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4 theoretical models of addiction?
genetic/biological

disease

psychological

familial
Diversion behavior includes
1. increased time in or near the narcotic supply

2. unusual choices and amounts of drug sign-outs
Most frequently abused drug?
#1 = versed

#2 = Nitrous

#3 = opioids
3 most prevalent indicators that prompted suspicion?
1. behavioral changes

2. inappropriate drug request

3. mood swings
What gender is more likely to use drugs
males
of all the theoretical models postulated, what model is now the most widely accepted rationale for CD among healthcare professional
the disease model
what are two reasons an overdose may occur?
1. abuser tries a drug such as sufentanil for the first time

2. an addict who relapses and uses the same amount after months of abstinence
Opioid withdrawal is characterized by 3 or more of the following signs....
dysphoria, nausea and vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection or sweating, diarrhea, yawing, fever, or insomnia
Johnson's 4-stage model of progression
1. learning the mood swing
2. seeking the mood swing
3. harmful dependency
4. using to feel normal
Learning the mood swing?
* recreational or medicinal
* Experience is pleasant
* Relaxing, no side effects
* Aware of substance's positive effects
Seeking the mood swing?
* Using to repeat effect
* May occasionally overdo it
* Many remain at this stage
Harmful dependency?
* begin to lose control
* experience is no longer fun
* adverse effects, costly
* unacceptable behavior
Using to feel normal?
* total loss of control
* Use to avoid withdrawal, pain
* consumed with compulsion
Onset of addiction....

Sufentanil?

Fentanyl?

Morphine, demerol?

Alcohol?
Sufent = days

Fent = Few months

morphine....several months

Alcohol...years
Risk factors (trigger mechanisms) for addictive behavior?
- ease of drug availability

-prior experimentation with mood altering drugs

-job-related stress

-respect not equivalent to responsibility

- knowledge of the powers of drugs
Stress-related risk factors?
-life and death decision making

- long hours

-altered sleep pattern
Risk factors for SRNA's
STRESS

financial problems

lack of coping skills

depression
What is the most difficult obstacle to overcome for both the chemically addicted person and their colleagues
"DENIAL"
Stages of enabling
1. anxiety, increasing tension, denial

2. preoccupation, assuming responsibility

3. coping mechanisms

4. crisis, suicide, overdose
what is a "refractometer"
looks at how the drug refracts light...so they will know if you empty a bottle of fentanyl and replace it with 0.9 NS
Men (CRNA's) account for what % of peer assistance hotline callers?
80%
Persistent behavioral and performance problems of the addict?
- absenteeism
-loss of time on duty ( increased breaks, etc...)

-confusion, lack of concentration

-spasmodic work pattern

-escalating error or incident rate
Steps toward intervention...
-documentation
-research all options
-identify financial resources
-identify treatment programs
-meet with the team
-conduct intervention
-debriefing and closure
Failed intervention occurs when?
- plan falls apart, team turns confrontational

- nurse refuse evaluation

-treatment facility not available