Five-year outcomes studies suggest that with appropriate treatment, outcomes are indeed excellent among physicians, compared with their peers. Two such studies, led by researchers from the Institute of Behavior and Health in Rockville, Md., respectively showed that 102 anesthesiologists treated and monitored under PHP supervision had excellent outcomes similar to those of other impaired physicians (Anesth Analg. 2009;109[3]:891-6), and that 144 surgeons treated under PHP supervision had positive outcomes similar to those of nonsurgeons (Arch Surg. 2011;146[11]:1286-91).
In their review article, Dr. Gold and Dr. Merlo concluded that for physicians overall, “appropriate intervention (e.g., typically in with the state PHP), methods of evaluation and treatment for addicted physicians are extremely effective. The combination of medical, psychosocial, and support group interventions, combined with extensive posttreatment monitoring and drug testing, generally results in sustained recovery among the physicians who attend specialized treatment programs. These outcomes are typically obtained even when physicians did not enter treatment voluntarily. Thus, it is likely that impaired professional programs represent the best treatment available for opioid use disorders, and nonphysician addicts would likely experience a similar benefit from participating in such a program.”
Dr. Angres agreed that physicians in general are “a good outcome group.”
“If treated and monitored appropriately, these are some of the best outcomes we see in addiction treatment,” he said.
Many factors are involved in the superior results among physicians vs. their nonphysician counterparts, he said, explaining that physicians tend to be particularly conscientious, hard-working individuals with good support systems and personality variables that allow them to persevere under difficult circumstances. They also have a great deal riding on recovery in terms of reentering the practice of medicine.
“So motivation is a big issue. ... All of these things come together,” he said.
Changing trends
In addition to the stress-related factors that appear to be contributing to increased substance abuse and dependence, concerning cultural trends are emerging.
“We have an epidemic among young adults,” Dr. Angres said.
Heroin, prescription opiates, psychostimulants, binge drinking – all are occurring in epidemic proportions throughout our culture, including among the new generation of medical students and young physicians, he added.
“We are seeing for the first time, even in the last year or so, medical students, residents, and young adults who are addicted to drugs like heroin because it is so ubiquitous. So this is a new phenomenon. This is just a new reality. It’s not a massive problem [in medicine], but it is something that we’re seeing that we didn’t see before. ... These are emerging issues that are disconcerting,” he said.
Dr. Gold also noted the changing trends, explaining that over the course of his career, substance misuse and dependence have emerged and changed.
“In the ’70s and ’80s, medical students rarely presented in need of treatment, but when they did, they had alcohol, tobacco, and benzodiazepine problems. Residents ... had problems with prescription opiates, and many programs reported overdoses. More recently, medical students no longer smoke cigarettes. ... Now it is marijuana,” he said, adding that binge drinking, club drugs, and psychostimulant abuse also are on the rise.
Students now are more like their peers and unlike their mentors with respect to drug misuse, use, and dependence, and there is an emerging concern that the most heavily involved students in terms of drug abuse and addiction will select one specialty or another based on drug access, said Dr. Gold, now professor (adjunct) at the University of Southern California, Los Angeles, and at Washington University in St. Louis.
“They often are surprised that the college of medicine, their patients, and professors do not accept as appropriate behavior the taking of another person’s [attention-deficit/hyperactivity disorder] medication, or smoking cannabis, or taking drugs for their mentees,” he said.
As for treatment in this new era of substance abuse and dependence, the approach remains much the same, Dr. Angres said, noting that medication-assisted treatment may be necessary for heroin addiction. A concern, however, is that the relapse rate may be higher.
“We don’t know what that will mean,” he said. “It will be years before we can see how it plays out with physicians with [heroin], but you do the same things, with perhaps some extra support above and beyond [the standard approach].”
Dr. Angres disclosed that he is part owner of the Positive Sobriety Institute, which treats addicted professionals, including physicians. Dr. Gold reported having no relevant financial disclosures.
*Correction, 03/09/2016: An earlier version of this story misstated the term sometimes used to describe physicians with addictive behaviors