Combined Alcoholics Anonymous and professional care for addicted physicians
Department of Psychiatry, New York University School of Medicine, NY 10016. American Journal of Psychiatry
(Impact Factor: 12.3).
The authors studied 100 impaired physicians who were successfully treated in a program that combined professionally directed psychotherapeutic treatment and peer-led self-help. An average of 33.4 months after admission they all reported being abstinent and rated Alcoholics Anonymous (AA) as more important to their recovery than professionally directed modalities. Feelings of affiliativeness to AA, which were very high, were strong predictors of the respondents' perceived support for their recovery. These feelings, and an identification with the role of care giver in addiction treatment, appeared to be central to their recovery process.
Available from: Leonard A Jason
- "To summarize, studies indicate that both the receipt and provision of help within AA can aid in recovery. Receiving help from others in AA relates to abstinence (Sheeren, 1998), and this source of aid may be more important to recovery than the receipt of help from individuals not affiliated with AA (Carlson et al., 1994; Galanter et al., 1990). Moreover, it was reported that providing help to others may be just as useful in maintaining abstinence as the receipt of help (Galanter et al.). "
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ABSTRACT: Alcoholics Anonymous (AA) is the most commonly used program for substance abuse recovery and one of the few models to demonstrate positive abstinence outcomes. Although little is known regarding the underlying mechanisms that make this program effective, one frequently cited aspect is social support. In order to gain insight into the processes at work in AA, this paper reviewed 24 papers examining the relationship between AA and social network variables. Various types of social support were included in the review such as structural support, functional support, general support, alcohol-specific support, and recovery helping. Overall, this review found that AA involvement is related to a variety of positive qualitative and quantitative changes in social support networks. Although AA had the greatest impact on friend networks, it had less influence on networks consisting of family members or others. In addition, support from others in AA was found to be of great value to recovery, and individuals with harmful social networks supportive of drinking actually benefited the most from AA involvement. Furthermore, social support variables consistently mediated AA's impact on abstinence, suggesting that social support is a mechanism in the effectiveness of AA in promoting a sober lifestyle. Recommendations are made for future research and clinical practice.
Available from: dartmouth.edu
- "Questionnaire The instruments that comprised the questionnaire had been previously used in similar contexts, and appear to have adequate psychometric properties (Galanter et al. 1990, Carlson et al. 1994). The questionnaire typically took 30–60 minutes to complete. "
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ABSTRACT: The literature addressing substance use patterns among medical professionals suggests that specialty, gender, age, familial substance abuse, and access/familiarity with prescription drugs are associated with particular chemical dependencies. These studies have rarely compared nurses and physicians directly, thereby making if difficult to tailor interventions to the potentially unique needs of each group.
This paper reports a study to compare the initial clinical presentations, service utilization patterns, and post-treatment functioning of nurses and physicians who received services in an addiction treatment programme.
This exploratory study combined data collected through retrospective record reviews and prospective questionnaires. There were three types of dependent variables: initial clinical characteristics, treatment utilization patterns, and post-treatment functioning. The independent variable was membership of either professional group. Time both in treatment and between discharge and follow-up were covariates.
Nurses and physicians showed comparable results in most domains. Among the statistically significant differences between groups, a subset was particularly noteworthy. Prior to participating in the programme nurses showed significantly less personality disturbance than physicians, although they tended to work and live in environments with more triggers to relapse, such as other substance users. After the index hospitalization, nurses received less primary treatment, worked longer hours, and were more symptomatic than physicians. Furthermore, nurses reported more frequent and severe work-related sanctions as a consequence of their behavioural disorders.
In most areas of study, nurses and physicians demonstrated comparable results; however, a series of statistically significant differences suggest that these groups may have unique clinical needs. The policy implications of these findings are discussed.
Available from: alcalc.oxfordjournals.org
- "Other reports exclude from outcome evaluation those who fail to enter or complete programmes of treatment. In a report from New York University, a cohort of 550 doctors who had recently received treatment were approached to complete a research questionnaire (Galanter et al., 1990). Only 116 agreed and 16 were disqualified, leaving 100, which permitted the authors to claim an apparent 100% successful treatment. "
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ABSTRACT: This paper reports the long-term recovery rate among 100 alcoholic doctors over a 21-year period. Included are 20 doctors who relapsed and re-recovered, 10 who died of non-alcohol related causes and eight who died of alcohol-linked causes. Also reported are abstinence, attendance at self-help group meetings, mortality and employment.
Selected doctors were the first 100 consecutive alcoholic doctors to become members of the North West Doctors and Dentists Group (NWDDG) between 1980 and 1988. Information sources combine prospective data obtained from each doctor at the time of first contact with the results of questionnaires distributed in 1988 and 2001 and continuing prospective reporting of mortality by relatives.
There is a 9% incidence of oral or oesophagopharyngeal cancer. Reported mortality, mostly by relatives, revealed that 24 doctors died directly of their alcoholism. We observed a 73% recovery rate for a 17-year average duration, over a 21-year period. Comparison of recovery with abstinence showed a strong correlation. For the first 6 months of recovery, there was also a strong relationship between recovery and attending meetings of self-help groups. This relationship is not sustained in the long term, though 14 doctors with an average recovery of 20 years still attend meetings regularly. Of 56 doctors currently known to have survived, 29 have retired and 27 are still working as doctors. Three doctors have been drinking normally for an average of 17 years.
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