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The AANA Peer Assistance Advisors (PAA), the AANA Wellness Program, and the American Association of Nurse Anesthetists (AANA) recognize that the disease of addiction is characterized by a chronic, progressive, and potentially fatal process that may destroy the professional, the family, and the anesthesia community. (See AANA Position Statement Number 1.7, Substance Misuse and Chemical Dependency).
In the interest of patient safety and practitioner well-being, the PAA, as a component of the AANA Wellness Program, investigate the availability and effectiveness of treatment modalities specific to anesthesia professionals and students, and act as a resource to the community regarding treatment issues.
Chemical Dependency in anesthesia professionals and students can be successfully treated. The PAA are aware of the essential role of appropriate, adequate and effective treatment plays in successful treatment and return to anesthesia practice. Anesthesia professionals and students have unique treatment needs for a variety of reasons including, controlled substance availability, potential loss of profession when inadequately treated, professional guilt and shame and a tendency to intellectualize the treatment process, among others. Various treatment options exist for the disease of addiction. Success rates in the treatment of the chemically dependent anesthesia professional or student vary widely between treatment modalities. The PAAs function to determine and recommend which available treatment modalities offer the highest rate of success.
- Inpatient Treatment at a Substance Abuse and Mental Health Services Administration (SAMHSA) certified Inpatient Comprehensive Addiction Treatment Center experienced in treating health care professionals.
- Completion of a minimum of 28 days (also termed “short term”) of inpatient treatment is recommended, with 90 days of treatment (also termed “long term”) being most desirable and offering the highest success rate.
- The treatment center chosen should at a minimum include:
- Comprehensive evaluation and treatment recommendations by an American Society of Addiction Medicine (ASAM) board certified addictionologist in all cases.
- Evaluation by an American Academy of Addiction Psychiatry (AAAP) boarded Addiction Psychiatrist where appropriate.
- Appropriate neuro-psychiatric and or psychometric testing where appropriate.
- When detoxification is medically indicated, inpatient medically supervised detoxification.
- Emphasis on a long term 12 step model of abstinence based recovery.
- Evaluation of suitability for, and timing of, the return to anesthesia practice.
The PAAs do not advocate outpatient treatment, including Intensive Outpatient Treatment, for the disease of addiction in anesthesia providers and students due to the high rate of recidivism. Any relapse after outpatient treatment should only be treated under the long term inpatient modality.
Compliance with all treatment center recommendations for continuing care after discharge, including relapse prevention techniques, recovering professionals meeting attendance, active participation in the 12 step recovery community, and monitoring of random urine drug screens. Drug Screen Monitoring should be through a formal program administered by a state board of nursing or alternative program for a minimum of 5 years, though monitoring for the professional lifetime is ideal. We only support abstinence based recovery and strict avoidance of opioid replacement therapy (ORT) in CRNAs and student nurse anesthetists in clinical practice. We support the utilization of Naltrexone where the addictionologist has deemed it appropriate. See also: AANA Peer Assistance Advisors' Recommendation for Reentry of the Nurse Anesthetists or Student with Chemical Dependency
If you have any questions, please contact a Peer Assistance Advisor.
www.AANAPeerAssistance.com
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