Learning Anesthesiology
CHEMICAL DEPENDENCYCOULD MY COLLEAGUE BE A DRUG ADDICT?...
July 6, 2005
Greg Gordon, MD
Objectives: Participants will
Definition:
Chemical dependency =
Disease model
Sometimes all it takes: environment helps host become willing to experiment once with agent.
Narcotic and/or ethanol abuse: 10-13% of anesthesiologists
Areas to look for problems as disease progresses:
Drug use takes priority over increasingly more alternatives leading to progressive loss of control in the following areas (usually in this order):
Historical notes
Anesthesiologists:
Treatment
Recovery model of Alcoholics Anonymous
Detox/Education/Behavior modification
Prognosis - Eg.: MAG-IPP (Medical Assoc of Georgia Impaired Physician Program):
- Experience heightened sensitivity toward the disorder of chemical dependency
- Be able to define and describe symptoms of the disease of chemical dependency
- Be able to help in decisions about intervention, referral for treatment and return to work.
Definition:
Chemical dependency =
- CONTINUED (COMPULSIVE) use of a
- CHEMICAL SUBSTANCE,
- despite adverse CONSEQUENCES, indicating a CONTROL problem.
- Major concomitant associated sign or symptom is usually DENIAL of loss of control.
Disease model
- Primary, chronic progressive disease.
- May be fatal.
- Three essential elements:
- HOST (each of us is vulnerable)
- AGENT (duration and progression largely function of agent)
- ENVIRONMENT
Sometimes all it takes: environment helps host become willing to experiment once with agent.
- Spontaneous recovery is possible but relatively rare.
- Outside help is almost always needed.
- Denial: colleagues, friends, family, too. ("conspiracy of silence")
Narcotic and/or ethanol abuse: 10-13% of anesthesiologists
Areas to look for problems as disease progresses:
Drug use takes priority over increasingly more alternatives leading to progressive loss of control in the following areas (usually in this order):
- Community, social, church, avocations
- Friends, colleagues
- Family, loved ones
- Job, work, making a living (personal identity)
- Life itself
Historical notes
- William Halstead, the "father of modern surgery" suffered from cocaine and morphine addiction.
- Horace Wells, dentist who first noted analgesic effects of N2O, tried it on himself, died by suicide four years later in jail.
Anesthesiologists:
- 4% of docs,
- but 12% of docs in treatment for substance abuse
Treatment
Recovery model of Alcoholics Anonymous
Detox/Education/Behavior modification
- Inpatient start often necessary
- Group therapy
- Naltrexone (po: 72 hours duration)
- Antabuse
Prognosis - Eg.: MAG-IPP (Medical Assoc of Georgia Impaired Physician Program):
- 334 docs; 4 mos inpatient + 20 mos outpatient:
- 93% in recovery, practicing medicine 2-10 yrs out
- mortality from addiction: 1%
- Anesthesiologist subgroup: (resident, academic, private)
- 56 completed treatment:
- 55 in recovery, practicing medicine (36 in anesthesia)
- 25% relapsed:
- 90% first year
- 98% first two years
- 9 did NOT complete treatment: 4 DIED of addictive disease (>40% mortality)
- 56 completed treatment:
- Model Curriculum on Drug Abuse and Addiction for Residents in Anesthesiology. Arnold J. Berry, M.D., M.P.H., Chair, American Society of Anesthesiologists Committee on Occupational Health and William P. Arnold III, M.D., Chair, et al, Task Force on Chemical Dependence
-
Chemical Dependence in Anesthesiologists: What you need to know when you need to know it. ASA
-
Chemical Dependency: Exposing a Silent Enemy. ASA Newsletter 65(5), May, 2001
- State Medical Board of Ohio Approved Treatment Providers
- Video: Unmasking Addiction, Chemical Dependency in Anesthesiology. ASA. Janssen Pharmaceutica.
- Video: Wearing Masks, The Potential for Drug Addiction in Anesthesia. Association of Anesthesia Program Directors. Rainbow Productions, Inc., chicago. 1993