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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Co

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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

learn@organizationalwellness.com (2) Look for upcoming announcements

Organizational Wellness

@Orgwell

www.organizationalwellness.com