THERAPY: Understanding the disease through the group process.

* INDIVIDUAL THERAPY: Focusing on the addict's interpersonal issues.

* FAMILY THERAPY: Co-dependency issues are identified and worked through.

* RELAPSE PREVENTION: Guidelines for the recovering addict to rely on when faced with life stressors that may precipitate relapse behaviors

* SUPPORT GROUPS: The most successful recoverees fully participate in support groups such as NA or AA, which include working the 12 steps and confiding in a sponsor. The heart of NA and AA's program is total lifetime abstinence from alcohol and drugs-one day at a time. In Connecticut, there is also an anonymous, confidential peer support group for recovering nurses called Nurses for Nurses. This is a group of nurses in various stages of recovery and is a significant resource for nurses facing all issues of addiction.

Treatment non-compliance is the biggest cause of relapses for all chronic illnesses, including asthma, diabetes, hypertension, and addiction. For drug addiction, as well as for other chronic diseases, the individual's motivation and behavior are clearly important elements of success in treatment and recovery.

Predisposing Factors for Nurses

Specific factors predispose the nurse to this disease and actually allow for the initiation and continuation of substance abuse.

EDUCATION-We witness the cause and effect of medications. Drugs DO work!

* Alleviating the suffering of patients

* No emphasis on consequences of misuse

* Presumption that education equates immunity

* Ignoring the fact that it is an occupational hazard

PHARMACOLOGICAL OPTIMISM

* A blind faith in drugs develops

* Pavlovian response-reach for a pill or shot to relieve pain and suffering

* Self-diagnosing leads to self medicating

ACCESSIBILITY OF NARCOTICS

* Easy access leads to higher probability of use and abuse

ROLE STRAIN

* Rotating shifts-leads to disrupted sleep patterns and sleep deprivation

* Expectation that nurses must "control" emotions

* Heightened acuity level of care, fewer nurses, reduced time frame to complete nursing care

* Lack of support when crisis situations arise and lack of praise when crisis is resolved

ENABLING

Two major forms of enabling are:

PROFESSIONAL

* Lack of knowledge of addiction

* Lack of knowledge of the dynamics of recovery

* Fear of being manipulated

* Feeling powerless confronting a co-worker

* "No talk" rule-fear of litigation

EMPLOYER

* Rationalizing employee's behaviors

* Allowing sloppy performance

* Lightening the employee's workload

* Offering excuses

* Termination of employee

These forms of enabling are dangerous. The cycle continues to put the patients in jeopardy as the nurse becomes increasingly ill. Enabling robs the addicted nurse of the experiences that could propel them toward treatment and recovery.