Conversation with LeClair Bissell.
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Biomedical subjects
Publications and source records attributed to L Bissell.
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To evaluate the effect on physicians and nurses of being closely involved with one or more chemical dependent persons, a sample of 67 physicians and 133 nurses with chemical dependent significant others was surveyed. The majority reported that the quality of their work was adversely affected by this association. Reduced ability to concentrate, absenteeism, errors, poor judgment, and patient neglect were reported. Most reported their professional education had not prepared them to recognize and assist people with chemical dependence and half thought their professional education negatively influenced their ability to help. About half had attempted to treat the chemical dependent person(s) themselves, sometimes giving medication and occasionally diverting drugs for this purpose. Most said their self-esteem and self-confidence were damaged by these relationships. Over one-third reported being diagnosed as depressed and 12% had attempted suicide. There were few differences between physicians and nurses on the effects of being in a co-dependent relationship(s), although nurses and women were more likely to have chemically dependent parents. Implications for professional education are identified.
A survey of 300 U.S. nurses recovering from alcohol and other drug dependency was conducted to describe the effect of drug use on job performance and related disciplinary actions. Subjects reported experimentation with or dependence on a variety of drug categories. Many visible effects on job performance were reported but only 23% reported disciplinary action against their nursing licenses. Females and older nurses were more often dependent on alcohol, while younger nurses and males reported narcotic dependency with greater frequency. Narcotic use was significantly related to disciplinary action.
An interview study of 86 pharmacists recovering from alcohol or other drug addiction was conducted to describe their experiences during development of and recovery from the addiction. Patterned after similar studies of other recovering health-care professionals, the study permitted comparisons with these other groups. Many felt inadequately prepared to recognize or deal with warning signs of problems of addiction in themselves or others. Forty-four had been arrested; 45 had experienced unemployment because of drinking or other drug use; 16 lost their licenses. Eighteen reported suicide attempts, 13 by drug overdose. Most reported experiences that are regarded as late-stage events, although 50 had never been subject to board action because of their drinking and other drug use. The use of chemicals interfered with the pharmacists' lives long before they were consciously worried about it. For 18, recovery occurred through the assistance of mutual-help groups alone; others had a variety of treatment experiences. Fewer pharmacists reported addiction to only alcohol than did other health-care professionals. Very few reported addiction to parenteral drugs, a significant deviation from the other groups studied. Pharmacists differed from other groups also in that they were extra scrupulous in reporting acts of dishonesty associated with their addiction, which may make their behavior appear worse than that of the other groups when the opposite may be the case. The profession must begin to answer questions about how recovering pharmacists should be treated, and what the role of professional groups in their recovery is.
To examine the patterns of diagnosis, referral, and help-seeking behaviors of alcoholic women physicians, 95 women physicians and five women medical students were interviewed. Both groups were self-described alcoholics and members of Alcoholics Anonymous and were abstinent from alcohol for at least one year. Subjects participated in one-hour interviews with a recovered alcoholic professional woman. Addictions to drugs other than alcohol were common, with only 40% reporting addiction to alcohol alone. Seventy-three reported serious suicidal ideation prior to sobriety, 26 after the drinking ended. Thirty-eight had made overt suicide attempts, 15 more than once. The presence of alcoholics in the nuclear family and marital instability were common. Treatment experiences varied from none other than Alcoholics Anonymous (21%) to long-term residential treatment of 15 weeks or more per episode (23%). Most had reached treatment through circumstances other than referral by therapists or intervention by impaired-physician committees. Their current procedures should be evaluated with the particular needs of women in mind.
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Members of the American Medical Society on Alcoholism were studied to shed light on medical manpower needs in the alcoholism field. Findings were compared to AMA and federal survey data for all American physicians. AMSA respondents were broadly distributed among specialties: primarily psychiatrists, internists, and family practitioners. They were evenly divided between office-based and institutional practice, and most were on medical school faculties. Regarding alcoholism treatment, they generally agreed that Alcoholics Anonymous is necessary and that nonmedical counsellors are effective, although their attitudes on the etiology of alcoholism were divided. This sample of physicians in alcoholism, although not inclusive of all in the field, represents a diverse group, with differing clinical and educational needs.
Alcoholism flourishes in the community occupying single room occupancy (SRO) dwellings on Manhattan's west side. Individuals in this setting have few social resources and by reason of background and deprivation are inhibited from seeking help for their alcoholism. Consequently a direct in-person outreach approach is required in order to effect treatment. The milieu is rife with physical and psychological threats to occupants. These present unique challenges to the community alcoholism counselor who, as a member of an interdisciplinary community mental health treatment team, seeks to intervene. Counselor is viewed by client as an intruder in the environment. Breaking the isolation in which the client is immersed and developing a bond with him becomes the most immediate and most difficult of the several tasks facing the counselor.
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This paper presents data on 50 alcoholic social workers who had successfully stopped drinking for one year or more. In spite of the fact that these social workers were in many cases visibly in trouble with 63 arrests, 120 inpatient admissions, 13 suicide attempts, and a high reported incidence of addiction to other drugs, they found that collaegues and superiors as well as professionals from whom they sought individual treatment were extremely reluctant to confront the alcoholism problem directly. The authors urge social workers to consider ways of offering help to colleagues in a more systematic manner than is currently available.
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The authors suggest that the misunderstanding by many social workers of the particular values of Alcoholics Anonymous and the skills of alcoholism counselors can involve alcoholic patients themselves in the stress of reconciling different approaches to treatment. They call upon all who treat alcoholics to build mutual trust and cooperation on two assumptions basic to all forms of treatment-that alcoholism is a disease and abstinence is essential to recovery.
The authors conducted interviews with 98 recovered alcoholic physicians, all of whom had been entirely abstinent for a minimum of one calendar year. Psychiatry was the only specialty clearly overrepresented. A disproportionate number of subjects reported high standing in their medical school classes. Nearly half of the sample had experienced difficulty with drugs other than alcohol. While legal sanctions and admission to health care and correctional institutions were common among this group, relatively little formal response of a disciplinary nature from colleagues or medical organizations was reported.
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