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CORK Bibliography: Impaired Professionals

62 citations. January 2003 to present

Prepared: September 2011

[Anon]. Nevada Supreme Court Orders: Order of stayed suspension with conditions. Nevada Lawyer 13: 44+, 2005. (7 legal refs.)

This column reports the outcome for an attorney with an alcohol problem. The attorney was ssued a stayed 30 day suspension, subject to successful completion of a one-year probation with multiple conditions, including random alcohol testing, participation in Lawyers Concerned for Lawyers and Alcoholics Anonymous, and reimbursement of costs arising directly from misconduct and from the disciplinary proceedings.

[editor]. Discipline: Judge Langton to be given rare reprimand. The Montana Lawyer 31(October): 27+, 2005. (0 refs.)

This article reports on the disciplinary steps taken in response to alcohol-related incidents by a Montana judge.

Abbott AA. Meeting the challenges of substance misuse: Making inroads one step at a time. Health & Social Work 28(2): 83-88, 2003. (16 refs.)

The matrix of substance misuse knows no ethical. social, gender or racial boundary. Social workers must join ranks with other caring professionals to chip away at the micro level of the problem by helping those with problems stave off their personal pain.

Ahmadi J; Maharlooy N; Alishahi M. Substance abuse: Prevalence in a sample of nursing students. Journal of Clinical Nursing 13(1): 60-64, 2004. (12 refs.)

Aims. The aim of this research was to evaluate the prevalence of substance abuse in a sample of Iranian nursing students. Design and measurements. Four hundred nursing students (85.25% were females and 14.25% were male) were assessed by a confidential questionnaire based on DSM-IV, which was distributed, completed by the students and collected in the same session. Findings. Mean age of the females was 20.3 and of males was 22.8. Of the subjects, 27.3% (21.4% of females and 61% of males) reported usage of substance(s) once or more sometime during their lives: cigarette (25.3%), alcohol (5.8%), opium (8.5%), cocaine (1.5%), hashish (1.5%), marijuana (0.8%) and morphine (0.5%). Only 3.8% of the participants (1.8% of females and 15.3% of males) reported still using substances: cigarettes (3.3%), alcohol (1.7%), opium (0.8%), cocaine (0.5%) and marijuana (0.3%). About 11.8% of the subjects (10% of females and 22% of males) reported using of substances occasionally (at least once a month): cigarette (10.8%), alcohol (3.5%), opium (4.3%), cocaine (0.5%) and hashish (0.3%). Some used or were using more than one substance. Conclusions. Substance use was significantly related to sex: higher among males than females. Tobacco and opium were found to be the most prevalent form of substance use among students. Pleasurable purposes, habit, need (to avoid withdrawal symptoms) and tension were the major reasons for substance use. There was no report of psychedelics use. These results are, however, different from those studies carried out in the west, although there is some overlap. Cultural attitudes toward substance use quite likely affect the types and patterns of use. These findings can be considered when planning preventive and therapeutic programmes. Relevance to clinical practice. Substance use can reduce scientific progress and academic achievement of nursing students; therefore, authorities of the university must be able to assess the extent of the problem, understand the contributing factors, recognize signs and symptoms, and use educational interventions in identifying and preventing substance dependency.

Baldwin JN; Bartek JK; Scott DM; Davis-Hall RE; DeSimone EM. Survey of alcohol and other drug use attitudes and behaviors in nursing students18. Substance Abuse 30(3): 230-238, 2009. (18 refs.)

Statewide nursing student alcohol and other drug (AOD) use attitudes and behaviors were assessed. Response was 929/2017 (46%) (practical nursing [n = 173/301] 57.3%; diploma and associate degree in nursing [n = 282/417] 67.6%; bachelor of science in nursing [n = 474/1299] 36.5%). Nearly 44% reported inadequate substance abuse education. Past-year AOD use included tobacco 36.9%, marijuana 6.8%, sedatives 4.6%, and opioids 2.6%. Past-year AOD-related events included blackouts 19.8%, class/work under the influence 6.3%, patient care under the influence 3.9%, lowered grades/job evaluations 6.6%, and legal charges 3.6%. Heavy drinking was reported by 28.9%. Practical nursing (PN) students most often reported tobacco use and sedative use, whereas Bachelor of Science in nursing (BSN) students most often reported marijuana use. Family histories of alcohol-related problems and drug-related problems were reported, respectively, by 48.1% and 19.2% of respondents; 51.1% reported at least one of these. PN students most often reported such family histories. Nursing educational systems should proactively address student AOD prevention, education, and assistance.

Barber MW; Fairclough A. A comparison of alcohol and drug use among dental undergraduates and a group of non-medical, professional undergraduates. British Dental Journal 201(9): 581-584, 2006. (24 refs.)

Objective: To compare the alcohol and drug use of dental and law undergraduates. Design Anonymous self-report questionnaire. Subjects and methods All dental undergraduates (n=263) and a randomly selected group of law undergraduates (n=180) from the same university were questioned on their use of alcohol, tobacco and illicit drugs. Results Current tobacco use was reported by 7% of dental students and 19% of law students. Alcohol use was reported by 86% of dental students and 88% of law students, with 44% of dental students and 52% of law students estimating they drank above recommended safe limits (14 units for females, 21 units for men). Binge drinking was reported by 71% of dental students and 75% of law students, with weekly binge drinking reported by 27% and 34% of dental and law students respectively. Cannabis experience was reported by 44% of dental students and 52% of law students, with current use reported by 12% and 25% of dental and law students respectively. A small proportion of dental and law students reported using other class A and B drugs including ecstasy, amphetamines and cocaine. Conclusions: Dental students appear to be indulging in similar levels of alcohol and illicit drug use when compared to students of a different, non-medical faculty. Binge drinking may be more prevalent than previously thought, with potential risks to health, patient safety and professional status.

Beckstead JW. The moderating effects of attitudes on nurses' intentions to report impaired practice. Journal of Applied Social Psychology 35(5): 905-921, 2005. (25 refs.)

Nurses compose the largest segment of employees in the U.S. health care industry. Nurses whose professional functioning is impaired because of substance abuse represent a threat to the health and safety of patients, other health care staff, and themselves. Attitudes toward substance use have been studied in relation to nurses' intentions (decisions) to report impaired colleagues. Whether, and to what extent, these attitudes may interact with the characteristics of the "offense" to influence intentions to report impaired practice is unknown. In this article we analyze intentions to report a variety of impaired nursing practice scenarios, obtained using a policy-capturing method, to determine the extent to which attitudes held by the "reporter" influence intentions by moderating the effects of the offense characteristics. Intention data from a sample of 120 nurses were modeled using hierarchical techniques to test the moderating hypothesis. Evidence for the moderating effects of attitudes is discussed.

Bialous SA; Sarna L; Wewers ME; Froelicher ES; Danao L. Nurses' perspectives of smoking initiation, addiction, and cessation. Nursing Research 53(6): 387-395, 2004. (47 refs.)

Background: It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. Objectives: To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions. Methods: Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes. Results: Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. Conclusions: Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.

Brown JG; Trinkoff A; Smith L. Nurses in recovery: The burden of life problems and confidence to resist relapse. Journal of Addictions Nursing 14(3): 133-137, 2003. (27 refs.)

Nurses returning to work while in treatment for addictions are at risk for relapse to substance use. Little is known about the types of stressors that nurses experience during participation in alternative-to-disci pline programs for addictions, and how the burden of life problems relate to their confidence in ability to resist relapse. Recovering nurses enrolled in an alternative-to-discipline program were surveyed anonymously. The types of problems they experienced and their confidence in ability to resist relapse were measured. Three-fourths of nurses reported a lower burden of problems after enrolling in an alternative-to-discipline program, though some problems tended to persist. During recovery, the most common problems were financial, eating/appetite/weight, depression, fatigue, and tension. Self-reported confidence in ability to resist relapse was very high. Logistic regression analyses were used to identify the association of problem burden to high versus low confidence in high-risk situations. These results suggest that most nurses show improvement in problems after enrolling in an alternative-to-discipline program, and that some types of problems and a higher problem burden significantly reduced confidence in the nurses' ability to resist relapse to substance use.

Bugle L; Jackson E; Kornegay K; Rives K. Attitudes of nursing faculty regarding nursing students with a chemical dependency: A national survey. Journal of Addictions Nursing 14(3): 125-132, 2003. (32 refs.)

The purpose of the current study was to determine the attitudes of nursing faculty in institutions of higher learning toward student nurses with chemical dependency problems. A descriptive nationwide mail-out survey of 874 randomly selected faculty from 200 randomly selected nursing programs was conducted. Subjects completed a 32-item "Perceptions of Student Nurses Impairment Inventory" and a 5-item demographic survey for age, years of teaching experience, years of nursing experience, personal experience with chemically dependent individuals, and religious preference. It was concluded that nursing faculty: (1) believe they have a responsibility to help chemically dependent student nurses receive assistance; (2) believe chemical dependency occurs before beginning nursing education; (3) do not believe little can be done to help impaired student nurses; (4) do not believe chemical dependency is caused by personality weakness; (5) are not sure about their own ability to recognize chemical dependency in a student nurse; and (6) believe state boards of nursing have responsibilities to assist, refer, advise, and protect student nurses and applicants for licensure who admit to being chemically dependent.

Darbro N. Alternative diversion programs for nurses with impaired practice: Completers and non-completers. Journal of Addictions Nursing 16(4): 169-182, 2005. (89 refs.)

The purpose of this study was to describe, explain, and compare the experiences of nurses who were completers and non-completers of an alternative diversion program for chemically dependent nurses. Risk factors for substance abuse are explored. Sixteen nurses who had participated in an alternative diversion program for chemically dependent nurses were interviewed for this study. Fourteen of these nurses completed second interviews. Qualitative analysis of these interviews was conducted utilizing the constant comparative method. Common issues for the nurses included medical conditions and dual diagnosis for which legal prescriptions were frequently obtained. Most of the nurses worked in critical care, noted stressful work conditions, and diverted medications from the workplace for their own use. They also listed emotional stresses associated with impaired practice and addiction, primarily isolation, depression, shame, and guilt. They noted a culture of stigma and mistreatment of addicts and alcoholics by many professionals. Positive commonalities included improved nursing practice, such as being more patient, tolerant, and compassionate, as a result of their own recovery work. They learned to utilize social support systems, which led them from isolation and hiding to involvement and disclosure. The nurses identified a pivotal event as being the leverage needed to move them into a lifestyle of recovery. Completers were highly motivated to retain their nursing licenses, and they strongly affiliated with other recovering nurses. In retrospect, they viewed the coercion of the program as having positive benefits. They took a brief amount of time off nursing early in their recovery. Most importantly, they had prepared and developed a relapse prevention plan. Non-completers were considering getting out of nursing or combining nursing with another field of endeavor. They did not feel affiliated with other nurses in recovery. They viewed the coercion of the alternative program as punitive and having no positive value. They felt they were forced out of participation in the program for unsupported reasons. In spite of this, seven of eight of the non-completers remained in recovery.

Dickey KW. Ethical moment - What are ethical responsibilities when I suspect an employee of substance abuse? (letter). Journal of the American Dental Association 138(2): 245-246, 2007. (1 refs.)

Dunn D. Substance abuse among nurses: Defining the issue. AORN J 82(4): 572-596, 2005. (34 refs.)

The prevalence of substance abuse in the nurse population is believed to parallel that in the general population (i.e. approximately 10%). Nurses with substance abuse problems need help. They are in danger of harming patients, the facility's reputation, the nursing profession, and themselves. The consequences of not reporting concerns can be far worse than those of reporting the issue. Part one of this two-part series discusses how society views addiction and the nursing profession, signs and symptoms of substance abuse, reasons nurses should report an impaired colleague, the code of silence that exists among nurses, and board of nursing jurisdiction.

Ellis DM. Remedy: A decade of diversion: Empirical evidence that alternative discipline is working for Arizona lawyers. Emory Law Journal 52: 1221-1237, 2003. (45 refs.)

A decade ago in Arizona, pioneering proponents of alternatives to traditional prosecutorial disciplinary proceedings said offering diversion - assistance rather than reprimands - is good common sense and makes good business sense. ... This statistical analysis of data from the time the State Bar of Arizona's Law Office Management Assistance Program (LOMAP) was established in April 1992 through April 2002, is, to the best of the researcher's knowledge, the only study of its kind to date. Archival data was collected and analyzed for all of the 661 charges that resulted in referral to a LOMAP diversion program, involving 448 separate lawyers. ... It is worth noting that, while 14.2% of informal charges that resulted in diversion were filed against female lawyers, females make up 15.4% of those who successfully completed diversion and only 10.6% of those who failed to complete their terms of diversion. ... Based on the data collected and analyzed, there is a statistically significant difference in the number and severity of subsequent disciplinary charges between lawyers who have completed a LOMAP diversion program and those who have not completed such a program. ... Periodic research should be conducted to determine when diversion "graduates" are receiving additional charges, and LOMAP should offer management or other appropriate assistance. ... Sound management know-how and know-when, however, are the building blocks of good client service. ... State Bar of Arizona's Law Office Management Assistance Program (LOMAP) was established in April 1992 through April 2002, is, to the best of the researcher's knowledge, the only study of its kind to date. Archival data was collected and analyzed for all of the 661 charges that resulted in referral to a LOMAP diversion program, involving 448 separate lawyers. More than 100 variables were tracked. The researcher utilized several statistical procedures, including correlation and regression analysis, to determine outcomes of the program. The researcher also interviewed a number of people, including founders of LOMAP, a lawyer who represents other lawyers in disciplinary proceedings, and a former Chief Bar Counsel who has evaluated lawyer regulation systems in more than twenty states and two foreign countries.

Finnemore M. The faces of addiction: OSB members share their stories of dependency and addiction -- and recovery. The Oregon State Bar Bulletin 66(August/September): 17-, 2006. (0 refs.)

This article provides first person accounts of lawyers problems with alcohol and other drugs, with mention of factors that were involved in the person's use, the nature of problems created, the factors that prompted treatment and facilitate recovery. The role of the Oregon Attorney Assistance Program is noted.

Fletcher CE. Experience with peer assistance for impaired nurses in Michigan. Journal of Nursing Scholarship 36(1): 92-93, 2004. (13 refs.)

This descriptive study was conducted to provide a chronological account of subsequent events in Michigan. A Michigan Nurses Association (MNA) task force to consider the issues of impaired practice became the Impaired Professional Committee. An MNA "hotline" was set up to provide information about impaired practice and referrals to peer-assistance groups. But the committee realized that peer-assistance groups for nurses were often struggling to remain viable. Groups were small, widely scattered, and mostly unknown. The strength of peer assistance was that recovering nurses were able to reach out to, identify with, and practice tough love with their impaired peers. The weak point was that, as volunteers, these peers had many other obligations. Additionally, not all impaired nurses were responsive to the efforts of volunteers. The committee researched the issues and found that: (a) impaired nurses needed to be given a chance for rehabilitation before being punished, (b) peers in a voluntary capacity could not accomplish all that was needed, and (c) legislation was needed to address the issues. With the strong support of MNA, new state licensure and discipline laws became effective in April 1994. The Health Professional Disciplinary Reform legislation changed the way registrants and applicants for license or registration are regulated by 19 health profession boards in Michigan, concurrently shortening the time required for the disciplinary process. To balance mandatory reporting, Public Act 80 encourages chemically dependent or mentally ill health care professionals to seek confidential treatment rather than being sanctioned publicly. Health professionals may be admitted into the health professional recovery program (HPRP) if the health professionals acknowledge their impairment, agree to participate in a recovery plan that meets the criteria developed by the HPRP, and voluntarily withdraw from or limit the scope of their practice as determined necessary under the criteria established by the committee. Treatment reports go directly to the HPRP without involving the licensing board, Michigan Department of Community Health/Bureau of Health Professions, or the state's attorney general. The identity of participants in an approved HPRP program is confidential and is not subject to discovery or subpoena under the Freedom of Information Act unless participants fail to satisfactorily complete or they lie about successfully completing treatment.

Fletcher CE; Ronis DL. Satisfaction of impaired health care professionals with mandatory treatment and monitoring. Journal of Addictive Diseases 24(3): 61-75, 2005. (31 refs.)

Objective. To measure the satisfaction of impaired health professionals with treatment and monitoring programs in Michigan and Indiana. Method. Mailed surveys assessed overall program satisfaction, usefulness of various aspects of monitoring, and several miscellaneous items. Persons active in the Michigan (n = 620) and Indiana (n = 267) programs in July 2002 were included. Anonymous responses were received from 263 (43%) of Michigan and 120 (45%) of Indiana participants. Results. Means on the 1 to 5 satisfaction subscale were 3.6 (SD =.94) for Michigan and 4.1 (SD =.86) for Indiana. Means on the I to 4 monitoring subscale were 2.7 (SD =.62) for Michigan and 2.7 (SD =.57) for Indiana. Forty percent of Michigan respondents and 53% of Indiana respondents lacked insurance coverage for program costs. Thirty-nine percent of Michigan and 35% of Indiana respondents reported substance abuse or mental health difficulties prior to their professional career.

Freeman J. Ethics Watch: Turning in impaired lawyers for misconduct. South Carolina Lawyer 15: 9-21, 2004. (43 legal refs.)

Consider the following findings -- Benjamin Sells, The Soul of the Law, 17 (1994) (substance abuse estimated to be tied to 70 percent of complaints against lawyers); Charles J. Santangelo & Donald W. Morrison, Alcohol Abuse on the Rise Among Lawyers, 209 N.Y.L.J. 5, 5 (1993) (claiming that in New York and California, 50 to 70 percent of all complaints against lawyers involve alcohol abuse); ABA Commission on Impaired Attorneys, An Overview of Lawyer Assistance Programs in the United States 1 (1991) (estimating that 40 to 75 percent of disciplinary complaints stem from alcohol, drugs or mental health problems); Muchogrosso, Oregon State Bar Professional Liability Fund, Profile of Legal Malpractice -- A Statistical Study of the Determinative Characteristics of the Lawyers' Professional Liability Fund (May 1981) (reporting that of 100 lawyers who entered Oregon's lawyer assistance program for alcohol or drug abuse therapy, 61 percent had disciplinary complaints and 60 percent had malpractice suits pending against them). In the face of overwhelming evidence linking lawyer impairment and ethical misconduct, the organized bar has started to speak openly about the ethical problems impairment presents. This column deals with ABA Formal Ethics Opinion 03-431, which considers lawyers' duty to report other members of the bar, outside the firm in which we practice, when a mental condition (such as alcoholism, drug addition, senility or mental illness) impairs the lawyer's ability to effectively represent a client. Questions examined are: How impairment is manifested; how impairment can be unethical; requirements for client consent; if there is a pre-reporting duty to consult with the offending lawyer; and what to do when in doubt.

Gallagher JC. Drugs, alcohol, mental health and the Vermont lawyer. Vermont Bar Journal & Law Digest 32(Spring): 5-6, 2006

This President's Column deals with alcohol and drug abuse among lawyers are scary. Data is provided on the rate of alcohol drug problems of lawyers compared to the general population, about 70 higher. It is noted that malpractice cases against lawyers are more frequent and the cost of liability insurance adds to the lawyer's ever-increasing overhead. The impact of lawyers' alcohol/drug impact on the profession and clients is noted. The state bars of California, Minnesota, and New Jersey estimate that two-thirds of disciplinary complaints in those states result from substance abuse. Data on malpractice are also provided. The Oregon Attorney Assistance Program, an offshoot of the Oregon State Bar Association, recently completed a ten-year study of fifty-five recovering attorneys, who had practiced at least five years before and after "their sobriety dates." In the five-year period before sobriety, the fifty-five lawyers suffered eighty-three malpractice claims. The incidence of malpractice claims dropped to twenty-one during the five years following sobriety. These statistics represented a 30 percent annual claim rate before sobriety and an 8 percent rate after. Interestingly, this 8 percent post-sobriety rate was dramatically lower than the average malpractice rate of all Oregon lawyers, 13.5 percent. At an average cost of $16,500 per malpractice case, the study concluded the bar saved $ 200,000 a year from the recovery program for this group. There is also discussion of efforts by the Vermont Bar Association to enhance its attorney assistance program.

Gnadt B. Religiousness, current substance use, and early risk indicators for substance abuse in nursing students. Journal of Addictions Nursing 17(3): 151-158, 2006. (41 refs.)

Nursing students have been targeted by the American Nurses' Association (ANA) for efforts focused on the prevention of substance abuse. This study surveyed 241 nursing students enrolled in their first year of nursing courses at seven faith-based colleges and universities. The purposes were to investigate the prevalence of current substance use and the number of early risk indicators for substance abuse and dependence among nursing students, and to examine the relationships among religiousness, current substance use, and early risk indicators for substance abuse. Efinger's Alcohol Risk Survey, the CAGE Questionnaire, and the Intrinsic/Extrinsic Revised Scale were used to collect data. Twenty-four percent of respondents reported current substance use, 15% scored in the probable abuse/dependence category: those who were more religious tended to have lower prevalence rates of substance use as well as fewer numbers of early risk indicators.

Gross SR; Wolff K; Strang J; Marshall EJ. Follow-up of provision of inpatient treatment for UK healthcare professionals with alcohol dependence: Snapshot of a pilot specialist National Health Service. Substance Use & Misuse 44(13): 1916-1925, 2009. (13 refs.)

Alcohol dependent healthcare professionals (AHCPs) entering a specialized National Health Service (NHS) inpatient treatment facility in southeast London, UK, were investigated. A retrospective case-note analysis was conducted, supplemented with a postal questionnaire. Twenty-three mature (mean age 46 7 years; 13 male) AHCPs, 82% of admissions, with a mean duration of alcohol dependence of 16.5 years were followed-up at an average of 26 months postdischarge. Half of the sample met criteria for lifetime psychiatric disorder. Physical illness was also a prominent problem. At follow-up, six professionals reported continuous abstinence since discharge. For those who continued drinking, there was a significant reduction in daily quantity consumed. This study suggests that the absence of an adequate treatment infrastructure and administrative resources have a major impact on access to treatment services and outcomes for addicted healthcare professionals. There is a need for supported and dedicated services for this group within the UK National Health Service. The study's limitations are noted.

Hamilton B; Taylor G. On our way with alternatives-to-discipline for nurses with addictions? Commentary on Monroe T & Kenaga H (2011) Don't ask don't tell: substance abuse and addiction among nurses. Journal of Clinical Nursing 20, 504-509 (editorial). Journal of Clinical Nursing 20(13-14): 2083-2084, 2011. (5 refs.)

Heise B. The historical context of addiction in the nursing profession: 1850-1982. Journal of Addictions Nursing 14(3): 117-124, 2003. (71 refs.)

Intertwined in the history of substance abuse in the United States is the history of addiction in the nursing profession. This historical research explores the context of addiction in the nursing profession with reference to social, medical, political, and legal events from 1850 until the American Nurses' Association officially acknowledged addiction in the nursing profession in 1982 with guidelines for the impaired nurse. Prior to these guidelines colleagues looked the other way hoping the nurse would solve the problem by herself or if not, just leave. If caught, punitive action was taken. Nurses lost their licenses, their source of income (meaning no resources for rehabilitation treatment), and often went to jail.

Katsavdakis KA; Gabbard GO; Athey GI. Profiles of impaired health professionals. Bulletin of the Menninger Clinic 68(1): 60-72, 2004. (12 refs.)

There are numerous studies that describe the characteristics of impaired health professionals and the types of professional misconduct leading to licensing board action. These studies have two fundamental limitations. The first is the sampling procedure, and the second is that they typically do not examine health professionals who are currently in treatment. This study describes the problems that lead health professionals-comprising psychiatrists, nonpsychiatric physicians, psychologists and social workers-to seek treatment and the sources of referral for treatment. A total of 334 health professionals were studied who sought out an evaluation or treatment at The Menninger Clinic between 1985 and 2000. The findings indicated that the participants' therapist was the largest referral source and that the most commonly cited problems leading to referral were marital and emotional difficulties rather than substance abuse, boundary violations, or prescribing problems. Licensing and regulatory agencies can take proactive steps to identify professionals with social and emotional vulnerabilities who may be at greater risk for unethical and negligent behavior.

Kenna GA; Lewis DC. Risk factors for alcohol and other drug use by healthcare professionals. Substance Abuse Treatment, Prevention, and Policy 3(e-article 3), 2008. (46 refs.)

Background: Given the increasingly stressful environment due to manpower shortages in the healthcare system in general, substance induced impairment among some healthcare professions is anticipated to grow. Though recent studies suggest that the prevalence of substance abuse is no higher in healthcare professionals (HPs) than the general population, given the responsibility to the public, any impairment could place the public at increased risk for errors. Few studies have ever reported predictors or risk factors for alcohol and other drug use (AOD) across a sample of HPs. Methods: The study used a cross-sectional, descriptive self-report survey in a small northeastern state. A 7-page survey was mailed to a stratified random sample of 697 dentists, nurses, pharmacists and physicians registered in a northeastern state. The main outcome measures were demographic characteristics, lifetime, past year and past month prevalence of AOD use, the frequency of use, drug related dysfunctions, drug misuse and abuse potential. Six contacts during the summer of 2002 resulted in a 68.7% response rate (479/697). Results: Risk factors contributing to any reported past year AOD use, as well as significant (defined as the amount of AOD use by the top 25% of respondents) past year AOD use by HPs were examined using logistic regression. Risk factors of any self-reported past year AOD use included moderate or more frequency of alcohol use, being in situations when offered AODs, feeling immune to the addictive effects of drugs (pharmaceutical invincibility) and socializing with substance abusers. Risk factors of significant past year AOD use were HPs with younger licensees, a moderate pattern of alcohol use and not socializing with substance abusers. Conclusion: National and state organizations need to develop policies that focus on prevention, treatment, and rehabilitation of alcohol and other drug-using healthcare professionals. The results of this study may help to delineate the characteristics of HPs abusing drugs, leading to the development of more effective policies designed to protect the public, and move toward more tailored and effective intervention strategies for HPs.

Kenna GA; Wood MD. In search of pharmacological optimism: Investigating beliefs about effects of drugs: A pilot study. Addiction Research & Theory 16(4): 383-399, 2008. (63 refs.)

The healthcare (HC) literature suggests that pharmacological optimism (PO) is a risk factor contributing to the initiation of substance use by HC professionals. Expectancies, or beliefs about the effects of alcohol and illicit drugs, have shown consistent relations with self-reported drug use across a number of populations. This preliminary study investigated if the domain of expectancies extends to prescription drugs (i.e. medications) or the misuse of licit drugs. A self-report cross-sectional survey was administered to pharmacy and nursing (healthcare) as well as other college undergraduate and graduate students (nonhealthcare) from third to sixth years (N = 401). Healthcare (HC) and nonhealthcare (NHC) college students completed a questionnaire assessing drug use, the pharmacological optimism (POS) and the willingness to use scales (POS). Using principal components analysis, the POS yielded four identifiable factors. The results of the present pilot study provide limited support for the reliability and validity for the POS. We report that pharmacological optimism predicted unique variance in drug use over that predicted by willingness to use and observed no differences between HC and NHC students on the POS, nor was associated with greater drug use by HC students. This preliminary study defines pharmacological optimism as an expectancy, which in combination with one's willingness to use drugs and other factors may influence misuse of licit drugs by HC workers. While the results support the notion of pharmacological optimism, these beliefs did not contribute to drug use by HC students.

Kenna GA; Wood MD. Prevalence of substance use by pharmacists and other health professionals. Journal of the American Pharmaceutical Association 44(6): 684-693, 2004

OBJECTIVES: To assess substance use, misuse, and abuse rates across a representative sample of dentists, nurses, pharmacists, and physicians; compare these rates to available general population data; and determine whether pharmacists report disproportionate unauthorized or illicit substance use. DESIGN: Cross-sectional, descriptive self-report survey. SETTING: A small northeastern state. PARTICIPANTS: Stratified random sample of dentists, nurses, pharmacists, and physicians. INTERVENTIONS: Mailed 7-page survey. MAIN OUTCOME MEASURES: Demographic characteristics; lifetime, past-year, and month prevalence of substance use; frequency of use; drug-related dysfunctions; drug misuse; and abuse potential. RESULTS: Six contacts with participants in the summer 2002 resulted in a 68.7% response rate. More than one half (58.7%) of pharmacists reported using a nonprescribed drug at least once in their lifetime. Though total illicit drug use rates by pharmacists were not noticeably different from those of other health professional (HP) groups, a greater proportion of pharmacists reported lifetime use of minor opiates, anxiolytics, and stimulants. Past-year prevalence of drug use was highest among pharmacists (12.8%). Except for anxiolytics, past-year prevalence of use of most other medications by pharmacists was slightly greater than prevalence of use rates reported by physicians and more prevalent than use rates reported in the general population. As with the other HP groups, pharmacists reported low levels of substance-associated dysfunctions and potential abuse. CONCLUSION: The findings suggest that lifetime nonprescribed drug use by pharmacists does not appear to be disproportionate when compared with other groups of HPs. Specific drug use rates varied across HP groups, possibly suggesting medication access facilitates drug-associated experiences by HPs. Consequently, unauthorized or illicit substance use by HPs, including pharmacists, suggests the need for more intensive educational programs on practitioner impairment.

Kenna GA; Wood MD. Substance use by pharmacy and nursing practitioners and students in a northeastern state. American Journal of Health-System Pharmacy 61(9): 921-30, 2004. (63 refs.)

PURPOSE: The prevalence and predictors of substance use among pharmacists and nurses and pharmacy and nursing students were studied. METHODS: During summer 2002, pharmacists and nurses in a northeastern state were mailed an anonymous survey to determine their use of alcohol, tobacco, and commonly abused drugs; to determine their ease of access to controlled substances; and to measure their family history of alcohol and drug problems. A similar but not identical survey was distributed to pharmacy and nursing students during spring 2000. RESULTS: A total of 262 usable questionnaires were received from pharmacists and nurses (response rate, 72.8%), and 138 usable questionnaires were received from students (35.3%). Large majorities of nursing students, pharmacy students, and nurses were women. A higher percentage of pharmacists reported having used an opioid or an anxiolytic at least once in their lives (24.8% and 14.3%, respectively) than nurses (14.5% and 7.8%). Higher percentages of nursing students and nurses reported having ever used an unprescribed drug (74.5% of nursing students and 63.6% of nurses). CONCLUSION: A survey of pharmacy and nursing practitioners and students in a northeastern state provided important information on alcohol, tobacco, and illicit drug use among these groups and highlighted the need for prevention and intervention.

Kenna GA; Wood MD. The prevalence of alcohol, cigarette and illicit drug use and problems among dentists. Journal of the American Dental Association 136(7): 1023-1032, 2005. (40 refs.)

Background. Primarily on the basis of qualitative data, use of alcohol and illicit drugs has been speculated to be higher among dentists. The authors conducted a study to assess self-reported substance use by dentists and compare these data with those regarding physicians and the general population (GP). Methods. A total of 113 dentists (65.3 percent) and 104 physicians (63.4 percent) from a northeastern state responded to a seven-page self-report survey during the summer of 2002. The survey assessed health care professionals' alcohol, cigarette and drug use; consequences of use; disciplinary occurrences and treatment; and professional and social influences. Results. Although about twice as many physicians as dentists reported heavy alcohol use, a greater number of dentists reported heavy episodic alcohol use over the past year and past month, as well as having more alcohol-use problems than physicians. Roughly twice as many physicians and three times the GP reported using anxiolytics than did dentists. More dentists than physicians reported past-year, but not past-month, minor opiate use. While more dentists reported being in social situations in which they were offered alcohol, more physicians reported being offered alcohol by pharmaceutical companies at various functions. Conclusions. Contrary to previous speculation, there is little evidence from the prevalence data the authors analyzed for this report to suggest that dentists are at a greater risk of developing alcohol- or other drug-use problems than is the GP. Practice implications. While the findings of this study do not suggest that substance use is more prevalent among dentists, educational institutions and state organizations still must be vigilant in educating, monitoring and encouraging dentists to voluntarily receive treatment.

Kogan LR; McConnell SL; Schoenfeld-Tacher R. Veterinary students and non-academic stressors. Journal of Veterinary Medical Education 32(2): 193-200, 2005. (40 refs.)

Psychological distress has been shown to affect the academic success, health, emotional well-being, and dropout rates of medical students. Although it can be assumed that stress has similar effects on veterinary students, there is a paucity of research pertaining to the psychological stressors and coping strategies of this group. This article focuses on selected non-academic areas (as identified through a survey of currently enrolled students) that can create significant stressors for veterinary students. Also assessed and discussed here are poor coping strategies (e.g., substance abuse) and gender differences in perceived stressors and coping strategies that emerged from the survey. Results suggest the need for veterinary programs to integrate academic and professional skills instruction with personal life balance training and access to psychological services.

Kornegay K; Bugle L; Jackson EA; Rives K. Facing a problem of great concern: Nursing faculty's lived experience of encounters with chemically dependent nursing students. Journal of Addictions Nursing 15(3): 125-132, 2004. (30 refs.)

This article focuses on the qualitative component of a study of nursing faculty attitudes toward student nurses perceived as having chemical dependency problems. A multi-cluster random sampling procedure was used to survey 874 participants; 324 participants responded to the survey, resulting in a response rate of 37%. Narrative analysis was used to analyze descriptions of encounters with chemically dependent student nurses as well as faculty perceptions of how religious/spiritual beliefs influenced their attitudes toward chemically dependent individuals. Four major themes emerged regarding the influence of religion/spirituality on attitudes toward individuals who may be chemically dependent; seven themes emerged regarding faculty encounters with chemically dependent nursing students. Study findings imply chemical dependency is a problem in academic circles that is frequently encountered by nursing faculty and that individuals with the potential to contribute productively to the profession of nursing are frequently lost to our profession for reasons directly or indirectly related to chemical dependency.

Levin J. Legal Ethics. The mentally impaired lawyer: What is our obligation to report. CBA Record 18: 54, 2004. (0 refs.)

Rule 1 of both the Illinois Rules of Professional Conduct and the ABA Model Rules state that a "lawyer shall provide competent representation to a client." Other Rules impose numerous obligations on lawyers in the context of their practice. Since lawyers are subject to the risk of illness, aging and substance abuse, a serious question arises when a lawyer becomes disabled or impaired and not able to provide competent representation. Each of us hopes that we will be enough aware of our own impairment to take appropriate action for the good of our clients and the profession. What, however, should we do if we know that another lawyer is impaired and unable to provide competent representation, and continues to practice? The ABA has recently promulgated two Formal Opinions addressing when mental impairment impacts on the lawyer's ability to function. The first is Formal Opinion 03-429 which discusses a lawyer's "Obligations With Respect to Mentally Impaired Lawyer in the Firm." This opinion states that: If a lawyer's mental impairment is known to partners in a law firm or a lawyer having direct supervisory authority over the impaired lawyer, steps must be taken that are designed to give reasonable assurance that such impairment will not result in breaches of the Model Rules. If the mental impairment of a lawyer has resulted in a violation of the Model Rules, an obligation may exist to report the violation to the appropriate professional authority. The Opinion continues to explain that the firm may have an obligation to discuss the circumstances of the change of responsibility with the client under Model Rule 1.4(b) which states: "A lawyer shall explain a matter to the extent reasonably necessary to permit the client to make informed decisions regarding the representation." The Opinion relies on Model Rules 16, and 5.1(a) and (b), in reaching its conclusion that a law firm has responsibility for lawyers within the firm who may suffer from a mental impairment. Rule 1.16 of both the ABA and the Illinois Rules provides: (a) A lawyer representing a client before a tribunal shall withdraw from employment (with permission of the tribunal if such permission is required), and a lawyer representing a client in other matters shall withdraw from employment, if: (2) the lawyer knows or reasonably should know that such continued employment will result in violation of these Rules; [or] (3) the lawyer's mental or physical condition renders it unreasonably difficult for the lawyer to carry out the employment effectively.

Long MW; Cassidy BA; Sucher M; Stoehr JD. Prevention of relapse in the recovery of Arizona health care providers. Journal of Addictive Diseases 25(1): 65-72, 2006. (13 refs.)

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. The findings suggest several subjective factors that contributed to the subjects' relapse included (1) dishonesty to self, (2) not working a 12 step program, and (3) denial of the problem. Factors reported to be helpful for future relapse prevention were (1) abstinence from substance use, (2) working a 12 step program, and (3) having spiritual beliefs. 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. 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.

Maher-Brisen P. Addiction: An occupational hazard in nursing? (editorial). American Journal of Nursing 107(8): 78-79, 2007. (13 refs.)

Monahan G. Drug use/misuse among health professionals. Substance Use & Misuse 38(11/13): 1877-1881, 2003. (1 refs.)

Health professionals are among special populations in need of substance use/misuse prevention and treatment services. The behavior of impaired health professionals often have dire consequences to one's social, financial, and psychological life. This presentation outlines the epidemiology of substance use/misuse among health professionals, the consequences of the problem, and treatment issues. The work of Dr. Robert Coombs of the University of California, Los Angeles, School of Medicine and other United States and international scholars is reviewed. Cross-national policies in the field are highlighted. Unresolved critical issues are noted and discussion of needed future research.

Monroe T. Addressing substance abuse among nursing students: Development of a prototype alternative-to-dismissal policy. Journal of Nursing Education 48(5): 272-278, 2009. (37 refs.)

Substance abuse and dependency are health issues that require effective policies within nursing education. In 2007, the University of Memphis School of Nursing drafted a new substance abuse policy using the American Association of Colleges of Nursing's Policy and Guidelines for Prevention and Management of Substance Abuse in the Nursing Education Community. These guidelines include the assumption that addiction is an illness that can be treated and the philosophy that schools of nursing are committed to assisting students with recovery. The new policy at University of Memphis School of Nursing incorporated prevention, education, identification, evaluation, treatment referral, and reentry guidelines, as well as disciplinary action for students unwilling to undergo rehabilitation. It is hoped this new substance abuse policy will serve as a prototype for other institutions.

Monroe T; Kenaga H. Don't ask don't tell: Substance abuse and addiction among nurses. Journal of Clinical Nursing 20(3-4): 504-509, 2011. (27 refs.)

Aim. The purpose of this manuscript is to illustrate the challenges faced by nurses who abuse substances and to promote international dialogue about what practitioners, administrators, health care providers and students can do when they suspect someone in the profession is abusing substances, or they may themselves be suffering from addiction. Background. Addiction among nurses has been recognised by professionals in the field for over 100 years, and current estimates place rates of substance misuse, abuse and addiction rates as high as 20% among practicing nurses. Unfortunately, fear of punishment and discipline may keep nurses or students from asking for help for themselves or from reporting a colleague or friend who is in need of help. Design. Discursive paper. Method. This paper synthesises the results of three previous papers conducted on substance abuse policies in the nursing profession. In the first paper, the authors reviewed the history of addiction in nursing and compared disciplinary and alternative-to-discipline policies. The second focused on the development of an alternative-to-dismissal policy for substance abuse in a school of nursing and using telephone and email interviews, and the final paper reported findings of what types of polices seem to be working to retain and rehabilitate nurses who suffer from addiction in the. Lastly, this paper introduces international policy for nurses with addictions. Conclusions. Poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired students or professionals to ask for help. Providing early intervention and assistance is essential in helping colleagues and students recover from an addictive disorder and providing a non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions. Relevance to clinical practice. Recognition of a colleague's need of treatment is the important first step in the rehabilitation process. Early intervention and assistance are essential for helping colleagues and students to recover from an addictive disorder and providing a confidential, non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care.

Myers HL; Myers LB. 'It's difficult being a dentist': Stress and health in the general dental practitioner. British Dental Journal 197(2): 89-93, 2004. (16 refs.)

Objective The aim of the study was to investigate overall stress, workstress and health in general dental practitioners (GDPs). Design, setting and subjects A nationwide anonymous cross-sectional survey was undertaken using stratified random sampling of 2,441 GDPs in the UK. Main outcome measures Measures included perceived stress, Work Stress Inventory for Dentists, job dissatisfaction, measures of health symptoms and health behaviour, dental and demographic information. Results The main findings were that perceived stress was significantly correlated with measures of dental stress. Work-related factors: fragility of dentist - patient relationship, time and scheduling pressures, staff and technical problems, job dissatisfaction, percentage NHS, and number of hours worked per week together explained nearly a half of GDPs overall stress in their life (linear multiple regression, adjusted r(2) = 0.48, F (2, 2404) = 509.68, P < 0.0001). Health behaviours such as alcohol use was associated with work stress (r = 0.18, P < 0.001) and over a third of GDPs were overweight or obese. Sixty per cent of GDPs reported being nervy, tense or depressed, 58.3% reported headache, 60% reported difficulty in sleeping and 48.2% reported feeling tired for no apparent reason. These were all related to work stress (one way analysis of variance, F (1,2211) = 241.53 P < 0.0001, F (1,2214) = 86.17 P < 0.0001; F (1, 2215) = 125.55 P < 0.0001; F (1,2211) = 209.67 P < 0.0001 respectively). Levels of minor psychiatric symptoms were high, with 32.0% of cases identified. The amount of backache was also high (reported by 68.3% of GDPs). Conclusion A high percentage of NHS dentistry was associated with high levels of overall stress in GDPs' lives, indicating that the nature of NHS dentistry should be carefully investigated to try to improve GDPs working conditions. A comparatively large number of dentists reported high levels of psychological stress symptoms, such as being nervy, tense and depressed, showing minor psychiatric symptoms, with alcohol use being related to stress. Other factors reported which were not related to stress but may be related to the actual practice of dentistry were that a third of dentists were overweight or obese and over 60% reported backache. Overall, these findings indicate the stressful nature of dentistry and difficulties in working conditions. The next step should be to develop interventions to help dentists to reduce stress in the dental surgery.

Naegle MA. An overview of the American Nurses' Association's Action on Impaired Practice with suggestions for future directions. Journal of Addictions Nursing 14(3): 145-147, 2003. (13 refs.)

Discusses an overview of the American Nurses' Association's action on impaired practice with suggestions for future directions. The recently revised American Nurses' Association (ANA) Social Policy Statement (ANA, 2003) delineates nurses' responsibilities to the profession, American society, and the health of the nation. Unified national action by the American Nurses' Association began with advocacy for nurses by committed nursing and medical experts and a policy statement developed by three cooperating organizations. The stigma associated with alcohol, other drugs, and psychiatric illness resulted in underreporting because reporting was perceived as damaging to the professional image. Many nurses experiencing alcohol, drug, or mental health problems felt shame and may have practiced deception, further reducing the number of cases reported. Efforts toward health promotion and policies limiting smoking, access to alcohol, more careful monitoring of drugs in the workplace, and education on impaired practice have supported change. The development, review, and refinement of organizational policies and programming will assist in retaining our most valuable professional resources, registered nurses.

Nunes LC; Pinheiro PR; Pequeno TC; Pinheiro MCD. Toward an application to psychological disorders diagnosis. Advances in Experimental Medicine and Biology: Software Tools and Algorithms For Biological Systems 696: 573- 580, 2011. (13 refs.)

Psychological disorders have kept away and incapacitated professionals in different sectors of activities. The most serious problems may be associated with various types of pathologies; however, it appears, more often, as psychotic disorders, mood disorders, anxiety disorders, antisocial personality, multiple personality and addiction, causing a micro level damage to the individual and his/her family and in a macro level to the production system and the country welfare. The lack of early diagnosis has provided reactive measures, and sometimes very late, when the professional is already showing psychological signs of incapacity to work. This study aims to help the early diagnosis of psychological disorders with a hybrid proposal of an expert system that is integrated to structured methodologies in decision support (Multi-Criteria Decision Analysis - MCDA) and knowledge structured representations into production rules and probabilities (Artificial Intelligence - AI).

Pooler D; Sheheen F; Davidson J. Professional impairment: A history and one state's response. Journal of Addictive Diseases 28(2): 113-123, 2009. (36 refs.)

Professionals who provide care to clients may have an impaired practice because of alcohol or drug abuse problems. Health care professionals can harm clients when their practice is impaired. Evidence suggests that doctors, nurses, pharmacists, psychologists, and social workers are vulnerable to substance misuse. A professional with an impaired practice can recover with help. This article reviews the literature on impaired practice of health professionals and highlights prevalence rates of drug and alcohol problems. South Carolina's recovering professional program is one response that protects the public and helps the professional get better.

Pooler D; Sheheen F; Davidson J. Professional impairment: A history and one state's response. Journal of Addictive Diseases 28(2): 113-123, 2009. (36 refs.)

Pooler DK; Siebert DC; Faul AC; Huber R. Personal history and professional impairment: Implications for social workers and their employers. Administration in Social Work 32(2): 69-85, 2008. (42 refs.)

This paper examines the personal histories of social workers and investigates how these variables were related to diminished professional functioning (i.e., professional impairment). One thousand practicing NASW members were anonymously surveyed as part of the study "Work and Well-Being: A Study of North Carolina Social Workers." Social workers responded to 11 personal history questions, and an analysis found statistically significant differences in professional impairment scores for all but three-of these variables. Regression analysis found that five personal history variables explained the most variance in professional impairment scores. This study's findings have important implications for organizations that employ social workers. Managers, supervisors, and administrators can create organizational conditions that make it safe for social workers to seek help for their problems. Professional impairment and concomitant personal history issues should be explored in social workers' formal education and subsequent training to prevent harm to clients and create a healthier workplace.

Quinlan D. Impaired nursing practice: A national perspective on peer assistance in the U.S. Journal of Addictions Nursing 14(3): 149-155, 2003. (11 refs.)

Impaired practice in nursing deserves frank discussion, realistic policy development and renewed understanding as a disease process. With the increasing stressors of the workplace and shortage of nurses, quality treatment and retention are essential to the profession. This article reviews this national dilemma from recognition to resolution and describes advocacy approaches that offer viable solutions through programming and policy while affording greater public protection.

Rassool GH; Villar-Luis M; Carraro TE; Lopes G. Undergraduate nursing students' perceptions of substance use and misuse: a Brazilian position. Journal of Psychiatry and Mental Health Nursing 13(1): 85-89, 2006. (20 refs.)

Alcohol, cocaine and cannabis are the substances most commonly abused in Brazil. There is limited evidence on the perceptions of undergraduate nursing students towards substance misuse. Negative attitudes, in combination with the lack of appropriate knowledge and skills, may result in minimal care provided to substance misusers. The alms of the study are to examine the knowledge and attitudes of undergraduate nursing students towards substance misusers and consider the implications of these attitudes for nursing education. The Nurse Education in Alcohol and Drug Educational Faculty Survey (NEADA) questionnaire on knowledge and education, nursing interventions, attitudes and values was distributed to undergraduate nurses (n = 227) in the south and south-eastern part of Brazil. The findings showed that there is a lack of adequate education in drug and alcohol use and misuse, including competency skills, but the participants were positive about treatment interventions. A paradigm shift in nurse education curricula and further research studies on attitudes and values towards substance misuse should be on the educational agenda. These are challenges faced by nurses to meet the healthcare needs of substance misusers.

Roesner J. The unlikely face of addiction. Veterinary Economics 48(5): 73-75, 2007. (0 refs.)

This is a first person account of a veterinarian who was identified as being impaired by colleagues, using both alcohol and amphetamines, and also suffering from depression. She was provided the opportunity to participate in a program for chemically dependence physicians rather than being prosecuted for drug theft, entered a program and has been sober and straight for over 10 years. Included is a sidebar are the results of a survey of veterinarians. Sixty percent reported having ever worked with a staff member who they believed abused drugs or alcohol; 17% reported working with a veterinarian who was thought to be abusing drugs or alcohol; 4% reported personal history of drug or alcohol abuse (7%) preferred not to answer); 2% of respondents reported their practice having been investigated by the DEA; and 18% reported an outside party had stolen controlled substances from the practice. See for information about assistance for impaired veterinarians.

Rothstein L. Law students and lawyers with mental health and substance abuse problems: Protecting the public and the individual. University of Pittsburgh Law Review 69(3): 531-566, 2008. (82 legal refs.)

Summary: ... A joint task force of law school representatives, national legal education organizations, legal employers, and licensing and other agencies could help to address some of these issues. ... Part II of this Article provides an overview of the policies, practices, and procedures that affect individuals with mental health and substance abuse impairments at various stages of entering and continuing in the legal profession. ... Even if the criminal or other misconduct relates to a disability, it is probably legal to ask about misconduct. ... Individuals who have been working to encourage law students to use the services need to understand that even though the LAP programs refer to themselves as "confidential," the students may still be required to report that they sought counseling. ... In addition to clinical education (in which a faculty member and/or a practicing attorney have direct supervision of client contact), many law schools provide externships or other placement programs through which law students (under the supervision of a practicing attorney or judge and with direction from a faculty member) handle legal matters for real clients. ... The AALS Report noted that "the most effective lawyer assistance programs have implemented many or all of the ABA Commission's Guidelines . . . and emphasize three areas for action: education; assistance with diagnosis, intervention, and treatment; and assistance with aftercare and recovery."

Sadeghi M; Navidi M. Substance use among medical residents in Tehran, Iran. Addictive Disorders and Their Treatment 4(3): 121-124, 2005. (9 refs.)

The aim of this study was to obtain an estimate of the prevalence of various substance use among resident doctors of medical universities in Tehran, Iran. A 43-item questionnaire was distributed among 1795 residents of 3 main medical universities in Tehran. Response rate was 68.2%. Alcohol was the most widely used substance, although the rate was much less frequent than the rates reported in Western countries. Opium, cannabis, and heroin use were in the next order, whereas opium was the most frequently reported substance for daily use. Recreation was the main reason for the substance use. The majority of substance users had started their use in general medical training. Substance use was correlated positively to male gender and a positive family history of any substance use and negatively to having religious beliefs and practices. Although the study showed that most cases of substance use were limited to casual use, high figures of lifetime use mandates the implementation of training, psychoeducation, and preventive programs, especially in the general medical training period.

Shaw MF; McGovern MP; Angres DH; Rawal P. Physicians and nurses with substance use disorders. Journal of Advanced Nursing 47(5): 561-571, 2004. (46 refs.)

Background. The literature addressing substance use patterns among medical professionals suggests that specialty, gender, age, familial substance abuse, and access/familiarity with prescription drugs are associated with particular chemical dependencies. These studies have rarely compared nurses and physicians directly, thereby making if difficult to tailor interventions to the potentially unique needs of each group. Aim. This paper reports a study to compare the initial clinical presentations, service utilization patterns, and post-treatment functioning of nurses and physicians who received services in an addiction treatment programme. Method. This exploratory study combined data collected through retrospective record reviews and prospective questionnaires. There were three types of dependent variables: initial clinical characteristics, treatment utilization patterns, and post-treatment functioning. The independent variable was membership of either professional group. Time both in treatment and between discharge and follow-up were covariates. Results. Nurses and physicians showed comparable results in most domains. Among the statistically significant differences between groups, a subset was particularly noteworthy. Prior to participating in the programme nurses showed significantly less personality disturbance than physicians, although they tended to work and live in environments with more triggers to relapse, such as other substance users. After the index hospitalization, nurses received less primary treatment, worked longer hours, and were more symptomatic than physicians. Furthermore, nurses reported more frequent and severe work-related sanctions as a consequence of their behavioural disorders. Conclusion. In most areas of study, nurses and physicians demonstrated comparable results; however, a series of statistically significant differences suggest that these groups may have unique clinical needs. The policy implications of these findings are discussed.

Siebert DC. Denial of AOD use: An issue for social workers and the profession. Health & Social Work 28(2): 89-98, 2003. (29 refs.)

The author investigated AOD use among social workers, examined its potential negative professional consequences and explored the denial that may facilitate AOD abuse. Results are reported from an anonymous survey of 751 NASW members in North Carolina. Twelve percent of the sample were at serious risk of AOD abuse, 28 percent reported binge drinking during the preceding year, and 21 percent had used drugs illegally since becoming a social worker. In addition, 34 percent of respondents at serious risk of AOD abuse reported at least one impairment incident, and 39 percent agreed that they had worked when too distressed to be effective. Only 9 percent of those at serious risk reported current problems with alcohol or other drugs, 28 percent of them reported being in recovery, notwithstanding their current drinking and using. Research and practice implications for social workers, supervisors, and the profession are presented.

Siebert DC. Help seeking for AOD misuse among social workers: Patterns, barriers, and implications. Social Work 50(1): 65-75, 2005. (38 refs.)

Social workers experience alcohol and other drug (AOD) problems, yet little is known about how they deal with these issues. To begin to address this gap in knowledge, this study presents data from a sample of NASW members and describes how frequently social workers seek support for AOD problems, the kinds of assistance they typically obtain, how helpful they find the assistance, the barriers that discourage them from seeking help, and the relationship between help seeking and impairment. The data suggest that social workers do not frequently seek help, even when they are high-risk AOD users. Respondents reported a number of personal reasons for not obtaining assistance, but when they sought help, they found both peer support and formal treatment beneficial. Help seeking was also related to a variety of professional impairments. Implications for practice and research are discussed.

Smith PL; Moss SB. Psychologist impairment: What is it, how can it be prevented, and what can be done to address it? Clinical Psychology: Science and Practice 16(1): 1-15, 2009. (75 refs.)

Research indicates that psychologists self-report a variety of problems related to their personal and professional functioning, such as depression, substance abuse, and burnout. These difficulties not only lead to psychologist distress, but can also result in impairment and have a negative effect on patient care. This review of the psychologist impairment literature provides information on the historical movement toward colleague assistance, rates of impairment, identifying distress and impairment, intervening with an impaired colleague, barriers to treatment, and preventing impairment. It is suggested that, through education of psychologists and graduate trainees, impairment may be prevented or its effects minimized.

Smith PL; Moss SB. Psychologist impairment: What is it, how can it be prevented, and what can be done to address it? Clinical Psychology: Science and Practice 16(1): 1-15, 2009. (75 refs.)

Smith WC. Pass the bar, flunk rehab. ABA Journal 89(January): 18-19, 2003. (0 refs.)

This piece is part of the column entitled, "LawBeat News." Drawing upon anecdotal accounts of attorneys in treatment or with substance use treatment, it takes the position that traits which make people good lawyers --such as argumentativeness, workaholism, and egotism--may hinder their rehabilitation and recovery. Data is provided on the prevalence of alcohol and other drugs problems among those in the law profession. (NB. No sources are provided.) There is discussion of the ABA's Commission on Lawyer Assistance Programs, as well as the need for specialized treatment programs for lawyers versus their inclusion in treatment settings with a range of people.

Sweeney TJ; Myers DP; Molea J. Treatment for attorneys with substance related and co-occurring psychiatric disorders: Demographics and outcomes. Journal of Addictive Diseases 23(1): 55-64, 2004. (6 refs.)

The following paper is the result of a retrospective study of clinical case files of legal professionals treated for substance-related and co-occurring psychiatric disorders at a recovery center specializing in the care of impaired professionals. Attorneys traditionally differ from healthcare professionals in two important ways: first, they prematurely leave treatment in greater numbers, and second, they suffer a higher incidence of co-occurring psychiatric disorders. Sixty percent of the attorneys presented with concurrent psychiatric conditions (Axis I and Axis 11), compared to 46% of their healthcare colleagues. More than half of the lawyers treated had a prior history of criminal arrest. Sixty-four percent completed treatment compared to an 86% completion rate for medical professionals. The completion rate for lawyers improved significantly following institution of a dedicated impaired attorneys' program under the direction of an attorney/clinician in October of 1999. Prospective studies are needed to determine if attorneys are at greater risk of developing substance related and/or psychiatric disorders than are other professionals of similar demographic backgrounds and what specialized intervention, treatment, and case management services might be necessary to assure equivalent outcomes.

Talbert JJ. Substance abuse among nurses. (editorial). Clinical Journal of Oncology Nursing 13(1): 17-19, 2009. (16 refs.)

Underwood B; Fox K; Nixon PJ. Alcohol and drug use among vocational dental practitioners. British Dental Journal 195(5): 265-268, 2003. (24 refs.)

Objective This study was designed to investigate the prevalence of alcohol and drug use in vocational dental practitioners (VDPs).Design Anonymous self-report questionnaire. Subjects and methods All UK vocational dental practitioners (n = 719) who started practice in the summer of 1999 were questioned on their use of alcohol, tobacco, cannabis and other illicit drugs whilst a VDP and before graduation. Results Eighty-nine per cent of males and 88% of females reported alcohol use. Of these, 35% of males and 36% of females drank above sensible levels (up to 21 units per week for males, 14 units for females), with 48% of males and 52% of females 'binge drinking'. Thirty-three per cent of respondents reported cannabis use whilst a VDP. Regular drug use (use at least once a month) other than cannabis whilst a VDP was found to be highest among males, with regular ecstasy use reported by 4% and regular cocaine use reported by 2%. Regular tobacco use (ten or more cigarettes per day) was reported by 9% of VDPs. Regular tobacco users were found to be six times more likely to use cannabis on a regular basis, three times more likely to use ecstasy on a regular basis and four times more likely to use cocaine on a regular basis than those VDPs who reported non regular tobacco use. Conclusion: VDPs are drinking above sensible limits, binge drinking, using tobacco and indulging in illicit drug use to a degree that will cause health problems. However, use of all substances had reduced since qualification.

Voss JP. Pro bono profile. Helping lawyers, judges & law students: Lawyers' assistance program celebrates 25 years. Chicago Bar Association 19(October): 49-64, 2005

In early 1980s a small group of Illinois lawyers, including those who had struggled with their own addiction and found recovery, saw the impact of alcoholism in the legal community and wanted to help their colleagues. Thus began a powerful movement that led to the Lawyers' Assistance Program as an important resource in providing confidential help to those in the profession of law. Lawyers' Assistance Program has a three-fold mission: to protect clients from impaired lawyers and judges; to help lawyers, judges, law students, and their families with alcohol/drug addiction and mental health problems; and to educate the legal community about these issues. With the support of the Chicago Bar Association and the Illinois Bar Association, Lawyers' Assistance Program, Inc. was formed as a not-for-profit organization. LAP volunteers met with lawyers who needed assistance and provided intervention services to help those who did not realize they had a problem. Funding is now provided through $7 of annual lawyer registration fees. Now -- 25 years later -- Lawyers' Assistance Program offers a more comprehensive program addressesing mental health problems that range from stress and anxiety to depression, bipolar illness, and compulsive disorders, such as problem gambling. With a professional staff that coordinates its many volunteers, LAP provides professional assessment, peer assistance, referral to professional counseling and treatment programs, intervention, 12-step programs, facilitated support groups, and education. Confidentiality is a cornerstone of Lawyers' Assistance Program. All client interactions with LAP are held in strict confidence according to Supreme Court Rule 1.6. LAP serves lawyers, judges, and law students but has no link to the Attorney Registration and Disciplinary Commission or the Judicial Inquiry Board. It keeps no permanent records and only demographic statistics and information are made public.

West MM. A kaleidoscopic review of literature about substance abuse impairment in nursing: Progress toward identification of early risk indicators? (review). Journal of Addictions Nursing 14(3): 139-144, 2003. (51 refs.)

This review presents a snapshot of the research that has been done on substance abuse impairment in nursing. Research has focused primarily on the prevalence of impairment, then attitudes about impairment, followed by identifying antecedents and characteristics of impaired nurses. Many of the research studies focused on middle- to late-stage risk factors, with very few exploring early risk indicators. Exploration of early risk factors is still in the beginning stages. A review of the literature shows the evolution of research as investigations progressed from identifying prevalence and attitudes, to identifying antecedents and risk factors. The section on risk factors with impairment is separated into five topics: (1) general studies about risk factors, (2) early risk factors with impairment, (3) sensation seeking as a risk factor, (4) family drug/alcohol use history, and (5) multidimensional factors related to impairment. Researchers generally agree that substance abuse is a prevalent problem, that nurses are as prone to impairment as the rest of society, and that the causes of impairment are multi-factorial. Prevention, education, and early intervention could be initiated with nurses and student nurses once early risk factors are identified.

Winwood PC; Winefield AH; Lushington K. The role of occupational stress in the maladaptive use of alcohol by dentists: A study of South Australian general dental practitioners. Australian Dental Journal 48(2): 102-109, 2003. (51 refs.)

Background: It is well recognized that dentistry is a stressful profession. However, there are conflicting views about the extent to which such stress contributes to hazardous drinking among dentists. In addition, the relative contributions of stress and pre-existing vulnerability in predicting alcohol problems among dentists generally (and Australian dentists in particular) have yet to be determined. Methods: The levels of stress and alcohol consumption of 312 South Australian dentists were measured. Factors known to mediate vulnerability to alcohol disorders were also assessed with appropriate psychometric instruments. Results: High levels of stress/burnout, consistent with other studies of dentists' stress, were recorded. Hazardous levels of alcohol consumption, which were between two and four times higher than the normative South Australian population, were also reported, particularly among males and rural dentists. Conclusions: To a significant extent, stress and hazardous alcohol consumption are both present among South Australian dentists. However, compared with work stress/burnout, existing personal vulnerability factors are much stronger predictors of such hazardous alcohol consumption. We suggest that professional dental bodies, and state Dental Boards, may play a role in ensuring stress inoculation and guidance on safe limits of alcohol consumption for dentists-in-training; and in creating appropriate mechanisms for assisting dentists who experience alcohol related difficulties.