Help seeking by health professionals for addiction: A mixed studies review☆
Introduction
Drug and/or alcohol addiction occurs amongst some individuals from most age, educational, economic, cultural, gender, and occupational groupings—including health professionals. Research suggests that addiction occurs amongst health professionals at rates similar to the general population (e.g., Balissieri, 2007, Kunyk, 2015, Oreskovich et al., 2015, Warner et al., 2013). When addiction is active and untreated amongst health professionals, it is a serious and complex occupational and professional issue impacting numerous stakeholders including: the health professional with the disorder; their families, patients and colleagues; their employers and professional regulators; and the broader health community. Amongst other concerns, risks are introduced to patient safety, the health of the health professional, and the image of the health professions. The actual number of health professionals impaired by addictions that are undetected and providing healthcare is unknown, as is the cost of their impairment as defined by substandard care and/or malpractice settlements and awards (Avery et al., 2000). However, when addiction is detected losses related to declines in staff morale, turnover, management time, health, disability, and treatment benefits, and regulatory and legal costs can be mitigated (LaGodna and Hendrix, 1989, McLellan et al., 2008). Given the expenditures involved with their extension training, ongoing struggles with recruitment and retention, and the importance of their contributions to the health of society, it seems reasonable to conclude that early detection and treatment of health professionals with addiction is an ideal aspiration for all stakeholders.
Addiction need not translate into the end of a health professional's career. Evidence-based treatments exist, and their outcomes are similar to other chronic and relapsing diseases including hypertension, asthma, and type 2 diabetes (McLellan et al., 2007). Furthermore, return to professional practice amongst health professionals has been demonstrated to be achievable, sustainable and safe when following evidence-based interventions which include long-term aftercare programs (e.g., Brewster et al., 2008, DuPont et al., 2009a, McLellan et al., 2008). The goal for managing this issue well must therefore be to better understand and facilitate the conditions that will encourage health professionals into seeking help at the earliest point possible to achieve the most optimum health and risk-reducing outcomes.
Several theories of help seeking have been advanced each explicating the processes related to different diseases or life challenges. These theories suggest that help seeking occurs when individuals recognize that a problem exists and needs to change (Saunders et al., 2006), but is unlikely to be resolved without external help (Cauce et al., 2002). Oftentimes, this recognition does not come easily as many individuals deny or minimize addiction and help seeking occurs only when the immediate costs of addiction become untenable (Becker and Murphy, 1988). With stigmatized problems, including addiction, the person's context and culture may influence the interpretation of their behavior, such as drug or alcohol use, as problematic (Liang et al., 2005). When acknowledged, individuals may attempt to resolve the addiction on their own before considering seeking formal help (King and Tucker, 1998). The presence of barriers, whether real or perceived, may halt this process (Fox et al., 2001, Tucker, 1995). Given this, finding ways to reduce the barriers and to facilitate help seeking are paramount.
Overall, the role of barriers and the impact of cultural meaning are recurring themes central to help seeking for stigmatized problems (Hui et al., 2014). To date, research appears to be focused on ethnic culture as the context in which meanings are embedded. We extend these extant models to hypothesize that the professional context in which an individual works may have its own unique culture through which the meaning of help seeking for addiction emerges. In this study, we focus on the process of help seeking for addiction by health professionals. We suggest that health professionals may face a number of unique challenges (and opportunities) to obtaining help for addiction as a result of their common socialization experiences.
Further complicating help seeking for addiction amongst health professionals is the reality that many jurisdictions have several separate regulatory boards and/or acts for health professionals, with each authority establishing their own approach to dealing with addiction-related issues amongst their members and/or employees. Many of these health organizational and regulatory entities have not established formal processes and amongst those that have, variations exist between regions and across health professions (Brooks et al., 2012, DuPont et al., 2009b, Monroe et al., 2013, Shaw et al., 2004). To determine the most appropriate strategies for dealing with this complex problem, it is critical to understand the factors that affect the context and decision-making processes of health professionals as they engage (or not) in help seeking for addiction. Therefore, the purpose of this study was to examine what the extant qualitative and quantitative literature reveals about the process taken by health professionals for help seeking for addiction. This knowledge is critical for health professional regulators and employers to develop and implement effective approaches for encouraging and engaging health professionals into addiction treatment at the earliest possible point to reduce risks to the individuals’ health and to limit impaired professional practice.
Section snippets
Materials and methods
The purpose of this sequential exploratory mixed studies review (Pluye and Nha Hong, 2014) was to determine what the extant literature reveals about the process of help seeking taken by health professionals for addiction. To do so, we first conducted a meta-synthesis of the qualitative literature (phase-one) to garner a broad understanding of the characteristics and processes of health professional's decisions regarding help seeking. We then conducted a narrative synthesis of the quantitative
Phase-one: qualitative research
The eight included qualitative studies, considered an adequate number for reviews of qualitative studies (Sandelowski and Barroso, 2007), represented help seeking for addiction in a variety of countries and amongst different populations of health professionals. The total sample of 335 health professionals included: 162 physicians, 95 pharmacists, 66 nurses, and 12 dentists. Within this sample, there were 112 males, 63 females, and 160 where gender had not been specified. Studies were conducted
Discussion
This mixed studies review used a recognized approach to synthesize primary data from existing qualitative and quantitative studies in English on health professionals from diverse disciplines and six countries to uncover the process of help seeking for addiction as well as factors that facilitate or deter help seeking. The key findings from the qualitative literature focus on the context and process by which health professionals move from recognizing the addiction to actively seeking help. The
Conclusions
Integration of the findings of our qualitative and quantitative syntheses suggest that there are multiple points in the inherent context and process of help seeking for health professionals that offer promise for earlier intervention strategies. Facilitating the help seeking process for health professionals with addiction is an effective strategy to reduce associated risks to the health professional, their families and colleagues, their employers and regulatory bodies, and the general public.
Acknowledgments
We thank Patrice Drake and Michael Lee for their invaluable contributions to the study.
Conflict of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors disclose receipt of the following financial support for the research of this article: University of Alberta Endowment Fund for the Future and Centre for Effective Business Management of Addiction Treatment Grants.
Ethical approval: None.
References (59)
- et al.
The impaired physician
Prim. Care Update Ob. Gyns.
(2000) - et al.
Setting the standard for recovery: physicians’ health programs
J. Subst. Abuse Treat.
(2009) - et al.
How are addicted physicians treated? A national survey of physician health programs
J. Subst. Abuse Treat.
(2009) - et al.
Natural resolution of alcohol problems without treatment: environmental contexts surrounding the initiation and maintenance of stable abstinence or moderation drinking
Addict. Behav.
(1998) - et al.
Female physicians and substance abuse: comparisons with male physicians presenting for assessment
J. Subst. Abuse Treat.
(1998) - et al.
Recovering substance-impaired pharmacists’ views regarding occupational risks for addiction
J. Am. Pharm. Assoc.
(2012) - et al.
Combining qualitative and quantitative research within mixed method research designs: a methodological review
Int. J. Nurs. Stud.
(2011) - et al.
Synthesizing evidence on complex interventions: how meta-analytical, qualitative, and mixed-method approaches can contribute
J. Clin. Epidemiol.
(2013) - et al.
Person-related and treatment-related barriers to alcohol treatment
J. Subst. Abuse Treat.
(2006) ASAM Responds to ‘Physician Health Programs: More Harm than Good?’
(2015)
Public Policy Statement on Returning to Work: People Treated for Alcoholism and Other Drug Dependencies
Impaired healthcare professionals
Crit. Care Med.
A theory of rational addiction
J. Polit. Econ.
Substance misuse amongst anaesthetists in the United Kingdom and Ireland
Anaesthesia
The prevalence and patterns of substance abuse among nurse anesthesia students
AANA J.
Characteristics and outcomes of doctors in a substance dependence monitoring programme in Canada: prospective descriptive study
BMJ
The addicted doctor. Caring professionals?
Br. J. Psychiatry
Comparing substance use monitoring and treatment variations among physician health programs
Am. J. Addict.
Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth
J. Consult. Clin. Psychol.
Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care
Research for practice. Program for recovering nurses: an evaluation
Medsurg Nurs.
Addicted health professionals
J. Subst. Misuse
Illicit prescription drug use among pharmacists: evidence of a paradox of familiarity
Work Occup.
Alternative diversion programs for nurses with impaired practice: completers and non-completers
J. Addict. Nurs.
Mountains to climb: male nurses and their perspective on professional impairment
Int. J. Hum. Caring
Synthesizing qualitative and quantitative evidence: a review of possible methods
J. Health Serv. Res. Policy
Women exposed to intimate partner violence. Expectations and experiences when they encounter health care professionals: a meta-analysis of qualitative studies
Arch. Intern. Med.
Barriers to help seeking for mental disorders in a rural impoverished population
Community Ment. Health J.
Retrospective survey of substance abuse in anaesthetists in Australia and New Zealand from 2004 to 2013
Anesth. Intens. Care
Cited by (23)
Why Health-care Professionals Often Do Not Ask for Help: Understanding the Stigma Associated with Substance Use Disorders
2023, Nursing Clinics of North AmericaReflexive thematic analysis of job-related problems associated with pharmacist suicide, 2003–2019
2023, Research in Social and Administrative PharmacyJob-Related Problems Prior to Nurse Suicide, 2003-2017: A Mixed Methods Analysis Using Natural Language Processing and Thematic Analysis
2021, Journal of Nursing RegulationCitation Excerpt :A widely cited study of Canadian nurses reported that more than 90% of nurses with an active SUD were practicing nursing with no substance use treatment (Kunyk, 2015). The threat of the loss of employment or licensure, coupled with the shame of losing the nursing identity and the stigma many in the health professions associate with addiction, may create a seemingly insurmountable barrier to nurses seeking help for an active SUD (Kunyk et al., 2016). Painful misconceptions around substance use, such as the pervasive myth that substance use is a personal failure, that a person with an active SUD must hit “rock bottom” before they will accept help, and a continuing disciplinary rather than rehabilitative approach to addiction all contribute to an environment that discourages self-reporting and promotes stigma (Kunyk et al., 2016; Mumba, 2018).
A systematic integrative review of the literature on midwives and student midwives engaged in problematic substance use
2020, MidwiferyCitation Excerpt :The literature in relation to rehabilitation for healthcare professionals engaged in PSU remains largely dominated by outcomes for physicians (Weenink et al., 2017), of whom it is thought 8–15% are affected (Vayr et al., 2019). Generally, compassion, respect for confidentiality and a non-punitive atmosphere appear essential to recovery and the development of safer working environments, as opposed to strategies relating to discipline and stigma (Kunyk, 2015; Kunyk et al., 2016). A failure to adequately support healthcare staff engaged in PSU has been associated with organisational complicity and culpability (Searle et al., 2017).
Outcomes of Substance Use Disorder Monitoring Programs for Nurses
2020, Journal of Nursing RegulationSubstance Use in Registered Nurses: Where Legal, Medical, and Personal Collide
2019, Journal of Nursing RegulationCitation Excerpt :RNs are often exposed to the benefits of substances, have access to them, and potentially believe they are competent enough to self-medicate. These factors have surfaced as compromising the individual’s motivation, at least initially, in seeking help (Kunyk, Inness, et al., 2016). Theme 4, Deliberate Diversion, Deceit, and Deception, may be linked to the perception of RNs being emboldened by their daily experiences and beliefs that their actions would continue unnoticed, which may lengthen the time from recognizing the problem to seeking assistance.
- ☆
Portions of this article were presented at the International Academy of Law and Mental Health Congress, July 14, 2015, in Vienna, Austria.