What is substance use disorder, addiction, alcoholism chemical dependency, and what is the difference?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the terms addiction, alcoholism, chemical dependency, substance abuse, substance dependence, rather it refers to substance use disorders, which are defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual. Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.

Why is a Tennessee Dental Wellness Foundation (TDWF) Program necessary?

We expect a lot from our dental professionals – they are under constant pressure to perform and when caring for patients, there is no room for error. However, they are people, too. Like us, they can get stressed and burned out; they can suffer from mental or emotional illnesses, or fall victim to addictions or self-destructive behavior. When they do, like us, it can affect their careers and their families. But they are unique in that their illnesses and behaviors can impact the safety of others. The Wellness Foundation Program was created to help them get better even as it works to protect and safeguard patients. Tennessee’s regulatory and healthcare entities know the special needs dental professionals have and support the Wellness Foundation as it steps in to assist dental professions.

What problems does the TDWF address?

  • Substance Use Disorder – Alcohol or Drug Dependency
  • Disruptive Behavior
  • Boundary Issues
  • Psychiatric Disorders
  • Stress Issues
  • Cognitive Deficits

Who is the Wellness Foundation able to assist?

  • Dentist
  • Dental Students
  • Hygienist
  • Dental Assistants 

Why should I care?

Paragraph III.2.D, on page 6 of the ADA ‘Principles of Ethics and Code of Professional Conduct’, states:

  • It is unethical for a dentist to practice while abusing controlled substances, alcohol or other chemical agents which impair the ability to practice.
  • All dentists have an ethical obligation to urge chemically impaired colleagues to seek treatment.
  • Dentists with first-hand knowledge that a colleague is practicing dentistry when so impaired have an ethical responsibility to report such evidence to the professional assistance committee of a dental society.

In Tennessee, the professional assistance the Tennessee Dental Wellness Foundation (TDWF). “Reporting” a dentist, hygienist, and/or dental assistant to the TDWF is the first step in the road to recovery.

What is enabling, codependency, and al-anon?

People who live with a practicing alcoholic or addict are in a horribly difficult situation. Those folks have often tried numerous schemes to control the person’s drinking or using, all of which have ended in failure and frustration. As with the active addict, to acknowledge they have a problem that they’ve proven repeatedly they cannot solve is simply not possible for most people to accept.

Staff people, family members, and colleagues all have vested interests that are threatened by the presence of chemical dependency in a dentist. Staff might lose their jobs if the dentist loses his or her license. Family members’ financial security is on the line. Colleagues do not want the embarrassment of acknowledging there may be “one of them” in their profession. Those interests all fuel denial and enabling.

People around a chemically dependent person typically exhibit behaviors that work to maintain denial of the problem, resulting in perpetuation of the chemical dependency. For example, the spouse who calls the office to report the dentist has a touch of the flu to explain an absence due to a Monday morning hangover is just setting the stage for the next incident. The dentist is bailed out and need not face a consequence that could have helped gradually break through his or her wall of denial.  The spouse has “enabled” the dentist’s behavior.  Codependency can be defined as a type of dysfunctional helping relationship where one person supports or enables another person’s drug addiction, alcoholism, gambling addiction, poor mental health, immaturity, irresponsibility, or under-achievement.

As 12 step programs work well for recovering addicts and alcoholics, they work well for enablers and codependents. Groups such as Alanon and Alateen have tailored the 12 steps to the needs of codependents. Addictions counselors are also excellent resources for treatment of codependence. 

How do I know when a provider needs help?

If a provider you know is unable to perform their professional duties in a reasonable, safe manner consistent with professional standards, they could endanger patients. Warning signs can include increased absenteeism, subtle changes in behavior or appearance that may increase in severity over time; deteriorating job performance and progress notes; mood swings and personality changes; overreaction to situations that is out of character from the past.

Can I report someone anonymously?

Yes. Anyone can contact the TDWF with concern about a dental professional at 615.628.3200. We will take your information for our own purposes but if requested, we will honor your need for anonymity.

How does the program work?

The process usually starts with a phone call, during which a dentist or other healthcare provider with one of the above issues is identified. Once the problem is independently verified, normally the TDWF’s Director or a member of the Board of Directors conducts an interview (or an intervention) with them, and if needed, sends them to a licensed expert for evaluation of their problem. If treatment is recommended, the Wellness Foundation supports them during that time and following treatment, helps them with re-entry into their practice. During a contract period, which ranges according to the individual need, the Wellness Foundation helps with monitoring and accountability of their post-treatment care regimen, which can include therapy, support groups, random urine drug testing, on-the-job monitoring, and quarterly visits with the Director. The TDWF also offers support with any licensing, insurance or disciplinary issues during that time. At the end of the agreed contract period, the dentist or other dental profession is released from TDWF oversight, but the program remains available to assist with any further recovery issues.

How is the work of the TDWF funded?

A good portion of the program’s support comes from a grant from the State of Tennessee and donations from individual dental professionals, certain TDA districts have been helpful, providing education sometimes brings in donations, and individual donations by the general public. Your support is invaluable to us – please join with us in continuing to provide a lifeline for Tennessee dental health care professionals.

What is a Caduceus Group?

Caduceus is a specialized 12 Step type of meeting in which only health care professionals can attend.  There are a number of them all over the State and the discussions are confidential.  It is a place where the health care professional can come and meet with colleagues and discuss difficulties they may be experiencing and know the information will not be shared in public.  Feedback and advice and be freely given.

Is the TDWF a branch or an arm of the Tennessee Board of Dentistry?

No. The TDWF acts like a consultant to the Board, when asks. It also advocates before the Board for fellow dentists, dental hygienists, and dental assistants who may have had some difficulties but have been successfully treated.

Are all referrals to the TDWF reported to the Board?

No.  In fact, if referrals follow the TDWF’s recommendations the TDWF will advocate for the dental professional in front of the Board if advocacy is needed.

Does the Board of Dentistry ever refer dental professionals to the Wellness Foundation?

In fact, it is common for the Board of Dentistry to refer a dental professional to the TDWF, especially when the problem involves substance use disorder.