Spring Edition 2021

Mark Aitken: The support you deserve: Nurses, midwives and substance use

Mark Aitken explores why nurses and midwives are more vulnerable to problems related to substance use than ever and offers resources to help readers understand this complex issue. Read more. 

Tessa Moriarty: Extending a hand of care: Supporting managers to support nurses and midwives dealing with substance issues

Experienced mental health nurse Tessa Moriarty writes about the complexity of problems related to substance use for nurses and midwives, and how managers can support team members struggling with this issue. Read more.

Counselling Online: 6 signs it’s time to cut down your drinking — and how to start

The team from Counselling Online share the signs that it might be time for change. Read more. 

Celeste Pinney: A new flow: Find relaxation in the hobby chest, not the wine glass

Hobbies and pasttimes are a powerful tool to counter problems related to substance use. Nurse & Midwife Support’s Celeste Pinney writes about finding healthy outlets as an alternative to drinking and drug use. Read more.

Podcast: Support for nurses and midwifes struggling with substances with Adam Searby

We talk to Adam Searby, president of Drug and Alcohol Nurses of Australasia (DANA) about how nurses and midwives can seek support if they are experiencing problems related to drugs and alcohol. Read more. 
 

By Mark Aitken, Stakeholder Engagement Manager, Nurse & Midwife Support

Nurses and midwives do complex, challenging, unpredictable and vital work. We often don’t acknowledge that our work exposes us and makes us vulnerable to physical and mental health issues, including problems related to substance use.

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” — Rachel Naomi Remen  

What is a drinking or drug problem?

Problems related to substance use are a health issue. The factors that cause a person to develop problems related to substances are complex and varied, as are the problems themselves. Some people might find themselves using alcohol or drugs more plentifully or more often than they’re comfortable with, while others may come to realise they are physically or emotionally dependent. All experiences are valid and someone doesn’t need to have a very serious problem before they can benefit from reaching out for assistance — and, on the other hand, it’s never too late to get help even if the problem has become very serious. 

Why do some nurses or midwives develop problems related to substances?

Nurses and midwives report varied experiences of developing problems related to substance use. It is extremely common for people who are struggling with substance use to have experienced trauma at some point in their lives — in fact, 1 in 2 patients in addiction treatment have symptoms of PTSD. The vicarious trauma many nurses and midwives experience in the workplace — often over decades —  may make them more vulnerable to problems related to substances. 

Other common risk factors for nurses and midwives who struggle with drinking or drug use include (but are not limited to):

• childhood and or adolescent trauma
• vicarious stress
• chronic stress
• chronic pain
• mental illness and self-medication
• post-traumatic stress disorder
• burnout
• moral distress
• compassion fatigue and
• shift work.

Assess the situation

If you think you might be experiencing a problem, you can take a self-assessment to help you understand whether your health may be at risk. 

• Assess your drinking (AUDIT)
• Assess your drug-taking (DUDIT) (via Turning Point)

These assessments and their results are 100% anonymous and confidential. 

The support you deserve

Nurses and midwives with problematic substance use concerns deserve sensitive, compassionate, and considered support — yet many report feeling isolated, unsupported, and fearful. Many feel they can never reveal the problem to employers, peers, friends and loved ones due to stigma. We’re here to offer confidential, non-judgmental support 24/7 — give us a call on 1800 667 877. 

In this edition you will find a range of blogs, resources, and podcasts to help you understand problems related to substance use, whether you are experiencing them yourself, supporting someone specific, or want to better understand the problem and how it affects people in our industry. Remember that 1 in 5 Australians will experience an alcohol, drug or gambling disorder in their lifetime, so it’s likely that more people around you are struggling than you might ever guess.  
 

Our extended family: Turning Point

Nurse & Midwife Support is operated by Turning Point, Australia’s leading national addiction treatment, education, and research centre. The nurses and midwives who answer your calls work alongside the drug and alcohol counsellors of Turning Point’s telehealth services such as Counselling Online and Gambling Help Online. In fact, many of the members of our team actually used to work on that team, and we are so grateful for the experience and expertise they bring to Nurse & Midwife Support. 

Turning Point seeks to transform the way society provides treatment, specialist care and support for those affected by addiction. For Turning Point, issues of stigma, significant delays in help-seeking, knowledge gaps across the health workforce, a fragmented service system, and a siloed response to addiction are key areas that must see improvement. They offer research, treatment, education and training programs designed to improve access and effectiveness of treatment to people who are struggling with all forms of addiction. 

Addicted Australia

In 2020, Turning Point partnered with SBS and Blackfella Films to create the documentary series Addicted Australia, which followed 10 Australians with serious drug, alcohol and gambling problems through a holistic, tailored and extended treatment program that models the kind of treatment that Turning Point believes is the future of recovery. This documentary offers valuable insight into the daily lives of people struggling with substance dependency. 

Thanks to our team

To inform the newsletter content priorities I met with two experienced drug and alcohol nurses: Jackie Shaw and Cally Berryman who work at Nurse & Midwife Support. I asked Jackie and Cally what they really wanted us to share with our readers. They were unanimous that it is essential to encourage support, compassion, empathy and care when hearing the issues from those experiencing problems related to substance use, and that it is crucial that managers have the knowledge and skills to support nurses, midwives or students who disclose an issue. 

As a service, we have benefited enormously from Cally and Jackie’s expertise in this area, and we are so grateful. In fact, Cally’s work was integral to the creation of Nurse & Midwife Support. She wrote a PhD thesis Nurses’ drug and alcohol use and dependence: creating understanding, which investigated drug and alcohol use among Victorian nurses. Cally’s research findings and the vision of several nurses led to the formation of the Victorian Nurses Health Program in 2006, now known as the Nursing and Midwifery Health Program Victoria. The experience of the NMHPV and advice and expertise of Cally were instrumental in informing the establishment of Nurse & Midwife Support. 

In this issue

Tessa Moriarty: Extending a hand of care: Supporting managers to support nurses and midwives dealing with substance issues

Experienced mental health nurse Tessa Moriarty writes about the complexity of problems related to substance use for nurses and midwives, and how managers can support team members struggling with this issue.

Counselling Online: 6 signs it’s time to cut down your drinking — and how to start

The team from Counselling Online, the free national online drug and alcohol counselling service, share some signs that might indicate it’s time to make a change, what harm looks like, and how you can get started. 

Celeste Pinney: A new flow: Find relaxation in the hobby chest, not the wine glass

Hobbies and pasttimes are a powerful tool to counter problems related to substance use. Nurse & Midwife Support’s Celeste Pinney writes about finding healthy outlets as an alternative to drinking and drug use. 

Podcast: Support for nurses and midwifes struggling with substances with Adam Searby

We talk to Adam Searby, president of Drug and Alcohol Nurses of Australasia (DANA) about how nurses and midwives can seek support if they are experiencing problems related to drugs and alcohol.
 

Other resources

NMHPV Podcast: Conversations that Connect Episode 1: Keys to a nurse or midwife thriving in recovery from their alcohol or other drug (AOD) addiction (a personal story)

Heather Pickard is a nurse who is now the CEO of the Self-Help Addiction Resource Centre (SHARC). She is 27 years in recovery and shares the story of her journey to offer hope to others. Heather shares her thoughts on the risks for nurses and midwives in relation to developing problems related to substances, the reasons nurses and midwives may not seek support, the importance of self-care and how to access support. Heather tells us that nurses and midwives are often loaded with shame and stigma when experiencing problems how that can impede their access to support. However, key to Heather’s recovery was another nurse who recognised her problem and provided support and care. It is the nursing and midwifery community that can be our greatest support. Throughout this podcast, Heather provides hope that recovery is possible. Heather reminds us that to live our best life we need to be ‘humans being’, not just ‘humans doing’! Check out the episode. 

Heather also assisted us as we prepared this newsletter, and we could not be more grateful for her input! 

Oxford House: Residential rehabilitation services for nurses and midwives

SHARC have collaborated with NMHPV and the ANMF Vic branch to establish residential rehabilitation services for nurses and midwives with problematic substance use via Oxford Houses. This is an open-ended program that provides secure, supportive, and affordable homes for people recovering from alcohol and other drugs. Oxford Houses is three-quarter-way living, where residents are responsible for strengthening their own recovery and accountable for managing the affairs of their home within the Oxford Houses guidelines.

Find out more about the program here. 

Drug and Alcohol Nurses of Australasia (DANA) position statement: Problematic substance use by nurses and midwives

DANA recently updated their position statement: Problematic substance use by nurses and midwives. The statement acknowledges the importance of protecting the public, the profession, and the individual in relation to problematic substance use, and describes the responsibilities of individuals, colleagues, employers, the profession, and government in managing this issue. Read the statement. 

The Booze-less drinking game: Research to build better understanding

While there is now greater understanding of the issues influencing and impacting nurses and midwives with substance dependency and problems related to substance use, there is also limited research to explain the reasons and complexities of this issue. 
Our podcast guest Adam Searby is conducting research to provide insights on whether a relationship exists between nurses’ work settings, work stress and their alcohol consumption: Alcohol Consumption in Australian Nurses & Midwives: An Action-Design Study.

The research is investigating the prevalence of ‘at-risk’ drinking among Australia nurses and midwives. The study aims to understand the drinking habits of Australian nurses and midwives and will test existing technology-based interventions for at-risk drinking, typically delivered via mobile apps, to establish if they would prove effective among nurses and midwives. 

The survey is not currently accepting new participants. 

Research on the origin and development of problems with substances

Here is some research on various aspects of the genesis of problems related to substances

• Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population
• Chronic Stress, Drug Use, and Vulnerability to Addiction
• Substance Use and Mental Illness Among Nurses: Workplace Warning Signs and Barriers to Seeking Assistance
• Shift-Work-Play: understanding the positive and negative experiences of male and female shift workers to inform opportunities for intervention to improve health and wellbeing
• Secure Your Mask First: The Importance of Self-Care

COVID-19 and substance use

Chronic Stress is a risk factor for developing substance dependency. The COVID-19 pandemic has stressed, challenged, and exhausted nurses and midwives and we continue to feel the impact.

Research examining ambulance attendances for alcohol-related harms during COVID-19 restrictions in Victoria found that attendances to homes increased by 9 percent in 2020, with those from more socioeconomic advantaged areas showing the largest percentage change. Read about the research. 

Further resources

Counselling and referral 

• Nurse & Midwife Support 1800 667 877

Please be aware that there are many treatment and rehabilitation services available that are not evidence-based and can be expensive. If you or someone you know is considering entering a treatment program, it’s a good idea to get a referral from a trustworthy source. Counselling Online and the Alcohol and Drug Information Service in your state have been government-funded to offer this information. Get in touch with Nurse & Midwife Support or one of the services below for more information. 

• Counselling Online — 24/7 webchat
• Telephone support in your state 

Research and information

• Turning Point
• Alcohol and Drug Foundation (ADF) 
• Penington Institute

Self-help and peer support resources

• Counselling Online Peer Support Forums
• SMART Recovery Meetings
• Self Help Addiction Resource Centre (SHARC)  1300 660 068 
• Alcoholics Anonymous Australia
• Narcotics Anonymous Australia
• Hello Sunday Morning 
  • Daybreak App

Harm-minimisation services

• CAHMA (ACT)
• NUAA (NSW)
• NTAHC (NT)
• QuIHN (QLD)
• Clean Needle Program (SA)
• Needle and Syringe Programs (TAS)
• Harm Reduction Victoria
• Harm Reduction WA

Resources for family, friends and other significant others

• Family Drug Help (via SHARC) 1300 660 068 
• Counselling Online Friends and Family Forums
• Al-Anon Family Groups 
• Nar-Anon Family Groups

If you know of further research or resources relevant to this topic we would love to hear from you! Pass them on to [email protected].

If you are impacted by problematic substance use, please access support — it’s never too early, and it’s never too late. Give us a call on 1800 667 877. Your health matters! 

Mark Aitken RN
Stakeholder Engagement Manager
Nurse & Midwife Support

By Tessa Moriarty

Note:

In this piece I’ll use the term ‘problems with substances’ to encompass both problematic substance use and substance use disorder. I am defining problematic substance use as when the use of alcohol, drugs or other substances contributes to and negatively impacts on the nurse or midwife’s workplace practice. A substance use disorder is defined here (from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (2013) as the abuse of, misuse of or dependency on alcohol or drugs.

Our duty of care

In Australia, employers have a legal obligation to address alcohol and other drug issues in the workplace through the ‘duty of care’ provisions in the OHS Act 2011. So how can Nurse and Midwife managers compassionately and sensitively provide that duty of care to nurses and midwives experiencing problematic substance use and substance use disorders? 

Compassionate approaches create better outcomes for all and nurses and midwives can be supported to sustain recovery and remain in the workforce — while also ensuring public safety.

The management of nurses and midwives with problems with substances must include approaches that are empathic, supportive and compassionate. Recently we have moved away from punitive and regulatory management responses and increasingly implemented responses that seek to provide early identification, proactive and confidential treatment, and where there is an identified and diagnosed substance use disorder — supportive of monitoring of on-going recovery. 

While nurses and midwives tend to have the same rates of problems with substances as the general public, the nature and stressors of their work make them vulnerable to regular and problematic substance use and dependence. Current estimates are that the percentage of nurses (and potentially midwives), with problems with substances and dependency ranges from 2–10% and some estimates suggest it may exceed 14–20%. Additionally, the pressures of the COVID-19 pandemic have increased workplace stress and this is likely to have intensified nurses and midwives’ vulnerability to regular and problems with substances — perhaps as a stress-management response. 

Your role as a manager

Your behaviour as a manager, and the culture you create in your nursing or midwifery team is the biggest influence on work practice and workplace experience. We know that as managers you are most often the person a nurse or midwife will disclose an issue to, and the first person that might notice they are struggling at work. 

Yet, we also know that the issue of substance use is not adequately managed in the workplace through appropriate support and training. Only 30% of organisations provide guidelines for managers on how to deal with disclosure and how to refer for support, with just 27% giving information for employees about disclosing a problem with alcohol and/or drugs. So, it’s critical that Nurse and Midwife managers are knowledgeable about problematic substance use and substance disorders in the workplace and know (and/or seek guidance) on how to appropriately manage and support their nurses and midwives when the issue arises.  

It is also equally important to be aware of your own value judgements and beliefs about substance use and substance use disorders, so that they are not inadvertently negatively impacting the care and compassion your nurse or midwife requires from you in the management and support of this complex issue.  

Nurses and midwives who have problems with substances should viewed with compassion and should not be labelled in a negative or derogatory light. There are always factors occurring in their lives outside the workplace that aren’t always known or visible and are likely to be contributing to this issue.  Substance use is often a response to trauma or distress and may be used as a solution to a deeper problem or set of problems.  So, as you endeavour to provide support to your nurse or midwife struggling with their problems with substances, it can be helpful to remember this.  In addition, it’s important to acknowledge that you won’t have all the answers.  You don’t have to be the expert. 

It might also be important to keep in mind that in your efforts to support, understand and manage the problem with your nurse or midwife — you too could benefit from guidance and support yourself.  Don’t hesitate to contact your Human Resources department or the confidential support and information provided by Nurse & Midwife Support on 1800 667 877 or by email.  

Remember: Notification is only mandatory where there is risk of substantial harm

You must make a mandatory notification if you form a reasonable belief that the practitioner is placing the public at risk of substantial harm (a high threshold for reporting harm) by practising with an impairment.

You should make a mandatory notification only if you believe there is a risk of substantial harm. A risk of substantial harm is a high threshold for reporting risk of harm to the public. Learn more about what 'substantial harm' means from Ahpra. 

Early identification

Not every nurse or midwife who uses drugs and/or alcohol will misuse or become dependent on them. However, even infrequent problematic or excessive use may impact adversely on work practice and the overall workplace environment. That’s why it is important for nurse and midwife managers to recognise problems early.  As a manager you know your staff well and recognising issues early supports better outcomes.   

It is essential that if you believe that a nurse or midwife has a problem with alcohol or drugs, not to assume that there is one specific problem behind what is going on for them, or one single approach or even solution to this issue. 

Every nurse or midwife and every workplace situation needs to be dealt with uniquely, with sensitivity and understanding.  Any interventions with nurses or midwives about their alcohol or drug use should value them, the profession they (and you) love, and the patients/clients with whom they work.

There is no one single way of managing this issue, but your response should be grounded in empathy. The key is that it is no different to the way in which you would attend to the problems of patients — with concern, compassion, sensitivity and care. 

Workplace behaviours that may indicate problematic substance use

While it is not my intention to provide an exhaustive list of behaviours that may indicate a nurse or midwife has problems with substances, there are some indicators that must be addressed and not ignored when they come to attention.  A reminder here also of the importance of providing understanding and sensitivity to those who come to you to talk about or report their colleague’s workplace practice of behaviour. Speaking up about a concern or problem with their colleague can be an extremely difficult thing to do. They too require support and discretion. 

However, central to any workplace behaviours which may indicate a problem — and therefore your intervention — is paying attention to the frequency of those behaviours, if other team members report them to you, and if the safety of others is compromised or at risk.  

Some of the more commonly documented workplace behaviours that may indicate problematic substance use or substance disorders are: 

• problems in performance and punctuality
• frequent tiredness and falling asleep on the job
• volunteering to administer narcotics to other colleague’s patients
• smelling of alcohol
• repeated failure to remember work tasks
• unexplained absences 
• incomplete or erroneous medication charting
• repeated errors or discrepancies.  

Many of these issues are not exclusive to problems related to substances and could also indicate other mental or general health issues, so it is important to keep an open mind. Again, the emphasis within your approach is the need for sensitive and caring intervention.

Also, if a nurse or midwife does attend work clearly under the influence of drugs or alcohol, you should act with immediacy to deal with any safety-critical issues. Your organisation will have a policy and procedure to support how situations like this should be managed and if the situation involved other staff, consider if debriefing for yourself and others is required. 
 

Prevention is key

Though the emphasis so far has been on early identification, I would like to back-track to the issue of prevention.  Your primary role in prevention is to establish a positive and supportive workplace environment and work practices.

In the Line Manager’s Guide – Drug and Alcohol Misuse, the CIPD highlight the value of a supportive workplace environment.  I have adapted some of their tips to the nursing and midwifery field. 

• create a caring and supportive environment where nurses and midwives feel able to ask for help and respond with immediacy and sensitivity when this occurs
• provide education and staff development on harmful use of alcohol and other drug issues and substance use disorders  
• be sensitive to heavy workloads and reducing work related stressors where possible
• where possible allow rotation of work areas and offer changes to contracts and rosters for nurses and midwives in crisis’ 
• avoid fuelling a drinking culture — consider the implications for wellbeing and inclusion when planning work events
• ensure staff are aware of drug policies and procedures and that incident reports where there are drug count anomalies are completed promptly
• have clear and thorough audit processes for drug purchasing, distribution, handling, administration and storage of medications and that these practices comply with professional and legal requirements and
• ensure your nurses and midwives get regular clinical supervision that is constructive and supportive.

Supporting Nurses and Midwives to remain in — or return to — the workplace

Whether you have identified problematic substance use or a diagnosed substance use disorder, it is important to ask the nurse or midwife you are supporting what they think they need. Because every nurse or midwife’s situation is unique, it will be crucial to hear and understand their perspective and situation. This can be placed alongside the supports and treatments that are available. Prepare for them to be embarrassed, emotional or even angry. Some nurses or midwives may require time out away from the workplace, work-role adjustments or temporary reduction in workloads. Others may find the structure of regular work helpful but need flexibility in rostering to attend treatment appointments. As a manager you have a crucial role in facilitating and supporting a range of options that may allow the nurse or midwife to either remain in the workplace or re-integrate back into it. 

In summary, when our colleagues are struggling with problematic substance use or have a diagnosed substance use disorder – they need us to extend to them, our hand of care. 

I finish with a point from Heather Pickard, registered nurse and chair of the NMHPV board. Heather shared her story on the NMHP podcast, Conversations that Connect Episode 1 - Keys to a nurse or midwife thriving in recovery from their alcohol or other drug (AOD). Heather shared her personal story, which is a reminder to us all:  

“Sometimes when we're at a very low period in our lives, particularly around something like substance abuse (which is so loaded with shame and stigma), we can actually not see hope for ourselves. Not only can't we see hope for ourselves in establishing recovery but the idea of being able to return in a meaningful way to the profession that we love can seem so distant”.  

Heather is a wonderful clinician who has been able to thrive in her beloved profession. With support, your nurses and midwives have the best potential to find hope for the future and recover. 
 

Get support

Helping your team to navigate these issues can be stressful. If you’d like to chat about it, reach out to Nurse & Midwife Support — free, confidential, 24/7. Give us a call on 1800 667 877 or by email. 

About Tessa Moriarty

Tessa Moriarty is a credentialed Mental Health Nurse Consultant with over 30 years’ experience across public, private and primary health care, mental health and drug and alcohol settings. She has worked in a variety of senior leadership and executive roles and is an experienced group facilitator, clinical supervisor and psychotherapist. Much of Tessa’s work in recent years has focused on supporting those working in clinical settings – providing individual and group clinical supervision and reflective practice. She also works as a mental health nurse consultant for Primary Health Networks and always tries to bring a humanistic approach to the clinical governance and service review projects she undertakes.  

By Counselling Online

For many Australians drinking is a regular part of life. Broadly, people think that drinking is safe, especially because it’s legal and very easy to buy. However, it can do a great deal of damage to people, their families and communities.

What are some signs of an issue? 

But how do you know if your drinking has got out of hand, and what can you do about it? Here are some signs you can look out for. 

1. Is your drinking impacting your health, fitness or wellbeing

You might be noticing that it feels like drinking is having a harmful effect on your health. Even something that is seen as fairly ‘normal’ and innocuous like having a hangover can be concerning if it happens frequently or severely enough. More broadly, if you often feel unwell, sluggish, unhappy or are experiencing erratic emotions, it may be a sign that drinking is having a negative impact and it might be time to reevaluate. 

If you are feeling unwell or shaky and find that drinking alcohol helps you feel better, this can be a sign of dependence to alcohol and is something you should speak to a health professional about.

2. Has drinking taken over other aspects of your life?

Have you chosen to drink instead of taking part in other activities? Maybe you’ve missed work because you were hungover, or bailed on a close friend because you preferred to stay home alone and drink. If you are prioritising drinking over things that are very important to you, it may be a sign that it’s time to make a change. 

3. Have you been increasing your drinking over time?

Do you find that you have to drink more than you used to to get the same effect? Sometimes it can creep up on you, so you don’t realise until later when you’re cleaning up the empty bottles or noticing how much you spent the night before at the pub. Many people consider it a badge of honour to be able to drink a lot without showing signs of drunkenness, but in many cases it is a sign that you’re building a tolerance to alcohol and that it may be time to make a change.

4. Do you feel guilt, remorse or anxiety after drinking?

Maybe you drink more than you’d like to, do things you regret when you’re drunk, or struggle to remember what you’ve done at all. Post-drinking anxiety is a common enough phenomenon that it has a nickname: ‘hangxiety’. There’s actually a chemical cause for the feelings of dread many people wake with the morning after a heavy drinking session — as professor of neuropsychopharmacology David Nutt explained to Amy Fleming of The Guardian:

Alcohol, he says, targets the Gaba (gamma-aminobutyric acid) receptor, which sends chemical messages through the brain and central nervous system to inhibit the activity of nerve cells. Put simply, it calms the brain, reducing excitement by making fewer neurons fire. “Alcohol stimulates Gaba, which is why you get relaxed and cheerful when you drink,” explains Nutt.

The first two drinks lull you into a blissful Gaba-induced state of chill. When you get to the third or fourth drink, another brain-slackening effect kicks in: you start blocking glutamate, the main excitatory transmitter in the brain. “More glutamate means more anxiety,” says Nutt. “Less glutamate means less anxiety.”… 

The body registers this new imbalance in brain chemicals and attempts to put things right. It is a little like when you eat a lot of sweets and your body goes into insulin-producing overdrive to get the blood sugar levels down to normal; as soon as the sweets have been digested, all that insulin causes your blood sugar to crash. When you are drunk, your body goes on a mission to bring Gaba levels down to normal and turn glutamate back up. When you stop drinking, therefore, you end up with unnaturally low Gaba function and a spike in glutamate – a situation that leads to anxiety, says Nutt…

Alcohol also causes a small rise in noradrenaline – known as the fight-or-flight hormone. “Noradrenaline suppresses stress when you first take it, and increases it in withdrawal,” says Nutt. “Severe anxiety can be considered a surge of noradrenaline in the brain.”

These chemical changes can last for days, and even years if somebody becomes physically dependent on alcohol. If you’re beginning to feel more anxious more regularly after a drinking session, it may be a sign that your brain needs a break. 

5. Have you, or someone close to you been hurt because of your drinking?

Whether it’s physical or emotional harm that has been caused, it is a critical time to have a look at your drinking, the effect it is having and whether it’s time to make some changes. Be honest with yourself, but don’t self-flagellate. The most important thing is realising the harm and working to make sure things are different in the future. 

6. Has someone expressed concern about your drinking?

This could be a relative, friend or even coworker. If other people are noticing signs that your drinking may be a cause for concern, it might be time to take a closer look at what's going on. 

Nurses and midwives are positions of responsibility and that can mean that you’re under more scrutiny than the average person. If a peer or manager raises concerns about what’s going on, you might feel angry or embarrassed, but it’s important to try not to feel defensive. It’s likely that they’re acting out of concern for your welfare and the welfare of your patients, and have a vested interest in seeing you successfully get the situation under control. 

Whether the person approaches you about it kindly or not, this is an opportunity for you to assess how you’re feeling about your situation, and whether it might be time to reach out for support. 

Is drinking harm widespread?

Whether you’re facing a burgeoning problem or have developed an alcohol dependency, it’s important to know that you are not alone. Struggles with alcohol are an incredible common health issue for Australians. 

According to Professor Dan Lubman, the average Australian knows seven people struggling with addiction, but have no idea who they are. One in six Australians drink alcohol at harmful levels, putting them at risk of alcohol-related disease or injury, and one in five will develop an alcohol use disorder during their lifetime. Alcohol is also the most common substance that people need support with when contacting our service. 
 

Why don’t people seek support?

Alcohol dependency is a real health issue that is treatable with support, but the stigmatisation of problems related to substance use means that many people do not reach out for support. Prof Lubman points out that there is an average of a 20-year delay before people who are struggling reach out for support — but the path to recovery can grow more difficult the longer you hesitate. 

As a health professional, you no doubt understand the benefits of evidence-based treatment for health problems. Treatment and prevention of substance dependency is no different. If you wouldn’t delay getting a funny-looking mole checked out, it’s a good idea to get your niggling doubts about your relationship with alcohol checked out, even if it might feel like you’re overreacting. 
 

What should I do about it?

Start small and give Nurse & Midwife Support a call on 1800 667 877 to chat about how you’re feeling. The path to recovery — and what the destination even looks like — is different for everybody. They can offer you free, confidential support 24/7 and help you figure out what you might like your next steps to be, whether you want to cut down on drinking or stop altogether.

This blog was adapted for nurses and midwives from a piece that originally appeared on Counselling Online. Counselling Online is a free and confidential service that provides 24/7 support to people across Australia affected by alcohol or drug use. This service is funded by the federal government.

By Celeste Pinney, Nurse & Midwife Support Clinician

The Delta wave has left many of us feeling like we’re drowning in a soup of stress. Life as we know it, at least for now, has changed quite dramatically.  Stress is now the norm for many and stress, as unavoidable as it sometimes is, can have far-reaching and deleterious impacts on our emotional, physical, and mental wellbeing, especially if sustained and not managed well.

There are many evidence-based strategies we can use to buffer the impacts of stress. Examples include: 

• exercise
• limiting alcohol to safe levels
• good sleep hygiene 
• mind body practices such as meditation and 
• staying socially connected. 

As health practitioners, most of us know this, but when we’re struggling it can be hard to ground ourselves and we might instead turn to harmful coping strategies. Right now many of us are working long shifts wearing PPE, with too many patients and not enough staff. When we leave work we’re still struggling with lockdown fatigue and the fear of contracting COVID. In these circumstances the task of caring for oneself and implementing self-care practises may feel like an insurmountable task. 

In times of heightened stress, it can be tempting to reach for the quick fix stress reliever. We might find one glass of wine turning into two, three, or more. As we build up our tolerance it can take more and more just to feel normal. It turns into an unhelpful cycle of alcohol use that ends up just exacerbating our distress. 

Here are some suggestions to avoid that cycle and find simple and easy ways to bring contentedness, joy, and ease into your lives in other ways.

Take control of your feelings

COVID-19 has reminded us that we don’t always have control over what happens in life. This can be frightening and confronting. It’s important to remind ourselves that while we can’t control what happens to us, we do have a say in how we respond to situations — it is, if you’ll forgive the pun, our response-ability. 

We can control our words and actions, how we hold ourselves, and how we decide to spend our free time. Managing the uncertainty in our lives is an important skill we can learn to develop. 

Research shows that we can make important contributions to our own happiness, even when facing adversity. In the paper Pursuing Happiness: The Architecture of Sustainable Change, psychologists Lyubomirsky, Sheldon and Schkade explored how happiness could be increased and sustained. They demonstrated that 50% of our happiness is determined by genetics, and another 10% is determined by circumstance. That leaves a 40% window for us to take intentional action towards improving our satisfaction in life. Building inner resources to cope with difficulties is a crucial life skill. The pandemic may just be a pertinent time to practice developing effective strategies.
 

Choose nourishing activities

It’s common for people who would like to make changes to their drinking or other substance use to report that they feel boredom and disengagement in addition to persistent anxiety. Introducing healthy hobbies and engaging activities is therefore an important tool to make change. 

Our largest cities are finally emerging from lockdown, but it will probably be a while before the full range of leisure activities are available to us. In the meantime, you’re probably looking for ways to pass the time — and some activities are better for your mental health than others.

Veg mindfully 

A Netflix or Instagram binge might sometimes feel irresistible, but research shows that overindulging in activities like watching TV or browsing on social media can damage our health. These kinds of activities can be very passive and often don’t help us learn new skills or hobbies. Whilst we get a quick hit of dopamine from these activities, it doesn’t really change our state of mind in a way our brains need to feel better in the long term. Many people end up feeling like they’ve wasted their time, and report feeling more anxious and depressed the more time they spend scrolling. 

If you reflect and feel you genuinely enjoy watching tv or the time you spend on TikTok, we’re not saying you should cut them out altogether — but try to be present and engage mindfully. For example, if you love TV mysteries, consider setting up a Crime Club with your friends and meeting monthly to discuss what you’ve watched. When you’re exhausted, that might sound like a lot of effort, but in the long run increasing your engagement will increase your energy. 

The neuropsychology of ‘flow’ 

Creative, engaging activities are more likely to put us in a state known as ‘flow’, which induces a feeling of being completely absorbed in the present moment. We can probably all relate to having this experience this at some stage in our lives, even if only briefly — and how wonderful it can feel. 

Mihaly Csikszentmihalyi began researching flow states in the 1970s and discovered that it wasn’t the absence of stress or challenge that generated life satisfaction, but absorbed focus on meaningful activity. He observed: 

“The best moments in our lives are not the passive, receptive, relaxing times . . . The best moments usually occur if a person’s body or mind is stretched to its limits in a voluntary effort to accomplish something difficult and worthwhile.”

Steven Kotler, Executive Director of the Flow Research Collective suggests that when in a flow state, our brain waves transition from the faster-moving beta waves to the borderline between the slower alpha and theta waves. This neurobiological activity promotes creativity. Kotler also observes that when in flow, “dorsolateral prefrontal cortex—the part of the brain charged with self-monitoring and impulse control—goes quiet. The DLPFC is our inner critic, that voice of doubt and disparagement.” 

Positive psychology research backs up the suggestion that spending time on creative goals leads to improved experiences of mental health and is associated with feelings of joy, happiness, and optimism. Being creative can be a wellness solution. Alongside healthy eating, exercise, and sleep, including some form of creative activity in your life can be a potent mind body approach that you can add to your toolkit.

Activities for growth 

So if activities designed for zoning out can be harmful, what kind of activities are good for us? 

The authors of Increasing happiness in the general population: Empirically supported self-help suggest that some activities can help calm and soothe our nervous systems. Based on research, they identified three key criteria for beneficial activities: 

• meaning 
• engagement and enjoyment
• ability to persevere. 

Activities that meet these criteria are more likely to create a lasting change in life satisfaction. 

So what are those activities? It’s different for everyone! Some ideas are: 

• arts and crafts
  • pottery
  • playing a musical instrument
  • woodwork
  • sewing
• gardening
• cooking
• writing
• brainteasers
  • jigsaw puzzles
  • crosswords 
• sports and other movement-based activities
  • dance
  • martial arts
  • yoga

 
They key is to be creative, and the job is enjoyment!  

Identify the barriers to creative enjoyment 

If you don’t usually partake in the kind of structured leisure time activities like those we’ve suggested, have a think about why. If none of them sound engaging to you, that’s fine — think about identifying something that does. 

If they do sound engaging, but you just never get around to doing them, why? Have a think about what stops you and what you could do to overcome that. For example:

• If you want to try ceramics but lack the expertise, sign up for a class. 
• If you enjoy painting but never do it because you can’t face the mess of setting up (and cleaning up after), consider investing in an iPad and Apple Pencil. 
• If you’d like to write but never seem to find the ‘right’ time, give yourself some structure — set up a dedicated time a couple of times a week, or join a creative writing group online or in your local community. If you’re not sure where to find one, your local library can probably help. 
• If you never go to dance class because you’d rather spend time with your family, think about having family dance night. 

If you’re not sure what sounds fun to you — try everything! Exploring what you find enjoyable is a worthy pursuit all on its own. Ask your friends and family to help you find a new hobby. The added benefit of this is that social connection has been shown solidly in the research to improve all facets of health, including reducing rates of depression and anxiety, strengthening our immune system, and even increasing our longevity.

Create change

Finding new ways to spend might mean changing habits that no longer serve us. I’ve previously written about habit change and how to go about finding ways to create new and more positive habits. You can also check out our podcast episode on the importance of self-care. 

It may feel strange to replace alcohol with an alternative destress activity you haven’t previously explored, but the benefits to your mental and emotional health are worth it!

As you work on making change, it’s important not to denigrate yourself for the aspects of your life you’re not happy with. If you want to cut down on alcohol or drug use, that’s a beneficial goal, but it’s important to remember that struggling does not reflect on your worth, strength, or capability. Be kind to yourself and understand that you’ve been handling the stress, anxiety or even trauma you’ve been experiencing as well as you can, but it’s not working and it is time to try something new. 

Research to understand alcohol use in our workforce

Research shows that affected communities are drinking more alcohol to deal with the stress of the COVID-19 pandemic. It seems inevitable that would also apply to the busy medical professionals who are often struggling to keep up with the demand on the medical system. That’s why Dr Adam Searby believes that there is an urgent need to collect more data about nurses’ alcohol consumption and devise strategies to address any issues. 

Dr Searby has invited nurses and midwives to take part in his research study, the Booze-Less Drinking Game survey. The survey will provide an overview of alcohol consumption among Australian nurses. The survey is no longer recruiting participants, but keep an eye out for results! 

Seek support

If you’d like to chat to somebody about what you’re experiencing, we’re always here for you — free, confidential, 24/7 — call us on 1800 667 877, or email us. 

We know nurses and midwives can be concerned that Ahpra will be notified if they seek health for substance use, but we would only need to make a mandatory notification if a nurse or midwife was placing the public at substantial risk of harm by practising with an impairment. Not all impairments need to be reported. A nurse or midwife may have an impairment that causes a detrimental impact on their capacity to practise but, unless it poses a substantial risk of harm to patients, it does not trigger a mandatory notification.

By NMS Podcast

Listen to Episode 30

Podcast details

Episode: 30
Guest: Dr Adam Searby
Duration: 40:17
Tags: Substance use disorder, addiction, drugs, alcohol, mental health
Soundcloud: Listen to Episode 30

Introduction

For many nurses and midwives, talking about problems related to substance use can be challenging, anxiety provoking and evoke complex feelings including fear, shame, and stigma. Many do not know where to start to access support.

We thought you may need a helping hand if you are struggling with this issue yourself or supporting someone who is struggling. 

On this episode of the Your Health Matters podcast we speak to Registered Nurse Dr Adam Searby, lecturer at the School of Nursing and Midwifery, Faculty of Health, Deakin University and president of Drug and Alcohol Nurses of Australasia (DANA).

We discuss the complexity of substance dependency, its impact on nurses and midwives and the range of emotions it evokes. Adam outlines the key elements of the DANA position statement, Problematic Substance Use by Nurses and Midwives.

DANA believes that protection of the public from possible harm and protection of the profession from disrepute, resulting from a nurse or midwife misusing substances is paramount in addressing this issue. Prevention, early recognition, and intervention, along with effective treatment programs, are essential.

We discuss the research project Adam is leading and encourage nurses and midwives to participate: Alcohol Consumption in Australian Nurses: An Action-Design Study.

The research does not set out to demonise the practice of social drinking among nurses and midwives but to understand the impact of stress on the alcohol use of nurses and midwives. The preliminary data indicates a link between the increasing work stress particularly caused by the COVID-10 pandemic and alcohol consumption. 

Adam encourages any nurse, midwife or student dealing with problematic substance use to get help early and shares the inspirational story of Rachel Shuster, a nurse in recovery who shares her story on the podcast Health Professionals in Recovery Episode 3: Hold on to That Last Glimmer of Hope. Check out the episode here. Rachel will leave you with hope and encouragement that recovery is possible.

We also discuss the research of Marea Topp, a New Zealand nurse who completed her PhD on New Zealand nurses’ altered work performance because of problematic substance use and the risk of working with a hangover on quality of care and safety. Check out her thesis, New Zealand Nurses’ Alcohol and Other Drug Use. 

We hope the podcast encourages you to access support if you are dealing with problems related to substance use. If you’d like to talk, take a minute to reach out for support — give Nurse & Midwife Support a call on 1800 667 877.

Your health really does matter!

Mark Aitken RN
Stakeholder Engagement Manager
Nurse & Midwife Support

About our guest

Dr Adam Searby
Lecturer, School of Nursing & Midwifery, Faculty of Health
President, Drug and Alcohol Nurses of Australasia (DANA)
Dr Adam Searby has worked in clinically in mental health and alcohol and other drug (AOD) settings, and is currently a lecturer at Deakin University in Melbourne. Adam has completed research into the alcohol and other drug nursing workforce in Australia and New Zealand, including the challenges faced during the COVID-19 pandemic. He has recently commenced work on a project examining alcohol consumption among Australian nurses. Adam is the current president of the Drug and Alcohol Nurses of Australasia (DANA), a board member of both the Australian Alcohol and other Drugs Council (AADC) and the Australasian Professional Society on Alcohol and Drugs (APSAD), and a working group member of the National Centre for Clinical Research on Emerging Drugs (NCCRED).

Listen to Episode 30: Support for nurses and midwives struggling with substances with Dr Adam Searby