Psychiatric Times. Vol. 26 No. 9

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ADDICTIVE DISORDERS

Successful Treatment of Physicians With Addictions

Addiction Impairs More Physicians Than Any Other Disease

By Lisa J. Merlo, PhD and Mark S. Gold, MD | August 28, 2009

Dr Merlo is an assistant professor in the department of psychiatry, divisions of addiction medicine and child and adolescent psychiatry, at the University of Florida, Gainesville. Dr Gold is the Donald and Arlene Dizney Eminent Scholar. He is a distinguished professor in the departments of psychiatry, neuroscience, anesthesiology, and community health and family medicine at the University of Florida, and chair of the department of psychiatry at the McKnight Brain Institute. The authors report that they have no conflicts of interest concerning the subject matter of this article.

Finally, with the addition of 5 years of treatment and urine testing, most addiction-treatment programs for physicians report 5-year sobriety, return to work, and return to function of greater than 70%, even for physicians who are addicted to crack cocaine or opioids.⁴³ Outcomes are defined over a 5-year period and confirmed by random drug screening. A program without random drug testing may not even exist in the United States. We see testing as an essential component of continued treatment for the recovering physician⁴⁴ and the earliest warning sign that the physician is in need of more or different treatment.

Urine testing, coordinated by treatment contract with contingency management, is supervised by the PHP. In many states, the physician calls an 800 number daily and is randomized to urine test or no test but given at least 1 urine test weekly. This behavioral intervention is a powerful tool in keeping the disease and the consequences of use in the present.⁴⁵ Research has shown that 96% of physicians who undergo urine testing remain drug-free, while only 64% of those who are not subject to testing maintain their sobriety.⁴⁶ Drug screening should include personalized testing for the drugs most commonly used by the physician. In addition, blood tests or hair testing may prove beneficial.

Conclusion

Fortunately, with appropriate treatment and adequate monitoring, the prognosis for physicians recovering from addiction is quite good. Sustained recovery may be negatively affected in physicians with comorbid psychiatric disorders, and prognosis is worse for those who have a family history of addiction, abuse opioids, or use multiple drugs.^2,47.48 Environmental exposure to potent opioids may be a factor in determining relapse.^15-17,49 Additional factors that contribute to relapse include inadequate coping skills, interpersonal skill deficits, family dysfunction, continued denial regarding the nature and severity of addiction, overconfidence, and shame and/or guilt.^36,50

Research repeatedly has shown that physicians generally fare much better than the general public following addiction treatment.^51-54 Although accommodations may be needed (eg, decreasing hours or eliminating night shifts),⁵¹ approximately 75% to 85% are able to return to work,^36,55 do not use drugs, and lead a productive life.⁵⁶ As a result, it has been suggested that this PHP treatment approach (including drug screening⁵⁷) should be implemented as the standard of care for all individuals with suspected addiction, not just physicians.

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by Paul Becker | April 16, 2013 2:39 PM EDT

As a physician who has been treated, retreated, and has had multiple relapses, I can only add that while inpatient treatment is very beneficial, it is often linked as a 'kind of punishment for the relapse. Since 90 days of inpatient treatment seems to be recommended, this is very disruptive to the physician in solo private practice who lives alone and because of treatment is unable to manage his affairs. Often, the PHP tells the physician that he or she is going for a 'ten day evaluation'. Of course the ten days suddenly becomes 90 days and this individual has no power in relating the problems which develop as a consequent of 90 days of treatment. The physician feels trapped, ambushed, and deceived intentionally. Inpatient treatment centers usually assume a cookie-cutter approach to each patient and any request for accommodation is denied. It seems more like a boot-camp than the treatment of a fatally incompacitating disease.

In summary, it is best to be completely honest with these physicians, compassionate, and accommodating.

Also in this Special Report

Pathological Gambling: Update on Assessment and Treatment

Smoking Cessation During Substance Abuse Treatment

Successful Treatment of Physicians With Addictions

The Neurobiological Development of Addiction

Image © iStockphoto.com

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TOPIC INDEX

Developmental/Genetic

Nutritional/Metabolic

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