The Non-anesthetic Substance
Abusing Provider
Colleen Amundson BSN, RN, SRNA
Shannon Bachman BSN, RN, SRNA
Objectives
• 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
The Addicted
Anesthesia Provider
• Dr. William S.
Halstead
developed an
addiction to
cocaine while
learning its
potential use as
an anesthetic.
Fast forward- to 1960 and beyond
• 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
Abuse vs. Addiction
*Abuse usually
precedes addiction
Contributing Factors
• Genetics
– Family history
– Genomics
• Personality
– Sensationseeking
– MacAndrew
Scale
• Psychological
– Underlying
mood disorders
– Selfdiagnose/selftreat
Zuckerman’s Sensation Seeking
Scale and MacAndrew Scale
Student Registered
Nurse Anesthetists
score higher on
these tests
indicating a higher
propensity for
alcohol abuse and
addiction
Psychological Factors
• “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)
Alcohol’s effect on the brain
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Nerve cells
Cerebral cortex
Frontal lobe
Cerebellum
Hippocampus
Hypothalamus
Medulla
Alcohol-related brain damage
• Premature aging
hypothesis
Signs and symptoms
What do you do if you suspect a coworker?
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CAGE questions
Personal questions
Intervention
What to expect
1. Supervised detox
2. Psychiatric evaluation
3. Inpatient treatment
4. Outpatient treatment
5. Individual and group
therapy sessions
6. Self help groups (12step program)
7. Family therapy
8. Story telling
Re-entry into Practice
• 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.
Pharmacologic Treatment
• Disulfiram
• Topiramate
Pharmacologic Treatment
• Naltrexone:
• Acamprosate:
AANA Standards and Drug-Testing
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
Rules regarding alcohol use in
anesthesia
• There are no time limits
on alcohol consumption • Should there be?
for anesthesia
providers.
There is No Shame in Recovery
• http://www.aana.com/resourc
es2/healthwellness/Pages/GettingHelp.aspx
• http://www.aa.org
• http://www.helpguide.org/me
ntal/alcohol_abuse_alcoholis
m_signs_effects_treatment.ht
m
References
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http://www.aana.com/resources2/health-wellness/Pages/default.aspx
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Quinlan, D. (2009). Imagining in time: Peer assistance reaches its 25th year. American Association
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