Running head: PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 1
Perceptual changes of the addicted
health care practitioner i...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 2
Abstract
Addictions are not uncommon within Health Care Practitioners (HCP)...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 3
Perceptual changes of the addicted
health care practitioner in long-term re...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 4
recovering practitioners who are likely working with us, “side-by-side,” in...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 5
Human Services, 1999 & 2010). Even though we have looked at the conceptual ...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 6
altering medications within our daily work, and stressful working condition...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 7
foundational statement of Narcotics Anonymous (2008) is “this is a spiritua...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 8
The construct of spirituality has long been linked within the foundation of...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 9
1. What is your title and role as a Health Care Practitioner?
2. What were ...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 10
Appendix B shows an Illinois regional map of six areas (Illinois Departmen...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 11
the interview process, all experiences and biases of the researchers would...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 12
level.” This information would not necessarily be intended for public know...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 13
References
Adams E. F., Lee, A. J., Pritchard, C. W., & White, R. J. (2010...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 14
754, 1-7. Retrieved from www.nhpf.org
Illinois Department of Public Health...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 15
California.
National Council of State Boards of Nursing. (2010). 2009-2012...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 16
from http://www.nida.nih.gov/PDF/RRComorbidity.pdf
United States Departmen...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 17
APPENDIX A
The Interview Questions
1) What is your title and role as a Hea...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 18
APPENDIX A
The Interview Questions (continued)
4) How have you changed (yo...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 19
APPENDIX B
Regional Illinois Map (IDPH, 2011) demonstrating regions of sam...
PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 20
Region 5
Region 6
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Recovery from Addictions in Healthcare workers - by Ann Sparks (research synthesis project 2011)

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Research Proposal of Experiential responses for various levels of health care workers who are in active recovery from addictions to mood altering substances.

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Recovery from Addictions in Healthcare workers - by Ann Sparks (research synthesis project 2011)

  1. 1. Running head: PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 1 Perceptual changes of the addicted health care practitioner in long-term recovery Ann M. Sparks Mennonite College of Nursing at Illinois State University
  2. 2. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 2 Abstract Addictions are not uncommon within Health Care Practitioners (HCP) with full-blown dependency sometimes exceeding a 15-20% prevalence rate (Luck & Hedrick, 2004; Monroe, Pearson & Kenaga, 2008). Since addiction has been defined as a disease, governing agencies have changed discipline from being punitive in nature to a non-punitive approach. Within the National Council of State Boards of Nursing (NCSBN), current research initiatives include “effective discipline and alternatives to discipline” for nurses who suffer from addiction (2009-2012 Strategic initiatives and research priorities, 2010). Medical policies for addictive behaviors are also aligned with this philosophy (AMA, 2011; Merlo, 2009). Top goals of the NCSBN are seeking to protect patients and to improve recovery levels of the addicted practitioner (Substance use disorder guidelines forum, 2010). That being said, perpetuating stigma and lack of information regarding mental health concerns and addictions within practitioners remains problematic (Tognazzini, 2008). Therefore, this qualitative study will examine the experiential journey and attitudes of 18 practitioners (nurses, mid- level and physicians), from various regions of Illinois, who followed the non-punitive recommendations and remained employed in their original health care career at least five years beyond the initial confirmed addiction. This research proposal will include using a Phenomenological Analysis of transcripts of interviews (Burns, 2009; Schultz, 2009) emerging themes will be identified, and then compared to the theory of Modeling and Role Modeling. These themes can then also be discussed in relation to previously existing policy, recovery literature, and concepts of stigma, trust and social support. ~ Key Words: addiction, recovery capital, impaired, medical, nursing, practitioner, help-seeking, stigma, social support, spirituality, perception.
  3. 3. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 3 Perceptual changes of the addicted health care practitioner in long-term recovery It is well known through the literature that health care practitioners (HCP), no matter whether nurse, mid-level practitioner, or physician, are not immune to the disease of addiction. Wilson & Compton (2009) report that 15% of nurses have used an illicit drug or abused alcohol in the past year and 69% reported of lifetime history of (wrongful) use “on at least one occasion.” HCP have at least the same prevalence of addictions and related co-morbid conditions as the general pubic, with the rate of full-blown addictions possibly topping greater than 15-20% (Luck & Hedrick, 2004; Monroe, Pearson & Kenaga, 2008). Merlo & Gold (2009) report that addiction causes more physician impairment than any other disease. Chemical dependency crosses all socioeconomic lines and according to Narcotics Anonymous (2008), as the addict believes, “drugs had given us the feeling that we could handle whatever situation might develop,” with denial being a common denominator. Because of the nature of addiction and associated mental illnesses (of depression and suicide), the two concepts cannot be fully separated according to the U. S. Dept of Health and Human Services speaking of comorbidity (2010), and often times addiction left untreated will end up in death (Clark & Farnsworth, 2006; Hegner, 2000; Luck & Hedrick, 2004; Miller, 2000; Merlo, 2009; Narcotics Anonymous, 2008). The problem: unfortunately, even though addiction prevalence is known to be nearly one in five within our own profession, we as practitioners actually know very little about the disease, or recovery, and we often actually perpetuate stigma (Tognazzini, 2008), even towards our own colleagues. Basic questions that present themselves are, “What have addicted practitioners experienced?” and “What perceptions do recovering health care practitioner addicts have, that contribute to their success?” This qualitative study using a descriptive phenomenological approach is designed to increase practitioner awareness of the disease of addiction within healthcare practitioners, and to address the issue of stigma head-on by getting to know the perceptions of a few
  4. 4. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 4 recovering practitioners who are likely working with us, “side-by-side,” in the clinical environment. By pulling together the views of nurses, mid-level practitioners and physicians, social strata differences will be intentionally ignored in this study, since we all share likenesses common to humanity (Schultz, 2009). We will look at the views of addicted practitioners who have successfully moved through a non-punitive program of recovery. The focus will be on those who have achieved long-term recovery (abstinence) and their perceptions of stigma, social support, and spirituality in the past and present. The results will be compared to the Modeling and Role Modeling (MRM) theory, the paradigm of recovery espoused by previous researchers, and the themes can then also be discussed in relation to previously existing policy, literature, and concepts of stigma, trust and social support. Review of the Literature Chemical dependency is a very complex disease that is life-long and cannot be “cured” (Narcotics Anonymous, 2008), therefore a consistent program of recovery is required to maintain abstinence. Tackling the problem requires a multidisciplinary approach to this multifaceted problem. There is a fair amount of research available on practitioner addiction identification, non-punitive treatment modalities, spirituality and social supports. But little literature can be found looking at the perceptions of the addict working in the healthcare field who is working a successful program of long-term recovery and health care practitioner stigma towards addictions. Quinlan (2009) tracks the 25-year history of a peer assistance program for nurse anesthetists who struggle with addictions. The theoretical literature sources from which the concept analyses of stigma, social support and spirituality are quite varied, and also include the background of the problem of addiction and complicating co-morbidities within healthcare practitioners (Adams, Lee, Prichard & White, 2010; Cashwell, Clark & Graves, 2009; Corrigan, 2008; Galanter, 2006; Hegner, 2000; Link & Phelan, 2001; Merlo & Gold, 2009; Miller, Mcgowen & Quillen, 2000; Narcotics Anonymous, 2008; NCSBN, 2010; Tognazzini, Davis, Kean, Osborne & Wong, 2008; U.S. Department of Health and
  5. 5. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 5 Human Services, 1999 & 2010). Even though we have looked at the conceptual definitions, the participants of the study will carry out their own extensive definitions based on their experiences in successful long-term recovery. The theoretical framework of Modeling and Role Modeling (Shultz, 2009) takes a superior “holistic, patient-focused” approach that includes a spiritual component and a non-judgmental approach by the practitioner, “supporting the client‟s model of the world.” This philosophy will guide this study to the end, when the study results will be compared to the theory. Empirical literature supports examining spirituality (Carter, 1998; Shealy, 2010; Shockey, Uegel & Windsor, 2008) and demonstrates the need for spiritually based recovery, thus further examination will be obtained through this study. Comparison of non-punitive recovery programs demonstrate that there are various approaches that may be taken to provide direction for treatment early in recovery (Clark & Farnsworth, 2006; Monroe, Pearson & Kenaga, 2008; Monroe, 2009) and addictions science has not yet settled on one definitive approach. Recovery capital of social supports, spirituality and 12-step affiliation (Laudet & White, 2008) are discussed in detail, giving groundwork for future comparisons of study information. Consequences of stigma (Link, Struening, Rehave, Phelan & Nuttbrock, 1997) on recovery efforts give an historical context of stigma research. A descriptive analysis of prevalence of the disease of addiction in nursing students (Monroe, 2009), and anesthesia providers (Luck & Hedrick, 2004) providing more evidence that all practitioners need to be included in this study. Of the 32 listed references, 28 sources (87%) were published within the past 10 years. The remaining five references include two U.S. Surgeon General reports that are 11 and 12 years old respectively (no more-recent reports were available on the web sites), and three articles were 11, 13 and 14 years old, have been used as supportive literature for the background of the problem and some of the roots of spiritual underpinnings of the disease and recovery. Considering the prevalence of addiction, it is clear that the literature is pertinent and applies to every practice setting as we view ourselves, and our colleagues, and as we care for our patients. With the high accessibility of mood
  6. 6. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 6 altering medications within our daily work, and stressful working conditions, education for nurses and physicians, as well as further research, are indicated regarding mental illness/addictions, stigma and self-help behaviors related to these diseases and concepts. Modeling and Role Modeling as the Theoretical/Conceptual Framework Addictions recovery is a holistic growth process of recovery capital including social supports and spirituality (Laudet & White, 2008; Galanter, 2006; Narcotics Anonymous, 2008). These concepts blend beautifully with the integrative middle-range nursing theory of Modeling and Role Modeling (MRM) since it is client-centered, placing the client‟s perceptions at the center of the interaction throughout the healing process (Schultz, 2009). This holistic theory integrates multiple disciplines of psychosocial development of Erickson, cognitive development of Piaget, basic human needs of Maslow, and stress adaptation of Selye and Engle, encouraging the nurse to “nurture the client (and) facilitate, not effect, the adaptive process, and accept the „client unconditionally.‟” According to Tognazzini (2008; Adams, et al., 2010), health-care providers actually perpetuate the stigma associated with mental illness. By reviewing these issues from a qualitative perspective, we can easily see that we cannot sit in judgment of those who suffer from the disease of addiction, whether they are our patients or our colleagues (who may need to be patients too), making this topic highly applicable in all levels of health care. Concepts from the MRM theory have guided the development of this study; according to Schultz (2009), the MRM framework identifies that persons are unique, and yet clearly identifies that all persons are alike in that the systems of mind, body and spirit do not work independently of each other. They are integrated and work dynamically with the biophysical, psychosocial, cognitive and social aspects of the person to function as a whole. Social supports are critical in the human construct, just as “spiritual energy unifies the dimensions of the holistic person.” The works of Carter (1998), Cashwell, et al. (2009), Shealy (2010), and Shorkey, et al. (2008) are also in agreement, pointing towards the direct link of spiritual growth as a foundation for addictions recovery. The
  7. 7. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 7 foundational statement of Narcotics Anonymous (2008) is “this is a spiritual program” for a disease that affects the mind, body and spirit. With stigma and fears being a few of the primary reasons addicts avoid treatment in the first place (Adams, et al., 2010; Clark & Farnsworth, 2006; Corrigan & Wassel, 2008; Hegner, 2000; Link, et al., 1997; Merlo & Gold, 2009; Tognazzini, 2008), we will look at the conceptual definitions of stigma, social support (Quinlan, 2009) and spirituality. It is out of these concepts that the phenomenological study questions will be formulated for the participants. Conceptual definitions of this study Stigma According to Link and Phalen (2001) stigma “exists when elements of labeling, stereotyping, separation, status loss, and discrimination occur together in a power situation that allows them.” The two aspects of stigma are 1) looking at the one who is doing the discriminating, and 2) looking at the recipients of the discriminating behavior. The implications are far-reaching, even to the point of being a persistent dilemma. The research of Link, et al. (1997) discovered that even a full year after significant improvement of mental health and comorbid addiction symptoms, stigma was found to still have a profound affect on the well-being of the clients. Stigma must be eradicated from our perceptions (U. S. Department of Health and Human Services, 1999) and we practitioners need to evaluate our own beliefs, to become knowledgeable about how we affect health care culture, and to demonstrate a climate of social justice, respect, dignity and integrity (Tognazzini, 2008). Social Support The conceptual definition of social support has long been known as the perception of feeling loved, cared for, esteemed and valued by people in close association with the participant. By seeking out social support, the individual is resisting isolation, which is a symptom of the disease of addiction (Laudet & White, 2008; Narcotics Anonymous, 2008). Spirituality
  8. 8. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 8 The construct of spirituality has long been linked within the foundation of healthy recovery from addictions. Many of those in recovery have identified spiritual aspects of their lives as being central to recovery (Carter, 2001; Cashwell, et al., 2009; Galanter, 2005). Within a healthy spirituality, the participant believes that a Higher Power (Laudet & White, 2008; Narcotics Anonymous, 2008) plays a significant role in life, and that personal strength and support can be ascertained from that Power. Spiritual principles such as humility, love, serenity and gratitude are gained through that relationship, and that some consider maturity in that process to be “spiritual enlightenment,” another aspect of recovery capital. Study Design and Methods Design The background of this study is focused on the concepts of stigma, social support and spirituality, and the problem of practitioner lack of knowledge of the disease of addiction and associated stigma, particularly within the health care profession. By performing this qualitative phenomenological study the researcher “dwells with” the experience of the participant (Burns, 2009) and therefore the impact if stigma, social support and spirituality can be better understood. By studying successful practitioners in recovery five years after originally entering non-punitive programs of recovery, the full impact of recovery “ownership” and conceptual definitions will be recognized. The Research Questionnaire. In looking at the research questions of “What have addicted practitioners experienced” and “What perceptions do recovering health care practitioner addicts have, that contribute to their success?” we will use the following basic questionnaire. This study will focus on several open-ended questions that the participant will be encouraged to expound upon through an audio-visual taped interview. The introductory question, plus three questions about experiences in the recovery process will be asked of the health care practitioners:
  9. 9. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 9 1. What is your title and role as a Health Care Practitioner? 2. What were your challenges of addiction in the beginning? 3. What has your own program of recovery been like? 4. How have you changed (your perceptions) through the program of recovery? Appendix A shows extensions of these questions and prompts for the participant to add further discussion into areas of perceptions related to early recovery, current recovery program, and perceptual changes that have occurred over time. The researcher would take notes during the interview process and could repeat the questions being asked. The key would be to increase an environment of trust and respect between researcher and informant (Speziale, 2007). As the interview proceeded into the unstructured portions, the researchers might continue with questions such as “What was that experience like for you?” in regards to feeling stigmatized, being held accountable at different levels of recovery, and the like. Method By using the Parse methodology of a phenomenological study, data collection would be by personal interview using a videotape to multi-sensorily immerse the researcher into the data (Burns, 2009). The open-ended interview questions will serve to open up to unstructured conversation with the purpose of answering the research questions (Speziale, 2007), but allowing the conversation to flow in an open-ended fashion. Target population. The target population of interest will be the health care practitioners who are addicted (to any mood altering substance) in Illinois, successfully working a non-punitive program of recovery for at least five years (from the time of first diagnosis of addiction), and clean/sober time of greater than three years. Study Sample.
  10. 10. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 10 Appendix B shows an Illinois regional map of six areas (Illinois Department of Public Health, 2011) from which one nurse, one mid-level practitioner, and one physician would participate in the study for a total of 18 participants. The best sampling method for this study would be snowballing (Speziale, 2007; Groenewald, 2004). That is, “using one informant to find another” to locate difficult to find participants. If it became evident that saturation of data was not being met during the research process, a second participant from each of these categories would be secured through which further study information would be sought. Speziale reports that to assure thorough data extraction, samples from a variety of backgrounds, ages, and cultural environments need to be obtained. The criteria for this study includes that the participant be involved in a non-punitive program of recovery for at least 5 years, and that there has been no relapse within the past 3 years. The participant must also state that he/she is an addict or alcoholic and the participant must have remained employed in original licensed role during recovery. All questions and sub-questions of the questionnaire must be answered with reasonable completeness to provide meaningful data for the study. Instruments and trustworthiness. As previously noted, the researchers interviewing the practitioners could repeat the questions to the respondents. Also, further unstructured open-ended questions would be encouraged, such as asking what certain experiences were like in regards to stigma, spirituality, social support and accountability. To assure trustworthiness, a researcher would be involved in the study that has extensive qualitative research experience to assure accuracy and so as to reduce the chance for error in transcribing and categorizing the data into themes. In addition to this, a return interview would be scheduled to ask if the exhaustive description given by the participant (now transcribed in writing and categorized into themes) clearly reflects the participant‟s experiences. An audit trail would be left for further examination to be available for future reference for confirmability. Before beginning
  11. 11. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 11 the interview process, all experiences and biases of the researchers would be documented and reviewed (Speziale, 2007; Burns, 2009), and any significantly biased attitudes perceived regarding addiction or addiction recovery would disqualify the researcher from the study. Unconditional acceptance of the informants and the discussions would be essential for trust to be maintained, as in accordance with the MRM nursing theory. Explicitation of the data. A research mentor (Speziale, 2007) would be engaged in the process of data division into themes and analysis and interpretation of the data obtained. “The explicitation process has five „steps‟ or phases, which are: 1) Bracketing and phenomenological reduction. 2) Delineating units of meaning. 3) Clustering of units of meaning to form themes. 4) Summarising each interview, validating it and where necessary modifying it, and 5) Extracting general and unique themes from all the interviews and making a composite summary (Groenewald, 2004).” Initial themes of recovery capital would be easily identified, such as social supports, spirituality, and perceptions of stigma and discrimination. But as the interviews opened up into an unstructured format, the further need for specialists in the social and addictions sciences may be necessary to interpret the data appropriately. Findings from the study would have multiple applications including comparison with previously existing policy, recovery literature, and concepts of stigma, trust and social support. Protection of participants For appropriate ethical clearance, Illinois State University‟s IRB would be consulted with full study details, and full written consent of the participants, assuring strictest confidentiality, would be obtained. Dissemination of the Project This proposed research is applicable to all levels and specialties of health care practice. All practitioners would benefit from the knowledge of such a study to open up discussion, self- examination, as well as to encourage reporting on a “caring level, rather than punitive, judgmental
  12. 12. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 12 level.” This information would not necessarily be intended for public knowledge as it may negatively affect public opinion of health care practitioners. Consulting a marketing strategist may be beneficial, and it might be best to create a glossy color flyer that has the heading labeled, “A deeper level of caring – collegial support through difficult times.” This title would tap into the practitioner‟s sense of caring and may trigger a memory of a situation where a colleague might have been able to benefit from early intervention as a result of being “impaired.” The flyer would be sent by mail to all Illinois medical and nursing practitioners (including RNs and LPNs). It would even be beneficial to offer regional conferences on such a topic of “Caring: stigma, addictions and collegial responsibility” with the offer of CEUs for all professionals attending. Illinois could well serve as a pilot study for National application of the information in the future. Summary and Conclusion Addiction is clearly disease that touches our lives profoundly, both within our patients and within our professions. As many as one in five practitioners suffer from mood altering chemical misuse and/or addiction (Luck & Hedrick, 2004; Monroe, Pearson & Kenaga, 2008). Our caring professions of nursing and medicine are over-ridden with high stress, long hours, access to drugs, expectations (real or perceived) of perfectionism, and stigma that keeps us from seeking the help we need. Shall we allow these stigmas and fears to keep us from discussing the topic on a truly caring level of compassion and respect? The research will help us “get to know” addicted colleagues, so that we may become more understanding and empathetic. This disease is like any other disease that we‟d seek help for, or encourage others to do so. Let us become educated and not contribute to the perpetuation of stigma and disease. Through the theory of Modeling and Role Modeling, we can practice integrity and pave the way towards stamping out prejudice and stigma. Let us meet patients where they are at, encourage hope, and practice caring as we encourage effective treatment towards addiction recovery. The next colleague needing help might just be your best friend or your self.
  13. 13. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 13 References Adams E. F., Lee, A. J., Pritchard, C. W., & White, R. J. (2010). What stops us from healing the healers: a survey of help-seeking behaviour, stigmatisation and depression within the medical profession. International Journal of Social Psychiatry, 56(4), 359-370. American Medical Association. (2011). Policies related to physician health. Retrieved from http://www.ama-assn.org/resources/doc/physician-health/policies-physicain-health.pdf American Psychological Association (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC. Burns, N., & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence. (6th ed.). Saunders–Elsevier, St. Louis, MO. Carter, T. M. (1998). The effects of spiritual practices on recovery from substance abuse. Journal of Psychiatric and Mental Health Nursing, 5, 409-413. Cashwell, C. S., Clark, P. B. & Graves, E. G. (2009). Step by step: avoiding bypass in 12-step work. Journal of addictions and Offender Counseling, 30, 37-48. Clark, C., & Farnsworth, J. (2006). Program for recovering nurses: An evaluation. Medical Surgical Nursing, 15(4), 223-230. Corrigan, P. W., & Wassel, A. (2008). Understanding and influencing the stigma of mental illness. Journal of Psychosocial Nursing, 46(1), 42-48. Galanter, M. (2006). Spirituality and addiction: a research and clinical perspective. The American Journal on Addictions, 15, 286-292. Groenewald, T. (2004). A phenomenological research design illustrated. International Journal of Qualitative Methods, 3(1). Article 4. Retrieved from http://www.ualberta.ca/~iiqm/backissues/3_1/pdf/groenewald.pdf Hegner, R. E. (2000). Surgeon General: Dispelling the myths and stigma of mental illness: The surgeon general‟s report on mental health. National Health Policy Forum, Issue Brief No.
  14. 14. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 14 754, 1-7. Retrieved from www.nhpf.org Illinois Department of Public Health. (2011). Healthy schools – Healthy living. Retrieved from http://www.bing.com/images/search?q=illinois+regional+map&view=detail&id=2C273ABF 6236F6011499D5770216E79FBCAC9158&first=61&FORM=IDFRIR Laudet, A. B., & White, W. L. (2008). Recovery capital as prospective predictor of sustained recovery, life satisfaction, and stress among former poly-substance users. Substance Use and Misuse, 43, 27-54. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology 27(1), 363-385. Link, B. G., Struening, E. L., Rahave, M., Phelan, J. C., & Nuttbrock, L. (1997). On stigma and its consequences: evidence from a longitudinal study of men with dual diagnosis and mental illness and substance abuse. Journal of Health and Social Behavior, 38, 177-190. Luck, S., & Hedrick, J. (2004). The alarming trend of substance abuse in anesthesia providers. Journal of PeriAnesthesia Nursing, 9(5), 308-311. Merlo, L. J., & Gold, M. S. (2009). Successful treatment of physicians with addictions. Psychiatric Times, 6(9), 1-9. Miller, M. N., Mcgowen, R., Quillen, J. H. (2000). The painful truth: Physicians are not invincible. Medscape Nurses News, Retrieved from http://www.medscape.com/viewarticle/4100643 Monroe, T., Pearson, F., & Kenaga, H. (2008). Procedures for handling cases of substance abuse among nurses: A comparison of disciplinary and alternative programs. Journal of Addictions Nursing, 19, 156-161. Monroe, T. (2009). Addressing substance abuse among nursing students: Development of a prototype alternative-to-dismissal policy. Journal of Nursing Education, 48(5), 272-278. World Service Office of Narcotics Anonymous. (2008). Narcotics Anonymous (6th ed.) Van Nuys,
  15. 15. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 15 California. National Council of State Boards of Nursing. (2010). 2009-2012 Strategic Initiatives and Research Priorities. Retrieved from https://www.ncsbn.org/169.htm National Council of State Boards of Nursing. (2010). Substance use disorder guidelines forum: Effective discipline and alternatives to discipline. Retrieved from https://www.ncsbn.org/2106.htm Quinlan, D. (2009). Imagining in time: Peer assistance reaches its 25th year. American Association of Nurse Anesthetists Journal, 77(4), 254-258. Rose, G. L., & Brown, R. E. (2010). The impaired anesthesiologist: not just about drugs and alcohol anymore. Journal of Clinical Anesthesia, 22, 379-384. Schultz, E. D. (2009). Modeling and Role-modeling. In S. J. Peterson & T. S. Bredow (Eds.), Middle range theories: Application to nursing research (2nd ed.) pp 233-253. Philadelphia: Lippincott Williams & Wilkins. Shealy, S. E. (2010). Toward an integrally informed approach to alcohol and drug treatment: bridging the science-spirit gap. Journal of Integral Theory and Practice, (4)3, 109-126. Shorkey, C., Uegel, M., & Windsor, L. C. (2008). Measuring dimensions of spirituality in chemical dependence treatment and recovery: research and practice. International Journal of Mental Health and Addiction, 6, 286-305. Speziale, H. J. S., & Carpenter, D. R. (2007). Qualitative research in nursing: Advancing the humanistic imperative. (4th ed.). Philadelphia: Lippincott Williams & Wilkins. Tognazzini, P., Davis, C., Kean, A. M., Osborne, M., & Wong, K. K. (2008). Reducing the stigma of mental illness. Canadian Nurse, 104(8), 30-3. United States Department of Health and Human Services. National Institute of Health, National Institute on Drug Abuse. Comorbity: Addiction and other mental illnesses. (NIH Publication Number 10-5771). Printed December 2008, Revised September 2010. Retrieved
  16. 16. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 16 from http://www.nida.nih.gov/PDF/RRComorbidity.pdf United States Department of Health and Human Services. Mental Health: A Report of the Surgeon General—Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html Wilson, H., & Compton, M. (2009). Reentry of the addicted Certified Nurse Anesthetist: A review of the literature. Journal of Addictions Nursing, 20, 177-184.
  17. 17. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 17 APPENDIX A The Interview Questions 1) What is your title and role as a Health Care Practitioner? 2) What were your own challenges of the addiction in the beginning? Stigmas – guilt & shame? Fears of License suspension/revocation? What others think? Issues of denial Problems with isolation Who could comprehend what I was going through? Was I lonely, even when not alone? Couldn‟t share weaknesses or feelings of inadequacy with others? A sense of “spiritual bankruptcy” Did I have self-centeredness and lack of spiritual principles? 3) What has your program of recovery been like? The process of recovery How I got into Treatment & aftercare – What choice was I given? 12-Steps? Alternative program of recovery? Special Caduceus group? NA/AA/other support groups? What I do now for my recovery? Feelings of stigma now, and what I‟d like my peers to know.
  18. 18. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 18 APPENDIX A The Interview Questions (continued) 4) How have you changed (your perceptions) through your program of recovery? Have I learned to view things differently? Stigmas & Fears – have my perceptions changed? Social support versus isolation  How have my support systems changed? Trust, transparency and accountability with (talk in detail about each below) With Self With Peers in the program With Sponsor (N/A?) With Accountability partner(s) (N/A?) With Family With Employer With licensing agencies.  Did you utilize a12-step Program? Talk in detail about your recovery – program, fellowship(s) and/or support group(s). Spiritual principles & my concept of a Higher Power Are you still being monitored through random drops? How do I feel about that? Do I need an external motivating source to keep me accountable? Talk about your level of “ownership” of your recovery program.
  19. 19. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 19 APPENDIX B Regional Illinois Map (IDPH, 2011) demonstrating regions of sampling for study RN/LPN Mid-Level Physician Region 1 Region 2 Region 3 Region 4
  20. 20. PERCEPTUAL CHANGES OF THE ADDICT IN RECOVERY 20 Region 5 Region 6

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