Treating drug-addicted doctors is good medicine

Feb 24, 2009

Doctors who become addicted to alcohol and other drugs can be treated successfully and returned to medical practice with the help of special programs that couple referral to treatment and monitoring with rapid responses to noncompliance, University of Florida researchers report.

The study is the first national-level analysis of such Physician Health Programs, and confirms they are effective alternatives to simply punishing drug-addicted doctors. The findings are published in the March issue of the Journal of Substance Abuse Treatment.

More than three-quarters of doctors enrolled in state programs stayed drug-free over a five-year monitoring period. The results were the same regardless of whether the doctor's drug of choice was alcohol, crack cocaine, prescription drugs or other substances.

"Treatment works," said Dr. Mark Gold, psychiatry chairman at the UF College of Medicine and the McKnight Brain Institute. "It has been shown now to be safe and effective and cost-effective."

But it's not just for doctors, said Gold, who with UF colleagues pioneered evaluation and treatment for drug-addicted doctors. "It should be a model for treatment of anyone with these diagnoses."

In general, rates of illicit drug use are lower among physicians than the general public, but rates of prescription misuse are five times higher among physicians, according to a 2008 review Gold co-authored in the Harvard Review of Psychiatry.

Gold and others conclude that drug problems in doctors are related to medical specialties that put them in regular contact with drugs of addiction, ease of access to drugs, stress and lack of early detection. Addiction also appears linked to physician-suicide.

Physician Health Programs are not addiction treatment programs, however. Instead, they provide intensive, long-term case management and monitoring. Fifty-five percent of doctors enrolled are mandated formally by a licensing board, hospital, malpractice insurance or other agency. The rest are informally "mandated" by others such as employers, families and colleagues. Doctors sign contracts agreeing to abstain from drugs or face intensified treatment, being reported to their medical licensing boards or losing their license.

The programs aim to save the lives and careers of addicted physicians, and to protect the public by addressing substance use among doctors. They are also are an effective way to remove noncompliant doctors from the practice of medicine.

"This isn't to cover it up, it's quite the opposite," said Temple University psychiatry chairman Dr. David Baron, who oversees Pennsylvania's program. "It allows for quality treatment and to make sure that we're still ensuring the safety of the public." Baron was not involved in the current study.

Program measures include group and individual therapy, residential and outpatient programs, surprise workplace visits from monitors, and links to 12-step programs of Alcoholics Anonymous and Narcotics Anonymous. Doctor-patients get care not just for drug problems, but also for accompanying medical or psychiatric disorders. They pay for their treatment, drug tests and follow-up care.

The research, funded by the Robert Wood Johnson Foundation, evaluated 904 physicians admitted to 16 state-run Physician Health Programs from 1995 to 2001. Collaborators included founding National Institute of Drug Abuse Director and former drug czar Dr. Robert Dupont, A. Thomas McLellan, of the University of Pennsylvania, and Lisa Merlo, of UF.

Previous studies have shown that in individual states, and on a small scale, the programs are effective. The current study, first reported at the Betty Ford Institute, has the largest sample of physicians ever followed, and over the longest period.

Doctors in the programs had to abstain from alcohol or other drugs, and were tested frequently at random for five or more years. If tests revealed they had returned to substance abuse, swift action was taken -- doctors were reported to the medical board, which could lead to loss of their licenses.

"It's the idea of a carrot and a stick," said Dr. Scott Teitelbaum, director of the UF-run Florida Recovery Center, which treats addicted physicians referred from around the country. "There's always a level of resistance -- people never feel they need the level of care that's recommended. Someone might not agree with you, but if they want to practice medicine they have to comply."

Often, with the support of peers and growing realization that treatment is working, physician-patients' motivations change from simply wanting to obey the rules to wanting to change their lives, Teitelbaum said.

One-fifth of doctors were reported to their board during treatment and monitoring -- some more than once with multiple disciplinary actions taken.

But 78 percent of doctors in the programs had no positive drug tests during five years of intensive monitoring. And five to seven years after starting treatment, 72 percent were actively practicing medicine, without drug abuse or malpractice.

Eighteen percent left medical practice, while others relapsed into drug use. Three percent of those who didn't complete their programs had substance-related deaths or committed suicide.

Although the programs employed a variety of approaches, the researchers found that success was not related to specific therapists or modes of therapy, but rather to the long-term nature of the treatment.

Still, there are some "essential ingredients" that successful programs have in common, Gold said. Those include treatment extended over years -- not weeks or months -- and unambiguous success markers such as urine testing and return to work and normal family activities.

Source: University of Florida

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

add to favorites email to friend print save as pdf

Related Stories

Icy research drills down on summer algae blooms

Apr 10, 2014

We've walked a mile out on the frozen skin of Missisquoi Bay. Clouds, snow and ice blend into an abstract collage of white shapes. To the west, a thin grey line, the New York shore, cuts the world in two. ...

Catching the early spread of breast cancer

Mar 19, 2014

When cancer spreads from one part of the body to another, it becomes even more deadly. It moves with stealth and can go undetected for months or years. But a new technology that uses "nano-flares" has the potential to catch ...

DIY microscope holds promise in battles against disease

Mar 10, 2014

(Phys.org) —Did they say fifty cents? That is how much researchers say it would cost, and maybe less, to make a microscope that you print on a piece of paper and then add some components and assemble in ...

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0

More news stories

Treating depression in Parkinson's patients

A group of scientists from the University of Kentucky College of Medicine and the Sanders-Brown Center on Aging has found interesting new information in a study on depression and neuropsychological function in Parkinson's ...

Impact glass stores biodata for millions of years

(Phys.org) —Bits of plant life encapsulated in molten glass by asteroid and comet impacts millions of years ago give geologists information about climate and life forms on the ancient Earth. Scientists ...