Nurses and addiction: He knows how and why it’s possible to cross the line

michael-humphreysMichael Humphrey knows firsthand what it means to be a nurse with a substance-use disorder. He understands, no matter how terrible the consequences, how on earth it is possible for nurses to cross the line. As an intensive care nurse for the University of Minnesota Hospital in the 1980s, he crossed that line himself.

“I never stole from patients — I didn’t have to,” he said. The leftover fentanyl after an open-heart surgery was there for the taking. “But I would have,” he said, likening addiction to “the person who is drowning and taking down the rescuer.”

Recovery came hard for Humphrey, who grew up in Brainerd in a family that demanded extreme self-reliance. After his first inpatient treatment experience (in 1989), “I fully expected to walk out 28 days later with no desire to use narcotics anymore,” he said. “But I threw away the Big Book in a garbage can on my way out the door.”

After relapsing (more than once), losing his license for a year, losing a business and going through two divorces, a strong sponsor and an equally strong therapist nudged him into a new state of mind and a deeper understanding of himself. They also nudged him into a new career — in the field of addiction treatment and recovery.

Humphrey now is director of the newspecialty treatment track program for nurses at Hazelden Betty Ford Foundation in Center City, Minn. Since it began in September, the program (which was announced early in May) has served more than 87 nurses from across the United States.

MinnPost asked Humphrey about what problems and challenges might contribute to addiction among nurses, and what’s missing in the way of help.

MinnPost: What motivated Hazelden Betty Ford to create a specialty treatment track for nurses?

Michael Humphrey: The evidence shows that the recovery rate of nurses is about half that of physicians [45 percent compared with 90 percent, respectively]. There are a lot of different variables. One that is most apparent is resources. Physicians are much more likely to be able to afford a longer duration in primary treatment.

Another [variable] is the working environment. … A doctor may prescribe a narcotic, the nurse actually has it in her hands. The physician has the knowledge of the pain relief associated with it, but as a nurse, you actually see the patient. You give them a pill, they haven’t been able to get out of bed, it takes two people to get them out of bed, suddenly you get them out of bed and up to the bathroom, and they’re standing there pain-free wanting their razor. So there’s this endorsement — it’s like living in an advertisement because you see the results of it.

Another big component is gender specific. Ninety-two percent of nurses are female. There’s a huge stigma surrounding women and substance-use disorder. Society will grant a lot of latitude for a man to overindulge and have some catastrophic events, but that same latitude is not granted to women.

We’re finding that the nurses who are coming into the program are sicker than the general population. … A female nurse will go to a prescribing physician and will complain of anxiety and depression, and be treated for it, but they’ll leave out the alcohol use. So that medication will just further their addiction.

MP: Addiction has been called an “occupational hazard” for nurses. Do you agree with that?

MH: There’s a fair amount of injury on the job — lifting patients and that sort of thing. And the work environment requires a lot of scrambling, a lot of thinking outside the box. It’s a very intense job. You may be taking care of five patients, and say you have one who goes into cardiac arrest. You may be tied up with that for 45 minutes. You’ve just set yourself back, and you still need to catch up with the other patients.

There’s a nursing shortage. There always will be a nursing shortage. So you’re understaffed. You are subjected to physicians coming and doing rounds on their patients, and you need to make them feel as if their patients are the only ones you’re really taking care of. And that’s just a part of the culture of nursing. The culture is changing: In the old days, nurses would stand up when the doctor came onto the unit, and there was a definite pecking order. That’s just the way it was, and it was pretty much universal. That still exists to a great degree.

It’s an occupational hazard in that there are very, very high expectations. And it’s nearly impossible to meet them.

MP: What’s your impression of the size of this issue?

MH: I think it’s underreported. I actually think that the rate of addiction among nurses [reported to be 1 in 10, as in the general population] is much, much higher. “Liver checks” and “liquid rounds” are some of the designations [for use]. Going out for a drink after work is widely accepted. It’s a great stress reliever. It’s accepted if you are inebriated and a little bit out of control. It’s part of the culture.

MP: Because of patients’ vulnerability, nurses struggling with addiction it seems are especially subject to judgment. How do you help nurses come to terms with crossing the line?

MH: That’s one of the major stumbling blocks. And it’s one of the reasons we have a separate nursing group, so people feel free to talk about their crossing of moral lines.You feel very much alone — that you’re the only one who’s ever done that. And I think it helps to be with a cohort and establish a commonality. “Yes, we have crossed moral lines. Now what do we do about it?” Well, let’s look at what substance-use disorder is. It is a disease, and you don’t need to ever go back to crossing those moral lines. And therefore you’re at a crossroads: It’s not that you can erase anything you’ve done. But you can restore the relationships and restore trust the best that you can, only with more realistic expectations of oneself, more boundary setting — these sorts of things.

Self-forgiveness is probably the most difficult thing — more so among women than men. Failure as a mother, failure as a caregiver [produces] mounds of shame. You’ll find people unable to forgive themselves. It takes a lot longer, due to stigma but also their own idea that “I have been a failure, and I’m no good.”

We make a big point of looking at guilt versus shame. Guilt is a good person who has done something wrong. Shame is, “I’m just a bad person.” So many people are in that shame mode and have a core belief that they are bad. You need to start to have forgiveness, to know that there’s hope of never having to cross those lines again, and that you can continue to move forward.

A nursing team is very special. You’re all team players and you really have to cover for each other. You’re very dependent on each other. So when people reenter that environment, they carry a lot of shame because it’s hard for them to get over the fact that they have done careless work, have let the team down, and the nurses who are receiving people back are oftentimes not very forgiving.

MP: What are some other barriers to recovery?

MH: Nursing chooses nurses before they choose nursing. Nurses come from dysfunctional families — some studies have found that as many as 70 percent come from some kind of abuse situation or other dysfunction. When somebody becomes a caretaker very young, their brain is still in development. They become a responsible adult at a time when they should be being nurtured. They start to develop these truths, but more than that they develop expectations and lifestyles that compel them to put the care of others above their own. It would be great to have some research, but most of this is anecdotal.

The establishment of a strong person comes very early … and therefore there’s a lot of self-reliance. Therefore you’re not going to go to anybody to talk about your problem. You’ve been taking care of yourself all these years, and all of a sudden there’s a failure of the ability to do that.

MP: Are there some nurses who leave treatment understanding that they must leave their professions?

MH: Most are able to reenter when recovery is achieved, but some may move to a different area. It’s interesting because you can look at specialties in nursing and see adifferent style of using: Hospice nurses are typically binge drinkers. Emergency room nurses have higher use of stimulants and marijuana. They [the latter] enjoy the drama and the trauma, and perhaps that may not be well-suited to recovery because it will drag them back into the adrenalin rush.

MP: What’s missing in the way of supports for nurses who are struggling?

MH: Minnesota is the land of 10,000 addiction centers, a hot bed for recovery. But it’s somewhat amazing that we haven’t been able to recognize and create cohort groups for nurses. Although there have been some grassroots support groups for nurses, they tend to die out. They’re not very well-established. What’s needed is a formalized peer assistance group for nurses. Addiction is treated fairly aggressively by the Board of Nursing. And that’s not a judgment thing, but I think that it does keep people away from treatment. Article Link…

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