Or how to avoid burnout

1. We admitted difficulty living as a health-care professional only, that our problems arise from this single focus in life.
2. We came to believe that accepting help and support from everything life has to offer could restore our physical, mental, emotional, social and spiritual health.
3. We made a decision to turn our will and our lives over to the care of our fellows who have learned these lessons and a Higher Power as we understand one.
4. We made a searching and fearless personal inventory of our problems, strengths, goals and dreams.
5. We shared our list with trusted others, including our Higher Power, acknowledging our character weaknesses, virtues and humanity.
6. We became entirely ready to accept the help available to address our basic human needs.
7. With humility and an open mind we sought to correct the shortcomings in our lives.
8. We made a list of all persons and institutions we resented or harmed and became willing to address these issues.
9. We made direct amends where necessary and took any action required to relieve these tensions, except when to do so would harm others.
10. We continue to monitor internal feelings and needs, promptly admitting when we had a problem.
11. We remained open and responsive to the help, guidance and love we can receive from others who care about us, including our Higher Power.
12. Having achieved personal revitalisation as the result of these steps, we try to carry this message to the others in our lives and to practice these principles in all our affairs.

After Kaufman M. (1999) The Twelve-Steps for physicians who seek rehumanising. Ontario Medical Review. November.

Resilient Practitioner, The: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals by Thomas M. Skovholt Read more about this title…

Does Drinking Reduce Stress?

By Michael A. Sayette, Ph.D.

For centuries, people have used alcohol to relieve stress-that is, the interpretation of an event as signaling harm, loss, or threat. The person usually responds to stress with a variety of behavioral, biological, and cognitive changes. Alcohol consumption can result in a stress response dampening (SRD) effect, which can be assessed using various measures.

Numerous individual differences and situational factors help determine the extent to which a person experiences SRD after consuming alcohol.

Individual differences include

• a family history of alcoholism,
• personality traits,
• extent of self-consciousness,
• cognitive functioning, and
• gender.
• Situational factors influencing alcohol’s SRD effect include
• distractions during a stressful situation and
• the timing of drinking and stress.

The attention-allocation model and the appraisal disruption model have been advanced to explain the influence of those situational factors.

Alcohol Research & Health, Vol. 23, No. 4, 1999

Concise TSF and Brief-TSF Research Summary

All the elements of TSF have moderate to strong research support, most of which has been replicated.

NB: AA does not participate in research but individual members do. The huge volume of peripheral research supports a strong case for recommending AA participation by alcoholics.

We know: -

• that Twelve Step Facilitation reduces alcohol abuse , improves related consequences, and improves employment prospects.
• that Alcoholics Anonymous has good efficacy, and that Peer Sponsoring/social support is an essential element in AA’s success.
• that recovering people who help recovering people maintain better sobriety and have greater involvement in the general community.
• that men, women, adolescence, African-Americans, Hispanics and gay men benefit from AA. That all socio-demographic groups are represented.
• that AA is suitable for head trauma victims, and methadone patients.
• that AA has wide acceptance and is readily available in almost all communities. The current global membership of AA is approximately 2.06 million.
• that participation in Alcoholics Anonymous improves medication compliance for mental health patients, improves psychological functioning, Improves coping, reduces child abuse and domestic violence, reduces healthcare usage, reduces hospitalisation, reduces medical symptoms, reduces subsequent treatment demand, reduces mortality, and reduces associated costs.
• that healthcare workers have good success rates for substance abuse treatment and recovery from alcoholism that can be improved with AA participation.
• that alcoholics with social networks supportive of drinking have better outcomes if they initiate AA attendance while in treatment.
• that affiliation with AA is enhanced if prospects gain an awareness of the culture and methods used by AA and that sobriety is better than drinking prior to attending AA.
• that 80% of Australian, 87% of USA, and 65% of UK doctors believe that Alcoholics Anonymous is the treatment of choice for alcoholism, but overall they do not understand how AA works.
• that more than 80% of specialist alcohol and drug treatment staff support Alcoholics Anonymous treatment referral and 92% of another specialist A & D service requested training in 12 Step approaches.
• that AA Peer Sponsor contact at the healthcare worker office/institution increases initiation and sustained attendance at AA meetings.
• that active and regular AA participation is one of the more effective ways to effect lifestyle changes for alcoholics.
• that routinely engaging patients in continuing outpatient care is likely to yield better outcomes..
• that most people in the early stages of alcoholism seek help from GP’s or Community Health Centres.
• that individuals with substance abuse medical conditions benefit from integrated medical and substance abuse treatment, and approaches such as TSF can be cost-effective.
• that for every $1.00 invested in intervention $4.30 is saved in future healthcare costs.

This project gathered survey information from physicians, physician assistants, dentists and pharmacists in Arizona who, while enrolled or following a completion of a monitored aftercare program, had relapsed back to active chemical dependency.

In general, survey respondents were male, averaged 52 years of age, had relapsed several times and started abusing illicit drugs and alcohol in high school or college.

The findings suggest several subjective factors that contributed to the subjects’ relapse included;

• dishonesty to self,
• not working a 12 step program, and
• denial of the problem.

Factors reported to be helpful for future relapse prevention were

• abstinence from substance use,
• working a 12 step program, and
• having spiritual beliefs.

By identifying the specific causes of relapse, future studies may attempt to decrease the percentage of health care providers who relapse by recognizing signs of problematic behavior before they occur.

Long MW, Cassidy BA, Sucher M, Stoehr JD. Prevention of relapse in the recovery of Arizona health care providers. J Addict Dis. 2006;25(1):65-72.

A Sponsorship Guide for 12-Step Programs by M. T. Read more about this title…

Dual Disorders – Third Edition

Depression. Schizophrenia. Post-traumatic stress disorder. Bipolar disorder.

Millions of individuals diagnosed with psychiatric or emotional disorders must battle an equally menacing and powerful disease–chemical dependency–alcoholism, drug addiction, medication addiction.

First published in 1993, Dual Disorders is the leading text on the biological and psychological relationship between mental illness and addiction.

The third edition of this Hazelden best-seller has been updated to include the latest research, information about new medications, and an explanation of new diagnostic criteria.

Key features and benefits

• outlines the relationship between chemical dependency and psychiatric disorders
• contains important resources for chemically dependent individuals and their families
• presents practical relapse prevention strategies
• pharmacotherapy

Dual Disorders – Buy 3rd Ed today!

This study analyzed the Alcoholics Anonymous (AA) participation of 55 patients during the 3 months after their discharge from structured treatment, when dropout is high.

Three levels of meeting attendance were discerned:

• low,
• mid-level, and
• “90 meetings in 90 days.”

Of greatest interest, the mid-level group showed mixed interest in AA practices despite substantial meeting attendance, that is,

• they admitted powerlessness over alcohol, but had less enthusiasm for the higher power concept, and relapsed significantly;
• they were likely to have a sponsor, but were less involved with other AA members; and
• they reported working the 12 Steps, but were less interested in the AA literature.

Findings suggest that individuals who are attending AA but having difficulty embracing key aspects of the program need professional assistance that focuses more on AA practices and tenets and meeting attendance.

Barriers to affiliation can also serve as opportunities for furthering both counselling goals and affiliation.

Research; Paul Elliott Caldwell and Henry S.G. Cutter. Journal of Substance Abuse Treatment. Volume 15, Issue 3, May-June 1998, Pages 221-228

• See also:
• Twelve Step Facilitation
• Brief-TSF Description
• AA and Treatment Work Better Together
• Alcohol Related Brain Injury
• THE TWELVE REWARDS OF RECOVERY

Prevalence of positive substance abuse screen results among adolescent primary care patients

Objectives; To measure the prevalence of positive substance use screen results among adolescent primary care patients and to estimate the prevalence of substance-related problems and disorders.

Results; Overall, 14.8% of adolescents had positive results on the CRAFFT screen.

Prevalence rates differed significantly across practices (P < .001) after adjusting for demographic factors.

The highest positive rates on the CRAFFT screen were at

• School-based health centers (29.5%) and
• Rural family practice (24.2%),
• Middle rate was at the adolescent clinic (16.6%), and
• Lowest rates were at the health maintenance organization (14.1%) and
• Pediatric clinic (8.0%).
• Sick visits had the highest rate (23.2%).
• Well-child care visits had a significantly lower rate (11.4%, P < .001).

Statistical modeling estimated that 11.3% of all patients had problematic use,

• 7.1% had abuse, and
• 3.2% had dependence.

Conclusion; Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only.

Arch Pediatr Adolesc Med. 2007;161(11):1035-1041.

Teens Under the Influence: The Truth About Kids, Alcohol, and Other Drugs- How to Recognize the Problem and What to Do About It by Katherine Ketcham Read more about this title…

Cannabis use and risk of psychotic or affective mental health outcomes

Background; Whether cannabis can cause psychotic or affective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or affective mental health outcomes.

Methods; We searched databases from their inception to September, 2006, searched reference lists of studies selected for inclusion, and contacted experts. Studies were included if longitudinal and population based. 35 studies from 4804 references were included. Data extraction and quality assessment were done independently and in duplicate.

"we conclude that there is now sufficient evidence to warn young people
that using cannabis could increase their risk of developing a psychotic illness later in life."

Findings; There was an increased risk of any psychotic outcome in individuals who had ever used cannabis (pooled adjusted odds ratio=1·41, 95% CI 1·20-1·65). Findings were consistent with a dose-response effect, with greater risk in people who used cannabis most frequently (2·09, 1·54-2·84). Results of analyses restricted to studies of more clinically relevant psychotic disorders were similar. Depression, suicidal thoughts, and anxiety outcomes were examined separately. Findings for these outcomes were less consistent, and fewer attempts were made to address non-causal explanations, than for psychosis. A substantial confounding effect was present for both psychotic and affective outcomes.

Interpretation; The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication effects, although evidence for affective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.

Theresa HM Moore, Stanley Zammit, Anne Lingford-Hughes, Thomas RE Barnes, Peter B Jones, Margaret Burke and Glyn Lewis. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet 2007; 370:319-328

Life With Hope: A Return to Living Through the Twelve Steps and Twelve Traditions of Marijuana Anonymous

Drugs, Brains, and Behavior: The Science of Addiction

This new, 30-page, full-color booklet explains in layman’s terms how science has revolutionized the understanding of drug addiction as a brain disease that affects behavior. 

The ‘Science of Addiction’ booklet discusses the reasons people take drugs, why some people become addicted while others do not, how drugs work in the brain, and how addiction can be prevented and treated.

The booklet is available to read, download or order at: http://www.drugabuse.gov/scienceofaddiction/

http://www.drugabuse.gov/scienceofaddiction/sciofaddiction.pdf

Publication Year: 2007

Publisher

National Institute on Drug Abuse (NIDA)
6001 Executive Boulevard
Bethesda, md 20892
Phone: 301-443-1124
Website: http://www.nida.nih.gov

The Role of Stress in Alcohol Use, Alcoholism Treatment, and Relapse

By Kathleen T. Brady, M.D., Ph.D., and Susan C. Sonne, Pharm.D.

Addiction to alcohol or other drugs (AODs) is a complex problem determined by multiple factors, including psychological and physiological components. Stress is considered a major contributor to the initiation and continuation of AOD use as well as to relapse.

Many studies that have demonstrated an association between AOD use and stress have been unable to establish a causal relationship between the two. However, stress and the body’s response to it most likely play a role in the vulnerability to initial AOD use, initiation of AOD abuse treatment, and relapse in recovering AOD users.

This relationship probably is mediated, at least in part, by common neurochemical systems, such as the serotonin, dopamine, and opiate peptide systems, as well as the hypothalamic-pituitary-adrenal (HPA) axis. Further exploration of these connections should lead to important pharmacological developments in the prevention and treatment of AOD abuse.

Studies indicate that treatment techniques which foster coping skills, problem solving skills, and social support play a pivotal role in successful treatment.

In the future, individualized treatment approaches that emphasize stress management strategies in those patients in whom a clear connection between stress and relapse exists will become particularly important.

Alcohol Research & Health, Vol. 23, No. 4, 1999