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Chapter 43. Substance Use Disorders Among Physicians

J. Wesley Boyd, M.D., Ph.D.; John R. Knight, M.D.
DOI: 10.1176/appi.books.9781585623440.357067

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Excerpt

In years past, the prevalence of addictive disorders in the medical profession was widely exaggerated. In fact, physicians have rates of substance abuse and dependence that are very similar to those of the general population. Physicians' patterns of use, however, differ in that physicians most often misuse prescription drugs and do so for reasons of self-treatment. Physicians have greater access than most to very potent psychoactive medications and are subject to unique stresses, and when they become impaired as a result of psychoactive substance use, other people may be placed in jeopardy as well. In this chapter, we present the key features of the problem of substance abuse among physicians and a structured approach to intervention, treatment, and monitoring that has a high rate of success and allows the great majority of physicians with substance use disorders to return safely to medical practice.

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TABLE 43–1. Warning signs of substance misuse among physicians
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TABLE 43–2. Principles of directive interventions
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TABLE 43–3. Outcome of physician treatment and monitoring programs
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TABLE 43–4. Outcomes of Massachusetts Physician Health Services substance use disorder contracts
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The term impaired physician historically referred not only to physicians with substance use disorders but also to those with medical, psychiatric, or behavior disorders that impede the ability to practice medicine safely and effectively. This term is now considered archaic and should be replaced by more accurate, less pejorative language.

Physicians are vulnerable to substance abuse and dependence at rates comparable to those of nonphysicians.

Signs and symptoms of a substance use disorder often present first at home and other nonprofessional settings. When problems manifest themselves in the medical workplace, the substance use usually has been occurring for years.

The effect of a physician's substance misuse can extend far beyond the personal toll on the physician and may extend to professional colleagues, patients, and family members.

Early intervention for or prevention of physician substance misuse is vitally important.

Dealing with a colleague who has a substance use disorder often requires consideration of both legal and ethical issues.

Every state in the United States has a physician health program. State physician health programs provide or facilitate independent assessments for physicians with substance use disorders, provide guidance to hospital administrators and physician health committees, and contract with physicians who agree to treatment and complete abstinence from alcohol and drug use to provide monitoring and advocacy.

Physicians in monitoring programs should not be deprived of appropriate treatment for other psychiatric disorders or pain. Stimulant medications, tranquilizers, and narcotic analgesics can be safely prescribed with appropriate safeguards and open communication among all treating physicians.

The success rates for physicians who undergo substance abuse treatment are quite high, with most programs reporting positive outcomes in the 75%–85% range.

Recovering physicians should consult with an attorney before making a self-report to the state licensing board and when answering confidential health-related questions on license renewal, job application, and hospital or insurance credentialing forms.

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CME Activity

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Sample questions:
1.
Which of the following is not true regarding the term impaired physician?
2.
Which of the following statements regarding the epidemiology of substance use disorders in physicians in the United States is false?
3.
In the course of progressive substance abuse in physicians, which is usually the last place symptoms of substance use are evident?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
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