Relapse_prevention_+_monitoring by pengxiang


  You are here –
Brian Fingerson, RPh
   President of Kentucky Professionals
    Recovery Network
   Administer addictions recovery
    programs for pharmacy, dentistry,
    veterinary medicine, respiratory care,
    and physical therapy
   >30 years pharmacy practice with
    > 22 years working with HCP with
Clinical Definition (IMHO)
Relapse Prevention and
   You’ve been to treatment (or not)
    and then what? How do we help
    them continue the process……
Yes…you are unique – just like
those fishes
   Recovery commonly refers to a
    process of initiating abstinence
    from illicit drug and/or alcohol use,
    along with necessary life changes
    to help maintain sobriety over time.
   It’s a life long progression – and
    there may be obstacles and
    setbacks along the journey.
   Sometimes called a “slip”
     “Sobriety Losing Its Priority”

     “Something Lousy I Planned”

     Could be defined as an initial
      episode of drug or alcohol use
      after a period of abstinence.
     viewed as a breakdown
 It’s
 in the recovery process i.e. a
 major digression in the
 individual’s attempt to
 escape the bonds of
So what’s the purpose of HCP
monitoring programs?

 To ease the transition
  between treatment and
  return to “life” or the “real
 To help maintain
JAMA. 2005;293:1453-1460

   Domino et al did a study on “Risk
    Factors for Relapse In Health Care
    Professionals With Substance Use
   And what they found was -
The risk of relapse with substance use
was increased in HCP who:

   Used a major opioid
   Or had a coexisting psychiatric
   Or a family history of substance use
   And……

   The presence of more than one (1)
    of these risk factors and previous
    relapse further increased the
    likelihood of relapse.
   And these observations should be
    considered in monitoring the
    recovery of HCP.
Re-Entry into the “real
world”, i.e. the addict returns
  Home and Work and Balance
    What Do We Mean-the Addict
   Where has she
    been? Gone how
   Did she go to a
    formal treatment
    program? Out of
   Has she been “not
    practicing” – and if
    so – for how long?
Let’s Talk About Home First:
   Was the spouse or significant other
    involved in the decision to seek
   Did this person get involved during
    the family part of any formal
    treatment? Are there parents or
    children or siblings involved?
   Did these persons take advantage
    of 12-Step programs e.g. Al-Anon
    or Nar-Anon?
Is There Resentment Because Of:
   Lack of income
   No help with
   No help with
    upkeep of a
   Need for
    explaining where
    is she/he
Re-entry into life - What to Avoid

   Former play places
    “play pens”
   Former playmates
   Former play things
   “Triggers” for using in
    the home
We have to do what?
12-Step Meetings and ……

   In virtually every case they will be
    required to attend 12-Step recovery
    meetings with varying frequency.
    “It works the best for the most.”
   They may be encouraged to use
    Caduceus meetings in addition.
   We may well suggest joining IDAA
Return to Practice

   Protection of
    public is the
    #1 priority for
    us and for
Urged to attend conferences that deal
with addiction recovery

   Health care professional
    conferences e.g. CAPTASA
   SE PRN
   ADA Well-being Conference
   University of Utah School on….
   IDAA
        Fear and Anxiety

   What do I do about anonymity with:
     Co-workers
     Patients/Clients/

    Plenty of questions
Agreement with recovery program
within the profession:

   For a specific length of time
   Shared with employer or partner(s)
   May limit number of hours worked
   Approved practice site
   Not PIC or have POA or DEA i.e. responsibilities or
    privileges that may be a danger
   They may be asked to appear before the committee
    of their profession which deals with impairments
   Other things we’ll talk about shortly
Medication List: Are they OK to use?

   Yes
   No
   Maybe – more later
   What precautions e.g.
    MAR, witnesses
   “Safe medication
   Non-drug alternatives
Monthly Self Report:
   Sobriety date!
   Change in work status
   Sponsor contact frequency
   Up-to-date meeting attendance logs
   What step are you working on
   What service work are you doing
   Are you praying daily
   When was your last PRN contact
Monthly Self Report cont.
   Spouse/significant other concerns
   Counseling
   Warning signs of relapse in your
    life* (more in a moment)
   Cravings
   Defects of character dealt with
   Attitude toward recovery
   Eating/Exercise/Fun
Preventing a Lapse (slip) from
Becoming a Relapse

   Stop consuming the illicit
    substance(s) as soon as possible.
   Stopping sooner means far less
    physical and mental anguish due to
    renewed substance dependence and
   Use the slip as a learning
More prevention:

   Examine the sequence of events
    leading up to the slip; what could
    have been done differently to avoid
   Do not make excuses but, at the
    same time, do not beat yourself up.
   Get immediately back into the
    program of recovery
More prevention:

   Take pride in renewed efforts to
    stay “clean”; rather than punishing
    yourself for past events leading up
    to the slip.

   (adapted from: Volpicelli and Szalavitz 2000)
She may have:

   Modifications of practice type
   Practice monitoring by peers/others
   Protocols for required mood-altering
    drugs for a legitimate medical
    problem – more on this in a bit
   Consequences should she return to
    substance use
Use of pain medications in the
recovering person (Rick K in Ohio)

   RP must have a doctor that is
    diagnosing the condition! i.e. no
   RP must be honest with the
    practitioner about his/her addiction.
   RP must be IN RECOVERY!
More guidelines:

   Oxycodone or hydrocodone are
    used but consider alternatives.
   RP should not be in possession of
    the medications. Also use an MAR
   Pray before, during and after the
And more yet:

   Monitor the pain level closely –
    chronic pain can and will lead to
    relapse. Work around it!
   Destroy unused or un-needed
    medicines immediately – don’t leave
    them around the house.
And last from RK

   “The only defense I had was a
    spiritual defense. The spiritual
    defense came because my head and
    body were in meetings.
16 Points: Assessing Progress in
Recovery i.e. Monitoring!!!!!

   G. Douglas
    Talbott, MD,
    - Talbott Recovery
    Campus, Atlanta,
16 Points

   1. Meetings – yes – 12-Step
   2. Sponsor – and use of said
   3. Monitoring – formal and informal
   4. Emotional traps e.g. anger,
    guilt, depression, anxiety, insomnia,
16 Points

   5. Additions/Subtractions to
    addiction history (secrets)
   6. Compulsive behaviors (sex,
    food, nicotine, gambling, theft,
   7. Current
    therapy/treatment/medications both
    Rx and OTC
   8. Relationships (family, spouse,
    parents, children, friends)
16 Points

   9. Physical Health – an exercise
   10. Leisure time – fun – (safe, non-
    adrenaline rush, risk taking) Stress
    = > chance of relapse
   11. Work (professional status,
    duties, attitudes)
   12. Financial status
16 Points

   13. Legal – licensure status
   14. Additional training and/or
    continuing professional education
   15. Spiritual program – more on
    this later
   16. “Soft” part of the recovery
    program – e.g. fellowship and
Alcoholics Anonymous, Page 85

   “We are not cured of alcoholism.
    What we really have is a daily
    reprieve contingent on the
    maintenance of our spiritual
“Twelve and Twelve” page 174

   “We of AA obey spiritual principles,
    at first because we must, then
    because we ought to, and ultimately
    because we love the kind of life
    such obedience brings. Great
    suffering and great love are AA’s
    disciplinarians; we need no others.”
And then AA’s Step 12:

   “Having had a spiritual
    awakening as the result of these
    steps, we tried to carry this
    message to alcoholics, and to
    practice these principles in all our
   Emphasis added by BF
Fr Bernie’s Eagle Wings Vol. 11 #7
   Page 28 of Big Book (Alcoholics
    Anonymous): “If what we have learned
    and felt and seen means anything at all, it
    means that all of us, whatever our race,
    creed or color are the children of a living
    Creator with whom we may form a
    relationship upon simple and
    understandable terms as soon as we are
    willing and honest enough to try.”
Fr Bernie then writes:

   “The key word in this statement
    is relationship. Spirituality is a
    relationship not a belief system.
    My religion is my belief system.
    My spirituality is my relationship
    with my Higher Power.”
My experience says:

 12-Step recovery does
 the best for the most. I
 can speak from
 experience, ODAAT.
  “The alcoholic is like a tornado, roaring
  his way through the lives of others.”

“Hearts are broken” from the Big Book
page 82

            Recovery by Mike Vye
We Would Like Return to This:
And not this:
   For further information:
   Brian Fingerson, RPh
   Brian Fingerson, Inc. dba KYPRN
   202 Bellemeade Road
   Louisville, KY 40222-4502
   502-749-8385

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