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Medina-Martínez J, Aliño M, Vázquez-Martínez A, Villanueva-Blasco VJ, Cano-López I. Risk and Protective Factors Associated with Drug Use in Healthcare Professionals: A Systematic Review. J Psychoactive Drugs 2024; 56:397-411. [PMID: 37341709 DOI: 10.1080/02791072.2023.2227173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
Healthcare professionals are exposed to stressful situations that may favor substance use vulnerability. This systematic review aims to synthesize the risk and protective factors associated with use, abuse, and dependence of alcohol, tobacco, psychoactive drugs, and cannabis in healthcare professionals. Following PRISMA recommendations, a systematic search was performed in PsycINFO, Web of Science, PubMed/MEDLINE, Embase, Scopus, and Cochrane Library. The search yielded 1523 studies, of which 19 were selected. The identified risk factors were demographic factors (i.e. male gender, and single/divorced marital status), psychopathological factors, social factors, positive attitudes toward drugs, unhealthy lifestyle habits, the COVID-19 pandemic, and the coexistence of the use of several substances. The protective factors were demographic factors (i.e. ethnicity and having dependent children), healthy lifestyle habits, and workplace anti-drug policies (i.e. restriction of tobacco use). These findings highlight the need for preventive actions against drug use in healthcare professionals to improve their health and reduce the possible negative impact on their healthcare practice. Knowledge of modifiable risk and protective factors allows their incorporation as components in preventive actions, and non-modifiable factors (e.g. demographic variables) may contribute to the detection of groups of greater vulnerability to propose selective prevention actions in this population.
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Affiliation(s)
| | - Marta Aliño
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group in Psychology and Quality of Life (PsiCal)/VIU-NED Chair of Global Neuroscience and Social Change, Valencian International University, Valencia, Spain
| | - Andrea Vázquez-Martínez
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group in Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Valencia, Spain
| | - Víctor José Villanueva-Blasco
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group in Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Valencia, Spain
| | - Irene Cano-López
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group in Psychology and Quality of Life (PsiCal)/VIU-NED Chair of Global Neuroscience and Social Change, Valencian International University, Valencia, Spain
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Parish CL, Feaster DJ, Pollack HA, Horigian VE, Wang X, Jacobs P, Pereyra MR, Drymon C, Allen E, Gooden LK, Del Rio C, Metsch LR. Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey. JMIR Res Protoc 2023; 12:e47548. [PMID: 37751236 PMCID: PMC10565625 DOI: 10.2196/47548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. OBJECTIVE To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers' clinical practices in caring for their patients. The survey also queried providers' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. METHODS Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. RESULTS Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. CONCLUSIONS Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47548.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Daniel J Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Xiaoming Wang
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Petra Jacobs
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | | | - Elizabeth Allen
- National Opinion Research Center, Chicago, IL, United States
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- School of General Studies, Columbia University, New York, NY, United States
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McNeely HL, Nelson-Brantley H, Teel C, Peterson M. Role of Stigma for Health Care Professionals With Nonmedical Substance Use. West J Nurs Res 2023; 45:833-842. [PMID: 37586033 DOI: 10.1177/01939459231187983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Stigma toward those with non-medical substance use may present as anticipated, perceived, enacted, or internalized stigma. OBJECTIVE The purpose of the study was to describe the role of stigma on health care professionals with non-medical substance use, from the perspective of treatment providers. Soliciting information about stigma from treatment providers is a unique perspective lacking in current literature. METHODS A qualitative descriptive design was used with semi-structured interviews of treatment providers (N = 16) in Colorado. Inductive content analysis was used to identify concepts and themes across interviews. RESULTS Findings showed that stigma is a major concern and a barrier for health care professionals seeking substance use treatment. Nurses and physicians demonstrate shame and guilt (internalized stigma) around their substance use. These professionals also experience fear around their reputation (perceived stigma) and challenges around re-entry to the workforce after treatment (anticipated stigma). CONCLUSIONS The awareness of existing stigma as well as internalized stigma impacts how health care professionals approach treatment, recovery, and returning to work.
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Affiliation(s)
- Heidi L McNeely
- School of Nursing, The University of Kansas, Kansas City, KS, USA
| | | | - Cynthia Teel
- School of Nursing, The University of Kansas, Kansas City, KS, USA
| | - Moya Peterson
- School of Nursing and School of Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
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Lysandrou AE, Teitelbaum SA, Merlo L, Phalin B, Janner A, Solomon L, Hunt J, Lewis B. Co-occurring pain and addiction: prognostic implications for healthcare professionals in residential treatment for substance use disorder. J Addict Dis 2023:1-10. [PMID: 37380371 DOI: 10.1080/10550887.2023.2223505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Objectives: Chronic pain is both an important antecedent and consequence of substance use. Although evidence suggests healthcare professionals may be uniquely vulnerable to chronic pain, this vulnerability remains largely unexamined in the context of recovery from substance use disorders (SUDs). We characterized pain in a sample of treatment-seeking individuals, examined potential differences in pain trajectories between healthcare professionals and non-healthcare patients, and interrogated potential pain-related vulnerabilities in treatment outcomes between these groups. Methods: Patients with SUDs (n = 663; 251 women) completed questionnaires indexing pain intensity, craving, and abstinence self-efficacy (including self-efficacy in pain-related contexts). Assessments were conducted at treatment entry, 30 days, and discharge. Analyses included chi-square and longitudinal mixed models. Results: The proportion of healthcare and non-healthcare patients endorsing recent pain was equivalent (χ2=1.78, p=.18). Healthcare professionals reported lower pain intensity (p = 0.02) and higher abstinence self-efficacy (p < 0.001). Profession by pain interactions (ps <.040) revealed that among medical professionals, associations between pain and all three treatment outcomes of interest were more robust relative to the non-healthcare group. Conclusions: Results suggest that although healthcare professionals endorse similar rates of pain and lower average pain intensity, they may be uniquely vulnerable to pain-related disruptions in craving and abstinence self-efficacy.
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Affiliation(s)
- Apollonia E Lysandrou
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Florida Recovery Center, Gainesville, FL, USA
- Center for Addiction Research & Education, Gainesville, FL, USA
| | - Scott A Teitelbaum
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Florida Recovery Center, Gainesville, FL, USA
| | - Lisa Merlo
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
- Center for Addiction Research & Education, Gainesville, FL, USA
| | - Ben Phalin
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Florida Recovery Center, Gainesville, FL, USA
| | - Amanda Janner
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Florida Recovery Center, Gainesville, FL, USA
| | - Laurie Solomon
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Florida Recovery Center, Gainesville, FL, USA
| | - Jason Hunt
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Florida Recovery Center, Gainesville, FL, USA
| | - Ben Lewis
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Florida Recovery Center, Gainesville, FL, USA
- Center for Addiction Research & Education, Gainesville, FL, USA
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Gir E, Baptista CJ, Reis RK, Menegueti MG, Pillon SC, de Oliveira E Silva AC. Increased use of psychoactive substances among Brazilian health care professionals during the COVID-19 pandemic. Arch Psychiatr Nurs 2022; 41:359-367. [PMID: 36428073 DOI: 10.1016/j.apnu.2022.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/04/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022]
Abstract
This study aimed to estimate the prevalence of increased psychoactive substance use (PSU) and associated factors among health care professionals. A cross-sectional and analytical study with 12,086 Brazilian health professionals was undertaken. An online questionnaire was used to gather data concerning sociodemographic factors, increased consumption of alcoholic beverages, tobacco, and hypnotics or sedatives during the COVID-19 pandemic. The prevalence of tobacco, alcoholic beverages, and hypnotic or sedative consumption were 17.8 %, 69.0 % and 17.1 %, respectively. Regression analyses indicated that having no religion and social isolation were associated with increased PASU during the pandemic. COVID-19 pandemic stressors may increase PASU, and increased PASU may increase the risk of substance use disorders and substance use-related chronic diseases, such as cancer.
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Affiliation(s)
- Elucir Gir
- Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | | | - Renata Karina Reis
- Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | | | - Sandra Cristina Pillon
- Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Bourgeault IL, Atanackovic J, McMillan K, Akuamoah-Boateng H, Simkin S. The pathway from mental health, leaves of absence, and return to work of health professionals: Gender and leadership matter. Healthc Manage Forum 2022; 35:199-206. [PMID: 35678073 PMCID: PMC9237852 DOI: 10.1177/08404704221092953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Health professions are ranked among the most stressful occupations and have a much higher likelihood of absenteeism from work. In this article, we present findings from four health professional case studies in our Healthy Professional Worker partnership, involving surveys with 1,860 respondents and 163 interviews with nurses, physicians, midwives, and dentists conducted between December 2020 and April 2021. We found that the pathway from mental health experiences through to the decision to take a leave of absence and return to work differed between the health professions and that both gender and leadership matter greatly. There is a need to de-stigmatize mental health issues and encourage greater awareness and support from supervisors and colleagues. Leadership can play an important role in mitigating mental health issues, and as such investment in both leadership training and mentorship are important first steps in acting upon our research findings.
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Affiliation(s)
| | | | - Kim McMillan
- 151181University of Ottawa, Ottawa, Ontario, Canada
| | | | - Sarah Simkin
- 151181University of Ottawa, Ottawa, Ontario, Canada
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Shadakshari D, Muliyala KP, Jayarajan D, Kandasamy A. Occupational Challenges in Physicians with Substance Use Disorder: A Qualitative Study. Indian J Psychol Med 2022; 44:253-258. [PMID: 35656432 PMCID: PMC9125475 DOI: 10.1177/02537176211020520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) in physicians impact their professional responsibilities toward patients. Understanding the difficulties of physicians with SUDs would facilitate early identification and reduce the complications they face in various domains, particularly in settings where there are no physician-health care programs. In this background, we aimed to understand the challenges physicians with SUDs face at their workplace. METHODS Qualitative in-depth interviews of 21 physicians receiving treatment from a tertiary care addiction medicine center for their SUD were conducted and, based on the transcripts from the interview after coding and recoding, through inductive content analysis, themes and subthemes were identified. RESULTS The following occupational challenges were identified: direct consequences of the psychoactive effect of the substance, adverse effects on clinical care and service delivery, impairment in regularity and punctuality, changes in the physicians' behaviors, changes in the work environment and diverse responses of colleagues and the hospital administration toward substance use-related actions, ethical issues at workplace, and effects on career growth. CONCLUSIONS SUDs in physicians have a significant impact on their functioning at work, affecting patient care, interpersonal relationships as well as career growth. Knowledge of occupational challenges among physicians with SUD will help us in understanding the severity of the problem.
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Affiliation(s)
- Darshan Shadakshari
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Krishna Prasad Muliyala
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Deepak Jayarajan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arun Kandasamy
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Möckel L, Gerhard A, Mohr M, Armbrust CI, Möckel C. Prevalence of pain, analgesic self-medication and mental health in German pre-hospital emergency medical service personnel: a nationwide survey pilot-study. Int Arch Occup Environ Health 2021; 94:1975-1982. [PMID: 34097107 PMCID: PMC8180540 DOI: 10.1007/s00420-021-01730-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/09/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study was to estimate the prevalence of pain, the extent of analgesics intake and the mental health status of German pre-hospital emergency medical service (EMS) personnel. METHODS We conducted a nationwide online survey, which consisted of sociodemographic and job-related items, questions on pain and analgesics intake and the short-version of the validated Depression-Anxiety-Stress Scale (DASS-21). RESULTS A total of 774 EMS personnel with a mean age of 33.03 (standard error [SE] 0.37) years were included into the final analysis of which 23.77% were female. Pain was reported by 58.64% (454 of 774) of the study participants with 10.72% (95% confidence interval [CI] 8.54%; 13.29%) suffering from chronic, 1.68% (95% CI 0.89%; 2.87%) from acute and 46.25% (95% CI 41.49%; 51.30%) from recurrent pain, respectively. Most frequent location of pain was lumbar spine. Analgesics were used by 52.76% (239 of 454) of pre-hospital EMS personnel with pain (acute 76.92% / chronic 69.88% / recurrent 47.90%). Moreover, participants with chronic and recurrent pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress (p ≤ 0.001) levels compared to those without pain, respectively. CONCLUSION This study indicates a high prevalence of pain and analgesics usage in participating German pre-hospital EMS personnel and a poorer mental health in those with chronic and recurrent pain. Therefore, disease prevention and health promotion measures are needed to preserve health of pre-hospital EMS personnel.
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Affiliation(s)
- Luis Möckel
- HSD Hochschule Döpfer GmbH, University of Applied Sciences, Waidmarkt 3 & 9, 50676, Cologne, Germany.
| | - Angela Gerhard
- HSD Hochschule Döpfer GmbH, University of Applied Sciences, Waidmarkt 3 & 9, 50676, Cologne, Germany
| | - Mara Mohr
- HSD Hochschule Döpfer GmbH, University of Applied Sciences, Waidmarkt 3 & 9, 50676, Cologne, Germany
| | - Christoph Immanuel Armbrust
- HSD Hochschule Döpfer GmbH, University of Applied Sciences, Prüfeninger Straße 20, 93049, Regensburg, Germany
| | - Christina Möckel
- HSD Hochschule Döpfer GmbH, University of Applied Sciences, Waidmarkt 3 & 9, 50676, Cologne, Germany
- Forschungszentrum Jülich, Wilhelm-Johnen-Straße, 52428, Jülich, Germany
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Choi B. Opioid use disorder, job strain, and high physical job demands in US workers. Int Arch Occup Environ Health 2020; 93:577-588. [PMID: 31919662 DOI: 10.1007/s00420-019-01514-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/27/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Little is known about the work environmental risk factors for opioid use disorder (OUD) in working populations. The purpose of this study is to examine whether adverse physical and psychosocial working conditions are associated with OUD in a working population of the United States (US). METHODS Among the participants of the National Survey of Midlife Development in the United States (MIDUS) II Study (2004-2006), 2134 workers (1059 men and 1075 women; mean age, 51 years) were chosen for this study. OUD was measured with self-administered questions in line with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSD-5). Physical demands (physical efforts, heavy lifting, and crouching/stooping/kneeling) and psychosocial work stressors (skill discretion, decision authority, job control, psychological job demands, supervisor and coworker support at work, job insecurity, and work hours) were measured with a standard questionnaire. RESULTS The prevalence of OUD was 3.8%. In multivariate analyses, low skill discretion, high psychological job demands, job strain (a combination of low control and high demands), and high physical job demands were significantly associated with OUD. The multivariate prevalence ratios for OUD by job strain and frequent heavy lifting were 1.98 (1.27-3.10) and 2.23 (1.22-4.10), respectively. Job strain was more strongly associated with OUD in men, while high physical job demands were more strongly associated with OUD in women. CONCLUSION This study implies that adverse physical and psychosocial working conditions may be important risk factors for OUD in US working populations. Future longitudinal and mechanistic studies are urgently warranted.
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Affiliation(s)
- BongKyoo Choi
- Department of Medicine and Program in Public Health, University of California Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.
- Center for Work and Health Research, Irvine, CA, USA.
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Ribeiro ÍAP, Fernandes MA, Pillon SC. Prevalence and factors associated with the consumption of psychoactive substances by health care workers. Rev Bras Enferm 2020; 73:e20200279. [DOI: 10.1590/0034-7167-2020-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to estimate prevalence and factors associated with the consumption of psychoactive substances among health care workers in hospitals. Method: cross-sectional study, with a sample of 289 health care professionals in a large hospital in Teresina, Piauí, Brazil. Results: 243 (84.1%) reported consumption of psychoactive substances; 124 (86.7%) of professionals who classed their level of satisfaction as moderate had double the chance (OR = 1.98 CI95% 1.02- 3.85) of consuming psychoactive substances; 40 (93%) of those with low level of satisfaction showed a four times higher chance (OR = 4.05 CI95% 1.15-14.26) of consumption; and 72 (75.8%) of those who reported a “good” state of health before work had a 54% lower chance of consumption (OR= 0.46 CI95% 0.234-0919). Conclusion: consumption of psychoactive substances was associated with factors related to level of job satisfaction and perceived health status before work
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Abstract
There are approximately 3.1 million nurses in the Unites States (U.S. Census Bureau, 2016), and approximately 8% of them experience substance use disorders (Kunyk, 2015). Nurses with impaired practice are referred to peer assistance programs as they seek rehabilitation. As of 2016, 348 nurses in Texas Peer Assistance Program for Nurses were actively participating in the program for substance-abuse-related offenses. Over the last 6 years (2010-2016), 1,553 nurses were referred to Texas Peer Assistance Program for Nurses specifically for substance-abuse-related problems. These represent 2% of the population of nurses in Texas. The average age of participants was 40.1 years. Women represented 75% of participants, and 76% were registered nurses. About 41% successfully completed the program without relapsing, and 32% reported at least one relapse. Varieties of drugs were abused including prescription drugs and illegal drugs. Opioids were the most frequently abused class of drugs, followed by alcohol and stimulants. Most nurses obtained their drugs by diverting from patients. Contrary to what is in the literature, nurses working in long-term care, medical-surgical units, and home health care had the highest prevalence of impaired practice. Psychiatric comorbidity was not significantly associated with relapse, but self-report status was significantly associated with gender, age category, license type, relapse, and drug of choice. There was a significant inverse relationship between time it takes to enroll and number of abstinent days. Men were also more likely to be employed while in the program.
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Employment implications of nurses going through peer assistance programs for substance use disorders. Arch Psychiatr Nurs 2018; 32:561-567. [PMID: 30029748 DOI: 10.1016/j.apnu.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/14/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
Nurses constitute approximately 36% of all healthcare providers, and 2% of the labor force in the United States (American Nurses Association [ANA], 2016). However, about 8% of nurses suffer from substance use disorders ([SUD]; Kunyk, 2015) and must participate in peer assistance programs to maintain their licenses (Darbro & Malliarakis, 2012). The purpose of this study was to describe the lived experiences of nurses with SUD participating in peer assistance programs and the subsequent employment implications. A Phenomenological approach was used to answer the research questions. Ten nurses were recruited from local support meetings and a thematic inductive approach was utilized to develop four overarching themes, which included stress from restriction, guilt and shame, gratitude for being caught, and keeping up with recovery. Understanding the challenges recovering nurses face when being incorporated into the workforce is important in implementing policies that facilitate a smooth transition.
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Kiepek N, Baron JL. Use of substances among professionals and students of professional programs: a review of the literature. DRUGS: EDUCATION, PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2017.1375080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Niki Kiepek
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Jonnie-Lyn Baron
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
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Pedersen AF, Sørensen JK, Bruun NH, Christensen B, Vedsted P. Risky alcohol use in Danish physicians: Associated with alexithymia and burnout? Drug Alcohol Depend 2016; 160:119-26. [PMID: 26832935 DOI: 10.1016/j.drugalcdep.2015.12.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/10/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Alcohol abuse may be elicited by psychological problems and can influence physicians' health and patient safety. To act on it, we need knowledge on the prevalence of the disorder and its associations with psychological factors and physicians' well-being. The aim of this study was to explore whether burnout and alexithymia are associated with risky alcohol consumption in physicians and whether burnout mediates the association between alexithymia and risky alcohol consumption. METHODS In this cross-sectional study, 4,000 randomly selected physicians received an electronic questionnaire by email containing the Alcohol Use Disorders Identification Test (AUDIT), the Maslach Burnout Inventory Human-Services-Survey (MBI-HSS) and the Toronto Alexithymia Scale (TAS-20). A total of 1,841 physicians completed the questionnaire (46%). RESULTS 18.8% reached the criteria for risky alcohol consumption. The likelihood of having risky alcohol consumption was associated with high levels of alexithymia (OR=1.93, 95%CI=1.37-2.74, P<0.001). Moreover, risky alcohol consumption was associated with burnout (OR=1.86, 95%CI=1.13-3.05, P<0.014) and each individual burnout dimension: emotional exhaustion (OR=1.89, 95%CI=1.33-2.69, P<0.001), depersonalisation (OR=2.23, 95%CI=1.53-3.25, P<0.001) and low levels of personal accomplishment (OR=1.66, 95%CI=1.14-2.41, P=0.008). Mediation analysis suggested that the association between alexithymia and risky alcohol consumption was partially mediated through depersonalisation. CONCLUSIONS The results emphasize a need for enhancing emotional self-awareness in physicians as psychological traits, work-pressure and alcohol dependence might be self-reinforcing aspects for the individual physician. As alcohol dependence and burnout may have consequences for patient safety separately, the aggregated influence of these factors has to be examined.
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Affiliation(s)
- Anette Fischer Pedersen
- Research Centre for Cancer Diagnosis in Primary Car-CaP, The Research Unit for General Practice, Aarhus University, Denmark.
| | | | - Niels Henrik Bruun
- Department of Public Health, Institute of General Medical Practice, Aarhus University, Denmark
| | - Bo Christensen
- Department of Public Health, Institute of General Medical Practice, Aarhus University, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Car-CaP, The Research Unit for General Practice, Aarhus University, Denmark
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Robitaille C, Collin J. Prescription Psychostimulant Use Among Young Adults: A Narrative Review of Qualitative Studies. Subst Use Misuse 2016; 51:357-69. [PMID: 26886251 DOI: 10.3109/10826084.2015.1110170] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Within the last decade, the nonmedical use of prescription drugs has raised concern, particularly among young adults. Psychostimulants, that is to say amphetamine and its derivatives, are pharmaceuticals, which contribute to what has come to be known in Canada and the United States as the "prescription drug crisis." Research in the fields of public health, addiction studies, and neuroethics has attempted to further understand this mounting issue; however, there is a paucity of data concerning the underlying social logics related to the use of these substances. OBJECTIVES The objective of this article is to provide an overview of the current literature related to the social context of prescription psychostimulant use among young adults, and to discuss theoretical considerations as well as implications for future research. METHODS A narrative review of the literature was performed. RESULTS We found that research efforts have chiefly targeted college students, yet there is a lack of knowledge concerning other social groups likely to use these pharmaceuticals nonmedically, such as persons with high strain employment. Three main emerging patterns related to prescription psychostimulant use were identified: (1) control of external stressors, (2) strategic use toward the making of the self, and (3) increasing one's performance. CONCLUSIONS Prescription psychostimulant use among young adults is anchored in contemporary normativity and cannot be separated from the developing performance ethic within North-American and other Western societies. We suggest that pharmaceuticalization and Actor-Network Theory are useful conceptual tools to frame future research efforts.
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Affiliation(s)
- Caroline Robitaille
- a Social and Preventive Medicine, University of Montreal , Montreal , Canada
| | - Johanne Collin
- b Faculty of Pharmacy, University of Montreal , Montreal , Canada
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16
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Baillif-Couniou V, Kintz P, Sastre C, Pok PRP, Chèze M, Pépin G, Leonetti G, Pelissier-Alicot AL. Hair testing in postmortem diagnosis of substance abuse: An unusual case of slow-release oral morphine abuse in an adolescent. J Forensic Leg Med 2015; 36:172-6. [DOI: 10.1016/j.jflm.2015.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
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MacDonald K, Sciolla AF, Folsom D, Bazzo D, Searles C, Moutier C, Thomas ML, Borton K, Norcross B. Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. Gen Hosp Psychiatry 2015; 37:489-96. [PMID: 26554082 DOI: 10.1016/j.genhosppsych.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood trauma and maladaptive beliefs--in 100 attendees (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS We administered the Experiences in Close Relationship Questionnaire (ECR-R), Childhood Trauma Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships among self- and expert ratings and between different risk factors were examined. RESULTS Five percent of participants reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average attachment anxiety and attachment avoidance were low, and more than half of participants were rated “secure” by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSION Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
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18
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The PA profession and substance use disorder. JAAPA 2015; 28:11-4. [DOI: 10.1097/01.jaa.0000470437.07318.d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Telusca N, Ganguly K, Jeter C, Newmark JL. Substance Abuse Among Healthcare Professionals. Subst Abus 2015. [DOI: 10.1007/978-1-4939-1951-2_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. Gen Hosp Psychiatry 2015; 37:81-8. [PMID: 25440724 DOI: 10.1016/j.genhosppsych.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/20/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS We administered the Experiences in Close Relationships Questionnaire Revised (ECR-R), Childhood Trauma Questionnaire (CTQ) and Young Schema Questionnaire (YSQ) to 100 health care professionals attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships between self-ratings and expert ratings and among different risk factors were examined. RESULTS One fifth of participants reported moderate to severe childhood abuse; sixty percent reported moderate to severe emotional neglect. Despite this, average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSIONS Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
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Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program. J Addict Med 2014; 7:349-53. [PMID: 24089039 DOI: 10.1097/adm.0b013e31829da074] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Substance-related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of this study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring because of substance-related impairment, to develop better mechanisms for prevention and intervention. METHODS A total of 55 physicians (94.5% male) who were being monitored by their State physician health program because of substance-related impairment participated in guided focus group discussions. Participation was anonymous. Discussions were transcribed from 9 separate focus groups, lasting 60 to 90 minutes each. Qualitative analyses were conducted to examine themes. RESULTS All participants were diagnosed with substance dependence, and 69.1% of them endorsed a history of misusing prescription drugs. Participants documented the following 5 primary reasons for prescription drug misuse: (1) to manage physical pain, (2) to manage emotional/psychiatric distress, (3) to manage stressful situations, (4) to serve recreational purposes, and (5) to avoid withdrawal symptoms. CONCLUSIONS Our results emphasize the importance of self-medication as a leading reason for misusing prescription medications, although recreational use was also an important factor. Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education requirements throughout the physicians' careers.
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