Help seeking by health professionals for addiction: A mixed studies review

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Abstract

Background

When health professionals practice with active and untreated addiction, it is a complex occupational and professional issue impacting numerous stakeholders. Health professionals are responsive to evidence-based addiction interventions and their return-to-work has been demonstrated to be achievable, sustainable and safe. Facilitating help seeking in health professionals with addiction is a priority for reducing associated risks to their health and to patient safety.

Aim

The purpose of this study was to identify the process by which health professionals seek help for addiction, and factors that facilitate and deter help seeking, through a review of the qualitative and quantitative literature.

Methods

Both phases of this sequential mixed studies review followed the standard systematic review steps of: (1) identifying the review question, (2) defining eligibility criteria, (3) applying an extensive search strategy, (4) independent screening of titles and abstracts, (5) selecting relevant studies based on reviewing the full text, (6) appraising the quality of included studies, and (7) synthesizing the study findings. Our two searches of five databases from 1995 to 2015 resulted in the inclusion of eight qualitative and twenty-three quantitative studies. We first conducted a meta-synthesis of the qualitative literature to garner an understanding of the help seeking process for health professionals for addiction. We then conducted a narrative synthesis of the quantitative studies to generalize these findings through examining the data for convergent, complementary or divergent results.

Results

Synthesis of the included qualitative studies revealed that the professional and experiential context of healthcare compromised the health professional's readiness to seek help for addiction. Typically, a pivotal event initiated the help seeking process. The studies in the quantitative review identified that help seeking most often resulted from reports of adverse events to formal organizations such as their employer and regulatory bodies. This process does not adequately address the scope of health professionals requiring help for addiction. Informal sources such as colleagues and family, often aware of the addiction earlier, preferred referral to voluntary, confidential treatment programs.

Conclusions

Facilitating the help seeking process for health professionals with addiction in as effective strategy to reduce the associated risks to the health professional, their families and colleagues, their employers and regulatory bodies, and to the general public. Our findings suggest that intervention is possible at multiple points in the help seeking process for health professionals with addiction. Confidential, compassionate and supportive alternatives offer potential for closing this gap.

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.

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