Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States

Treatment Research Institute, 600 Public Ledger Building, 150 S Independence Mall, Philadelphia, PA 19106, USA.
BMJ (online) (Impact Factor: 17.45). 02/2008; 337(nov04 1):a2038. DOI: 10.1136/bmj.a2038
Source: PubMed

ABSTRACT To evaluate the effectiveness of US state physician health programmes in treating physicians with substance use disorders.
Five year, longitudinal, cohort study.
Purposive sample of 16 state physician health programmes in the United States.
904 physicians consecutively admitted to one of the 16 programmes from September 1995 to September 2001.
Completion of the programme, continued alcohol and drug misuse (regular urine tests), and occupational status at five years.
155 of 802 physicians (19.3%) with known outcomes failed the programme, usually early during treatment. Of the 647 (80.7%) who completed treatment and resumed practice under supervision and monitoring, alcohol or drug misuse was detected by urine testing in 126 (19%) over five years; 33 (26%) of these had a repeat positive test result. At five year follow-up, 631 (78.7%) physicians were licensed and working, 87 (10.8%) had their licences revoked, 28 (3.5%) had retired, 30 (3.7%) had died, and 26 (3.2%) had unknown status.
About three quarters of US physicians with substance use disorders managed in this subset of physician health programmes had favourable outcomes at five years. Such programmes seem to provide an appropriate combination of treatment, support, and sanctions to manage addiction among physicians effectively.

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    • "Knowledge about and access to effective suicide methods may explain the higher rates among doctors [3]. Although there is now evidence [4] [5] [6] [7] [8] that appropriate treatment for substance use disorders in physicians often results in return to safe and successful practice, little data exist on the identification of physicians at risk for suicide. "
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    ABSTRACT: Objective: We compared fitness-for-duty assessment findings of physicians who subsequently engaged in suicidal behavior and those who did not. Method: Assessments of 141 physicians evaluated at the Vanderbilt Comprehensive Assessment Program were retrospectively compared between those who later either attempted (n = 2) or completed (n = 5) suicide versus the remainder of the sample. Results: Subsequent suicidal behaviors were associated with being found unfit to practice (86% vs. 31%, P < .05), being in solo practice (71% vs. 33%) and chronically using benzodiazepines (57% vs. 11%, Fisher's Exact Test, P < .05). Conclusion: Being found unfit for practice may trigger a cascade of adverse social and financial consequences. Those engaged in solo practice may be particularly vulnerable due to isolation and lack of oversight by supportive colleagues. Finally, chronic benzodiazepine use may impair resilience due to associated brain dysfunction. Although these characteristics must be investigated prospectively, our observations suggest that they may be important signals of increased risk for suicidal behavior in physicians. The intense stress associated with medical practice and the relatively high rates of suicidal behavior among physicians make it important to be able to identify physicians who are at risk, so that appropriate preventive actions can be taken.
    General Hospital Psychiatry 11/2014; 36(6). DOI:10.1016/j.genhosppsych.2014.06.008 · 2.61 Impact Factor
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    • "The largest evaluation conducted to date regarding the effectiveness of this intensive and extended continuing care treatment approach involved a 5-year retrospective, intent-to-treat analysis of 904 physicians consecutively admitted to 16 state-level PHPs [84, 85]. Nearly all (88%) of the patients met diagnostic criteria for substance dependence and the remaining patients met criteria for substance abuse. "
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    ABSTRACT: There is little disagreement in the substance use treatment literature regarding the conceptualization of substance dependence as a cyclic, chronic condition consisting of alternating episodes of treatment and subsequent relapse. Likewise, substance use treatment efforts are increasingly being contextualized within a similar disease management framework, much like that of other chronic medical conditions (diabetes, hypertension, etc.). As such, substance use treatment has generally been viewed as a process comprised of two phases. Theoretically, the incorporation of some form of lower intensity continuing care services delivered in the context of outpatient treatment after the primary treatment phase (e.g., residential) appears to be a likely requisite if all stakeholders aspire to successful long-term clinical outcomes. Thus, the overarching objective of any continuing care model should be to sustain treatment gains attained in the primary phase in an effort to ultimately prevent relapse. Given the extant treatment literature clearly supports the contention that treatment is superior to no treatment, and longer lengths of stay is associated with a variety of positive outcomes, the more prudent question appears to be not whether treatment works, but rather what are the specific programmatic elements (e.g., duration, intensity) that comprise an adequate continuing care model. Generally speaking, it appears that the duration of continuing care should extend for a minimum of 3 to 6 months. However, continuing care over a protracted period of up to 12 months appears to be essential if a reasonable expectation of robust recovery is desired. Limitations of prior work and implications for routine clinical practice are also discussed.
    03/2014; 2014(3):692423. DOI:10.1155/2014/692423
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    • "More importantly, it has been reported that several specialties appear to have a higher than expected rate of SUD.1,4,5 Anesthesiology, emergency medicine, and psychiatry are the 3 specialties most commonly reported as being over-represented. In the most recent AAMC manpower survey, emergency medicine accounted for 2.9% of physicians,6 whereas, reports in the literature suggest that EPs (EP) account for 7% to 18% of physicians treated for SUD and managed by Physician Health Programs (PHPs).4,5,7 Despite their reported higher rates of SUD and participation in PHPs, there are no published data focusing specifically on the prognosis and recovery of EPs in these programs. "
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    ABSTRACT: Introduction: Emergency physicians (EPs) are reported to have a higher rate of substance use disorder (SUD) than most specialties, although little is known about their prognosis. We examined the outcomes of emergency physician compared to other physicians in the treatment of substance use disorders in Physician Health Programs (PHP). Methods: This study used the dataset from a 5-year, longitudinal, cohort study involving 904 physicians with diagnoses of SUD consecutively admitted to one of 16 state PHPs between 1995 and 2001. We compared 56 EPs to 724 other physicians. Main outcome variables were rates of relapse, successful completion of monitoring, and return to clinical practice. Results: EPs had a higher than expected rate of SUD (odds ratio [OR] 2.7 confidence interval [CI]: 2.1–3.5, p<0.001). Half of each group (49% of EPs and 50% of the others) enrolled in a PHP due to alcohol-related problems. Over a third of each group (38% of EPs and 34% of the others) enrolled due to opioid use. During monitoring by the PHPs, 13% of EPs had at least one positive drug test compared to 22% of the other physicians; however, this difference was not significant (p=0.13). At the end of the 5-year follow-up period, 71% of EPs and 64% of other physicians had completed their contracts and were no longer required to be monitored (OR 1.4 [CI: 0.8-2.6], p = 0.31). The study found that the proportion of EPs (84%) continuing their medical practice was generally as high as that of other physicians (72%) (OR 2.0 [CI: 1.0–4.1], p = 0.06). Conclusion: In the study EPs did very well in the PHPs with an 84% success rate in completion and return to clinical practice at 5 years. Of the 3 outcome variables measured, rates of relapse, successful completion of monitoring, and return to clinical practice, EPs had a high rate of success on all variables compared to the other physician cohort. These data support the conclusion that EM physicians do well following treatment of SUD with monitoring in PHPs and generally return to the practice of emergency medicine.
    The western journal of emergency medicine 02/2014; 15(1):20-5. DOI:10.5811/westjem.2013.7.17871
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