Hello, everyone, my name is Bridget Petrillo. I'm a. My name is Jack stem and I am a former. We are going to present to you today, the effect of stigma and shame for anesthesia providers. I am an alcoholic and a drug addict. My name is Bridget. This is my story of hazard help, healing and hope. When I graduated from anesthesia school in 1995. I hadn't realized that substance use disorder was an occupational hazard for anesthesia professionals. During the lecture we received in school, I remember thinking. Why would anybody be so stupid and divert drugs to use on themselves? Why would anybody want to give themselves a general anesthetic? In my mind, I had formulated a shameful and stigmatizing attitude against people with substance use disorder. I silently judged the patients with alcoholism and addiction diseases as moral defects and as bad human beings. I believe they were responsible and deserved their misfortune. A few years after graduating, I was living my best life. A great income, close friends, a challenging and rewarding career. And a great dog to go on adventures with. I was also drinking in a way I have learned since called binge drinking on weekends, vacations, and sometimes during the week after work. There was always booze in my home, and I used alcohol as medication for emotional and physical pain. I had moments of blackouts, which I now understand are early signs of alcohol use disorder. On 1 of my frequent skiing trips, I injured my knee and needed surgery. The surgery went well, but because my life was slightly unmanageable, or as I called it, then I was busy doing important things. I went back to work 2 weeks earlier than recommended. When my pain script ran out, I asked for another. My surgeon made it clear there would not be a third. So I asked a friend doctor for a script, my third round of pills. You see, I didn't know it. I was already on my way from substance misuse to substance use disorder, also known as addiction. At work, the fentanyl left over or drawn up for a canceled case seemed such a waste to send down the drain. I convinced myself that I needed it for physical therapy. I was working hard at it, trying to get back into shape. Truthfully, I also needed the drugs to feel normal. It did not take long for the use to progress from wanting and enjoying the pain relief to absolutely needing it. Within a few months after surgery, I noticed physical withdrawal symptoms when I didn't have drugs to take. And I started to become aware that my life was being destroyed. No amount of willpower, self-hatred, shame, guilt, or wanting to quit was going to allow me to stop using drugs. And now using meant stealing. I worked many hours to increase my opportunity to obtain drugs that I needed to avoid withdrawal. What materialized for me was nothing short of a miracle. My friends, co-workers, and family noticed a change in behavior. I was suddenly unavailable, unreliable, sickly appearing, complaining, depressed, moody, and overall a mess. They collaborated with each other. They used the AANA resources, a local psychiatrist, and a local rehab center to execute an intervention at 5 o'clock in the morning on January 27th, 1999. Help had arrived, and ironically, I didn't want it. I didn't think I deserved it. I was so far into addiction, I couldn't see any way out except to end my life. My thinking had become hijacked. The miracle here is that I allowed myself to get in the car, go to the treatment facility, admit I had a problem, and to listen to what my co-workers said before they left me at rehab. Please keep an open mind while you are here, she said. And I did just that. The healing began in treatment. At first, the focus is on the physical. Allow the drugs to be metabolized in a safe environment. Detox. Once the physical healing is underway, the mental and spiritual healing can begin. Three square meals, fellowship, counseling, the 12 steps, time and quiet meditation, lectures, movies, written assignments, and essentially learning a new way of living. This healing continued during inpatient and intensive outpatient treatment. And the healing never ends for me as I continue to work the 12 steps of recovery and focus every day on spiritual, mental, and physical well-being. The day I was released from treatment, I stated I will never go back to giving anesthesia. I will never set foot in that hospital again. And I really meant it with all my heart. I did have hope for my future. I was starting to shed some of the shame and guilt, the selfishness and self-pity. Rehab had given me strength. Other local 12 step groups came in and shared their hope and encouragement with us. For the first time in a long time, I felt I had something to live for. And I did. Now I needed to clean up the wreckage of my past actions. I worked at first to get my RN and then my CRNA license reinstated. It was hard and seemed impossible. At three and a half years sober, I was granted a CRNA license. By then, I had started to really miss it. My counselor, lawyer, and support system encouraged me to work the steps and get back to giving anesthesia. I remember the call from my previous employer. He had heard that I had my licenses and was interviewing at other hospitals. He wanted to know if I would consider returning to work there. They missed me and they were sorry about what had happened. They'd made some changes in their diversion protocols and hoped that I would feel comfortable and safe there. This blew me away. My next step became clear. I returned to the head of the bed at the hospital where I hit my bottom. Two years after that return, I met the man who would become my husband. The OR staff had conspired to get us together. He was working as a surgical PA in the operating room. Meeting him enhanced my life greatly and I would have missed it had I been too fearful to walk into that treatment center or worse, dead. As I continue to reflect upon all the hardships and painful introspection, I know that all of it was worth it. When I think there is something wrong with the circumstances of my life, I must look inward to see what can be changed in me and my attitudes and then move forward with spiritual assistance. It took an open mind to get me to and through rehab and an open mind continues to help in the maintenance of my sobriety and in my ability to help others. God has allowed me to be of service wherever I've worked. My new family's journey over the past 18 years has brought us to California, Arizona, and currently Texas. In my travels, I have faced stigma from hospitals, potential employers, licensing boards for being a recovering drug addict. And I have been welcomed too. The stigma hits hard. I do my best to stand tall and gain insight. I use these events as opportunities for growth to educate others. I won't lie though. My latest encounter was rough and after all I've survived, I still experience shame and despondence. Over the past 25 years, I have met many CRNAs, SRNAs, MDs, in various stages of addiction and recovery. Many experiences are not unlike mine. They have a history of trauma, injury, exposure, and family history of SUD. They had created a life that had become unsustainable and used substances to dull the pain like I did. I can offer my story of hope and healing. Many of us do return to the head of bed safely and are, in my opinion, an asset to a department or hospital system. I stay motivated to make my sobriety my number one priority. I want the next recovering anesthesia professional to be given a second chance like I was. Recovery is possible. Addiction is a treatable disease. I didn't believe this myself 25 years ago. I thought my life was over that first day in treatment. The truth is, my life was about to begin and become something beyond my wildest dreams. Hi, my name is Jack Stem. And unlike Bridget, I did not return to the profession. And I'll explain why as I tell my story. I had multiple exposures to mood-altering substances from my sixth year of life. I had my tonsils taken out when I was six. So I know I received mood-altering substances then. I don't have a recall. However, a couple of years later, I broke my leg and had pain medication for that. Don't have a whole lot of recall about how I felt about the pain medicine. But at the age of nine, I was finally able to cut the grass all by myself. So I was very impressed and ended up having a grass allergy. My eyes swelled shut. Thought I was going blind. Our family doctor heard me in the background and said, I'm going to prescribe something for the swelling in the eyes and something to calm him down. So he called in Actifed with Cody. And I was nine. And I can remember to this day how terrible that tasted and how wonderful I felt. I can remember laying on the couch with the cold compress and Bugs Bunny on the TV. And I said, man, that tastes terrible. But dude, this is awesome. So clearly, I don't react the same as a lot of folks. Now, my brother and sister had taken the same medication. Couldn't stand it. Yeah. So as I went through my life, I played high school football and had some injuries. I had pain medication when I had injuries. And I remember taking them as prescribed. And I don't have any real recall that it was sensational. But as time goes on, I think we change physically as well as mentally and emotionally. When I graduated high school, I had my first drink of alcohol. Nobody else in my family was drinking at the time. And I'd waited until I was out of high school, unlike a lot of my classmates. I have never smoked marijuana in my life, never ingested it in any form. And when I tell my story at meetings, people can't believe that I've never tried marijuana. But such is life. I started working my freshman year in college in an emergency room because I knew I wanted to get in health care. And I injured my back one night trying to move a large patient. And they discovered I had spondylolisthesis. So off and on for the next 15 years or so, I would have back pain. And sometimes it was incapacitating. And I would get a prescription for opiates. And I would take them as prescribed and did OK. I eventually entered anesthesia and knew that I'd found the answer to life. That was a career that changed me. My confidence grew as a result of being a CRNA. And the program where I trained, they expected you to practice independently. So we had a very good training program. After I graduated, we moved back to Cincinnati. That's where my wife and our families lived there. And eventually, as time went on, we had our first child, Carrie. She was born unexpectedly a couple of days early. But things went well. And then over the years, my second daughter, Kimberly, came along and when she was born, I decided I need to move to a different hospital because I wasn't making enough money and hadn't gotten any raises. So, a friend of mine and I found a trauma and high risk OB hospital where I eventually worked myself into the chief CRNA and OB. So, I was at the peak of my career, would never take days off. We were short staffed. I worked a lot of overtime, making a lot of money, just right in the midst of everything. And then my spondylolisthesis got worse and I needed a prescription. And then I needed another prescription and then I needed another one. And what I didn't realize is that I was becoming dependent. When my family doctor would no longer prescribe more opiates, I went to a neurosurgeon and he gave me a couple of prescriptions and said, that's it. Your back's not that bad. I'm not writing anymore. So, then I started asking residents at the hospital to write me prescriptions. I knew that as soon as my back pain was better, I would stop. Well, I think the residents began talking amongst themselves and I couldn't get prescriptions from them anymore. And as Bridget had said in her story, the waste fentanyl made sense. Why squirt that down the drain if I could use it for pain relief? I'll stop as soon as my back is better. Well, I went from IM injections of fentanyl to IV injections of fentanyl to IV injections of sufentanyl. And my life sucked. I'd lost 50 pounds in five months. Nobody wanted to work with me anymore because I turned into this ogre. My wife knew something was wrong, but didn't know what. And I eventually got to the point where I was so miserable, the thought of dying made perfect sense. So, as I went into work one day, I decided I was going to commit suicide that day. I went into the OR, set everything up, drew up sufentanyl, what I thought would be enough to kill me, but I mixed it with succinylcholine to make sure I definitely died. And before I could inject the concoction, somebody interrupted me. They didn't know that they interrupted me. Gave me enough time to reconsider what I was doing. So, a couple of days later, my back had gotten so bad, I started to develop foot drop. They did an emergency laminectomy, which was successful, and I was off work for five months. I came back to work, wearing a back brace, going to work half days. Hadn't thought about using the whole time I was off. Set up for my first case, popped that first vial of sufentanyl, broke out into sweat, had major anxiety, thought I was going to vomit, and now I know what that was. That was a trigger. And now I can't stop thinking of using. So, I started my little stash again, and on Friday, the kids had swimming lessons, so I decided that would be the perfect time. They left, and I shot up and overdosed because my tolerance had dropped. Fortunately, my youngest daughter, who was four at the time, forgot her swimsuit, came in to get the suit, went back out to the car and said, Mommy, Daddy's a funny color. And my wife was a nurse. She came flying in the house, started CPR, and I woke up at my hospital in the ER, and they admitted me because they thought maybe I had an arrhythmia or a seizure. But the ER doc did a tox screen, which I knew was going to come back positive, and I said to my best friend at the time, I said, Bob, I'm addicted to fentanyl, and I cringed waiting for him to say something. And what he said shocked me. He said, oh, thank goodness. And I said, excuse me, what do you mean? He said, dude, we thought you had cancer or AIDS. And I thought, so you thought I had a fatal disease and didn't say anything? Wow. Well, I think they knew what was going on. They didn't know what to do, so they didn't do anything. So I went off to treatment, didn't buy into the program, came back to work way too soon, relapsed, got fired, used a lot at another hospital, almost got caught, quit, got another job, was going through a divorce. Things got really bad. I started using again and got fired because they caught me. At that point, I decided that I probably should not go back to anesthesia, and I knew the only way to prevent me from going back at some point was to not have a license, so I surrendered my license. Little did I realize that would keep me out of jail because a few weeks later, I got a registered letter from the prosecutor who said be in his office with or without representation. So I went in and we had our pretrial hearing, and I spoke to the judge and told him that I had surrendered my license and that I was moving on and my sponsor was there. Finally, he said if you're going to give up that kind of money, you must be serious about your recovery. So he gave me probation with the warning that if I relapsed, I'd go to prison, and I was looking at eight years. So I moved on with my life. I left the profession, and I never thought I would ever come back until one day I got an email from a student nurse anesthetist in Michigan. She said, we'd like you to come and talk about addiction in the anesthesia provider. I had no idea how she knew that I was in recovery, and I was going to delete the email, but I saw that they were going to pay me 500 bucks. So I said, yeah, I don't know anybody in Michigan. I'll go to Michigan. Went well. Somebody sent me another email and said, Purgeon, Michigan. Come to Boston. I don't know anybody in Boston. Lynn Reed was in Boston. Lynn Reed was a recovery room nurse when I was in training, and she went into anesthesia, and she was president of OSANA, the Ohio State Association. And she said, we need a peer advisor, and you're the man. And after a lot of debate, I decided I would take the position. And I've been doing the peer assistance in Ohio since 2005, was on the peer assistance panel since 2017. And as a result of the lectures that I have given and the research I have done, I ended up becoming a counselor. So now I'm a counselor as well as peer advisor here in Ohio. And what I didn't realize was every time I share my story, my shame and guilt became less and less. So, you know, the thing that we would like to get across to people is this is a disease. It's treatable. Recovery is possible. I'm not the smartest guy in the world, and I'm not the strongest guy in the world, and yet I got 29 years of recovery. So I'm a good example of if you work the program, you can do this. And that's what I try to share with all of my colleagues as well as any other clients that I have. Nowadays, I even have my face on a billboard talking about long-term recovery and how we can reintegrate into society. So I'm really grateful that I have this opportunity to share my story and look forward to continuing to help others who struggle with this disease. Stigma is discrimination against an identifiable group of people. Stigma about people with SUD might include inaccurate thoughts like they are dangerous, incapable of receiving treatment, or at fault for their condition. I was introduced to stigma in my very first interview for an RN position at one year sober. I needed to work as an RN without narcotic access before I could return to anesthesia. The nurse manager told me she was going to pay me the lowest possible hourly rate because I was in recovery from addiction. She was angry and disappointed, and she let me know. Stigma stems from the oftentimes unsavory behavior of people who are in active addiction and false beliefs. People in active addiction lie, cheat, and steal. They are unreliable at best. I was unreliable. They often end up in the hospital and need our care. They aren't always easy to care for either. I have witnessed unkind statements about people with SUD by their actual providers. I've heard them called dirtbags, dregs of society, cockroaches, and losers. The moral dilemma I am faced with is the idea that if they judge these patients so harshly, they will judge me in the same manner. When I keep quiet, I swallow the shame once again. I now speak out against this language as it perpetuates stereotypes and is harmful. Addiction is not a moral failing or a lifestyle choice. For the person with serious SUD, taking drugs or alcohol is no longer pleasurable, as witnessed by my story and Jack's story. At the end of my addiction, my drug use wasn't a choice. It was life or death to me, as necessary as breathing. Using was a means of diminishing cravings and the excruciating distress of withdrawal. The negative consequences did not lessen my desperation or detour my use. The unsavory behaviors stop once the treatment starts. Like other chronic and progressive diseases, daily treatment improves outcomes and multifaceted treatment leads to long-lasting recovery. Substance use disorder and mental illness thrive in the dark. They feed on shame, stigma, and isolation. My hope in sharing my personal story is to shine light on the disease and eliminate barriers to treatment. If I can find recovery, receive help, and hope to return to the head of the bed, anyone can. Lifelong recovery is possible. Dr. Adams was the Surgeon General for the United States, I think, back in 2017. And his quotes from his extensive report on opiate use disorder and other mental health issues talks about how stigma keeps people in isolation, in denial, and in fear. And I can verify that. I was afraid to ask for help for fear that I would lose my license, lose my family, go to jail. I was just so afraid, so I didn't say anything. Plus, when I worked in the emergency room and people came in, I was one of those people who said, if you loved your family, you'd stop doing this. And the sad thing is I realized at one point I loved my family and I couldn't stop using it, but I was still afraid to ask for help. So stigma kills people. It decreases funding for research. It limits the amount of treatments that insurance companies will pay out for, which just doesn't make sense to me. And one of the things that we're trying to do is change that viewpoint, that this is not a moral failing. The one thing that finally told me this was not moral failing was when I realized mice and rats and other animals can become addicted, and they don't pray to the wrong God, and they don't hang around the wrong mice, and they're not weak or stupid. So if those things are not true for them, it's not true for me either. I didn't ask for this. I was looking for pain relief. And because of circumstances and genetics and exposure, the disease developed. So this is a treatable disease. Recovery is possible. Long-term recovery is possible. And as I said, I'm proof of that. And it's because I deal with my disease every day. I work my program on a daily basis. So, yes, we're trying to change that, and that's what the Peer Assistance Panel is about. So we're hoping that people will become interested in this and become wellness ambassadors in their state where they can help others deal with this issue as well. Thank you, Jack. You continue to be a source of inspiration for me. You have no idea how much strength I gain from listening to your story. And you're an amazing and powerful example of how getting better works, recovery works. And you're amazing. I think we both are. Yeah. Yeah, we both are. Yep. And we just picked the path, you know, we were guided by some other spiritual entity to help others, which we know is really helpful to our own program. Yeah. And, you know, in speaking about getting help, I plug these helpline cards all the time. They are there when you need them. Also, the website is amazing. But this helpline, I will say one more time, even though it says it on the card, 24-7, live answer, confidential support. We're here. All you have to do is reach out. And believe me, we don't judge people. We've been there. So we're here for you. Yes. Thank you so much, Jack. And thank you, everyone, for watching and paying attention. And I hope that you can use this information as a wellness ambassador.

substance use disorders

anesthesia providers

stigma and shame

addiction recovery

treatment and support

counseling