Health and Wellness/Chemical Dependency Research and Published Resources

Collection of research and published resources on anesthesia professionals' health, wellness, and addiction. See also the Peer Assistance News published articles.  

A Consistent Approach to Treatment and Reentry for CRNAs with Substance Use Disorder by K Bettinardi-Angres and CRNA R Garcia in Journal of Nursing Regulation. 2015 July; 6(2): 47-51.

A Fatality from Sevoflurane Abuse by B Levine, et al. in 2007 Journal of Analytical Toxicology.

A Need to Establish Programs to Detect and Prevent Drug Diversion, editorial by CH Lein (see also related research below Diversion of Drugs Within Health Care Facilities) Mayo Clin Proc. 2012:87(7):607-9.
A Strategy to Prevent Substance Abuse in an Academic Anesthesiology Department by J Tetzlaff et al. in J Clin Anesth. 2010 Mar;22(2):143-50.

A Study in De-Stressing, The American Nurse, November 19, 2013. Article features participation by Janet Dewan, CRNA, MS, chair, FY2013 Health & Wellness committee.

A Study of Occupational Stress, Scope of Practice, and Collaboration in Nurse Anesthetists Practicing in Anesthesia Care Team Settings. Alves SL. AANA J. December 2005;73(6):443-452.

A Substance Use Disorder Educational Session: Influence on Nurse Anesthesia Care Providers' Addiction Attitudes and Perceived Self-Efficacy to Recognize Chemical Impairment - a dissertation by CRNA Ferne Cohen,  May 2013.

A Survey of Inhalational Anaesthetic Abuse in Anaesthesia Training Programmes by JE Wilson, et al. in 2008 Anaesthesia.

A Survey of Propofol Abuse in Academic Anesthesia Programs by PE Wischmeyer, et al. in 2007 Anesthesia Analgesia.
Addiction in Anaesthesiologists and its Implications on Anaesthesia by N Gupta, R Garg, A Gupta, J Addict Med Ther Sci. 2014 1(1). 
Addiction and Substance Abuse in Anesthesiology by EO Bryson and JH Silverstein Anesthesiology. 2008 Nov;109(5):905-17.
Addiction to Propofol: A Study of 22 Treatment Cases by PH Early and T Finver J Addict Med, April 2013.
Anesthesiologists Recovering from Chemical Dependency: Can They Safely Return to the Operating Room? editorial by MR Oreskovich and RM Caldeiro. Mayo Clin Proc. July 2009;84(7):576-580.
Anesthesiologist with Substance Disorders: A 5-year Outcome Study from 16 State Physician Health Programs by GE Skipper, MD Campbell, RL DuPont. Anesth Analg. 2009;109(3):891-896.
Assessment of the Substance Abuse Curriculum in Schools of Nurse Anesthesia by CRNAs GD Clark, and JA Stone; J Addict Nurs, 11 (1999), pp. 123–135.
Burnout, Psychosomatic Symptoms and Job Satisfaction Among Dutch Nurse Anesthetists: A Survey
by V Meeusen, K VanDam, C Brown-Mahoney, et al. Acta Anaesthesiol Scand. May 2010;54(5):616-621.
Chemical Dependency and the Physician by KH Berge, MD Seppala, and AM Schipper. Mayo Clin Proc. 2009;84(7):625-631.
Chemical Dependency Treatment Outcomes of Residents in Anesthesiology: Results of a Survey by GB Collins, MS McAllister, M Jensen, and TA Gooden. Anesth Analg. 2005;101(5):1457-1462.
Controlled Drug Misuse by Certified Registered Nurse Anesthetists by CRNAs D Bell, JP McDonough, JS Ellison and EC Fitzhugh in AANA J. 1999;67(2):133-140.
Death from Propofol: Accident, Suicide, or Murder? by RR Kirby, JM Colaw, and MM Douglas. Anesth Analg. 2009;108(4):1182-1184.
Deaths from Recreational Use of Propofol in Korea by E Han, et al., in Forensic Science International (2013).
Detecting Diversion of Anesthetic Drugs by Providers by F Dexter. Anesth Analg. 2007;105(4):897-898.
Development of a Scheduled Drug Diversion Surveillance System Based on an Analysis of Atypical Drug Transactions by RH Epstein, DM Gratch, and Z Grunwald. Anesth Analg. 2007;105(4):1053-1060.
Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection and Prevention by KH Berge, et al., Mayo Clin Proc. 2012:87(7):674-682.  See also editorial by CA Lein, A Need to Establish Programs to Detect and Prevent Drug Diversion (above).
Doing A Job and Getting Something Good Out of It: On Stress and Well-Being in Anesthesia, J Larsson, M Sanner. Br J Anaesth. June 2010;105(1):34-37.
Don't ask Don't Tell: Substance Abuse and Addiction Among Nurses by T Monroe and J Kenaga. J Clin Nurs. 2010;20:504-509.
Energy Capacity Model for Nurses: The Impact of Relaxation and Restoration by S Hoolahan, P Greenhouse, R Hoffman, and L Lehman, Journal of Nursing Administration. 2012: 42(2):102-103.
Environmental Cues and Relapse: An Old Idea That Is New for Reentry of Recovering Anesthesia Care Professionals - Reply - I editorial by MR Oreskovich and RM Caldeiro. Mayo Clin Proc. November 2009;84(11):1041.
Evidence of Addiction by Anesthesiologists as Documented by Hair Analysis by P Kintz, M Villain, V Dumestre, and V Cirimele. Forensic Sci Int. 2005;153(1):81-84.
Exposure of Anesthesia Providers in Recovery from Substance Abuse to Potential Triggering Agents by CRNA Heather Hamza and EO Bryson, Journal of Clinical Anesthesia, Volume 23, Issue 7, November 2011, Pages 552-557. 
Fentanyl and Propofol Exposure in the Operating Room: Sensitization Hypothesis and Further Data
by LJ Merlo, BA Goldberger, D Kolodner, K Fitzgerald, MS Gold MS. J Addict Dis. 2008;27(3):67-76.
Five Year Outcomes in a Cohort Study of Physicians Treated for Substance Use Disorders in the United States by AT McLellan, GS Skipper, M Campbell, and RL DuPont. BMJ. 2008;337:a2018.
Health-Promoting Collaboration in Anesthesia Nursing: A Qualitative Study of Nurse Anesthetists in Norway in the August 2012 AANA Journal Special Research Edition by G Averlid and S Bihari Axelsson finds that collaboration through teamwork is a crucial factor in a positive work environment for nurse anesthetists.
High on the Job: Drug Abuse Among Surgical Staff by I Tsikitas. Outpatient Surgery Magazine. December 2009;10(12): 26-31.
Ignoring the Problem Will Not Make It Go Away, by Ira P. Gunn, CRNA, MLN, FAAN in CRNA: The Clinical Forum for Nurse Anesthetists, Vol. 2, No. 3 (August), 1986:p 2.
Impaired Healthcare Professional by MR Baldisseri. Crit Care Med. 2007;35(2suppl):S106-S116.
Intranasal Self-administration of Remifentanil as the Foray into Opioid Abuse by an Anesthesia Resident
(case report) by AI Levine, EO Bryson. Anesth Analg. 2009;110(2):524-525.
My Story: How one Percocet Prescription Triggered my Addiction in the December 2012 issue of the Journal of Medical Toxicology.  An emergency room nurse's personal story of a Percocet prescription that triggered an addictive dependency. 
Narcotics and the Anesthetist: Professional Hazards in the June 1962 Journal of the American Association of Nurse Anesthetists (now known as the AANA Journal) by John S. Lundy, MD and Florence A. McQuillen, CRNA.  
An early alert to addiction in anesthesia professionals.  
Non-narcotic Anesthetic Options for the Patient in Recovery from Substance Abuse, by CRNA Heather Hamza, Perioperative Addiction, 2012, Part 3, 263-282.
Nurses Recovering From Substance Use Disorders: A Review of Policies and Position Statements by
TB Monroe, et al. Journal of Nursing Administration. 2011; 41(10):415-421.
Nurses with Chemical Dependency: Promoting Successful Treatment and Reentry by DH Angres, K Bettinardi-Angres, and W Cross. J Nurs Regul. 2010;1(1):16-20.
One Approach to the Return to Residency for Anesthesia Residents Recovering from Opioid Addiction. EO Bryson and A Levine. J Clin Anesth. 2008;20(5):397-400. (Note: See Berge editorial above, The Anesthesiology Community's Approach . . . )
Opioid Abuse Among Nurse Anesthetists and Anesthesiologists in the April 2012 AANA Journal by CRNA E. Laura Wright, et al. regarding opioid abuse and dependency among nurse anesthetists and anesthesiologists and offers implications for future research. Abuse and dependency on potent opioids have long been recognized as problems among nurse anesthetists and anesthesiologists. Wright and co-author Zwerling are both members of the AANA Peer Assistance Advisors committee. 
Opioid-Abusing Health Care Professionals: Options for Treatment and Returning to Work After Treatment editorial in Mayo Clin Proc. by M Seppala and M Oreskovich. 2012;87(3):213-215. (see also Buprenorphine Maintenance Therapy in Opioid-Addicted HCP).
Peer Assistance Reaches its 25th Year by DS Quinlan. AANAJ. 2009;77(4):254-258.
Physicians and Nurses with Substance Use Disorders by MF Shaw, MP McGovern, DH Angres and P Rawal. J Adv Nurs. 2004;47(5):561-571.
Physicians Coping with Addiction Face Long Road Back by DM Pizzi DM. Anesthesiology News. 2009;35(11).
Physicians' Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues. CM DesRoches, SR Rao, JA Fromson, et al. JAMA. July 2010;304(2):187-193. (Note: See related editorial The Role of Professionalism and Self-regulation . . .)
Preventing, Detecting, and Investigating Drug Diversion in Health Care Facilities by K New in Journal of Nursing Regulations. April 2014;5(1):18-25.
Preventing Occupational Stress in Healthcare Workers (Review) by A Marine et al. in Cochrane Database
Syst Rev. 2006 Oct 18(4):CD002892. 
Prevention of Controlled Substance Diversion - Diversion in the Operating Room by B O'Neal, K Bass, and J Siegel. Hosp Pharm. 2007;42(4):359-367.
Procedures for Handling Cases of Substance Abuse Among Nurses: A Comparison of Disciplinary and Alternative Programs by T Monroe, F Pearson, and H Kenaga. Journal of Addictions Nursing. 2008;19(3):156-161.
Propofol Abuse Growing Problem for Anesthesiologists, by A Marcus. Anesthesiology News. 2007;33(5):1-4.
Propofol Abuse in Professionals by J Lee in the December 2012 Journal of Korean Medical Sciences.
Protective Factors Against Relapse for Practicing Nurse Anesthetists in Recovery from Anesthetic Opiate Dependency by AANA Peer Assistance Advisors Laura Wright, CRNA, PhD and Art Zwerling, CRNA, DNP, DAAPM, et al. in the April-June 2014 Journal of Addictions Nursing 
Reentry after Addiction Treatment: Research or Retrain? editorial by PH Earley and AJ Berry. Anesthesiology. 2009;110(6):1423-1424.
Reentry and Recidivism for Certified Registered Nurse Anesthetists by TB Monroe and CRNA Heather Hamza. J Nurs Regul. 2011;2(1):17-22.
Reentry of the Addicted Certified Registered Nurse Anesthetist: A Review of the Literature, by CRNA Heather Wilson Hamza and M Compton. This paper provides an extensive review of the literature pertaining to reentry of the recovering CRNA and relevant topics thereof. Journal of Addictions Nursing, 2009;20(4):177-184.
Risk Factors for Relapse in Health Care Professionals With Substance Use Disorders. K Domino, TF Hornbein, NK Polissar, et al.  JAMA. 2005;(293)12:1453-1460.
Setting the Standard for Recovery: Physicians' Health Programs by DuPont et al. J Subst Abuse Treat. 2009 Mar;36(2);159-71.
Stress and Burnout in Anaesthesia by A Nyssen and I Hansez. Curr Opin Anaeshtesiol. June 2008;21(3):406-411.
Stress and Burnout in Nurse Anesthesia in the April 2011 AANA Journal by CRNAs Anthony Chipas and Dennis McKenna reports on the study to determine the current level of stress and its physical manifestations in Certified Registered Nurse Anesthetists and student registered nurse anesthetists.
Stress: Perceptions, Manifestations, and Coping Mechanisms of Student Registered Nurse Anesthetists in the August 2012 AANA Journal Special Research Edition by CRNA Anthony Chipas, et al. provides data and analysis on the stressors experienced by the typical SRNA.
Stress Ratings and Health Promotion Practices Among RNs: A Case for Action by S Tucker et al. Journal of Nursing Administration. 2012; 42(5):282-292.
Substance Abuse by Anaesthetists in Australia and New Zealand, RA Fry. Anaesth Intensive Care. 2005;33(2):248-255.
Substance Abuse Recognition and Prevention Through Education chapter by EO Bryson in Comprehensive Guide to Education in Anesthesia, 2014.
Substance Use Disorder Among Anesthesiology Residents, 1975 - 2009 by D Warner, et al. December 4, 2013 Journal of the American Medical Association.   
Substance Use Disorder in Anesthesiology Residents: Still a Serious Program. Anesthesiology News by DO Warner and KH Berge. 2014; 78(7):38-39.
The Abuse Potential of Propofol by C Wilson, P Canning and EM Caravati. Clinical Toxicology. March 2010;48(3):165-170.
The Alarming Trend of Substance Abuse in Anesthesia Providers, by S Luck and J Hedrick. J Perianesth Nurs. 2004;19(5):308-311.
The Anesthesiology Community's Approach to Opioid and Anesthetic-abusing Personnel editorial by KH Berge, MD Seppala, WL Lanier. Anesthesiology. 2008;109(5):762-764. (Note: Editorial related to One Approach to the Return to Residency for Anesthesia Residents Recovering from Opioid Addiction).

The Concept of Reentry in the Addicted Anesthesia Provider by Jorje A. Valdes, CRNA, DNP published in the April 2014 AANA Journal
The Drug Seeking Anesthesia Provider, by CRNA Heather Hamza and EO Bryson. International Anesthesiology Clinics, 2011;49(1):157-171.
The Impaired Anesthesia Provider by DS Quinlan. AANA J. 1995;63(6):485-491.

The Misuse and Abuse of Propofol by TB Monroe, et al., in April 2011 Substance Use and Misuse.  
The Prevalence and Patterns of Substance Abuse Among Nurse Anesthesia Students by Gregory Bozimowski, CRNA, DNP, Carla Groh, RN, PhD, Patricia Rouen, RN, PhD, and Michael Dosch, CRNA, PhD in the AANA Journal, August 2014.

Two New Case Reports of Propofol Abuse and a Pattern Analysis of the Literature in 2012 issue (Vol. 1, No. 1) of the International Journal of Advanced Nursing Studies by CRNAs Mark Welliver, Anita Bertrand and Jennifer Garza, and Kathy Baker.  Bertrand is a member of the AANA Peer Assistance Advisors committee.

Urine Drug Screening: Practical Guide for Clinicians by KE Moeller, KC Lee, JC Kissack. Mayo Clin Proc. 2008;83(1):66-76.

Workplace Joy and Well-Being is Linked to Patient Safety, 2013 National Patient Safety Foundation (NPSF) white paper and seven recommendations for organizational actions.​

A History of Drug Addiction in Anesthesia chapter by C Kent and K Domino in the book The Wondrous Story of Anesthesia, 2014.

Addicted Healers: 5 key Signs Your Healthcare Professional May Be Drug Impaired, 2012 book by EO Bryson relates stories on addiction among health care professionals along with details to recognizing impaired individuals, and evidence on the genetics and neuroscience of chemical dependency.  AANA Journal book review by Art Zwerling, CRNA, DNP, DAAPM, a member of the AANA Peer Assistance Advisors Committee.

From Unbecoming a Nurse to Overcoming Addication: Candid Self-Portraits of Nurses in Recovery, 2010 book by Paula Davies Scimeca, RN, MS (see also Unbecoming a Nurse below).

"Promoting Professional Wellness," chapter 20 of A Professional Study and Resource Guide for the CRNA: Second Edition by CRNAs S Tunajek and D Quinlan, covers the professional responsibility of fitness-for-duty for safe patient care and to encourage healthy coping mechanisms for balancing personal, family, and career 
goals with physical and mental health  of a CRNA's professional. The book is available through the AANA Bookstore.

Re-Entry: A Guide for Nurses Dealing with Substance Use Disorder, 2013 book by Karolyn Crowley, RN and Carrie Morgan, BA published by Sigma Theta Tau International. See AANA Journal book review by Ann Bostic, CRNA, DNP and Martha Kral, CRNA, BSN, members of the AANA Peer Assistance Advisors Committee.

Substance Abuse Policies for Anesthesia, written by Bernadette T. Higgins Roche, CRNA, EdD  available through the AANA Bookstore.  Roche's book includes a  comprehensive resource for anesthesia providers and the first book to collect the policies, procedures, and structures needed in anesthesia departments to educate and protect practitioners through better understanding of substance misuse and dependency.

Unbecoming a Nurse: Bypassing the Hidden Chemical Dependency Trap, 2008 book by Paula Davies Scimeca, RN, MS outlines the complex issue of chemical dependency in nursing. Forward written by Sarah Stewart Gomes, daughter of CRNA Jan Stewart former AANA President who died of an accidental overdose of sufentenil.


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