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hospital either because someone is using them or because someone is selling them,” Shafford says. “And that happens. Absolutely. “We have ready access, easy access to medications that are potentially addict- ing,” she adds. “We work in very stress- ful environments. And many, many people are involved in administering these medications to patients, so there are many opportunities for these medica- tions to get diverted.” Lest those with impeccable inventory


systems think this is not their problem, the second step in the education process involves expanding the scope of what substance abuse entails. “We now know that there is a potential


“Substance abuse is associated with 50 to 70 health conditions that are treated by the health care industry.”


—Elizabeth Pace, MSM, RN, CEAP


for many anesthetic drugs to be abused: Propofol, Diazepam, all of the opioids we use on a daily basis in veterinary medicine are potential drugs of abuse,” Shafford says. “Tramadol is a sought- after drug of abuse as well, and it is not a controlled drug. But I think this issue involves more than medications. I think it also includes alcoholism. We should not ignore that, even though alcohol is a legal drug.” Lastly, practice owners and practice


managers should realize that, even if sub- stance abusers never divert medication and never work impaired, the physical side effects of addiction may still have a huge impact on their hospital’s bottom line. “Substance abuse is associated with


50 to 70 health conditions that are treated by the health care industry,” says Eliza- beth Pace, MSM, RN, CEAP, CEO of Peer Assistance Services, Inc. “Certainly we know of liver disease, pancreatitis, but there’s also gastritis and different kinds of cancers. And alcohol affects metabolism, calcium and Vitamin D, so certain condi- tions, like osteoporosis, are exacerbated among women and aging populations.” How do you, as a practice owner or


practice manager, address the issue of substance abuse with your team? Begin by creating a safe space to talk


about a condition that is still shrouded by stigma.


Trends magazine, April 2013


Addiction: Moral failing or medical condition? “Substance abuse is probably the


number one or number two preventable health care problem in the United States, but substance-abuse disorders are still considered moral issues. ‘Pull yourself up by your bootstraps’ and that kind of thing,” Pace says. “All professionals—it doesn’t matter who they are—tend to think, erroneously of course, that they know better, that they can manage bet- ter on their own. There’s a sense that we understand drugs and we can take care of our own problem. Talk about pharma- cologic optimism. Substance-abuse dis- order is a chronic, progressive and life- threatening illness. It’s a brain disease. It’s altered neurochemistry.” Articles such as “Microdialysis and


the Neurochemistry of Addiction,” pub- lished in Pharmacology Biochemistry and Behavior (Vol. 90, Issue 2) support Pace’s view. In that peer-reviewed document, authors Mary Torregrossa and Peter Kali- vas describe addiction as a process that begins with initial exposure to a drug and outline the neurochemical changes that occur with repeat use. “These changes in the brain are often


referred to as drug-induced neuroplas- ticity… [and] several neurotransmitter systems, including glutamate, GABA, the monoamines and others, are altered after chronic drug exposure,” Torregrossa and Kalivas write. Still, it may not be easy to shed the


belief that substance abuse and addiction are moral failings. “Stigma around addiction is alive and


well. It’s so discouraging to me. We have so much science around addiction, but there hasn’t been a parallel path with atti- tudes,” Pace says. “Ninety-nine percent of us know someone with a substance abuse problem. Maybe that person isn’t an addict, but he or she abuses alcohol or abuses prescription medication. Maybe that person is a binge drinker who comes to work hung over. “Most of the time, that individual is an excellent professional. Addiction is


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