Nursing's Hippest Mod Squad

Witnessed any risky behaviors lately? Call for backup


By Margaret Christensen

Need reliable information about body piercing? Tattooing? Gambling? Internet addiction? Substance abuse? Rest easy. Northeastern’s Vice Squad has studied it all.

This self-named group of nursing professors is currently made up of three members: assistant professor Margaret Christensen, adjunct faculty member Lynn Babington, and former associate professor Carol Patsdaughter. Former assistant professor Kathleen Miller was previously on the squad as well.

Each of us has research interests in various types of addiction. We had discovered that nurses often find themselves ill-equipped to deal with patients whose “vices” cause them health problems. And so, over the past several years, working singly and together, we have produced about ten papers and given a dozen or so talks, to help health practitioners better understand and suggest treatments for potentially dangerous behaviors.

One of our first articles, which Christensen, Patsdaughter, and Miller wrote in 1998, dealt with heroin addiction. We realized that, although substance abuse had historically been treated within the realm of psychiatric nursing, healthcare providers in all settings needed to be knowledgeable about it.

So, responding to the rise in heroin use in the late 1990s, we wrote a paper discussing heroin addiction—in particular, overdoses and treatment—that was aimed at nurses working in hospitals, emergency rooms, and clinics.

We discussed the signs of overdose, such as low blood pressure, pinpoint pupils, drowsiness, slow breathing, and symptoms that might be construed as shock. (All overdose symptoms, in fact, might easily be mistaken for something else—trauma resulting from a car accident, for instance.) We reminded nurses to check for needle tracks. We also discussed a medication called Narcan, which blocks the action of heroin in the body yet doesn’t cause any adverse effects if there turns out to be no heroin in the patient’s system.

And we described withdrawal symptoms—sweatiness, chills, anxiousness—and listed medications that can help treat them, such as methadone and a new drug called LAAM.

We have also studied body piercing and tattooing, both by examining popular literature and by visiting piercing and tattooing shops in Rhode Island and Massachusetts. Christensen, Patsdaughter, and Miller coauthored a 1999 paper on these phenomena.

In 1998, when we first started studying body piercing and tattooing, they were unregulated. Since then, many states have improved health guidelines associated with these practices, regarding the certification of artists and sterilization equipment, for instance. Massachusetts legalized tattooing in February (body piercing has always been legal in the state), allowing the commonwealth’s Department of Public Health to begin regulating its practice.

Even with these improvements in regulation, however, nurses as well as the general public need to know about health problems that could result from piercing and tattooing, such as hepatitis, HIV, infection, and scarring.

During our research, we examined the literature, largely written by the piercers or tattoo artists themselves, which provided historical information as well as some insights into why people get piercings or tattoos.

We also spent time in a number of piercing and tattooing shops. We found the shop owners—who often sported shaved heads, full-body tattooing, and lots of piercings—to be extremely open and helpful. They let us watch their techniques (which were sterile) and said they thought our efforts to promote knowledge about piercing and tattooing were a good idea.

In our paper, we recommended how someone considering body art might decide which piercer or tattoo artist to use. We talked about complications that could result from piercing and tattooing, and gave tips on good aftercare. And we stressed how important it is for nurses—especially those who work with adolescents—to be knowledgeable about these subjects.

Gambling was another issue tackled by Christensen, Patsdaughter, and Babington in the late 1990s. At the time, gambling was increasingly being discussed as a potentially addictive behavior. News programs featured stories about people whose lives had been ruined by excessive gambling. There was evidence that pathological gamblers suffered withdrawal symptoms when they couldn’t practice the behavior.

We interviewed nurses, physicians, and social workers to determine their awareness of the issue. We found that while most knew about problem gambling, few screened for it in their practices. Their information about gambling addiction came largely from popular literature or the news. (Even today, problem gambling is seldom covered in college courses, even within the psychology and health fields.) We decided to study gambling within older-adult and minority populations, because these two groups were underrepresented in the existing research.

Many problem gamblers, at some point, have a big win, which they spend a lot of time trying to repeat. Some start gambling when they’re young; others don’t begin until they’re much older. Some gambling addicts have had another family member who gambled.

However a gambling problem starts, it tends to escalate. Obsessive gamblers may lose a lot of money, borrow from others, ignore their health, or sink into hopelessness.

Yet they keep gambling. At this point, the obsession is no longer about winning; it’s about playing the game. People in this phase describe feeling a sense of euphoria when they gamble. In fact, some research indicates that the act of gambling lights up pleasure zones in the brain, much like other addictions do.

Still, we are approaching our study of gambling with an open mind, because for some—particularly the elderly—gambling may actually improve one’s health by serving as a beneficial social outlet.

We suggest that when nurses discover stress-related symptoms in patients, they ask those patients whether they gamble, how often, and with what amounts of money. If nurses don’t ask, patients tend not to tell. We also remind nurses of the resources available to help problem gamblers, such as Gamblers Anonymous or the Massachusetts Council on Compulsive Gambling.

Finally, we have studied compulsive computer use, also known as Internet addiction disorder (IAD), pathological computer-use disorder, or just plain old computer addiction. Those displaying this behavior have been called “netaholics” or “webaholics.”

IAD can cause a variety of physical and psychological problems, such as lack of sleep, poor eating habits, physical inactivity, poor social relationships, even the “shakes” when the computer can’t be used.

Few research studies have been conducted on this form of addiction. Nor have the health effects of being online for hours or days at a time been thoroughly addressed. We decided to write about clinical experiences in this area and—even more important—about treatment.

We met several times with Dr. Maressa Hecht Orzack at McLean Hospital to discuss the case studies of IAD patients she had treated. Eventually, we decided to coauthor a paper with Dr. Orzack, which outlines the cases of several IAD patients, including an adolescent, a graduate student, a middle-aged man, and a middle-aged woman.

The 15-year-old boy used the computer as a substitute for socialization; his computer addiction began in elementary school with video games and progressed to quest games on the Internet. The graduate student spent more time chatting in chat rooms than writing his dissertation, to the point where his wife was ready to divorce him.

Both the 52-year-old male executive and the 42-year-old woman were involved in cyber affairs, putting their marriages in jeopardy. The executive went as far as arranging to meet his cyber girlfriend.

With Internet fixation, as with other addictions, health practitioners should look for particular symptoms. Patients may report severe fatigue, muscle pain in the shoulders or back, and general stress. Some may mention they spend a lot of time on the computer, which should be regarded as a strong clue.

Though the treatment of addiction sometimes requires abstinence, new approaches are beginning to recognize that, for some obsessions, decreasing the addictive behavior is often a more effective course.

With computer addiction in particular, it’s unrealistic to expect patients to avoid using computers altogether. So IAD treatment focuses instead on limiting the amount of time spent online and improving other areas in patients’ lives that may be driving the addictive behavior.

An addicted person’s readiness for change is key to a successful treatment. Individual or group therapy can be extremely helpful. Still, treating any type of addiction is a lifetime pursuit, and staying in recovery sometimes takes as much effort as kicking the habit.

Clearly, contemporary health issues change with the times. While there is much work to be done in the areas we have pursued, we want our research to underscore the fact that social trends have a significant impact on public health. The Vice Squad will continue to help health practitioners recognize and treat many different potentially dangerous behaviors.

Margaret Christensen is an assistant professor in the School of Nursing at Bouvé College of Health Sciences. In addition to her research on addictive behaviors, she studies behavior analysis and change in adults with chronic diseases.