Treatment!

You are here – why?

Because

Brian Fingerson, RPh    President of Kentucky Professionals Recovery Network Administer addictions recovery programs for pharmacy, dentistry, veterinary medicine, respiratory care, and physical therapy >30 years pharmacy practice with > 22 years working with HCP with addictions

Clinical Definition (IMHO)

Relapse Prevention and Monitoring

 You’ve been to treatment (or not) and then what? How do we help them continue the process……

Yes…you are unique – just like those fishes

Recovery

  Recovery commonly refers to a process of initiating abstinence from illicit drug and/or alcohol use, along with necessary life changes to help maintain sobriety over time.

It’s a life long progression – and there may be obstacles and setbacks along the journey.

Lapse

 Sometimes called a “slip”  “ S obriety L osing I ts P riority”  “ S omething L ousy I P lanned”  Could be defined as an initial episode of drug or alcohol use after a period of abstinence.

Relapse

 It’s viewed as a breakdown in the recovery process i.e. a major digression in the individual’s attempt to escape the bonds of addiction.

So what’s the purpose of HCP monitoring programs?

 To ease the transition between treatment and return to “life” or the “real world.”  To help maintain recovery.

JAMA. 2005;293:1453-1460   Domino et al did a study on “Risk

Factors for Relapse In Health Care Professionals With Substance Use Disorders.”

And what they found was -

The risk of relapse with substance use was increased in HCP who:     Used a major opioid Or had a coexisting psychiatric illness Or a family history of substance use disorder And……

And….

  The presence of more than one (1) of these risk factors and previous relapse further increased the likelihood of relapse. And these observations should be considered in monitoring the recovery of HCP.

Re Entry into the “real world”, i.e. the addict returns

Home and Work and Balance

What Do We Mean-the Addict Returns?

   Where has she been? Gone how long?

Did she go to a formal treatment program? Out of town?

Has she been “not practicing” – and if so – for how long?

Let’s Talk About Home First:    Was the spouse or significant other involved in the decision to seek help?

Did this person get involved during the family part of any formal treatment? Are there parents or children or siblings involved?

Did these persons take advantage of 12-Step programs e.g. Al-Anon or Nar-Anon?

Is There Resentment Because Of:     Lack of income No help with children No help with upkeep of a home Need for explaining where is she/he

Re-entry into life - What to Avoid     Former play places “play pens” Former playmates Former play things “Triggers” for using in the home

We have to do what?

12 Step Meetings and ……    In virtually every case they will be required to attend 12-Step recovery meetings with varying frequency. “It works the best for the most.” They may be encouraged to use Caduceus meetings in addition.

We may well suggest joining IDAA @ www.idaa.org

.

Return to Practice  Protection of public is the #1 priority for us and for Boards.

Urged to attend conferences that deal with addiction recovery      Health care professional conferences e.g. CAPTASA SE PRN ADA Well-being Conference University of Utah School on….

IDAA

Fear and Anxiety  What do I do about anonymity with:   Co-workers Patients/Clients/ Customers Plenty of questions

Agreement with recovery program within the profession:        For a specific length of time Shared with employer or partner(s) May limit number of hours worked Approved practice site Not PIC or have POA or DEA i.e. responsibilities or privileges that may be a danger They may be asked to appear before the committee of their profession which deals with impairments Other things we’ll talk about shortly

Medication List: Are they OK to use?

      Yes No Maybe – more later What precautions e.g. MAR, witnesses “Safe medication booklets” Non-drug alternatives

Monthly Self Report:         Sobriety date!

Change in work status Sponsor contact frequency Up-to-date meeting attendance logs What step are you working on What service work are you doing Are you praying daily When was your last PRN contact

Monthly Self Report cont.

       Spouse/significant other concerns Counseling Warning signs of relapse in your life* (more in a moment) Cravings Defects of character dealt with Attitude toward recovery Eating/Exercise/Fun

Preventing a Lapse (slip) from Becoming a Relapse    Stop consuming the illicit substance(s) as soon as possible.

Stopping sooner means far less physical and mental anguish due to renewed substance dependence and craving.

Use the slip as a learning experience.

More prevention:    Examine the sequence of events leading up to the slip; what could have been done differently to avoid it?

Do not make excuses but, at the same time, do not beat yourself up.

Get immediately back into the program of recovery

More prevention:  Take pride in renewed efforts to stay “clean”; rather than punishing yourself for past events leading up to the slip.

 (adapted from: Volpicelli and Szalavitz 2000)

She may have:     Modifications of practice type Practice monitoring by peers/others Protocols for required mood-altering drugs for a legitimate medical problem – more on this in a bit Consequences should she return to substance use

Use of pain medications in the recovering person (Rick K in Ohio)    RP must have a doctor that is diagnosing the condition! i.e. no self-treatment!!!!!

RP must be honest with the practitioner about his/her addiction.

RP must be IN RECOVERY!

More guidelines:    Oxycodone or hydrocodone are used but consider alternatives.

RP should not be in possession of the medications. Also use an MAR Pray before, during and after the medication.

And more yet:   Monitor the pain level closely – chronic pain can and will lead to relapse. Work around it!

Destroy unused or un-needed medicines immediately – don’t leave them around the house.

And last from RK  “The only defense I had was a spiritual defense. The spiritual defense came because my head and body were in meetings.

MEETINGS SAVE LIVES…NO MEETINGS…NO MEDICINE!

16 Points: Assessing Progress in Recovery i.e. Monitoring!!!!!

 G. Douglas Talbott, MD, FASAM - Talbott Recovery Campus, Atlanta, GA

16 Points     1. Meetings – yes – 12-Step meetings 2. Sponsor – and use of said person 3. Monitoring – formal and informal 4. Emotional traps e.g. anger, guilt, depression, anxiety, insomnia, etc.

16 Points     5. Additions/Subtractions to addiction history (secrets) 6. Compulsive behaviors (sex, food, nicotine, gambling, theft, spending) 7. Current therapy/treatment/medications both Rx and OTC 8. Relationships (family, spouse, parents, children, friends)

16 Points     9. Physical Health – an exercise program 10. Leisure time – fun – (safe, non adrenaline rush, risk taking) Stress = > chance of relapse 11. Work (professional status, duties, attitudes) 12. Financial status

16 Points     13. Legal – licensure status 14. Additional training and/or continuing professional education 15. Spiritual program – more on this later 16. “Soft” part of the recovery program – e.g. fellowship and meditation

Alcoholics Anonymous, Page 85

 “We are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.”

“Twelve and Twelve” page 174

 “We of AA obey spiritual principles, at first because we must, then because we ought to, and ultimately because we love the kind of life such obedience brings. Great suffering and great love are AA’s disciplinarians; we need no others.”

And then AA’s Step 12:   “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” Emphasis added by BF

Fr Bernie’s Eagle Wings Vol. 11 #7  Page 28 of Big Book (Alcoholics Anonymous): “If what we have learned and felt and seen means anything at all, it means that all of us, whatever our race, creed or color are the children of a living Creator with whom we may form a relationship upon simple and understandable terms as soon as we are willing and honest enough to try.”

Fr Bernie then writes:  “The key word in this statement is relationship . Spirituality is a relationship not a belief system. My religion is my belief system. My spirituality is my relationship with my Higher Power.”

My experience says:  12-Step recovery does the best for the most. I can speak from experience, ODAAT.

“The alcoholic is like a tornado, roaring his way through the lives of others.” Page 82

“Hearts are broken” from the Big Book page 82 Recovery by Mike Vye

We Would Like Return to This:

And not this:

Questions?

       For further information: Brian Fingerson, RPh Brian Fingerson, Inc. dba KYPRN 202 Bellemeade Road Louisville, KY 40222-4502 502-749-8385 [email protected]