8/1/2017. Excess self criticism My best is finite Taught to excel as individuals, not to function collaboratively

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1 Educate you about the disease of Addiction and Mental Illness Dispel prejudice and misinformation, remove stigmas Provide resources Provide prevention strategies which contribute to overall wellness in the profession Convince you that you are likely to encounter these issues in your practice lifetime My goal is NOT to tell you not to drink. Addict diet pills ~10-11 years of age, street drugs and alcohol ~age 13 (first blackout) Eating disorder initially compulsive over-eating in childhood progressed to bulimia in adolescence and adulthood PTSD, depression with suicidal ideation, OCD Relentless overachiever, especially in academics (graduated top 10 in DVM class, internship) Hit bottom in 1986 in Auburn, Hospitalized at Talbot in March 1987 Participation in abusive relationships OCD in childhood, trichobezor Physical, emotional, and sexual abuse Joe Gloyd in JAVMA (circa 1987) "The veterinary student profile includes characteristics such as intelligence, self-starter, highly motivated, capable, set lofty goals, tend to self criticize, disappointment in the face of achievement and lost self esteem." These characteristics are common to addicts, ACOA s and those of us prone to depression and suicide. I would challenge you. These are characteristics of many of our staff as well. Continuous chemical sobriety since March 8, Twelve step based. Eating disorder recovery of same duration. Twelve step based. Continuous employment as a veterinarian since sobriety. Clinic owner since Married since Participation on state wellness committee since Help others, lecture. Board certified since 2000 (still on overachiever) Happy, meaningful, productive life Excess self criticism My best is finite Taught to excel as individuals, not to function collaboratively 1

2 Highly driven, deeply caring people Unique financial and ethical tensions High levels of stress, low level of well trained paraprofessional support Little stress management or wellness training in veterinary curriculum (this is changing). Self sufficiency is prized, self reliance is killing us A continued use of a substance or behavior in the face of consequences. Biological Basis (Amygdala, dopamine, seratonin), reward center Environmental, social components. Recognized by the AMA (1955 Alcoholism) & DSM4 (including diagnostic criteria, prognostic information. Is NOT a moral issue, NOT a weakness Denial is a component Tolerance develops Relapse is a potential Little emphasis on community or support in the profession Competition rather than colleagueship or collaboration Entitlement (44% of pharmacists self prescribe. How many DVM's?) Easy access to drugs with lower accountability than in other professions 70% of businesses in U.S. drug test, only 30% in veterinary medicine Thought you should cut down Annoyed when other people comment or criticize substance use Remorse and guilt over substance use AM use to treat hangover or steady nerves 9% serious distress 31% depressed 19% currently in therapy 32% thought people would be sympathetic to psychological issues DSMIV and WHO (ICD-10) Tolerance Withdrawal Limited control Negative consequences Neglect/postpone activities Excessive time spent using, planning, procuring, concealing Desire to cut down unsuccessful attempts to control or decrease in an enduring fashion 2

3 Initially overachievers "Top of the heap for DVMs Erratic performance, mood swings Emotional volatility or extreme lassitude Martyr or victim Deterioration in appearance Dishonesty, elaborate excuses Isolation, withdrawal Financial distress, stealing, borrowing Fascination with drug box, pharmacy, etc. Substance taken inappropriate times and amounts The job is the last to go; Family, physical and emotional health will be impacted first. DVMs 4x greater than normal population DVMs suicidal ideation females 19%, males 14%. General population 7.1% females, 5.1%males. 10 th leading cause of death. More suicides than homicide + war together 25 attempts for each success in the general population Men guns, women overdose UK 38.7% DVM students have suicidal ideation, 75% don t want anyone to know 6% (1/17) people have serious mental illness in the US DSM criteria, illness is not a choice or a moral issue Less than 1/3 of adults and ½ of mentally ill children get mental health help Multiple Forms Need help from trained mental health care provider (therapy, medication, other) Must rule out physical illness to diagnose (e.g. hypothyroid) Genetic, chemical (neurotransmitter), hormonal, situational/traumatic components ACE study (ACEStoohigh.com) 9% of DVM s report current serious psychological distress. US population 7.9 % Depression: DVM s 36.7% of females, 24.5% males. General population 22% in females, 15% in males. Mental illness Significant loss Substance abuse History of trauma or abuse (ACE questionnaire) Physical illness Impulsivity Feeling hopeless Family history, exposure to suicide Access to means Lack of health care Personality change Inability to cope Strange or grandiose activity/ideas Excessive anxiety Mood swings Prolonged sadness, apathy Changes in sleeping or eating Substance abuse Talking about self harm or suicide Risk seeking behavior I S P A T H Ideation Substance Abuse Purposelessness Anxiety Trapped Hopeless W Withdrawal A Anger R Recklessness M Mood change 3

4 Culture of self reliance Personality profile of those entering profession Stigma for seeking help Lack of awareness Lack of information on how to help Managerial burdens (little training, hard to find help) Long hours, heavy work load Financial Stress Poor work life balance Difficult client relationships Availability and knowledge of means of ending life Burn out rate Inadequate professional support Addiction General population 10% addiction Mental Illness 1/6 in general population What is the rate in people who go into animal health care? Suicide DVM 4x rate of general population What is the rate in our staff? Each suicide touches at least 6 other people or more Rate of suicide USA: /100,000 deaths We are regularly faced with is it worth it to pay the cost necessary to continue living? Randall Nett, MD Staff Managers Suicidal Ideations, discussion of suicide 85% 57% Depression or anxiety, prolonged period 96% 91% Diagnosed mental illness 88% 83% Use of alcohol or drugs 79% 70% Diagnosed of chemical dependency 68% 65% Compulsive food behavior 56% 45% Diagnosed eating disorder 12% 26% Exposure to domestic violence 56% 57% Exposure to violence outside the home 56% 57% Exposure to incarceration (jail or prison) 59% 39% Results were comparable in practice managers All questions were phrased, you or anyone in your life N=32 1 in 4 mentally ill are addicted Substance Abuse in 50% of suicide calls Share underlying causes (ACE, genetics) Addicts have 2x rate of mental illness 40-60% heritability Mental illness 17% Substance abuse 27% Battered parent 13% Criminal behavior 6% Psych abuse 11% Physical abuse 28% Sexual abuse 21% (ACEStohigh.com) 4

5 87% of 17K respondents had at least 1 ACE. 15.2% women and 9.2% men had ACE x risk for ischemic heart disease 4.1x risk for stroke 8.7x risk for COPD 1.6x risk for fracture 5.8x risk for Diabetes Addicts, people contemplating suicide, and sometimes those with mental illness are typically incapable of recognizing the reality of their situation. Action by a concerned party is often required to save a life. Please consider helping. 1220% risk suicide 460% risk depression 240% risk Hepatitis Lives Families Careers Please do not do Nothing! 5

6 Planned Focuses on facts and events Loving and non-judgemental but clear and firm Caring confrontation detailing losses and consequences of substance abuse Ends with choice of consequences verses help (AA, NA meeting, treatment) Must involve appropriate professional Help to guard against risk of self-destructive behavior on the part of the addict. Best to involve someone in active recovery Have a care plan for each person involved in the intervention. Even if the individual seeks help, the event is grueling and painful. If the individual does not seek help and you are required to follow through with consequences, it s even worse. Make a plan. Talk to mental health professional Gather facts dates, times, specific incidents, specific consequences of addicts behavior Research recovery options Form Intervention team rehearsed message and structured plan Decide on consequences if person does not seek recovery. What are you truly willing to follow through with? Make notes on what to say. Use I language. Express love, concern and belief the person is capable of getting well. Hold the intervention Is not a salvage operation Is not about bad people getting good Is the beginning of a life worth living Is about ill people getting well Results in the return to function of people who have something to give back to society and our profession Caring, concerned Let the person talk, don t censor, judge or discount, do not immediately suggest solutions Ask direct questions Are you thinking about killing yourself? How would you do it? Plans? If suicidal ideations call hotline or if imminent call 911 Help person find mental health resources or bring them with you Stay with the person while they make the call Involve a mental health professional We are vets not therapists Make plans for tomorrow A desire to get well A desire to accept assistance Active participation in 12 step meetings Putting something in place of substance (i.e. new coping techniques, stress management, recreation, community, spirituality) Accountability Wellness committee Random testing Peer support groups 6

7 Mental health professional Support network Coping skills training Reprogramming negative self talk, affirmations, guided imagery Spirituality for some people Service animals, emotional support animals for some people Medication for some people Healthy life style (food, exercise, sleep, recreation) Focus, dedication, sometimes outside monitoring You didn t cause it You can't cure it You can't control it Get help for yourself Disseminate information, educate, facilitate interventions and make referrals Advocate and mentor, liaison for employer monitoring contracts Anguish, guilt, rage, anger and the like are common feelings directed toward the addict or to someone who commits suicide. The disease of spouseaholism or codependency is a common finding in family members. Family and friends may recover even if the addict does not. Alanon Nami.org SAVE at utk.edu Come to my next talk States Wellness Committees AVMA ext. 625 avma.org > Wellness (Narcotics Anonymous) Listings in phone directory Suicide Prevention Lifeline TALK utk.edu > SAVE 7

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