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AANA Peer Assistance Advisors' Recommendations for the Treatment of the Disease of Addiction in Anesthesia Professionals and Students
The AANA Peer Assistance Advisors (PAA), the AANA Wellness Program, and the American Association of Nurse Anesthetists (AANA) recognize that the disease of addiction is characterized by a chronic, progressive, and potentially fatal process that may destroy the professional, the family, and the anesthesia community. (See AANA Position Statement Number 1.7, Substance Misuse and Chemical Dependency).
In the interest of patient safety and practitioner well-
Chemical Dependency in anesthesia professionals and students can be successfully treated. The PAA are aware of the essential role of appropriate, adequate and effective treatment in successful treatment and return to anesthesia practice. Anesthesia professionals and students have unique treatment needs for a variety of reasons including, controlled substance availability, potential loss of profession when inadequately treated, professional guilt and shame and a tendency to intellectualize the treatment process, among others. Various treatment options exist for the disease of addiction. Success rates in the treatment of the chemically dependent anesthesia professional or student vary widely between treatment modalities. The PAAs function to determine and recommend which available treatment modalities offer the highest rate of success.
The Peer Assistance Advisors recommendations for all chemically dependent anesthesia professionals and students:
- In the event of an intervention, it is imperative to follow the "Do's and Don't's of Conducting an Intervention" under Getting Help for Yourself and Others.
- Inpatient Treatment at a Substance Abuse and Mental Health Services Administration (SAMHSA) certified Inpatient Comprehensive Addiction Treatment Center experienced in treating healthcare professionals.
- Completion of a minimum of 28 days (also termed “short term”) of inpatient treatment is recommended, with 90 days of treatment (also termed “long term”) being most desirable and offering the highest success rate.
The treatment center chosen should at a minimum include:
- Comprehensive evaluation and treatment recommendations by an American Society of Addiction Medicine (ASAM) board certified addictionologist, committed to evaluating and treating anesthesia professionals in abstinence based recovery models in accordance with other safety sensitive occupations such as aviation, department of defense and department of transportation.
- Evaluation by an American Academy of Addiction Psychiatry (AAAP) boarded Addiction Psychiatrist where appropriate.
- Appropriate neuro-
psychiatric and or psychometric testing where appropriate. - When detoxification is medically indicated, inpatient medically supervised detoxification.
- Emphasis on a long term 12 step model of abstinence based recovery.
- Evaluation of suitability for, and timing of, the return to anesthesia practice as CRNA face unique obstacles and risks that can threaten their ability to maintain sobriety.
The PAAs do not advocate outpatient treatment, including Intensive Outpatient Treatment, for the disease of addiction in anesthesia professionals and students due to the high rate of recidivism. Any relapse after outpatient treatment should only be treated under the long term inpatient modality.
Because all anesthesia providers face special occupational risks and challenges by their exposure and access to drugs of abuse, the Peer Assistance Advisors' post-
Compliance with all treatment center recommendations for continuing care after discharge, including relapse prevention techniques, recovering professionals meeting attendance, active participation in the 12 step recovery community, and monitoring of random urine drug screens.