Article

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: 16.38). 02/2008; 337: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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    • "McGovern et al. [26] (2001) described 108 behavioral assessments of physicians, with a comparable age range but fewer female and " nonwhite " physicians than in our sample, and found higher rates of substance use disorders (58% vs. 38%). The lower rate of substance use diagnoses in our physician sample may be related to advances in addiction management [27] [28] [29]. Expertise in the recognition and management of substance use disorders in Physician Health Programs is now more widely available. "
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    • "A contract between the PHP and patient is developed, and the patient's family, employers, colleagues and regulatory bodies are kept informed throughout (DuPont et al., 2009). A study examining 5- year outcomes for practitioners across 16 PHPs (McLellan et al., 2008) found that those who failed the programme (19.3%) usually did so early on. Of those who did complete treatment, over 80% had no positive urine tests for drugs or alcohol at the 5-year follow-up. "
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