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.

  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We compared fitness-for-duty assessment findings of physicians who subsequently engaged in suicidal behavior and those who did not.
    General Hospital Psychiatry 11/2014; 36(6). DOI:10.1016/j.genhosppsych.2014.06.008 · 2.90 Impact Factor
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct. Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001-2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search. Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10-0.47, P<.001; mental health, %: OR=0.14, 95% CI=0.06-0.31, P<.001; sexual boundaries, %: OR=0.27, 95% CI=0.13-0.58, P=.001]. The number of referrals to evaluate physicians presenting with behavior alleged to be disruptive to clinical care increased following the 2008 Joint Commission guidelines that extended responsibility for professional conduct outside the profession itself to the institutions wherein physicians work. Better strategies to identify and manage disruptive physician behavior may allow those physicians to return to practice safely in the workplace.
    General hospital psychiatry 07/2013; 35(6). DOI:10.1016/j.genhosppsych.2013.06.009 · 2.90 Impact Factor
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to the public, yet they are often reluctant to seek help. To review literature regarding risk factors and potential barriers to help-seeking unique to doctors; to consider the success of interventions by specialist services for doctors. Key phrases regarding the 'mental health of doctors' were entered into internet searches and journal databases to identify relevant research. When key authors were identified, author-specific searches were carried out. There are contradictory reports about the prevalence of mental ill health in doctors but it is generally agreed that doctors face a large number of risk factors, both occupational and individual; and help-seeking is difficult due to complexities surrounding a doctor becoming a patient. Specialist services developed specifically for interventions for doctors with mental health problems tend to show promising results but further research is needed. The unique and complex situation of a doctor becoming a patient benefits from specialist services; such services should focus on early intervention and raising awareness.
    Journal of Mental Health 04/2011; 20(2):146-56. DOI:10.3109/09638237.2010.541300 · 1.01 Impact Factor
Show more


Available from