Chapter 95. Substance Dependence and Abuse in Anesthesia Care Providers

1. The incidence of opioid abuse among anesthesia providers is 1%.

2. Addiction is a treatable chronic, relapsing disease with a genetic predisposition.

3. Seventy-five percent of addicts declare themselves by age 27 years.

4. Drugs change the brain. The brain changes associated with addiction are independent of drug of abuse.

5. Addiction among anesthesia providers is most commonly detected through observed behavioral changes.

6. Interventions should be based on concern over wellness. Substance abuse is only one of several potential diagnoses that threaten wellness.

7. Intervention at an early stage of addiction is associated with greater treatment success than intervention at later stages.

8. Evidence-based treatment of addiction reduces relapse rates.

9. Most addicts have psychiatric comorbidities that must be treated concurrently to prevent relapse.

10. Reentry requires a contract between the abstinent colleague and his employer.

"[T]here is always soma, delicious soma, half a gramme for a half-holiday, a gramme for a weekend … A gramme is better than a damn … I wish I had my soma."

—Aldous Huxley, Brave New World, 1932

The United States manifests a significant ambivalence toward drugs. While the federal government wages war against the illicit drug industry and organized medicine campaigns against the nonmedical use of prescription drugs, the entertainment and advertising industries, in the spirit of Lieutenant Milo Minderbinder in Joseph Heller's Catch-22, bombard its citizens daily with prodrug references. Lyrics from Toby Keith's popular country music song "Get Drunk and Be Somebody" reflect a common mantra:

All week long, we're real nobodies,

But we just punched out: it's paycheck Friday.

Weekend's here, good God Almighty:

People, let's get drunk an' be somebody

Comedians receive knowing laughs and applause from their audiences when they reference or parody recreational drug use. Television, Internet, and movie advertisements suggest that life is more enjoyable in social settings involving alcohol and more manageable with medications ("Ask your doctor if this medication is right for you."). Helping people to "pass" drug tests is also a big business. For example, if "urine luck" is entered into an Internet search engine, almost 2 million citations are offered. Physicians and major pharmaceutical companies tout the benefit of medications to relieve pain. Anesthesia providers make their living daily demonstrating that drugs of high abuse potential can be safely administered. Even a brochure for the Wood Library Museum of Anesthesiology proclaims, "Thank Goodness They Inhaled." Drug and alcohol misuse is commonly associated with youthful experimentation. However, misuse also is triggered by internal and external pressures to improve self-confidence and performance on the athletic field, in the classroom, on competitive examinations, in the workplace, and in the bedroom to achieve a better body image, to feel more comfortable socially, to cope with the stresses of highly competitive work and study environments, and to escape from dysfunctional social relationships and unsatisfactory living situations. College students call this "pharming."...