Abstract
Addiction is a complex neuropsychiatric disorder. It involves heritable risk, well-described underlying neuropathology, a relapsing disease course, characteristic effects on personality and behavior, and multiple effective treatment modalities. Substance use disorders (SUD) occur in physicians at a rate equal to the general population, with alcohol, benzodiazepine, and opioid use disorders most commonly occurring. Mortality is markedly elevated in this population. Physician suicides are often associated with SUD, self-prescription, and alcohol intoxication. SUD can progress to professional impairment in physicians, but this is a late finding in the disease’s course. The paradigm shift to conceptualizing SUD as an illness (rather than a moral failing) led to the development of physician health programs (PHPs) in the United States. Treatment of SUD in physicians occurs under the supervision of PHPs, which act as diversion programs to avoid loss of medical licensure if treatment goals and sustained abstinence are met. Treatment is multimodal, inclusive of contingency management, pharmacotherapy, individual and group psychotherapy, and recovery-based community support groups. Outcomes are remarkably positive among physicians treated under PHP supervision, with 70–80% sustained remission and maintenance of medical practice on a 5-year follow-up.
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Earley PH. Physician health programs and addiction among physicians. In: Ries RK, Fiellin DA, Miller SC, Saitz R, editors. The ASAM principles of addiction medicine. 5th ed. New York: Wolters Kluwer; 2014.
Boyd JW, Knight JR. Substance use disorders among physicians. In: Galanter M, Kleber HD, Brady KT, editors. The American Psychiatric Publishing Textbook of substance abuse treatment, 5th Edition. American Psychiatric Publishing. 2015. https://psychiatryonline.org/doi/full/10.1176/appi.books.9781615370030.mg46. Accessed 1 Nov 2017.
Flaherty JA, Richman JA. Substance use and addiction among medical students, residents, and physicians. Psychiatr Clin North Am. 1993;16(1):189–97.
Rose JS, Campbell M, Skipper G. Prognosis for emergency physician with substance abuse recovery: 5-year outcome study. West J Emerg Med. 2014;15(1):20–5.
Brown SD, Goske MJ, Johnson CM. Beyond substance abuse: stress, burnout, and depression as causes of physician impairment and disruptive behavior. J Am Coll Radiol. 2009;6(7):479–85.
Yarborough WH. Substance use disorders in physician training programs. J Okla State Med Assoc. 1999;92(10):504–7.
Hughes PH, Conard SE, Baldwin DC Jr, Storr CL, Sheehan DV. Resident physician substance use in the United States. JAMA. 1991;265(16):2069–73.
McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337:a2038.
Merlo LJ, Campbell MD, Skipper GE, Shea CL, DuPont RL. Outcomes for physicians with opioid dependence treated without agonist pharmacotherapy in physician health programs. J Subst Abus Treat. 2016;64:47–54.
Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesth Analg. 2009;109(3):891–6.
Jackson ER, Shanafelt TD, Hasan O, Satele DV, Dyrbye LN. Burnout and alcohol abuse/dependence among U.S. medical students. Acad Med. 2016;91(9):1251–6.
Fry RA, Fry LE, Castanelli DJ. A retrospective survey of substance abuse in anesthetists in Australia and New Zealand from 2004 to 2013. Anaesth Intensive Care. 2015;43(1):111–7.
Clark DC, Daugherty SR. A norm-referenced longitudinal study of medical student drinking patterns. J Subst Abuse. 1990;2:15–37.
Sudan R, Seymour K. The impaired surgeon. Surg Clin N Am. 2016;96:89–93.
The sick physician: impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA. 1973;223(6):684–7.
Koob GF. Neurobiology of addiction. In: Galanter M, Kleber HD, Brady KT, editors. Textbook of substance abuse treatment, 5th Edition. American Psychiatric Publishing; 2015. https://psychiatryonline.org/doi/full/10.1176/appi.books.9781615370030.mg01. Accessed 15 Oct 2017.
DuPont RL, McLellan AT, White WL, et al. Setting the standard for recovery: physicians’ health programs. J Subst Abus Treat. 2009;36(2):159–71.
Policy on physician impairment. Federation of State Medical Boards. 2011. https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/grpol_policy-on-physician-impairment.pdf. Accessed 1 Nov 2017.
Public policy statement: physician illness vs. impairment. Federation of State Physician Health Programs. 2008. https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/grpol_policy-on-physician-impairment.pdf. Accessed 1 Nov 2017.
Braquehais MD, Tresidder A, DuPont RL. Service provision to physicians with mental health and addiction problems. Curr Opin Psychiatry. 2015;28:324–9.
Merlo LJ, Gold MS. Prescription opioid abuse and dependence among physicians: hypotheses and treatment. Harv Rev Psychiatry. 2008;16:181–94.
Physician responsibilities to impaired colleagues. In: Code of Medical Ethics Opinion 9.3.2. American Medical Association. 2016. https://www.ama-assn.org/delivering-care/physician-responsibilities-impaired-colleagues. Accessed 1 Nov 2017.
Braquehais MD, Lusilla P, Bel MJ, Navarro MC, Nasillo V, Diaz A, Valero S, Padros J, Bruguera E, Casas M. Dual diagnosis among physicians: a clinical perspective. J Dual Diagn. 2014;10(3):148–55.
Brooke D, Edwards G, Taylor C. Addiction as an occupational hazard: 144 doctors with drug and alcohol problems. Addiction. 1991;86(8):1011–6.
Galanter M, Dermatis H, Mansch P, McIntyre J, Perez-Fuentes G. Substance-abusing physicians: monitoring and twelve-step-based treatment. Am J Addict. 2007;16:117–23.
Physician health program guidelines. Federation of State Physician Health Programs. 2005. http://www.fsphp.org/sites/default/files/pdfs/2005_fsphp_guidelines-master_0.pdf. Accessed 30 Oct 2017.
Weiss Roberts L, Warner TD, Rogers M, Horwitz R, Redgrave G. Medical student illness and impairment: a vignette-based survey study involved 955 students at 9 medical schools. Compr Psychiatry. 2005;46:229–37.
Oreskovich MR, Shanafelt T, Dyrbye LN, Tan L, Sotile W, Satele D, West CP, Sloan J, Boone S. The prevalence of substance use disorders in American physicians. Am J Addict. 2015;24:30–8.
Knight JR. A 35-year-old physician with opioid dependence. JAMA. 2004;292(11):1351–7.
Reus VI, Fochtmann LJ, Bukstein O, Eyler AE, Hilty DM, Horvitz-Lennon M, Mahoney J, Pasic J, Weaver M, Wills CD, McIntyre J, Kidd J, Yager J, Hong S-H. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry. 2018;175:86–90.
Substance-related and addictive disorders. In: Diagnostic and statistical manual of mental disorders, Fifth Edition. American Psychiatric Publishing; 2013. https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm16. Accessed 15 Oct 2017.
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Kast, K.A., Avery, J. (2019). The Case of Dr. Sigi Halsted: Overdose in the OR. In: Gordon-Elliott, J., Rosen, A. (eds) Early Career Physician Mental Health and Wellness. Springer, Cham. https://doi.org/10.1007/978-3-030-10952-3_7
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