Addiction is a chronic multi-dimensional brain disease involving complex biological, behavioral and social systems. The etiology and pathophysiology involves complex epigenetic genetic variables that are not well understood. Most treatment for persons with SUD is crisis-driven acute care – namely detoxification and stabilization, followed by a referral to outpatient care, regardless of the disease severity or level of social support. Moreover, the majority of substance dependent persons do not enter treatment until their symptoms have resulted in a medical, legal, familial or occupational crisis, which has resulted in a revolving door of multiple, costly and largely ineffective treatment episodes where relapse within six months is the expected outcome. The exception to this deplorable state of affairs has been the overwhelming success of mandated treatment for professionals in safety sensitive positions, e.g., physicians.
Physician Health Programs
The prevalence of substance use disorders (SUD) among physicians has been estimated between 10% and 14%–slightly higher than the prevalence in the general population.
Rick factors vary among physicians according to their specialties. Anesthesiology or emergency medicine, for example, are overrepresented. Family medicine, although not reported as overrepresented, accounts for 15% to 20% of physicians with SUD who enroll in Physician Health Programs (PHP). This is the first report of Family Medicine physicians (FMPs) outcomes in PHPs.
My research and collaborative work with Bob DuPont and others, have reported physicians enrolled in PHPs on average tout a 75% to 90% abstinence rate at five years post treatment. However, outcomes of some specialties have been looked at in more detail in terms of risk factors unique to their specialty. For example, anesthesiologists have unfettered access to opioids and consequently suffer disproportionately from opioid use disorder compared to other specialties. This may be due in part to passive exposure to addictive drugs by anesthesiologists in the operating rooms or post treatment sensitization or both. Alcohol abuse and addiction is more common among surgeons. In this study, outcomes for FMPs, who represent the largest specialty within medicine, do as well as other physicians in PHPs when looking at five-year outcome data. However, FMPs were less likely to complete the monitoring contract (drug testing) at five years as compared to the other physician cohorts.
The success of these programs is unprecedented in our field. Yet until recently, the outcomes beyond the scope of mandated participation were unknown. A well-constructed survey by DuPont of former PHP participants who had successfully completed their mandated contracts—and were at least five years beyond graduation from the program, showed sustained success and identified the most valuable modalities within the PHPs and beyond. The findings include:
- 97.3% of study participants were currently licensed to practice medicine, of which, 93% were currently practicing medicine in some capacity and 80.6% were in full time practice.
- 97.2% of study participants reported that they were currently “in recovery.”
- 91.7% of study participants had attended 12 –Step meetings since completing the five-year PHP contract.
- 44.4% of study participants reported that religious practice was beneficial in maintaining sobriety. When asked to rank the most beneficial components of the PHP, overwhelmingly the study participants cited the 12-Step meetings, followed by the time spent in primary (usually inpatient) substance abuse treatment, and lastly, the mandatory drug testing.
Why Does this Matter?
Physician Health Programs’ outcomes are based upon objective measures, documented with urine testing and back-to-work (practice) evaluations. So, these PHP studies provide clear evidence that treatment works, and proven outcomes and abstinence can be documented for five years. It is not clear why Family Practitioners were less likely than their cohorts in other specialties to complete their monitoring contracts at the five-year benchmark. All things considered, the PHP programs have produced exceptional results. Yet more research into outcome variables is needed to better understand differences in outcomes and shed more light on what is working and helpful, while identifying obstacles to completion and recovery.