Avoid Burnout

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There’s a high turnover in the field of addiction treatment. That’s not good, because people with the most experience leave the field for more attractive work environments. I’d like to offer some ways of avoiding undue stress that leads to burnout.

Before we get to stress, it’s important to talk about why there’s burnout in this field. Many people think it’s all from patient behaviors, but that’s not the only reason.

True, it’s not always easy to work with patients in treatment for drug addiction. Addiction can cause all sorts of behaviors that can interfere with treatment, and trigger anger on the part of treatment providers. In patients with addiction, old behaviors don’t disappear overnight, and we have no right to expect them to do so. For humans, change takes time.

Program administrators can cause stress for program workers. Administrators who aren’t familiar with what happens on the front lines of addiction treatment may make unworkable changes to how treatment is to be provided. As an example, I once worked for an opioid treatment program who instructed a nurse to operate three dosing windows at the same time, by herself, to reduce wait time for patients to dose. I am not making this up. Obviously this was unworkable and unwise, yet the nurse was required to “prove” the unworkability before this lame idea was discarded.

Addiction treatment providers don’t make a great deal of money. Addiction treatment professionals earn an average income of $38,000 per year, with a range of $24,000 to $60,000 per year depending on experience, credentials and treatment setting.

Counselors at OTPs have tremendous workloads. State and federal regulations say OTPS can have no more than fifty patients assigned to each counselor. Even within that limit, there’s not enough time to attend to all patient needs. And besides time spent with the patients, the time spent on documentation and paperwork is overwhelming.

In the past, addiction counselors tended to be in recovery themselves, with their personal experience as their only credential. Now there’s a push for the substance abuse treatment field to become more professionalized. The pressure to prove competency causes ever-increasing paperwork to pop up like mushrooms after a rain. And the documentation forms change all of the time. Just as workers get used to one form, it’s changed again.

To paraphrase Terri Moyers, a world-renowned addiction treatment professional, the substance abuse field is addicted to documentation and they are in denial.

OK, so there are stresses working in the field. Maybe the field will improve someday. Until then, here are some ideas about dealing with burnout:

1. Take care of your physical health. We tell patients to do this, but are we setting good examples? Eat right, go to the doctor for routine medical health screens, get to the dentist periodically, and get enough sleep. We all know what to do.
2. Have a life outside of work. This is big. I have to remind myself of this one frequently. Don’t let work become your whole identity. When you are at home, is your mind also at home, or are you thinking about a work situation? Try to keep your mind and your feet in the same place.
3. Have a creative outlet. Right now, I make pillow covers out of recycled leather. I love it; I enjoy the process of creating, and it’s fun to give them as gifts, too. This last Christmas, everyone on my gift list got a pillow or two. My house is filling up again with pillows, so they can expect more pillows this year. I’ve even started selling them on ETSY, a website that sells arts & crafts https://www.etsy.com/shop/OoolaLeather?ref=search_shop_redirect
In times past, I’ve made quilts. I seem to be drawn to the textile arts.
What is your artistic outlet? It could be something you’ve never considered as art: cooking, decorating your house, or making home renovations, or something else.
4. Don’t take things personally. We all have bad days, and another person’s nasty response to you may have nothing to do with you. Make allowance and let it roll off.
5. Don’t stuff your feelings, either. If there’s a situation at work that you don’t like, don’t wait until you explode in anger to say something about it. Go to your supervisor or other appropriate person and state your feelings about what’s going on. You’re more likely to be heard if you’re calm and logical and not spew-y.
6. Don’t have unrealistic expectations. Drug addicts use drugs. Expect this to happen during the treatment of the disease. Relapse is never OK, but if the patient is lucky enough to live through it, help them figure out why it happened so they can avoid a similar situation in the future.
7. Do some kind of aerobic exercise if your physical condition permits. Besides health benefits, exercise can make a huge difference in my ability to handle stress. It doesn’t have to be heavy exercise; even going for a walk can reduce stress.
After I broke my leg last spring, I couldn’t exercise like I was used to, and I really missed it. I felt much better after my leg healed enough to do some of my normal activities.
8. Nurture your spiritual health. This doesn’t necessarily mean participation in an organized religion, although for some people it may. For me, anything that connects me to other people and to the God of my understanding is spiritual. I feel better and more centered when I regularly make time for prayer and meditation. Obviously people find different things that nurture them spiritually.

Despite the stresses, many of us prefer to work in the field of addiction treatment, for various reasons. For those people, working in the field of addiction treatment is an avocation, not just a vocation.

For me, I love to see the positive changes in patients’ lives, and to feel like I had some small part in that. In this field when addicts find recovery it isn’t just their lives that improve; families and then communities benefit, too. I didn’t see that when I worked in primary care.

I have the best job in the world.

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5 responses to this post.

  1. Great post. Another observation: rehabs and addiction treatment programs often behave like addicted family systems. The programs often attract those in recovery or those who love them.

    Over time, without attention to the culture of the organization, the healthy folks leave, and this increases the illness density of the organization. This adds stress and dysfunction.

    Cf also here on the barriers to growth: http://www.rehabs.com/pro-talk-articles/why-rehabs-struggle-to-grow/

    Fantastic piece btw.

    Reply

    • You are so right!!
      I worked many years for a sick organization where new ideas were viewed as treason. Many talented people were fired or quit out of disgust.

      Reply

  2. Posted by Sharon Dembinski on March 8, 2015 at 6:07 pm

    Burn out is a real problem. Turnover negatively effects patient care. I know patients who have had as many as 5-6 Counselors in one year due to turnover.
    I do not believe the Feds call for a 50:1 or to counselor ratio. Some states regulate ratios but not the Feds.

    Reply

  3. Posted by William Taylor, MD on March 9, 2015 at 2:29 pm

    Thanks for a thoughtful and caring post. I would only add that OTP hours are a source of additional stress. My heroes are the counselors and nurses who get up at 3:30 AM day after day so the OTP can open at 5 AM.

    Reply

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