September 22 is National Online Recovery Day, a campaign that takes place during National Recovery Month to raise awareness for online treatment of substance abuse. Getting help online is an effective way to fight shame and stigma. It is also an effective tool in combating workplace burnout in the healthcare industry – a problem that is growing at an alarming rate.
When it comes to workplace wellness, too often we make the mistake of categorizing it as a feel-good initiative. However, the well-being of our workforce, and especially our healthcare workforce, shouldn’t be dictated by feelings. Instead, science should take the lead.
As U.S. Surgeon General Dr. Vivek Murthy pointed out earlier this year, burnout is currently the biggest threat to healthcare. Burnout is defined by the APA Dictionary of Psychology as, “physical, emotional or mental exhaustion, accompanied by decreased motivation, lowered performance and negative attitudes towards oneself and others.”
Already an issue among medical personnel prior to COVID-19, burnout rates skyrocketed during the global pandemic. Pre-pandemic, the National Academies of Medicine (NAM) reported burnout rates of 54 percent among nurses and physicians, and 60 percent among medical students and residents. Now, more than 50 percent of all public health workers report feeling the effects of mental health conditions including anxiety and depression. Nurses in particular are at risk for burnout, as evidenced by high turnover rates and attrition in their field.
Referencing this crisis, Dr. Murthy astutely pointed out, “The nation’s health depends on the well-being of our health workforce. Confronting the long-standing drivers of burnout among our health workers must be a top national priority.” After all, medical professionals are the frontline for the rest of the population’s wellbeing. How can they be expected to care for others when they are not cared for themselves?”
Given the critical role healthcare workers play in society, and the rising burnout rates among their ranks, workplace wellness – and specifically, addressing burnout, has to be a top priority. As such, it is an issue that must be addressed with science- using data and facts.
So how can science be applied to workplace burnout? Well, to understand that, let’s understand the impact of workplace burnout on the workforce. We know that the pandemic has been a major driver in burnout and the conditions under which medical professionals have been working since 2020 have been nothing short of traumatic. Trauma and burnout manifest in mental health conditions including anxiety and depression.
We also know that mental illnesses and substance use disorders (SUDs) often present together. In fact, studies indicate that 70 percent of people struggling with a SUD have a comorbid mental health problem. SAMHSA, the Substance Abuse and Mental Health Services Administration reports that 75 percent of people in SUD treatment have histories of abuse and trauma.
Sadly, SUDs are grossly misunderstood, especially in the workplace. Typically, people with SUDs are viewed as having a personal flaw, a weakness, even a moral failing. But more likely they are self-medicating – often for a mental illness. It may be big or small, internally, or externally generated, and it usually presents as anxiety and/or depression. Often, it is underlaid by trauma. So, they seek relief – much the way someone with a headache would seek out ibuprofen.
The Journal of Addiction Medicine underscored this behavior. According to a study the journal published, the top five reasons why physicians misused prescription medication are to manage physical pain, to manage emotional/psychiatric distress, to manage stressful situations, to serve recreational purposes, and to avoid withdrawal symptoms.” Among the study’s conclusions was that the “results emphasize the importance of self-medication as a leading reason for misusing prescription medications.”
The burnout/trauma/SUD connection plays out among nurses. At Lionrock, the leading all-telehealth SUD treatment company I run, 6 percent of the clients we treated in 2020 and 2021 told us that they were employed as nurses. For context, nurses represent just 2.4 percent of the U.S. workforce.
Understanding this connection is key in understanding the role of science in addressing workplace burnout. Elevated levels of stress, present in trauma situations, lead to elevated amounts of the hormone cortisol in the brain, altering immune systems, and increasing risk factors for anxiety, depression, digestive problems, headaches, memory impairment and more. Likewise, stress leads to lower levels of brain-derived neurotrophic factor (BDNF), also known as the protein, abrineurin. BDNF keeps neurons strong, helps regulate metabolism, and lowers the risk of depression and other mental health disorders, according to a December 2015 paper in Archives of Medical Science. It also aids in recovery from SUDs.
On the other hand, people with low BDNF levels may be more likely to have drinking problems or relapse from recovery according to a 2019 study that found associations between low BDNF, anxiety and binge drinking.
In order for wellness programs to actually work in combating burnout among medical professionals, we must address the underlying factors. Here’s how:
First, offer programs that combat decreased BDNF levels. Social isolation and loneliness, in particular, are known to lower levels of BDNF. Hospitals like Brigham and Women’s in Boston offer peer support programs where trained peers reach out to stressed colleagues in an effort to mitigate isolation and foster a culture of support.
Next, offer workplace wellness activities that increase BDNF levels. Exercising, meditating and outdoor activities all are known to support BDNF.
Third, offer high quality SUDs treatment benefits to your team and consider including telehealth options. SUDs tend to be chronic and require as much care (treatment and support meetings) as possible – especially during the first year. The convenience of telehealth can make staying in treatment longer more palatable.
Feel good programs are nice, but science-based programs are essential if we want to keep our frontline healthcare workers healthy.