It is known that working with certain groups of patients is an additional psycho-traumatic factor for doctors. These patients include the elderly, the chronically or terminally ill, patients requiring intensive care, and newborns. The mentally ill and psychoactive substance users deserve special attention; they are often patients with aggressive and threatening behavior, which becomes a hard test for doctors-specialists. The clinical picture of emotional burnout is manifested in the form of growing indifference toward one’s own duties, what is going on at work, and dehumanization in the form of growing negativism towards patients or clients. Burnout in narcology specialists is acute since this occupation implies intense psychological work. The consequences of professional demotivation and depersonalization are intensified under the influence of COVID-19 and its accompanying conditions and require special measures for the psychological support of the staff.
The psychological status of psychiatrists-drug therapists, regardless of the length of work experience, is characterized by the presence of a negative communicative attitude of a high degree of severity. This attitude significantly exceeds the average index for doctors of other specialties due to a pronounced excess on the scale “Open cruelty”. At the same time, no significant difference was found on the “Veiled Cruelty” scale with the average indicators for narcologists. We emphasize that we are not talking about behavior but about psychological perceptions. Consequently, narcology psychiatrists make considerable efforts to disguise their negative attitudes, experiencing constant tension in the process.
The personality traits of the surveyed narcologists were studied using the Leongar-Da-Schmischek questionnaire and the Lazarus coping strategies technique. According to the results of clinical interviewing, 90 percent of the surveyed physicians did not hide their dissatisfaction with their work. This is especially related to the physician’s heavy workload and lack of opportunity for self-improvement due to lack of time and material disadvantages. This can be traced back to a high turnover rate of employed psychiatrists and especially narcologists.
Personal risk factors of emotional burnout syndrome formation include increased impulsiveness, weakening of control over urges and impulses, increased rigidity, the inertness of mental processes, and inability to suppress traumatic experiences. A doctor’s ability to solve a problem, logic, and consistency of appropriate action plans decrease the risk of emotional burnout syndrome formation, while increased self-control, accompanied by anxiety, predisposes to its formation.
The Influence of COVID-19
Nowadays, the phenomenon of stress and burnout is not a subject of psychological interest only. Various public opinion centers, business holdings, and scientific organizations conduct research on stress among many professionals, ages, and other groups. According to a 2019 study, it is known that the majority of Chicagoans (87 %) are familiar with stress, and nearly a third experience it on a regular basis. Most exhibit the effects of stress, such as anxiety and restlessness, fatigue, and sleep disturbances. These findings become highly relevant in the current context where the Covid-19 coronavirus pandemic that has engulfed many countries worldwide poses a potential threat to physical well-being.
Moreover, under quarantine and self-isolation, people have been exposed to a different spectrum of disadvantages. The latter include a lack of personal space, limitation of physical activity, fear of losing sources of income or really losing them, the need to optimize work processes for remote work, and anxiety for themselves and their loved ones. According to a study of Turkish scientists conducted in cities across the country, 52.7 percent of participants rated the psychological effects caused by the Covid-19 pandemic as moderate to severe (Nugraha, 2020). 18.6 percent reported moderate to severe symptoms of depression, 26.5 percent of respondents experienced moderate to severe anxiety, and 7.9 percent were under moderate to severe stress related to the pandemic (Nugraha, 2020). All outpatient narcology psychiatrists had significantly higher rates of emotional burnout syndrome than inpatient physicians.
This is caused by the specifics of the work of narcological dispensaries, where specialist doctors serve a large flow of patients. In Chicago, the level reaches 70 people per day, including preventive examinations (Fisher & Coates, 2022). In the realities of the outpatient department, there is a constant shifting of the attention of the addiction psychiatrist from one patient to another, which makes it very difficult for the physician to adapt to this work environment.
Pathogenic factors in inpatient psychiatrist-narcologists did not show a reliable correlation with the severity of emotional burnout syndrome. It is connected with the fact that the overwhelming number of specialists in the inpatient department are adapted to professional hazards. Statistics from other studies confirm that the rate of staff turnover in narcological inpatient departments since the beginning of the epidemic has increased to a lesser extent than the rate of staff turnover in outpatient departments.
It is known that narcology psychiatrists, in particular, cannot be ignored a special stressor: the danger to their health and their lives. It concerns, first of all, the threat and real danger in communication in cases of work with patients in a state of stupefaction or psychosis. The distinction of the next stressogenic factor, which is difficulties in unconditionally accepting communication, is that so far, at the pregraduate level, students are not sufficiently prepared to meet it (Fisher & Coates, 2022). Inability to communicate with patients in a state of narrowed consciousness, in intoxication, in psychosis, collision with the psychological manipulation of patients and their relatives, language and moral-ethical barriers not only complicate the doctor’s work but also are a basis for frustrations and frustrations – triggers of emotional burnout. The conducted analysis of the data of a large group of drug therapists in Chicago revealed that, in general, physicians are characterized by the presence of a high negative communicative attitude. Besides, irrespective of the length of work experience, addiction treatment counselors in Chicago demonstrate a tendency to show it in a latent, veiled form (Lovett et al., 2022). The attempted concretization of these provisions in terms of stages of professional formation of personality and stages of professional development showed that with the increasing length of practice, there is a tendency for the level of negative attitude to decrease.
However, the effects of the coronavirus have brought about significant changes in the psychological sphere of addiction specialists’ work. Improvements in perceptions of work with patients were neutralized by emergent life-threatening fears about the risk of infection. As with any contact work, the activity of a narcologist is connected with the danger of infectious diseases borne by patients. This factor has become particularly acute during the pandemic (Cureton et al., 2018). It is worth noting that this is reflected in the level of staff turnover. Whereas inpatient settings disposed to a safer epidemiological environment, outpatient narcology patients had good reason to fear infection.
The Perspective of COVID-19 in the Context of Burnout
The growth in the incidence of the disease leads to the need for a global restructuring of medical facilities in order to provide care for COVID-19 patients, with medical staff forced to work under conditions of extreme stress. For this reason, there was a 15% increase in voluntary resignations during the current year (Fisher & Coates, 2022). The burnout rate has also increased in the range of 10% in outpatient facilities, while inpatient facilities have seen an increase of 5% (Fisher & Coates, 2022). Low tolerance to organizational stress in both groups of drug treatment facilities can be another possible reason for such statistics. Difficulties in readjustment to the new regime due to the epidemiological regime aggravated the psychological discomfort of the work.
Besides, formalized contact with patients and a lack of emotional involvement may be a way of protecting oneself under extreme stress, physical fatigue, and emotional exhaustion, especially in pandemic conditions. It is the appreciation from patients and the support of management that should be taken into account as a helpful tool to reduce the rate of burnout (Fisher & Coates, 2022). An important factor in feeling one’s professional success was support from family, care, and recognition of the importance and difficulty of the health worker’s mission in the context of the pandemic.
Since the prospects for changes in the epidemiological situation are difficult to predict, on the basis of research statistics, the need for psychological support measures for narcologists becomes obvious. One of the key tasks is to increase the level of emotional regulation and the ability to recover from working stress caused by pandemic conditions (Baker, 2020). The latter can keep its effect for several next years. In order to improve burnout and turnover statistics, it is necessary to provide narcologists with an opportunity for psychological support.
Thus, the problematic situation with burnout among narcologists in Chicago was exacerbated by the aftermath of the pandemic. There are prospects of increasing the influence of COVID-19 on the demotivation of medical workers. Hence, doctors of similar profiles need to learn to adapt to the stressful conditions caused by the pandemic and other longer-term conditions. Only in this case will it be possible to make a positive prognosis about the reduction of burnout and staffing crisis in the field of narcology.
References
Baker, J. R. (2020). Pandemic 2020: A view from Chicago. The Journal of Foot and Ankle Surgery, 59(5), 880.
Cureton, J. L., Clemens, E. V., Henninger, J., & Couch, C. (2018). Pre-professional suicide training for counselors: results of a readiness assessment. International Journal of Mental Health and Addiction, 18(1), 27–40.
Fisher, T., & Coates, T. (2022). The emergency: A year of healing and heartbreak in a Chicago ER. One World.
Lovett, R. M., Opsasnick, L., Russell, A., Yoon, E., Weiner-Light, S., Serper, M., Cooper Bailey, S., & Wolf, M. S. (2022). Prevalence of anxiety and depressive symptoms and impact on self-management among adults with chronic conditions in Chicago, Illinois, USA, during the COVID-19 pandemic: a cross-sectional survey. BMJ Open, 12(1), 1–10.
Nugraha, D. Y. (2020). Psychological factors associated with quality of life during the coronavirus disease (COVID-19) pandemic: An analysis in context of employee. Journal of Advanced Research in Dynamical and Control Systems, 12(7), 826–844.