empowered use, health consciousness and prescription drugs with special focus on parents and the...
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Empowered Use, Health Consciousness and Prescription Drugs with Special Focus On Parents And The WorkplaceNational data show prescription drug abuse is growing at rates that wellness/lifestyle practitioners can no longer ignore. Coaches and wellness coordinators can benefit from knowledge about prescription misuse in topical areas the presenter will discuss: neuroscience, motivators (pain, mood energy), at-risk populations, and policy as well as mind-body practices as antidotes to the growing epidemic. The presenter will share a presentation developed for Substance Abuse & Mental Health Services Administration (SAMHSA) and that participants can use in their own setting. This presentation has a focus on the workplace and working parents. As this is a relatively new topic not often discussed in wellness practice, participants will be asked to complete a brief follow-up survey asking about the relevance and utility of this topic to their work in the wellness profession.TRANSCRIPT
Empowered Health Consciousness and Prescription Drugs
Special focus:
workplace and parents
Poll 3
Over the past few years, has there been an increase in over-prescribing or over-medication of prescription drugs?
A) Definitely Not
B) To some degree
C) Yes
D) Definitely Yes
E) In Between or Don’t Know
Core Concept 1: External Referencing*
• Using an external device, substance, process, person, thing to justify a certain way of being; this, instead of paying attention to internal (emotional, intuitive) signals and resources; always checking outside one-self before making decisions; not owning one’s own authority
• Example: We look outside ourselves instead of tuning in to or developing personal resources to solve an issue or improve a situation
• External referencing is one basis for dependence and addiction (also see “external locus of control” “codependence”) > Pathology: Münchausen's, Stockholm, Jonestown *Anne Wilson Schaef
External Referencing
Loss of Health (e.g., Pain, Mood)
“Natural “ or normative tendency
A culture that supports Health Consciousness & “Self as healer”
A culture that markets health as
a commodity
Core assumption: As we lose function, there is a natural tendency to look outside ourselves for help
Prescription Drug Use: Plotted as a Function of Health Loss and External Referencing
Core Concept 2: Technology’s Double-Edged Sword*
• Advances in pharmaceutical technologies afford relief and disease management
• These advances often have down-sides (e.g., side effects, potential for abuse and dependency)
Q. How do health service (wellness) providers work with these two cultural forces?
Tendency to commoditize health Technology’s
Double edge sword
Prevention Intervention Framework
PREVENTION Primary: Before use begins or use is as prescribed (minimal use) Secondary: After use begins and use is prescribed (some risk) Tertiary: Prescribed use is ongoing (higher risk) INTERVENTION Early: Signs of misuse in any of the above Mid-Level : Signs of misuse and abuse Serious: Abuse and dependence
OWLS Team Awareness/Team Resilience Programs (Raw Coping Power)
SEARCH “SL IDESHARE BENNET T TEAM AWARENESS”
• Evidence-based program focuses on giving worker’s skills in health consciousness at the team or cultural level
MODULE 2 (Team Ownership of Policy/Benefits) MODULE 3 (Raw Coping Power) cognitive behavioral resources and tools for stress management; from stress to thriving MODULE 6 (Encouragement) basic motivational interviewing skills for peer-to-peer compassion and referral to healthy alternatives (e.g., EAP, wellness coaches)
Certification Training in Fall 2014
Preview: Wellness and EAP professionals can do more to educate on prescription drug misuse/abuse
1. Speak knowledgeably about growing trends and risks
2. Use preventive education tools (like explaining “health consciousness”)
3. Become familiar with policies/regulations (state and workplace)
4. Know benefits (what is covered/not covered by insurance)
5. Have some understanding of brain mechanisms (educate on “brain health”)
6. Speak to interests of employees (e.g. parents; children of aging parents)
7. Understand motives behind use; generate alternatives for each
8. Know resources and vet them for validity
9. Focus on their own professional “wheel house”
(think global/societal problem but act local)
10. Use scenarios to engage workers in preventive thinking
11. Ask physicians/pharmacists for support on label reading
12. Use tips/guide sheets in a discussion format (not talking head)
Pre Webinar Survey Results (62 respondents)
Administer or manage wellness programs…………. Employee Assistance…………………………………………. Provide wellness services directly to clients/staff. Do wellness coaching………………………………………… Human Resources/Benefits……………………………….. Student……………………………………………………………… Multiple Roles…………………………………………………….
20 18 17 13 7 7 17
I am familiar with the growing problem of prescription drug misuse/abuse among adults (number)
5 2
5
28
24
Strongly Disagree Disagree In Between Agree Strongly Agree
82%
Agree Other
What is employees’ primary interest regarding receiving education on prescription drug misuse/abuse
(Number Ranked Top of 5)
21
15
11
8
7
Want to be better educated as consumers of prescription drugs
Concerned about productivity problems amongst coworkers who use/misuse
Concerned as parents
Concerned about own personal use
Concerned as children of aging parents
I would like more prevention tools to educate employees on prescription drug misuse/abuse (number)
1 0 3
29 29
Strongly Disagree Disagree In Between Agree Strongly Agree
94%
Agree Other
This is a SAMPLING of material
Need your feedback CHANGES TO MAKE?
WHAT WOULD YOU ADD?
Please complete survey
Link provided via email after
presentation to those who attend
$50 raffle for attending and completing the survey
Empowered Health Consciousness and Prescription Drugs
Special focus:
workplace and parents
Objectives
As a result of this workshop, participants will be able to:
1. Define “health consciousness” as key to preventing prescription drug misuse and abuse
2. List both the major risk factors associated with the increase in prescription drug misuse and abuse as well as healthy alternatives and protective factors that can diminish those risks
3. Take action steps to implement those healthy options for themselves and others who may be at risk
4. Use the above skills to reduce prescription drug misuse and abuse in their own work setting
Clarification
• If you are currently taking prescription medications: • This training supports your continued use as
prescribed. •And encourages you to review how you use in ways
that support your health and well-being. • This training also will review processes and healthy
life-styles/alternatives that you are invited to consider.
use misuse abuse
Use: only as prescribed and then dispensing in safe manner
Misuse: without a prescription or in ways not prescribed; and/or sharing with others
Abuse: tolerance for or dependency on drugs; using excessively; taking/stealing; life/work function is disrupted
Take care of your body.
It's the only place you
have to live.
- Jim Rohn
Health Consciousness Paying attention to what we ingest; getting exercise, rest; and using our body and mind
together for a health enhancing purpose
Outline Basic Understanding
Awareness
Responsibility
Healthy Alternatives
1
2
3
Key Topics
Special Groups
Brain Health
Population Risks/Strengths
A
B
C
Application Scenarios
Intermittent Team
Jeopardy Game
Case Study For Supervisory
Training
Section 1:
Knowledge
PART 1
Awareness
National
State-Level
Community-Level
Workplace
Coworker
Parent of Teens
Worker Child of
Aging Parents
http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf http://www.people.com/people/article/0,,20665333,00.html
2000 2003 2013 2013
Be Careful Warning? In Trouble Too late?
Note. Information on toxicology was obtained from Wikipedia or other autopsy reports freely available on the Internet. See also http://www.huffingtonpost.com/2012/08/26/celebrity-overdoses-deaths-prescription-drugs_n_1831731.html
Hydrocodone Acetaminophen L-methamphetamine Chlorpheniramine
November 10, 1977 December 20, 2009
August 9, 1963 February 11, 2012
Benadryl Xanax Marijuana Flexeril
April 4, 1979 January 22, 2008
Oxycodone Hydrocodone Diazepam Temazepam Alprazolam Doxylamine
August 29, 1958 June 25, 2009
Valium Lorazepam Midazolam Propofol Clonazapem Flomax
Heroin Cocaine Benzodiazepines Amphetamine
July 23, 1967 February 2, 2014
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landmarkmedia / Shutterstock.com Everett Collection / Shutterstock.com s_bukley / Shutterstock.com s_bukley / Shutterstock.com
http://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-pain-medications-risks-heroin-use
Major types of Prescription Drugs that are Abused
31%
Percentage of drugs misused or abused
• Reasons for increased use growth: • Direct consumer advertising (examples)
• Lack of professional education
• Overprescribing (first suggested treatment)
• Doctor Shopping
• Ineffective prescription monitoring
• Reactive Policies, rather than preventative
• General societal acceptance (no stigma)
• Social learning (increased parental use)
PART 2
Finding Responsibility
o The Individual
o The Media
o The Society
o The Economy
o Pharma Industry
o Policy Enforcement o Federal o State o Workplace
o Upbringing/Parents o Problem Childhood
o Unresolved Trauma o Social Group/Peers o Availability o Perceived Low Risk o Emerging Adulthood o Personality/Values
o Risk-Taking/Impulsivity o Conscientiousness o Health Consciousness
o Safety Culture o Health Culture o Policy Awareness o Supervisor modeling o Prevention Training o Availability o Coworkers o Health Benefits o Wellness Program
Take care of your body.
It's the only place you
have to live.
- Jim Rohn
Health Consciousness Paying attention to what we ingest; getting exercise, rest; and using our body and mind
together for a health enhancing purpose
Anxiety
Panic
Tension From Table 2 Hernandez, S. H., & Nelson, L. S. (2010). Prescription drug abuse: insight into the epidemic. Clinical Pharmacology & Therapeutics, 88(3), 307-317.
Pain
Energy
Weight Loss
Relax
Attention*
M O T I VAT I O N W H AT
*cognitive enhancement
Flip chart general benefits and risks
Flipchart 1: Your Views on Benefits and Risks
Anxiety
Panic
Tension
Pain
Energy
Weight Loss
Relax
Attention
Benefits Risks
Q. Do you Have any risks?
A. Get Help
Health Consciousness Paying attention to what we ingest; getting exercise, rest; and using our body and mind
together for a health enhancing purpose Anxiety
Panic
Tension
Pain
Energy
Weight Loss
Relax
Attention
Benefits Risks Healthy
Alternatives [1]
What if You Know Someone at Risk [2]
Our Prevention Focus in this
Training is in this Area
Flipchart 2: Healthy Alternatives & Nudging
[1] See Module 4 “Raw Coping Power” in Team Awareness or Centering Module in Team Resilience [2] See Module 6 “Encouragement” in Team Awareness or Compassion Module in Team Resilience
use misuse abuse
Use: only as prescribed and then dispensing in safe manner
Misuse: without a prescription or in ways not prescribed; and/or sharing with others
Abuse: tolerance for or dependency on drugs; using excessively; taking/stealing; life/work function is disrupted
Anxiety
Panic
Tension
Pain
Energy
Weight Loss
Relax
Attention
Poll 4
Do you think that proactive coaching around alternatives to prescription drugs is a viable approach for wellness professionals?
A. No
B. Yes—for primary prevention (before prescribing)
C. Yes—for weaning clients off of use and/or reducing misuse
D. Yes—as a supplement to prescriptions
E. All (B, C, D) or Some combination of B, C, and D
PART 3
Healthy Alternatives & Protective Factors
Health Consciousness
Protective Factors...You are Worthy and So Knighted!
• Those behaviors/lifestyles that protect an individual from seeking refuge in addictive or self-abusive behaviors
• Specifically, using healthy alternatives: habits, tactics, behaviors, acts, self-reminders to keep us in a state of Health Consciousness
• Also, putting ourselves in situations (social, work, play, healthy environments) that “pull” us to choose Health Consciousness
• Also, reaching out and being with others who “push” or “Nudge” us to choose Health Consciousness
Alternative Approaches to Pain
Research!America. (2013). National Poll: Chronic Pain and Drug Addiction. Zogby Analytics. Retrieved November 22, 2013 from http://www.researchamerica.org/uploads/March2013painaddiction.pdf.
There are many different ways to manage and reduce chronic pain. Based on your experience or what you have heard, which of the following treatments would you try to relieve chronic pain? (multiple responses allowed) [1016 National Poll; Mar 2013]
Exercise and Sleep*
• Quicker to sleep
• Better quality
• Better day-time functioning
• Less disturbed sleep
• Less dependence on prescription drugs for sleep
*http://www.sciencedirect.com/science/article/pii/S1836955312701066
Alternatives for stress
• Practice mindfulness • Body scan • Sitting meditation • Gentle yoga
• Encourages observation of body sensations, urges, and environmental stimuli
• Exercise • Enough sleep
Alternatives to prescription drug treatments
• Alternatives for pain • Steroid injections
• Nerve blocks
• Physical therapy
• Cognitive behavioral therapy
• Biofeedback
• Therapeutic Exercise
• Manipulative Therapy
• Cold/Heat
• Micro-stimulation (Electrotherapy)
• Ultrasound
PART 4
Special Groups (Children, Military, Job Stress)
Five Reasons Not to Share Prescription Drugs at Work
1 Take inventory of the prescription and OTC drugs you have at home. Do any of them have the potential for abuse? Properly destroy unused or outdated medicine.
2 Monitor and safeguard any and all prescription drugs that a child is currently taking.
3 Role model care and careful use (not misuse) of any and all prescription drugs you use. Use opportunity to educate.
4 Openly discuss the risks of use and the importance of medical supervision and proper disposal.
5 Understand motives behind signs of use or misuse (eg. weight loss, pain, better grades) and speak compassionately first.
6 Personally avoid websites that sell prescription drugs.
7 Be honest (come clean) if your child challenges your own use.
8 Discuss how avoidance is part of HEALTH CONSCIOUSNESS.
Things Parents Can Do to Help Teens Avoid Risks
http://medicineabuseproject.org/assets/documents/parent_talk_kit.pdf http://www.iowa.gov/odcp/images/pdf/Parentskids.pdf
1 The brain is still going through massive re-wiring between adolescence and adulthood (emerging adulthood)
2 Not all the wiring is there to manage impulses, strong feelings, and to accurately perceive risks, arousal (JUST REACT)
3 There are four very specific and special developmental needs (Dan Siegel’s “Essence of Adolescence”)
4 These should be cherished and cultivated for positive ends
5 Parents may recognize that they have not personally nurtured (role modeled) these in their own lives
Parents: Have Compassion!
The Growing Brain
http://www.psychologytoday.com/blog/inspire-rewire/201401/the-essence-adolescence
Emotional Spark
Social Engagement
Novelty Seeking
Creative Exploration
ES SE N CE
PART 5
Brain Health: Pain, Anxiety, Stress
Pain & Anxiety GENERALLY, WHY DOES PAIN CAUSE ABUSE, HOW PREVALENT IS IT?
• Doctors struggle: because over prescribing can cause problems like prescription drug abuse, but under-prescribing means that someone is suffering in pain.
• Chronic Pain has also increased in the US in general • Our population is generally getting older (baby boomers) • War has effected the younger generation • Increase in obesity • Decrease in frequency/intensity of exercise • Lack of fruit/vegetable consumption; fatty foods
• Anxiety also increased in the past few generations: • More social emphasis on extrinsic reward (status, $) that may
be unrealistic to attain • Less emphasis on intrinsic rewards and social connection • Theory: Individualism, unrealistic expectations, unstable
relationships
Pain Examples • Headaches • Abdominal • Back • Neck • Hand • Other Muscular-Skeletal • Fibromyalgia
Think About It!
• We drink caffeine because we know it gives us energy and wakes us up
• But do we really know EXACTLY what Prescription Drugs are doing to our brain?
It’s Your Brain: Be Nice to It!
Healthy Diet and Exercise
_______________________________
Stretching Body Posture
LESS Pain
MORE Healthy
Sleep* and Recovery
LESS Stress
It All Starts with Healthy Lifestyle
Open loop
positive feed back
*http://www.sciencedirect.com/science/article/pii/S1836955312701066
Poor Diet and Exercise -----------
No Stretching Poor Body Posture
More Pain
Less Sleep and
Energy Recovery
More Stress
Closed loop
of
negative habit
Be Mindful, Breathe, Explore Healthy Options
It’s Your Brain: Be Nice to It!
PART 6
Knowledge of Population Risks And Attempts to Address
Poll 5
What is the main driver of the growth of prescription misuse and abuse?
A) Oxycontin B) Increased sales efforts (marketing, advertising) C) Doctors are not educating enough D) Lack of regulations E) Lack of prevention education (general)
http://www.economist.com/blogs/democracyinamerica/2012/02/prescription-drugs
Source: Morbidity and Mortality Weekly Report, 2013.
It helps to know
One study looked at the percentage of people that could read and interpret warning labels on the side of prescription bottles.
Only about ½ or less in most cases were able to accurately read and interpret label warnings!
Prescription Drug Overdose Mortality Rates (per 100,000)
http://healthyamericans.org/reports/drugabuse2013/ http://www.cdc.gov/homeandrecreationalsafety/rxbrief/
Over 30 states with less than 5/100K
Only 1 state with less than 5/100K
Preventive efforts are growing
1.States are making progress
2.Policies exist to help us better monitor drugs
3.But we have to be aware of these policies
4.We can “own” these policies (see Policy Module from Team Awareness)
Trust for America’s Health http://healthyamericans.org/
When, where, and who purchased specific kinds of drugs, such as opioids and pseudoephedrine (meth)
Pharmacists expected to look for signs of abuse including: • Requests for early refills • Overly knowledgeable about the drugs • Overly-friendly with pharmacists • Altering prescriptions
Poll 6
Are you familiar with any of these regulations?
A) None of them
B) Some of them
C) Most of them
D) All of them
Prescription Guidelines: http://www.cdc.gov/HomeandRecreationalSafety/overdose/guidelines.html
An increasing number of states are implementing regulations
GOOD NEWS
http://www.drugabuse.gov/related-topics/trends-statistics/infographics/popping-pills-prescription-drug-abuse-in-america
http://youtu.be/omRdhT-eixE
http://healthyamericans.org/health-issues/rx-drug-abuse-report-app
Section 2:
Application
PART 7
What Would you do? Tough situations that don’t have a clear right or wrong answer
Scenarios: Select a Tough Situation
College
Teen Sports
Teen: Weight Loss
Military
Aging Dad
Aging Mom
Workplace
Poll 4
Which sample do you want to review?
A) College B) Military C) Teen Weight Loss D) Aging Dad E) Workplace
Aging Father
GRANDPA AL HAS HAD PREVIOUS PROBLEMS with depression and, through Medicare, has access to anti-depressants without pay. Al has figured out how to get two doctors to prescribe him, even though his state has a PDMP and a Pharmacy Lock-in program.
Al’s wife does not read well-will give Al the drug he wants. Al is now taking four times the prescribed daily dosage. His adult children have grown increasingly concerned about Al’s dependence but Al has arranged things so the children can’t talk to his doctor.
If you could show evidence that Al is at increased risk of death from overdose, what would you do?
Occupational Risk
DR. P. HAS BEEN A RESPECTED FAMILY PHYSICIAN for a decade. She has a successful practice, family, and friends. Lately, there has been some financial stress due to the economy. To make up she works longer hours, but she’s not bringing home as many bonuses. She began to take some Xanax when feeling overwhelmed.
Lately, she’s been taking one everyday. She prescribes them to herself and doesn’t have a business partner.
Does Dr. P.’s patients have anything to worry about? Who should be responsible for her prescription?
Preview: Wellness and EAP professionals can do more to educate on prescription drug misuse/abuse
1. Speak knowledgeably about growing trends and risks
2. Use preventive education tools (like explaining “health consciousness”)
3. Become familiar with policies/regulations (state and workplace)
4. Know benefits (what is covered/not covered by insurance)
5. Have some understanding of brain mechanisms (educate on “brain health”)
6. Speak to interests of employees (e.g. parents; children of aging parents)
7. Understand motives behind use; generate alternatives for each
8. Know resources and vet them for validity
9. Focus on their own professional “wheel house”
(think global/societal problem but act local)
10. Use scenarios to engage workers in preventive thinking
11. Ask physicians/pharmacists for support on label reading
12. Use tips/guide sheets in a discussion format (not talking head)
This is a SAMPLING of material
Need your feedback CHANGES TO MAKE?
WHAT WOULD YOU ADD?
Please complete survey
Link provided via email after
presentation to those who attend
$50 raffle for attending and completing the survey
Certification Training in Fall 2014
Interested in full slide deck and facilitator notes? (1) Send email to
[email protected] (2) Look for upcoming announcements
Organizational Wellness
@Orgwell
www.organizationalwellness.com